Thursday, November 27, 2003

A Hospital Homebirth

A Hospital Homebirth
Andria Brown

I went to my OB appointment on Wednesday, which was in the middle of my 41st week of pregnancy. I was measuring right on target for my gestation, and had a slightly dilated and fairly well effaced cervix. I was, as they say, “ripe,” but there was no way to know when the baby would decide to come – could be hours, could be days.

Wednesday night was restless, but I woke up on Thursday feeling wide-awake. When I made my first morning trip to the bathroom, I realized that I'd lost at least part of my mucus plug. I kept thinking I was feeling twinges in my belly, but then would talk myself into believing that they were imagined. I started my work day and tried to focus on other things, but as the morning wore on, I noticed that the twinges seemed to be coming pretty regularly, whether I thought about them or not. I tried to stay comfortable, which meant a lot of time sitting on or draping myself over a birth ball. I called Melissa, my doula, and gave her the status report. She was confident that the baby was coming, although she did warn me that there could still be another day or so of this type of labor.

The afternoon blended into the evening. I snacked a lot and drank water pretty much constantly. Jeff stayed at work during the day (per my request – I wasn’t ready for his eager/anxious energy), and we decided it was okay for him to teach his evening class, although he promised to keep it short. By the time he got home, my contractions were about ten minutes apart and getting noticeably stronger, although I could still walk around and talk through them.

We got into nightclothes and tried to rest, but I was too uncomfortable lying down while the contractions were happening. Around 11:30, the contractions were about six minutes apart and I was having trouble doing anything but deep breathing while they peaked, so we decided to call Melissa. She was over about half an hour later and watched me go through a few contractions to assess my status. I was still pretty composed at that point - I was doing nice, effective breathing and walking/rocking gracefully during each rush.

Shortly after Melissa arrived, I lost the last of my mucus plug and finally observed the "bloody show" that usually accompanies this. I was spotting pretty heavily from then on, and soon after that, we realized that I was having double contractions - just when I thought one was over, another would come right up behind it. I could tell that Jeff and Melissa both wanted to get to the hospital, but I think my nervousness about sitting through the drive made me hold off a while longer. I finally gave in around 1:00 am and we got ready to go. We stepped outside at 1:23, and just as I sent Jeff back inside to get the bottled drinks we forgot to grab, my very considerate water broke all over the front porch. I squish-waddled back inside to change shorts and shoes, and then we officially got on our way.

Thankfully, the roads were almost entirely empty, because that was not the safest drive we ever took. Jeff only ran one red light, when a signal refused to give us a green left turn arrow, but he was on edge and going as fast as he felt he could. My contractions felt more intense, partly from being in a sitting position and partly from having my water gone. I began low moaning through each rush instead of just deep breathing. I started getting really hot, and my legs began to shake, so I had a pretty good idea that I was in transition.

We got to the hospital and of course had to sign some papers and answer questions and go through the whole ER triage system. Melissa and Jeff did their best to keep my involvement to a minimum, although Jeff was fairly hard-pressed to answer questions about my social security number or height. Once I got processed, the ER nurse asked me to get in a wheelchair for the trip up to the birthing center, but there was no way I was going to do that – sitting down was just too painful. I refused as politely as I could, over her repeated insistence that it was a pretty long walk.

My memory gets a little hazy once we arrived at the birthing center. I felt like we walked off the elevator and into my room, although I realized afterward that there was quite some distance between those two points. We then met Stacy, the nurse who would be with us throughout the rest of labor and delivery. Stacy let us know that she'd have to run a monitor strip and put in an IV, so when I was in between contractions she strapped on two monitor belts and put in a heparin lock. At that point I fully understood every woman who ever requested an epidural, because lying there with those belts on made the contractions exponentially more difficult to handle. I got out of bed as soon as they'd let me and I walked around the best that I could. It was hard, though - the increased pain from the belts plus the fact that I was leaking blood and amniotic fluid on the tile floor made it pretty difficult to reposition myself safely. I kept asking and asking for the belts to be removed, and Stacy got them off as soon as she could. She checked me and I was elated to find out I was eight centimeters dilated.

My moans got deeper and louder, and eventually turned into growls. It didn't erase the intensity of the contractions, but it took some of the edge off. I also walked around in circles, rocked back and forth, and at one point, started twirling around like a demented Phish fan. I was hot and sweaty and desperately thirsty, but the ice chips I was allowed to have just made me feel queasy. I kept fanning myself with my gown between contractions. What they say about losing all modesty during labor is true – I didn’t care for a second that my entire lower body was exposed, and in fact, I probably would have been even happier if I’d been completely naked.

Stacy would quietly step in and monitor me with a Doppler whenever I had a break between contractions. My doctor was called and arrived after I'd been there for about an hour. He stayed very much in the background, though. When I felt like I was unable to refrain from pushing any longer, I asked to be checked again - I was at nine and a half centimeters, just short of full dilation. Getting that last little bit of cervix out of the way was probably one of the toughest obstacles I had to get through. I felt like my entire lower abdomen was being clutched by something strong and hot. There was a tremendous amount of pressure during the contractions, and trying not to push made it harder to focus on pain relief techniques.

We finally decided I was close enough to complete, and I was ready to start pushing. I started out pushing in sort of a modified hands and knees position, with my arms over the back of the raised head of the bed. It was a relief to push, although definitely intense in its own right. And much messier than the contractions alone - I was not only bleeding all over myself, but now that I was focusing on bearing down, anything smaller than a baby that could possibly come out of me tried to do so. Funny how quickly you get over the embarrassment of pooping yourself in public, though. Once I realized how much more effective pushing was if I just gave it my all and didn't worry about what came out, the better I was able to move the baby down. I bled, I peed, I pooped and I pushed. Over and over and over again.

I tried not to look at the clock, but I could tell I’d been working for a while. After about an hour and a half (I think), Stacy and Melissa suggested that I try a different position to help the baby wiggle into a better location, so I tried lying on my side with Jeff supporting my top leg and widening my pelvis while I was pushing. This felt pretty productive, but with no counter-pressure on my back between contractions, I couldn’t maintain the position for long. So I eventually ended up in the last place I expected – on my back with my legs pulled up. Stacy supported my perineum with a warm compress and performed perineal massage between contractions. I kept begging Jeff to push on my lower back when he wasn’t busy helping to support my legs. His hand must have been under me for nearly an hour, and I knew it couldn’t be comfortable for him, but it was the only relief I got from the sharp, spasm-like pain radiating out of my spine.

It seemed like I was trying to go up the down escalator, but eventually my doctor started appearing more frequently, and I could tell from the activity around me that I must be getting close. Stacy brought over a mirror so I could see the baby, but there was barely anything to see. I felt both discouraged and defiant. I started making more noise during pushes, clutching the handrails of the bed and doing the best I could to curl myself around the baby. Melissa and Jeff held my legs through each bout of pushing, and they were both talking more and encouraging me to push through the part of each contraction where I felt most tempted to stop.

The environment suddenly got much more medical. Bright lights were focused on my bed, and two new nurses appeared and slid plasticky sheets under me. Those two factors, plus the intensity of pushing, made me unable to handle the heat, so I pulled my gown over my head and lay there completely naked. My doctor reappeared and got into position at the foot of the bed. The new nurses began directing me through pushing, telling me to hold my breath and use that power to increase my power. This was the part of labor that was least like the way I’d imagined it. I’d hoped for a peaceful delivery, ideally with dimmed lights and only quiet, supportive verbal encouragement. Instead, I was baking under floodlights and having strangers boss me around.

Fortunately, it didn’t last all that much longer. My entire lower body felt completely full and stretched, although I’m pleased to report that I didn’t feel like I was coming apart at the seams, and I kept waiting for a “ring of fire” sensation that never came. It got to the point where my doctor said “This will be over in three minutes, two minutes or one minute – it’s up to you.” I’d already been pushing for over two and a half hours, so I voted for one minute. I pushed almost constantly, whether I felt a strong urge or not. Every sensation got more intense, but I was so focused on seeing the baby that I was almost able to push back the entire perception of pain. (Emphasis on almost.)

And then it was there. I looked down and could see the head. It didn’t come out all at once like I expected, but within two or three pushes, it was completely delivered. In the next push, the shoulders were free and, at 6:54 am, the entire body was out. My doctor quickly turned the baby to face us – he didn’t announce the gender, preferring instead to hand the squirming little bundle over to us and let us make the realization on our own. I barely remember what came out of my mouth, but I think I said “We have a girl.”

The nurses dried her off while she was still on my chest, and then wrapped her as best they could without taking her from me. Even after having seen her come out of me, I still couldn’t really fathom that she had any connection with what I’d just experienced. I finally turned to Jeff, who was not trying to hide the tears in his eyes, and asked what she looked like. We looked at her together and agreed that she’d be well suited by the name Meredith Harper – Meredith after my godmother, and Harper after the greatest one-time novelist in American literature (and a pretty badass Southern woman to boot). I held and nursed her for nearly an hour before a nurse asked to weigh and examine her. As I saw her across the room, I tried to absorb her existence. We had a daughter. I was a mother. It still didn’t seem entirely real, but when I heard a nurse call her by name, or felt her clutch at my skin when she was returned to my arms, I knew she was mine.

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