Molly Anne's Arrival - August 31, 2004
I've been trying to write Molly Anne's birth story for months now. Heck, the girl is nearly a year old. What keeps hanging me up is where to start the story - what is the beginning? At first I thought the beginning would be the start of labor, but then I realized that's not when her birth began. Next I thought perhaps her story should begin in December 2003 when I learned that she had come to me and I was pregnant. Then I realized that even that point wasn't truly the beginning.
The beginning starts in late August of 1991 soon after her brother Zachary was born. Zach and I had a pretty traumatic start to his life. His pregnancy went post-term and the obstetric team I was seeing insisted at 42 weeks that we had to undergo a chemical induction. I was very opposed but didn't believe I had any other options. The doctors threatened to no longer provide medical care to me if I didn't agree. So we checked into the hospital immediately - they wouldn't even let me drive back home to get clothing or snacks for Zach's dad.
Zach and I tolerated seven hours of intravenous pitocin before the labor and delivery nurse on staff insisted I needed an epidural or " &you won't have the energy to push your baby out!" I immediately broke into tears but consented to an epidural. At that point I had been having contractions for seven hours and my cervix was dilated to seven centimeters. After the epidural was started no more dilation occurred. Zach was delivered via a cesarean section approximately seven hours after the epidural was administered. While I was still on the operating table the obstetrician told me that I could have my next baby vaginally.
Twelve years later, I learned that my next baby had arrived. It was December 2003 and I thought I had the flu. I was tired and nauseous and felt achy all over. I spent a week doing not much more than napping and reading. I finally realized that my period was about a week late and decided, almost on a whim, to try a home pregnancy test. It was positive! I didn't believe it, of course, and tried another. I called a friend and she told me not to bother getting another box of test strips; I was pregnant.
My husband and I had been trying to conceive for three years and had really begun to believe that we wouldn't have a child. I was in shock and ecstatically happy at the same time. I wondered if I could shift gears and parent a newborn again. After all, my only child was nearly a teenager! That same morning, I called my local obstetrician's office and scheduled an appointment for a date that would be nine weeks into the pregnancy. I asked the receptionist if I could come in earlier and she said no. I wondered what sort of care that was. After all, how did I know what to eat, how would I get prenatal vitamins (when I was pregnant with my son, they were still a prescription-only item), how would I know what dangers to avoid during the pregnancy?
Well, it turned out I had some light spotting at around seven weeks and I went in then. The nurse practitioner examined me and did a sonogram. We got to see our beautiful Molly Anne when she was just a tiny little being with her yolk sack still attached! At that time we didn't know her gender just that she was a miracle and still healthy.
It was at that very same appointment that the nurse practitioner told me that I would have to have a c-section again. I calmly explained to her that the obstetrician who delivered my son had used a low transverse incision and sutured with two layers of stitches. He assured me that I'd be able to deliver vaginally with the next child. She explained that our local hospital couldn't permit vaginal deliveries after cesarean sections any longer.I thought for certain she was wrong; after all, the big binder that the hospital gave to expectant parents had a section in it about VBACs.
It was after that appointment that I began to research the state of birth in our country. I was appalled to see that the c-section rate had climbed to as high as 28% in some areas. I learned that most rural hospitals no longer permitted VBAC deliveries.
I scheduled an appointment to see one of the obstetricians in the practice to discuss my VBAC. I still believed I could have one. During that appointment I learned that the information I had received was indeed accurate: that current ACOG guidelines advise that obstetricians only perform VBAC deliveries in hospitals with 24-hour anesthesiologist and obstetrician coverage and our local hospital did not meet the necessary standards. I asked for a referral to an obstetrician who had hospital privileges at a hospital that did meet the necessary standards.
About a month later, I met with a perinatal specialist who practiced at a large metropolitan hospital in the nearest city. It was about an hour's drive from my home, but I was determined to give birth vaginally. After all, my child deserved a chance to enter this life naturally. This doctor asked a lot of questions about my first pregnancy and delivery. He had some concerns about my ability to deliver a child vaginally because my son had weighed nine pounds twelve ounces at birth and the obstetrician had recorded cephalo-pelvic disproportion as the reason for the c-section. The perinatal specialist decided to evaluate my pelvis himself and did an internal exam to measure my pelvis. He looked very confused afterward and told my husband and I that I had a roomy pelvis adequate to deliver a normal-sized baby.
We learned, though, that this doctor would only permit a trial of labor (that phrase alone made my blood boil) under rigid restrictions. I would have to have an epidural or a hep-lock for an epidural, I could not go post-term, I would have to have continuous internal fetal monitoring, and I would have to have an IV. I realized right then that I would never have a vaginal birth under those conditions. The anger and resentment alone would prevent me from giving birth if all the chemicals didn't.
It took me some time after that visit to the perinatal specialist to realize that I did indeed have another option. I could give birth at home without a doctor! I could find a midwife and have a natural birth in my own home. There would be no ACOG telling me what to do and no attorney deciding what was acceptable risk. My husband and I would determine what was acceptable and what was not! I did some research online and found a midwife who served my geographic area. I immediately called her and explained my circumstances. We talked for some time and scheduled an appointment for my husband and me to meet with her.
As soon as I discussed that phone call with my husband, we both knew we had found our midwife! The face-to-face visit confirmed it, as Jan was exactly what we had been searching for. Here was a birth professional that trusted birth and trusted my body. She didn't feel the need to have a laundry list of medical interventions to prepare for the possibility that my body would fail. She was there to support me and help our baby enter this world the way she was designed to enter.
We loved our prenatal visits with Jan despite the forty-five minute drive to her office. Actually in retrospect, I think the long drive was one thing we really enjoyed. It gave my husband and me a chance to talk about our baby and the upcoming birth without interruption. It was our "date" for baby talk.
At the appointments, Jan had me check my urine and weight myself and then we'd talk for a bit. If I had any questions or concerns, I'd usually bring them up at this point in the visit. Then she'd check my blood pressure and check my legs for swelling and then came the fun part - listening to our baby's heartbeat. It was great that Jan checked the baby's position as well. I didn't realize just how much CPMs (certified professional midwives) know about babies and positioning that doctors don't seem to know.
Jan suggested a diet high in protein and low in simple carbohydrates for me. I ate lots of healthy unprocessed foods and exercised twice daily by taking a one-mile walk with the family dog (and my husband in the evenings). I continued to take a prenatal vitamin and also added in a vegan iron supplement to boost my blood iron levels. I had a very healthy and happy pregnancy! Despite the fact that I started the pregnancy as an obese out-of-shape woman of 36 years of age, I had no complications and I attribute that to Jan's expert advice and guidance.
We expected our daughter to make her grand entrance sometime around August 21st based upon the sonogram done at seven weeks. But, due to some excess emotional/psychological baggage I was carrying around with me, she didn't arrive until August 31st. Those ten days were a bit frightening because we knew there would come a time when Jan wouldn't be comfortable continuing to plan for a homebirth. She was fabulous in not giving me a concrete cut-off date, but I knew we couldn't let things go on indefinitely either.
During those days after the expected due date, I used nettle and red raspberry leaves in a tea. I also continued to exercise regularly and my husband and I used nearly every natural form of inducement known. Still, our daughter wasn't making an appearance. I went to see the chiropractor and had some pelvic adjustments. They certainly made a difference and I felt better, but still no baby.
I finally had a discussion with Jan at a prenatal appointment. My husband, Paul, suggested that I was holding in a lot of anger related to my son's c-section. Jan and I talked and she agreed that might be the case. She gave me a homeopathic remedy to try. I spent another week crying and working through some of the grief I still had connected to my son's birth. Finally, early on the morning of August 31st I woke up with contractions at around 3 a.m. It wasn't anything new, necessarily, since I had been having contractions for nearly a month already. But I sensed these might be different. It was the first time I had early morning contractions. I used the toilet and went back to bed. I didn't bother to wake my husband up because I still wasn't sure this was the "real thing" yet.
At 5 a.m., the contractions woke me up and I began to time them. They were consistently about five minutes apart (some four and some six, but averaged out to five). We called Jan at around 6 am and let her know I was finally having contractions with some regularity. At least they had been regular for an hour. She told us to keep an eye on things and call her back when I needed or wanted her there. I hopped into the shower and knew that our baby was coming!
The contractions continued on that way for the next couple of hours. I think it was around 7 a.m. that Paul called Jan and let her know it'd be okay to come over. Jan arrived around 8 a.m., and I was just finishing up paying our bills online (I wanted every detail wrapped up before the baby came). Jan joked and said it couldn't be too far into the labor if I was still working at the computer.
It was soon after that that my son Zach woke up. We explained that I was in labor and that we thought his sister would be born today. We asked him again if he wanted to stay for her birth. He was thirteen years old then and very uninterested in hanging out while I was in labor and had no interest in viewing the birth. We called a family friend to pick him up and he went to stay at their house for the day. He left us with instructions to call him home, though, as soon as she was born!
Lucky, Jan's assistant, arrived at around 10 a.m. My contractions were still very easy to work through and I walked around our living room, dining room, and into the kitchen. They were coming about every three minutes or so by this time. As soon as Lucky arrived, the intensity of the contractions increased. Suddenly I couldn't talk through them any longer and I was "checking out" a bit. It was as if I was hearing people through a fog during the contractions. During one contraction in the kitchen, Lucky suggested we might want to move upstairs now - unless we wanted our baby born in the kitchen.
It was around this time that I entered active labor. Soon after I walked upstairs the contractions became very intense and the next six or so hours are a bit of a blur to me. I remember focusing intently on moving my baby down and just working through the contractions. The contractions were coming about a minute apart and were very strong. I remember vomiting a lot and not wanting Paul to touch me any more (I get very hypersensitive during this stage of labor).
At about 2 p.m. I hit a point where I was so exhausted I didn't know if I could go on, but Jan was fabulous and suggested that I try to move around more and she fed me some honey. I walked back and forth between the bathroom, my bedroom and the baby's room and did get another burst of energy. Sometime around 3:30 p.m. or so, Jan offered to check my cervix. This was the only time a cervical check was suggested and I wanted one done. If I hadn't made significant progress, we were going to consider using the birth tub or some other methods to try and give me some rest. I was very tired and agreed to a cervical check. She told me I was dilated to around 7/8 cm and 90% effaced - farther than I had dilated during my son's labor. That information gave me a bit of renewed energy and helped me move on toward Stage II.
I continued to have hard and difficult contractions for a while and then around 5:15 p.m. or so, Jan suggested a homeopathic remedy. She thought I might be fearful. I admit I was. I knew I had been in transition for a while now and worried that we might have to transfer. I didn't know how long I'd have the energy to keep up with the contractions. As soon as I took the remedy, I felt a strong urge to bear down and push. My daughter was on her way!
I continued to have very strong contractions and was now standing in my bedroom. I wanted Paul again. During contractions I would hold onto my husband and began to push. I pushed for a while standing up and Jan asked me if I wanted the birth stool (I had let her know during a prenatal visit that I thought I'd want to birth in a squatting position). Lucky went to get it from the van. After the stool arrived, I changed positions and sat on the birthing stool. Lucky coached me and let me know that it was in our baby's best interests if I could get three productive pushes during every contraction.
Jan and Lucky continued to monitor the baby's heart rate using a doppler. During the very first contraction on the birthing stool, my water broke and squirted all over Paul! At 6:30 p.m., Stage II officially began. After that the contractions seemed to get even stronger and I felt more of an urge to push. These contractions where I was able to push felt so much easier than the earlier contractions because they felt productive. Jan allowed me to continue to labor on the birthing stool for a while, but noticed during one monitoring that the baby's heart tones were weakening during contractions. She decided to have me use the oxygen mask during contractions. That immediately gave me a burst of more energy and brought the baby's heart rate back up to about 120 during contractions.
At some point (and I don't recall exactly when), the midwives decided we weren't making adequate progress pushing in that position and they suggested we move to the McRobert's position. Jan explained that this position might allow us to maximize the pelvis space available. This position involves the mother lying on her back with legs supported by labor assistants and pushed up and open (imagine a crab on its back). [Jan: We actually refer to this as the "stranded beetle" position, and don't prefer to use it. But in this case, Kari's baby was getting tired and showing some signs that she was ready to be out, so this position/technique seemed called-for.] Jan provided a length of fabric and instructed me to hold one end, with her holding the other, and during the contractions, we would both pull on the fabric, like a tug of war, as I pushed. This was meant to help bring the baby down faster. We began with Jan holding the fabric, and Paul and Lucky helping to support my legs. Eventually we moved to having Paul hold the fabric because my pushes were more constructive when he was there.
I continued to use the oxygen, and Jan and Lucky continued to monitor both the baby and me. Finally, after what seemed like only minutes but had really been hours [Jan: actually, just 1:43 of total pushing, very respectable for a first vaginal delivery], my daughter began to emerge. I remember hearing Paul say he could see her head. Then I heard Jan commenting that her hand was emerging with her head - no wonder it took so long to push her through! Then out slipped Molly Anne's head, arms and torso. But her hips and legs remained inside for another contraction. There was my daughter with her eyes wide open caught between her old world (my uterus) and her new world. With the next push she had fully arrived. Molly Anne entered this world at 8:13 p.m. after seventeen hours of labor.
The midwives immediately placed her on me and we spent about an hour or so snuggling while we waited for her umbilical cord to finish pulsing and I delivered the placenta. We immediately had Paul call my son, Zach, to come home and meet his sister. He was home within ten minutes and bounding up the stairs. He came into the bedroom to meet his sister and called down to our friend and his daughter to come and meet her as well. Our friend decided that this was a family affair and he let us know he'd come back in a few days.
I was exhausted, exhilarated, and hungry! Paul went downstairs to cook me some eggs and toast. While I ate, the new daddy held his daughter and began the bonding process.
Looking back on the day, it was hard work (that's why it's called labor) and not without significant discomfort, but it was the most exhilarating and empowering experience of my life. I didn't realize until it was over how much of my son's birth experience had been missed.
What I find most interesting is that the boy who was adamant that he not be there during the labor and delivery is now a homebirth advocate and believes that "every baby should be born at home." It makes a mother proud!
~Kari Marcotte