Thursday, June 14, 2012

Victoria's Birth

As promised, here is the birth story of my third child, born in April of this year. 

I was 22 weeks pregnant with my third child when my midwife told me that she would be retiring effective a few weeks before my due date. “Just give me another month,” she said. “I know I can get coverage in time to be able to deliver your baby.”

I live in New York, where certified nurse midwives (CNMs) can’t attend births in hospitals without a written agreement for backup with a licensed OB/Gyn. My due date was in mid-April, and my midwife was retiring at the end of March. She was hopeful that she could get someone to agree to cover her just for my birth, even though technically she would be retired. But there was no way I was going to wait a month to see if she could get coverage, and then making it even more difficult for me to find an alternative if she couldn’t. At the time, I adored my midwife and I was so upset that I would have to switch care, especially in the middle of my pregnancy.

As it turns out, my former midwife did me a favor. Never one to sit on things, I started calling midwifery practices as soon as I left her office, going in and out of a corner Starbucks to protect myself from the drizzling rain that chilly evening. I was incredibly fortunate to get a slot with a group of midwives I had considered with my previous pregnancy, and after the orientation, I knew I had made the right decision.

Being with this group of midwives meant that I would have a chance to deliver at the ever popular, and notoriously difficult to get into, Birthing Center within St. Luke’s Roosevelt Hospital. It was an amazing opportunity to finally have the birth I was hoping for, and one I would not have had with my former midwife (she was attending births at another hospital).

I tend to think that location is not as important as your support system. I think if you trust your birth attendant, for the most part the location comes second, though it also matters, of course (there are always exceptions). I knew a fair amount about this group of midwives from researching their practice and as I got to know each of them, I felt a great sense of relief and trust that they would be my advocates no matter where I ended up giving birth. Now that the Birthing Center had been dangled in my face, however, I wanted in.

This is a birth story, not a midwife recommendation, but I cannot write about this experience without discussing the fantastic care I received from this group. They advocate for, and trust, women. I commented to my husband after each visit what incredible listeners each of the midwives were and how comforting their advice always was. I was never rushed, never felt disrespected or stupid for asking any question, and my concerns were always addressed. Not a hand was placed on me without asking my permission—I was treated like an intelligent adult and my opinions and instincts concerning my pregnancy mattered.

It occurs to me that all of the above should be the standard—the fact that it was a new experience for me speaks to how much in need of improvement our medical system is, in particular our maternity care.  After years of “hand on the door” treatment, after the birth of my son, which left me emotionally and physically broken, after feeling essentially dumped by my former midwife—the type of care I received this time around was honestly something I had never expected.

Getting ready for this birth had meant I had to reconcile my feelings about my last birth. Though wonderful and life changing in its own right, it was also extremely stressful. Having your water break in the car somewhere in Manhattan while your husband is cursing at pedestrians is not exactly peaceful. This time my hope was to have a natural birth, but also a peaceful one, where I could appreciate the sensations and emotions. I knew I wanted to sit on a birthing ball and labor in water for as long as possible. I had bought a birthing gown, had a relaxation CD loaded into my iPod, had plenty of snacks, a picture of my kids to use as a focal point, good smelling lotion for massages—I was ready.

As I said in my previous birth story, each of my pregnancies and births has taught me something, and this one was no different. My darling Victoria took her time coming, making my pregnancy with her the longest and testing my limits and patience (both of which are very short).  She was in position for a good two weeks, moving down and pressing on my pelvis, making me feel like she was going to drop out any minute.

I had “pre-labor” symptoms from week 35 on. Then, I had almost two weeks of prodromal labor. I woke up every night around 3 a.m. with intense back pain and pressure, and would get a few good contractions that always made me think, “This is it.” No such luck. For an impatient control freak, this was a lesson. I was on an emotional roller coaster, up and down, up and down. Excitement, then disappointment. Incredible anticipation and elation, then restlessness.

Then there was the looming clock, the silent alarm imposed on my pregnancy by the almighty powers that be at the Birthing Center. The rule was, if you go over 40 weeks, 6 days, you automatically move to the regular Labor & Delivery floor. There are obviously many opinions on this matter, and my opinion is that this was the worst rule ever.

Many could chime in and say how ridiculous and wrong it is to have this sort of rule, and I would tend to agree with that. However, I’m sure the hospital has its reasons for instituting it, and whether I agree with it or not, I knew this going in, and I knew there would be no way around it. As a midwife whose blog I follow once said, “You buy the hospital ticket, you go for the hospital ride.” One note, since I’ve named the facility, this had absolutely nothing to do with the Birthing Center itself, nor its staff, nor the environment. It was wonderful.

My hope is that talking about this aspect of my experience will not overshadow my birth or the great facility that the SLR Birthing Center is. Risk out rules and all, they provide something that for many women like me is an opportunity to have the best of both worlds—birth without intervention with medical equipment and personnel close by.

Thankfully, the word “induction” was never even uttered by my midwives, and they had no problem with the pregnancy continuing so long as both baby and I were healthy. This time limit for the Birthing Center did, however, have a profound effect on my mental state (and that is the number one reason I oppose this rule). As the days passed and I got closer and closer to the “deadline,” I started to feel depressed. Once again, not good enough for the medical establishment. What was wrong with me that I couldn’t give birth within their parameters? Why wasn’t this baby coming already?

Then I got angry. There was nothing at all wrong with me. In fact, I decided, even if I did go into labor in time, I would show them and refuse to enter the Birthing Center! Besides, I reasoned that even if I did make it in time, the Birthing Center could be full, or closed. There was no guarantee I would make it in anyway. I would choose L&D and take control of my own destiny. No one was going to tell me where to birth, damn it.

On the morning of April 16th, at 40 weeks, 5 days, I woke up at 3:30 a.m. with the same backache, the same sporadic contractions. Here we go, I thought. Another sleepless night.

Only this time, after I had a snack and laid down on the couch around an hour later, I felt what I knew was a very real contraction.  About 15 minutes later I felt another, and then another 13 minutes after that. I woke up my husband and we timed a few together. Around 5:30 a.m. we called the midwife, and she called back with good news: the Birthing Center was open and awaiting our arrival. And of course, that’s exactly where we went.

Though I obviously was there for my births, they were all surreal, each for different reasons. With my son I was on various drugs and barely aware of what was happening. With my first daughter I had back labor and felt like I had one 45 minute continuous contraction. This time it seemed that I was actually going to get what I had hoped for, in the place I had wanted to be in for so long. I slowly got dressed, still in disbelief that it was happening. My husband picked up my mom and she stayed with our older kids. I woke my son and told him we were going to the hospital and gave my daughter a kiss as she slept.

In the car, I breathed through each contraction and chatted happily with my husband in between. Contractions were every seven minutes now. The last time we were in the car together and I was in labor, I was screaming at the top of my lungs and my husband was driving on sidewalks and running red lights.

We got to the hospital, parked the car, and up in the elevator we went. I couldn’t help but feel as if this was my first time—and in many ways it was. It was the first time I deliberately walked of my own accord into the place where I was to give birth. It was the first time I felt conscious, sane, and aware of what was happening. It was the first time that I was excited and full of anticipation, and I knew what the general progression of things was going to be.

We got to the labor floor and there was the sign, with an arrow: “Birthing Center.” Just seeing it now in my head brings tears to my eyes. We were here, we were going in, and I was going to have my baby in my arms soon. I don’t think I can adequately describe the sweet feeling of “knowing” that comes only from having this experience more than once.

We got in our room, I changed into my birthing gown (whereupon my midwife told me I looked like a goddess—bless her! I truly felt like one.), and sat for the blood test and fetal monitoring. Twenty minutes flew by, and I got on the birthing ball for a while. While I was on the ball, a woman I can describe only as the Best Nurse in Creation came in and after a pleasant chat suggested I get up and walk (contractions had spaced out just a bit). My husband and I went out to the blissfully quiet and private hall and walked. My midwives changed shifts but both ended up staying around, chatting with me about my birthing gown between contractions.

Best Nurse in Creation filled the jacuzzi tub, and then began the most awesome part of my labor. If you are reading this and considering laboring in water, consider no longer. It. Is. The. Best. I would do it a thousand times over. I labored in that tub, with my husband at my side, with the jets providing the utmost support and relief, for two hours. I don’t know how the nurse and midwife knew it was what we wanted because we never specified it, but they gave us privacy to labor, only coming in to intermittedly check the baby’s heartbeat and to see how we were doing.

I ate and drank to my heart’s content. I continued to be happy, relaxed, and in a positive state of mind, bowing my head and giving in to the flow of each contraction, making the sounds my body led me to make and visualizing opening and having my baby in my arms (though every time I did the latter I started to cry, interrupting my zen state). Contractions are likened to waves, and rightly so. Each one would start off low, then heighten and reach a crescendo before retreating and leaving me in an almost meditative state.

Once my “birthing sounds,” as they called them, started to get intense, my midwife came in and said we should probably check and see what’s happening, and then I’d either walk around or get back in the tub. Getting up and out of the water was like being pulled from a dream. But I was already nine centimeters dilated, and after two more hard contractions on the bed, I was ready to push my baby out. I remembered the sensations of the baby moving down from the birth of my first daughter, and I knew she would be here soon.

I pushed four times for only eight minutes—but it felt like an eternity! My husband said my face turned purple and broken capillaries would later confirm his observation. The physical sensations were at their most intense at this point and I was reacting to them. My midwife kept telling me to stop clenching my legs because I was holding the baby in and I said, “I can’t!” That’s when Best Nurse in Creation said, “Yes you can! Do it now!” And I did.

And then there was my baby, slimy and gooey like the others, looking exactly like her brother did seven years before. And I cried harder than I ever had at seeing my squirmy little one, another soul to love, another life to cherish. She was so beautiful and small and quite simply a miracle.

I’m still somewhat in disbelief that it happened this way. I’m indescribably grateful and I feel so lucky. Not that my body did what it was designed to do, mind you—I’m thankful to have had a healthy pregnancy that resulted in a healthy baby, and getting the birth I hoped for is the icing on the cake. After my first high-intervention birth, I felt like I had gotten robbed of the most amazing and miraculous human experience. And after having two intervention and drug free births, I wouldn’t have it any other way.

I wish more women would look upon labor and birth as a gift rather than as a cross we have to bear. As difficult as it can get, as intense as the physical sensations can be, for me it has been an immense privilege—to be able to communicate with my baby before she ever made a sound outside my womb.

Will we have another child? People are already asking. As we were getting ready to leave the hospital I was sad because I didn’t want to leave my birth behind. I knew I wanted to write about it as soon as possible, to be able to process it and remember the details. I almost want to have another baby so that I could get to relish just one more birth.

Time will tell. But if we start on this journey again, it will be a blessing and an honor once more. In the meantime, I look at my new little love and I thank her for giving me a sense of completeness that I never knew was possible.


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