Full Circle Midwifery

Sunday, July 15, 2018 was my predicted due date based on the date of conception and my menstrual cycle.  When I used the bathroom around noon, I noticed a different type of cervical mucus in my liner.  Finally!  The plug was coming out.  With Ezra, my plug started coming out at 7am on a Friday and I was in early labor all day until active labor started at 10pm that evening.  I expected cramping or contractions to pick up at some point.  I took a nap and we went to my parent’s house as we usually do on Sundays.  We went swimming and had dinner.  I updated my mom on my predicted labor status (any time now based on how Ezra’s went).

We got home and settled in for the night.  We watched some episodes of Home Improvement and James fell asleep around 11pm.  I couldn’t sleep, so I was listening to the Moth podcast.  I noticed on one of my bathroom trips before midnight that the cervical mucus was even heavier yet and there was some blood.  My cervix was opening!  The excitement made it even harder to sleep, but I tried anyway.  At midnight, Ezra came into our bed and laid down to sleep.  It was at that time also that back labor contractions began.  They felt the same as my first labor- pressure low in my back that wrapped around my front.  I didn’t feel any pain above that “ring of pressure”.  I laid in bed on my side and dozed between contractions.  I was mostly on my left side, but also flipped to my right.  I was still listening to the podcast to keep my mind occupied.

I had had my husband download a contraction timing app before we went to bed so that he could do that for me while I labored.  I decided to let him sleep instead since contractions were manageable and downloaded an app so I could do it myself.  I started timing contractions at 1:53am.  I had started texting my sister-in-law Cari sometime around then to let her know what was going on.  She was excited to support me via text message.  I sent her screen shots of the contraction timing app and discussed how I was feeling.  I also notified my sister-in-law Sarah, who was going to be my doula, of my progress.  At 2:47am I let Sarah know that contractions were starting to command more attention.  Sarah wasn’t responding to my text messages, so I called her at 3:23 am.  She was on her way at about 3:45am.

At 3am, I woke up James and told him Ezra needed to be put back to bed.  I let him know contractions needed more attention and I couldn’t lay down through them anymore.  We gave Ezra big hugs and he was put back in his bedroom down the hall.  I turned on the small light that is clipped to our headboard and laid over the yoga ball to try a different position.  James got to work right away taking items out of the birth kit and laying them out on the vanity.  He went downstairs and blew up the air mattress for his sister Hope.  She was coming to tend to Ezra if he woke up during labor and to take care of him that day.  She was on her way about 3:30am.

James then got to work setting up the birthing tub.  He laid down the tarp, aired it up, and hooked up the hose to the bathroom sink to get it filling.  I called out to him when I needed support through a contraction.  I was leaning over the end of the bed, using the bathroom frequently (go me!  that was a goal for this labor), and pacing the room per my midwife’s instructions.  I was drinking out of my pink sparkly water bottle that said “Don’t Forget to be Awesome”.  I drank quite a bit of water between 3-4am.  At one point I asked for a cold cloth from James.  I couldn’t help but crack a smile when he brought it out and laid it across my lower back (where the contractions hurt).  I told him it was for my head and he wiped around my face for me.

I had also been texting with Barb, the Assistant Midwife who lived closest to us.  I figured she’d be the one to come and check my progress if there was any question about this being real labor.  She encouraged me to call Patrice, the CPM, around 3:30am to let her know what was going on.  I called Patrice and spoke with her for about 15 minutes.  She asked me what the contractions felt like and the timing between them.  I told her contractions varied at 2-5 minutes apart and required breathing hard through them.  I was out of bed leaning over the yoga ball while on the phone with her.  She told me to try walking for 15 minutes and if contractions slowed at all, call her back and let her know.  Otherwise, she was on her way!  She also called Barb and Rachel, the Student Midwife, to tell them to head our way.

I had been telling James that based on how I was feeling, this baby was coming “sooner than Ezra”, meaning that it wouldn’t be 10 hours of active labor before it was time to push.  There was an urgency in the way my body was progressing at such a quick pace!  I had a contraction start while sitting on the toilet at about 3:15am.  I felt a crazy amount of pressure on my cervix like the baby was trying to come out.  The sensation scared me so much that I lept off the toilet to prevent the baby from coming.

A bit after 4 am, I started asking James if anyone had arrived yet.  I was getting anxious for any of of the midwives to arrive so that James wouldn’t have to deliver our baby!  At about 4:15am, labor took a turn towards Transition Town.  Contractions were coming with only a 1-2 minute break between them.  I started vocalizing while biting down on the cold cloth James had brought me earlier.  I was squeezing on the back rails of the chair sitting at my vanity while leaning over the yoga ball.  I felt liquid running down my thigh and told James to grab a towel to put under me, because I thought my water was slowly breaking.  I was still wearing my panties and liner, because I didn’t want to be naked just yet.

I was hoping to possibly make it through labor without vomiting, but oh transition gets me every time.  I threw up all the water I had drank earlier while contractions continued.  I was vomiting into my garbage basket when Rachel came through the door at 4:22am.  I was so happy a midwife had arrived!  Hope and Barb arrived not long after.  Hope laid down in our guest room and Barb came up to assist.  When Rachel came in, she quickly took stock of the situation and knew I was having a baby very soon.  She laid out blue pads under me, put on gloves, and helped me take my underwear off.  My water broke not long after all over the blue pads (the carpet survived!).  My vocalizations during contractions were loud, sometimes scream-y, and slightly tinged with frustration.  I wanted to drink more water, but I knew I would vomit.  I wanted a break between contractions just to breathe, but that wasn’t happening.  I remember saying at one point, “oh, come on!” when two contractions happened back to back.

While I labored through transition, I could hear the jingly sounds of text messages being exchanged between Patrice, the head midwife, and Barb.  Barb was telling her to drive faster, because I was close to pushing.  At 4:40 am, Rachel and James helped me get into the tub.  I enjoyed the sweet relief of its warmth only for a second before I was rearing back from the pain of contractions.  I was sitting on my bottom (kind of) and was pressing with my feet against the opposite side of the pool.  The pool is designed to be just big enough to fully extend legs or lean over the side when kneeling.  I was pushing my pelvis up out of the water and Rachel was telling me I had to either be in or out of the water, so I had to sit back down.  I asked for more water in the tub, but was told it was at the fill line.  Barb turned off the window air conditioner unit so that baby wouldn’t freeze when he or she came out.  I protested the a/c being off, but it had to be done.

I still had my cold cloth in my mouth for biting down through vocalizations.  I didn’t want to scare Ezra and biting into the cloth helped muffle my voice slightly.  My right hand held my sparkly water bottle.  My left hand grabbed onto James’ hand when needed.  He was over my left shoulder.  Barb was also at my left speaking in a calm voice telling me to control my breathing and try not to scream.  She told me to pant as much as possible to slow baby’s descent.  With every pushing contraction, I felt my body curl forward and my bottom bear down to push baby out.  I was terrified to push, because I remembered what it felt like with Ezra.  I was very aware of where baby’s head was with each push and break in between.  Finally I could feel the wonderful ring of fire as the head crowned.  I felt the pain and expected to need the next contraction to get the shoulders out, but suddenly Rachel was handing me my baby!  I looked down and immediately noticed the baby’s coloring was fair like mine.  Light hair and pale skin.  I paused while Barb rubbed the baby’s back to encourage circulation.  I heard the baby make one little cry, so I knew he or she was breathing.  I kept hearing Barb say something about muscle tone as she listened to baby’s heart and rubbed baby’s back.  I asked if I needed to do anything and she said to talk to baby and hold him or her close.  Once Barb was satisfied with baby pinking up, I lifted up baby to check between the legs and cried out with joy, “Oh my God, it’s a girl!”  I was sobbing and holding her and feeling amazed that I had a girl after thinking my baby was surely a boy all pregnancy.

Patrice walked through the door right after my joyful gender discovery and could only smile when she saw me in the tub holding a baby!  Sarah, my doula, also walked in minutes after baby was born.  She knelt down on my right side to encourage me to work with the contractions to deliver the placenta.  I asked if I had to push the placenta out or if it would just come.  They told me a push or two was needed and the placenta delivered easily.  I was surprised at how quickly after birth the contractions came to deliver the placenta.  I thought it had taken longer last time.  I watched them lift the placenta into the waiting pan and Patrice set up the cord to be cut.  I hadn’t originally wanted to deliver the placenta in the tub, because I wasn’t crazy about sitting in all the…stuff, but it really didn’t matter at the time.

I had the thought to ask what time it was!  What time did my baby enter the world?  I was shocked when Rachel said 4:51 am!  Could it be that I pushed for less than 10 minutes?  That she came within 30 minutes of Rachel’s arrival?  It all seemed too surreal.

After the placenta was born, I became aware of a deep pain in my bottom.  I kept saying my butt hurts and the pain made me cry.  I felt torn between wanting to take in my baby girl and being distracted by the pressure in my butt.  I felt like I wasn’t giving my precious baby the amount of attention she deserved!  Rachel and Barb helped me out of the tub while James held Violet to his bare chest.  They helped me get into my bed and get settled with baby.  The pain in my bottom was still making me cry out, so they helped me lay on my side briefly before I realized they were right that sitting up would actually provide the counter pressure needed to ease up the bottom pain.  The midwives figured my tailbone had sustained some bruising from the speed with which Violet passed through the birth canal.

Rachel brought me a menstrual pad that had been dampened and frozen to ease up some of the pain in my bottom.  I was finally focused enough to take in my baby girl.  She was beautiful.  Blonde hair, peaches and cream skin, alert eyes, and a small stork bite between her eyebrows.

The midwives sat on the floor and filled out paperwork such as the birth certificate work sheet and the very short birth log.  Violet nursed well on both sides within an hour after birth.  Once she had nursed and settled in, Barb came to the side of the bed opposite me to do the newborn exam.  She weighed 7 pounds 7 ounces and was the same length as Ezra at birth: 19.5 inches.  Everything else looked well with baby, so she was handed off to James while Barb helped me to the bathroom.  I was very touched by her gentle way of caring for the postpartum mother.  She helped me back to bed after I was all cleaned up and then it was time to be inspected for signs of tearing.

Rachel came over to do the exam while Patrice supervised,  I could hardly keep still as she gently poked around with a piece of gauze.  After some private conversing, Rachel came back over and said they were going to suggest I go in to see an OB to get my second degree tear stitched.  They said based on my bottom pain and inability to lie still, they didn’t think I would do well with the topical anesthetic they carry to do sutures.  As soon as next year, state licensure in Michigan should allow CNMs to carry injectable lidocaine, which would allow them to stitch deeper tears with less discomfort for the mother.

I was heartbroken about having to leave my precious baby girl the day she was born.  The lack of separation from my baby was one of the touchstones of homebirth that I was looking forward to the most.  I suggested calling the office of my primary care provider, Dr. Conrad, to see if she would do my stitches.  Though she is no longer a practicing obstetrician, she could probably still help me out.  The medical assistant called back and reminded me that Dr. Conrad does not work on Mondays.  She transferred me to the phone line for Dr. Schmidt and I spoke with one of her nurses about my request.  The staff members for both doctors had never had a request called in like this before- a home birth mama in need of stitches!

One of Dr. Schmidt’s nurses called me back and said I could be stitched at noon.  It was decided Rachel would meet us at the doctor office and Sarah would take care of Violet while we were gone.  I wasn’t crazy about leaving, but it had to be done.  We were seen fairly quickly at the doctor’s office and taken back to the procedure room.  Rachel and Dr. Schmidt chatted about the birth as Dr. Schmidt examined the tear.  There was only one touch that made me want to crawl up to the ceiling.  The four initial lidocaine injections hurt the most and made the tears come, but Rachel and James were troopers for letting their hands be squeezed.  Despite that pain, the stitching went very well and I only felt a tug here and there as she stitched.  Rachel watched closely as Dr. Schmidt worked the same piece of suture through the deeper tissues first, followed by the external tear.