Sometimes things don't go as planned. In this 2nd installment in the Birth Story series, Candice shares how she wanted to be more in control of things with baby #3. This is a rather long post, but it's an interesting read. And if you've ever thought about water birth, Candice delivers her own water birth story (pun intended) with brutal honesty. Make sure you check out Candice's blog, Monsters Gone Wild.
When it comes to birth, my philosophy is that every woman, every pregnancy and every birth are highly unique. I’m a ‘Let nature do its work’ type. My actions throughout my last pregnancy had the tendency to go against the grain, but I acted in accordance with what I needed to do to be at peace with my decisions. My choices are certainly not for everyone, but they were right for me.
My first two births were inductions. Inductions I deemed as unnecessary which left me feeling quite unsettled afterwards. I’m not opposed to interventions when used appropriately. But for me, there’s a big difference in coming away from a birth knowing something unwanted was really necessary and unavoidable versus coming away from the experience with doubts and regret. My first birth was far from ideal. My second birth was quite lovely given the situation, but it wasn’t on my terms and in the end I felt somewhat robbed. I went into my third birth wanting something more.
Prior to this last pregnancy, I had spent a few years studying midwifery. I had lived, breathed and experienced birth on many different levels and felt very well equipped to journey through the birthing process again. I received obstetrical care during my first two pregnancies, but this time, for the first time, I was with midwives. I wanted choice, control and the freedom to deliver at home, which were all lacking in my previous experiences. Unfortunately, some of those aspects were missing from the midwifery care I received as well.
My birth story begins several weeks before my son was even born. Those weeks were spent constantly battling to stay pregnant until nature decided it was time.
At 36 weeks, my baby was still not head down. He spent most of his time transverse, though would turn breech, oblique and vertex for short periods of time. I had an ultrasound to confirm presentation only for him to do not one but two somersaults during the scan. He was (and still is) quite the little gymnast! An ECV (external cephalic version) was not an option as my son was too mobile for it to be effective long term.
At 37 weeks, my son’s lie was still very unstable. Standard protocol advised for a cesarean due to the risk of cord prolapse and or malpresentation (specifically the risk of shoulder presentation during labour). The risks were there, but small. Eighty percent of transverse babies will turn longitudinal (most vertex) prior to or at the onset of labour. I refused the mere thought of a cesarean and opted for the expectant management approach. I was not supported in my decision.
At 38 weeks, my son was still transverse and still very mobile. Knowing how I felt about the cesarean option, my midwife suggested that I go to a hospital hours away for a controlled induction. There they would do an ECV in a cesarean section prepped OR. Once baby was turned head down they would break my water and hold baby vertex in hopes of having him settle down into my pelvis at which point they would start the oxytocin to get the contractions rolling. This was not something that the obstetricians in my community felt comfortable of doing, nor was it something I wanted. So I declined.
At 39 weeks very little had changed. Prior to my midwifery appointment, I gently maneuvered my little guy vertex and prayed he would stay there for the duration of my check up (note: this is not something I would advise others to do!). It worked, at least until my drive home when the little bugger decided to turn transverse again.
At 40 weeks (according to their due date which was 5 days sooner than the date based on my known ovulation, which is an entirely different rant for an entirely different day), I entered the postdates induction battle. For me personally, postdates alone was not a good enough indication for induction so I declined. I did however agree to biophysical profiles. My first antenatal monitoring session was booked for 40+3 according to their dates. 39+5 according to mine. Slight overkill, but I went along with it. I continued to receive biophysical profiles every two to three days. The ultrasound technicians were rather taken back by my being pregnant beyond 41 weeks. It just doesn’t happen in my community. Following my second BPP I returned to the administrative desk to book a subsequent ultrasound ‘just in case’ only to be told that I should march my pregnant belly up to L&D and demand an induction. Oh my!
At 41+3 I had a stretch and sweep and was once again advised that the community standard was to be induced. I declined again.
At 41+4 Baby stayed vertex ALL day long without me having to push him back in to place. Whew! That day I also agreed to an obstetrical consult following yet another BPP. He wanted to induce me right then and there! I refused. Then he went on to tell me that he would hold absolutely no liability if either one of us dies before, during, or after delivery. She used the words death and liability at least a dozen times each during that discussion. Sigh. Prior to leaving, the doctor requested an NST and I agreed. It was normal in all respects; however, it did show I was having contractions every 3-4 minutes. I could feel them, but they weren’t painful. The nurse saw these and took the strip away to show the doctor. She came back and told me that she thought I was in labour and that I was not to leave the hospital. Ha! I was planning a waterbirth at home. If I was in labour, I would be leaving ASAP! I can just see the news article now ‘Woman Gives Birth While Trying to Get AWAY From the Hospital’. She then asked to do a vaginal exam and commented that I may require an augmentation (oxytocin) to speed things along. I refused and quickly got myself out of there.
At 41+5 I had sex in the evening (shhhhh don’t tell my mother!) and at 9:45 PM, I had one crazy long contraction. Three minutes after that I had another and then another three minutes after that. Sex really does work! This continued until 10:15 at which point I checked my cervix. It was still closed and baby was still not engaged. I couldn’t even feel his head in my pelvis. I decided to get out of bed and try to preoccupy myself in a more upright and gravity friendly position. I updated my Facebook status, did a load of laundry and completed a few Sudoku puzzles. My contractions continued every 2-3 minutes the entire time. They hurt, but not in an excruciating painful kind of way. They were more like a giddy this is actually happening kind of pain.
At 11:15 the contractions were beginning to hurt. They stopped me in my tracks. I tried to check my cervix again but this time I couldn’t get a good feel. It had moved very posterior. I estimated myself to be approximately 3cm. Technically speaking labour in a woman who has given birth before is defined as being at least 4+centimeters and having regular contractions which are dilating the cervix. I have a history of having fairly quick labours, but I really didn’t want to be wrong in my assessment of myself. Having studied midwifery, if I were wrong and mistook ‘false/early” labour as being active my pride would have never lived it down. Instead of calling the midwife, I woke up my husband and reluctantly told him that he should fill the pool just in case. I made a plan to call the midwife in an hour. I was terrified of jinxing it!
At 11:45, I was rolling around on the floor cursing and swearing in pain. There was barely any water in my birth pool and we had already run out of hot water. My husband had to resort to boiling water on the stove to fill the pool. I was in a daze. I think the fire alarm went off at least once. How he managed setting that off while simply boiling water is beyond me, but it explains why he never cooks! I realized my decision to call the midwife in an hour was stupid, so I paged her right away. It took her 45 minutes to arrive and it was a rough 45 minutes. The contractions came on so hard and so fast. I was not prepared for them. I had two inductions previously, and coped fairly well, especially with my second. I had practiced progressive relaxation throughout my pregnancy. I had prepared myself to deal with the pain of labour and was able to do so without pain medications. This time around, I assumed I could handle the pain, so preparing for the pain aspect of labour took the back burner. I was so focused on battling for my birthing rights that I ended up entirely unprepared for what it was I was fighting for. I just could not get on top of my contractions and my husband was too busy filling the pool and boiling water to support me. I felt very alone. With the onset of each contraction I climbed up on our loveseat and leaned over the edge. By the completion of each contraction, I’d roll around the floor. On the couch, off the couch, on the couch, off the couch. That was my rhythm. There were no breaks in between. I’ve been to births where the women have actually been able to breathe and sometimes even talk between contractions. That wasn’t me. I was so so angry that wasn’t me. The intense pain was constant. It would decrease ever so slightly between, but it still remained at a constant h*ly f*ck*ng Sh*t level. With my first two labours, I never swore. I don’t swear. Never made a sound. Never even moved. I never ever ever envisioned myself losing control the way I did with this birth and my husband was taken aback by my behaviour as well. Luckily I never woke the kids, though I’m not too sure about the neighbours… I never asked!
At 12:30 the midwife arrived, saw me and agreed I was in labour. She said she didn’t need to do a vaginal exam. I must have looked really rough! Given my son’s recent unstable lie and the fact that he still wasn’t engaged prior to labour, I requested that she do a vaginal exam anyway. I’m not a big fan of vaginal exams and under ‘normal’ situations I think her hands off approach was acceptable; however, given my prenatal history I felt her initial decision to be very poorly thought out, which really made me doubt her competence during the remainder of the labour and birth. Not a good thing.
It took a while for her to be able to do the vaginal exam. The contractions just kept coming back to back and I NEEDED to be on my hands and knees and moving during them. Eventually she was able to get in there and I was 5-6cm dilated, the membranes were bulging and baby was at -2 station, which was still fairly high for being in active labour. At this point I considered transferring in to hospital for pain relief, but I quickly reconsidered when I remembered the hospital was a 45 minute drive away. So I got into the birth pool instead. There wasn’t as much water as I wanted, but there was enough to get in. The water was AMAZING! It reduced the pain in half. It still hurt like crazy, but it helped take the edge off. I honestly don’t know what I would have done it without that pool. It was a godsend, though I still didn’t cope well. I must have looked like a fish who had just gotten itself hooked. I was flipping and turning and splashing and thrashing. At one point I remember trying to get water unclogged from my ear while simultaneously trying to maneuver myself over the edge of the pool to vomit while contracting – all at the same time. And all this while “Today” by the Smashing Pumpkins played in the background. The lyrics “Today is the greatest day I’ve ever known” didn’t quite mesh with what I was feeling at the time.
My midwife sat across the room doing her paper work and offered zero labour support. My husband came up to the side of the pool to comfort me. He had our video camera hanging around his neck and looked like a tourist, so I cursed at him and told him to put the camera down. I had wanted the delivery videotaped so what I meant was I wanted him to turn the camera on and set it down somewhere, but he didn’t ‘get’ that so, unfortunately, I have no video footage.
At 01:05, I started feeling pressure. At 01:15, I started pushing. And pushing sucked! Again, it was a completely different experience than with my first two. With them, pushing took away some of the pain. It still hurt, but there was some relief. There was no relief this time around. Not pushing hurt. Pushing hurt more. But if I didn’t push, it was going to hurt longer. So I needed to push. Having my hand on my perineum and the baby’s head helped. It seemed to relieve some of the pressure and it was very reassuring to actually feel the progress. Pushing hands on was a VERY different experience, in a good way, than having someone else down there during the delivery.
While I was pushing, my 9-year-old son was awakened to come see the birth of his new little brother. We had discussed it beforehand and he wanted to be there. My 5-year-old daughter did not. She had told us that as long as we let her know the baby was born in the morning before she went to school, she’d be happy. Regretfully, afterwards she told us she had actually wanted to be there, too. Maybe next time, if there is ever a next time…
At 01:22, my son was born in the water at home. My membranes ruptured with the delivery of his head and he came out direct OP (sunny side/face looking up) which explains why the pain was so much more intense during the labour and with pushing. He was born into my hands, but once his head was delivered, the midwife came in and swooped him up. She said that when she saw that he was OP she was afraid his face would be lifted out of the water and then brought back down, which I suppose was a reasonable concern. In total, my labour lasted approximately 3 1/3 hours from the onset of my first contraction to the time he was in my arms. The first hour was nothing. The last two hours were intense. Crazy intense.
We stayed in the water for a few short minutes and then moved into my bedroom where I delivered the placenta and breastfed my baby boy for the first time. He was 9lbs 0oz. His color was perfect. His breathing was perfect. He was perfect.
The midwives told me that I had a small perineal tear that didn’t need repair because it came together nicely. I assumed it was a first degree laceration and was fine with their decision. I later discovered it was actually a second degree tear which never did heal correctly. Admittedly, I was and still am a bit peeved about that.
My immediate postpartum was fairly uneventful. I had a little bleed at one point as a result of a small clot, but it was quickly expelled with some uterine massage. Man that hurt! My sympathies go out to every woman I’ve ever done that to in the past. My blood loss was very normal. The only issue I had was I was unable to pee. I tried and I tried, but I just couldn’t. The problem with not being able to pee is that a full bladder increases your risk of hemorrhage. Typically, midwives won’t leave a home birth until the woman has peed. As a last resort, they will catheterize her beforehand; however, that increases the risk of her developing a UTI. My midwife did not want to catheterize me, because of that risk of infection. Instead, she left me with a needle of oxytocin and advised me to inject myself and call 911 should I start to hemorrhage. Since I had previously trained to be a midwife, I had given oxytocin injections to many many women over the years, but this was an entirely different set of circumstances. I was the woman! And I, having just given birth, was in no state to think logically and argue with her. The midwives left. My husband fell asleep. My baby fell asleep. And I stayed awake terrified I was going to bleed out. I was so worried that if I were to start hemorrhaging in my sleep I wouldn’t be able to regain enough consciousness to give myself the oxytocin and instruct my husband to call 911. It doesn’t matter how much training one has had, if they’re unconscious, it’s of absolutely no use to them. So I remained up, completely exhausted, trying to pee. Eventually, I did. But it made for a highly stressful and tiring night.
In the end, I avoided the interventions in which I thought were unnecessary and had the home water birth I had always dreamed of. Despite that, it wasn’t the birth I expected. It wasn’t bad, it was just intense and not what I had envisioned. It made me realize that choice of birthplace matters, but there is so much more involved when it comes to obtaining a positive birth experience. I am very much a home birth advocate, however I must admit that overall my second birth, my unnecessary induction in hospital, was a much more pleasant and empowering experience. Having good labour support, being mentally prepared for labour and having a birth attendant who respects your decisions and whom you trust, regardless of whether it’s a midwife or doctor, are ALL key essential components of having a soulfully fulfilling labour and delivery. If any one of those aspects are missing the whole experience can easily go off kilter.