Del’s Birth Story v1.0

Del Giacomo Walls, 12/8/11

I’m so happy to say our son is here and is wonderful! Del was born on December 8, at 11:06 pm. He weighed a charming seven pounds even, 20 3/4 inches long, and nursed with me in the delivery room as if it was his job to teach me how it’s done. He’s beautiful beyond words, we are achingly in love with him, and on top of everything, he’s what they must mean when they say “an easy baby” – at least so far.

I feel like there are half a dozen different ways I could tell his birth story, all of them the truth. There’s the version where the home birth was everything I wanted it to be, even though we ended up at the hospital for a little help at the end, and is both the hardest and coolest thing I’ve ever done. There’s the version where I am sad to have lost the precious opportunity to have birthed into my midwife’s hands in my own bedroom.  There’s the version where I am grateful that my amazing birth team supported me though 32 hours of labor at home and though a very challenging four in the hospital, and a patient obstetrician gave us some time, to see me through to a beautiful vaginal delivery in a place where the odds were stacked against that outcome. And there’s the version where I am outraged over how I was treated from the moment I sat on the hospital bed, at how my voice was taken from me, and the birth I knew we could have was hijacked by strangers with policies and forms and procedures, and my birth story now includes some of the things I most wanted never to experience. All versions end with joy at the birth of my son, amazement at feeling him move through and leave my body.

I don’t know yet how to tell all of that, all of those versions in one.  This is the first time I am sitting down to write this. Here goes:

On Monday of last week I thought maybe my water had broken. We went to the birth center that morning and they checked a swab of fluid and could not find “ferning” on a slide, which is the proof it’s amniotic fluid and not just abundant mucous or urine. So they said not broken waters, carry on as normal, but to be safe, no sex, no baths, etc. I went to work on Tuesday as normal. Tuesday night, through the night, I had a lot more of this “fluid” coming out when I would get out of bed, and I felt sure it was not urine. Wednesday morning, I called the midwives again and asked them to check again and just reassure me… we went back to the birth center and this time the slide confirmed it was amniotic fluid. My water was broken, and I was not having contractions. This meant we were “on the clock”, and needed to have active labor within 24 hrs, and a baby within 48. Our midwife highly recommended we elect the use of Cervadil to give contractions a “jump start”  – my cervix was already soft, 50% effaced and dilated to “a stretchy 1cm”. The Cervadil is a little tab of medication usually used to soften a cervix before a pitocin induction, but the BirthCare midwives were part of a study being done on Cervadil’s effectiveness in starting labors  in cases like premature rupture of membranes (like mine), or being past due date. The Cervadil is accompanied by a REALLY weird looking device that is inserted into the cervix then two little “balloon” chambers are filled with water – one little balloon inside my cervix and one outside – expanded by the water to about 4 cm. The pressure helps the cervix dilate, stimulate prostaglandins, and ideally get the uterus on board to start contracting. It worked! I had to stay at the birth center for Del’s heart rate to be monitored for two hours. I laid on my side resting, Zach brought me soup from Whole Foods, and sure enough – contractions began on cue. And baby was responding just fine. We were sent home (yes,with the weird balloon thing inside me – really weird feeling) to do all our early labor stuff.

We watched some of The Big Lebowski, we rested, we ate. I contracted. After about 4 hours, the balloon thing in my cervix came out on its own – which meant that I was now dilated to 4cm. We notified our midwife who was thrilled things were going as hoped. My friend Kristi came over. We ate. Kristi and Zach did some cleaning and arranging. I contracted. We were excited – baby coming soon! Zach was great – incredibly supportive, stayed near me the whole time, and kept me laughing, calm, helped me rest, held me though contractions. Sometime in the late evening, Kristi persuaded me to climb the stairs with her. We spent some time riding the elevator down and climbing back up the stairs, pausing for breath and contractions. They were coming around every 3-4 min, lasting 45-60 seconds. I was having increasing bloody show, and around 2 am the midwife, Laura, and birth assistant Claudia came over. I was dilated to 6cm and laboring well. My temp was good (meaning no worries of infection from broken water) and baby’s heart rate was great. I labored through the night and into the next day, with not much change in frequency though some increasing intensity of contractions. I had dilated to 8 or so. We alternated resting with activity, did some showers, some dancing to music, keeping up eating and drinking to stay strong. I was getting tired. As the afternoon wore on contractions were just not picking up. The only real problem with that was that we had this “clock” running. Baby was in good shape, and other than getting tired, I was great too. Sometime around 4pm, with no change in dilation, Laura suggested that I consider making a move to the hospital for a bit of pitocin to push the labor in high gear. She said if I felt I needed it, having an epidural could also allow me to rest while the pitocin picked things up and with luck I’d be ready to push very soon.

Zach wisely suggested that he and I take a shower and talk about this together. Though it was so far from what I had wanted this birth to be like, I trusted Laura’s instinct, and my own was also telling me we needed some help. Zach felt the same, and we decided to make the move. The distraction of packing up and getting to the car was disorienting. It was already getting dark out, and we had to drive through rush hour traffic to our transport hospital, Inova Alexandria, where our midwife practice has supportive backup. I asked Zach to pizza drive. He used to deliver pizzas in college, and has mad fast driving skills. He knew exactly what I meant. Kristi and I sat in the back seat and she freaked out about Zach’s driving while I told her, between contractions (and the awful feeling of sitting on the place where my baby’s head was!) to close her eyes if she couldn’t take it, stop telling him to slow down! We made it to the hospital – 40 minutes in the car. Ugh. Zach got us through registration easily because the midwife had called ahead with the information they would need. Sometime around 7 pm, my birth was hijacked.

It sounds melodramatic to put it like that. But I went from my home, with a small group of trusted and invited caregivers, where we made decisions together and let birth happen in it’s proper course, to a place where, for the next four hours, I don’t think any staff person spoke to me except to give me orders, and only once or twice responded to my questions. I was, within 20 minutes, strapped with so many monitors/wires/needles/tubes/cables/cuffs/clips that moving at all was far, far too much trouble and potentially got me chided or risked pulling a badly inserted IV out of my hand. No hand was free anymore to hold onto Zach, and he was having both to help me through contractions AND make sure tubes and cables were not wrapping around me as I was moved around for assessments and to reposition monitors. A slow drip of pitocin was started. At some point shortly after, I was laid onto my back for an assessment – reflexes, checking lungs, etc… I could not breathe and asked them to take me off my back. Around this same time, the baby’s heart rate dropped alarmingly. I didn’t know this. I only knew I was rolled suddenly back onto my side, a mask was put over my face, I could no longer be heard when I spoke, and about ten people were behaving frantically around me and the monitor behind me. They turned off the pitocin and turned up the other fluid IV to full blast. I didn’t know why and no one tried to tell me. I had to ask my midwife – who, along with birth assistant, we more or less sidelined by a cadre of nurses, on the far side of the delivery room. She came close and explained to me what was happening. She urged me to breathe for my baby, and Claudia told me to talk to the baby, tell him it was ok and we were going to be ok and he would be born soon.  I concentrated on this. It was all I could do. And it kept me from panicking. I was sad and angry too. And I very much doubted that I could labor any more with all this outside chaos around me.

Zach and I talked with Laura about an epidural. I was losing it. Not from labor – but from the disorienting and distressing atmosphere around me. From feeling so shut down, so drowned out of my own labor, so hijacked. It was a very dark place for me. In hindsight, the worst thing was being robbed of my voice and my own power. I knew how to have a baby, even with pitocin, and I was prepared, intelligent, knowledgeable, capable of cooperating with a sane birth process — but I felt completely, devastatingly powerless and the only way i could see to make this work for me and for my baby was to turn off either the internal or the external stimulus. And since we were already at the hospital and there was no going back from that (another loss of power – a decision you cannot take back) I needed to turn off the internal – the sensations of labor. Ideally, this would help me relax, allow them to turn the pitocin back on and finish that pesky final 1-2 cm of dilation. ALL THIS, for TWO CENTIMETERS OF CERVIX.

So, another of my “don’t want” items… I got an epidural. Even better: I got one that never took. Getting it was not as bad as I had thought, except for feeling the hot trickle of my own blood down my back when he put the needle in. Having it however, was disappointing. I never lost sensation of contractions, never lost any feeling anywhere. I felt the catheter go in and felt it come out later, I felt the next and the next internal exams, I felt every urge to push which forms the next to final chapter of this long birth story, and I felt my baby descend through my body and felt him come out of me and felt the two little stitches I needed at the end, I felt my placenta slide out. Most of this should have not have been felt, if the epidural had worked. Cue Alanis: isn’t it ironic?

The baby’s heart rate had stabilized, I’d been given a little more pitocin, only to have his heart rate decelerate again. So, no more pitocin for us. Is Alanis still playing in the background? Didn’t we come to the hospital for pitocin and an epidural? When the OB checked me next, she reported I was at 10 cm but I had an anterior lip of cervix. From my midwifery days, I knew this was nothing threatening but sort of represents one of the big “oh no, not this” moments in birth. It’s basically a fat lip of cervix that has swollen, usually from some slight positioning problem with either how mom is lying/moving or how baby’s head is applied to cervix. The trick is that it happens just as the urge to push is kicking in, and you CANNOT push till the the lip is gone. It goes on it’s own or with some massage. I think my OB massaged it some – add that to the list of things I should not have felt but did and it HURT – and then we were told to wait half an hour. The next 30 minutes, maybe 45, were the worst. NOT pushing is way harder than pushing. Within another couple of contractions, every fiber of my body was commanding that I push that baby out, and I had to resist. It was in this moment that I might have completely lost it if not for Claudia. That woman got in my face, nose to nose, for 30 minutes worth of hard contractions, making me blow out hard from pursed lips with her, through every 60-70 second contraction, claiming that you can’t blow hard and bear down at the same time. I think maybe she is only partly right but I fought my body for that whole time. I felt the baby’s head shifting inside me. Claudia told me I MUST relax between contractions and tell my body to open for my baby – she said pushing could take 2 to 3 hours. I thought I might scream then – Zach said my face was something between despair and “Oh Hell No!”  But I did what she told me. When contracting, I battled the urge to push, and when not contracting, I closed my eyes and spoke silently and deliberately to every bone and muscle between my baby’s head and the air in the outide world: open, be soft, give my baby room, be open, be soft, give my baby room. My eyes were closed and I could hear the people around me saying “Look she is sleeping!” But I wasn’t. I was willing my body to let this baby out because I didn’t think I could live if it was another three hours and I knew my baby needed to be out. I felt my birth canal relaxing and I could feel baby’s head descending even without my pushes. At LONG LAST the L&D nurse checked me again and confirmed the cervical lip was gone.  I could have told her that – I knew it was gone. She called the OB and I was helped onto my back to push.

On. To. My. Back. I asked if I could squat and was told no because I’d had an epidural. In my mind I said, Fuck your useless epidural, but there was not time to talk. I remember thinking though, “This is the final insult. I am pushing on my fucking back.”

Someone was holding my legs, someone was telling me how to curl, where to push, Zach was holding my head and coaching me through teeth-clenching, breathless, curling pushes, but my eyes were closed and I was pushing as if it might be the last thing I did in this life. It seemed like a lot – and if you’d told me later it lasted 5 minutes or 5 hours I’d have believed you. There was no time, only pushing. I felt burning and I was told to stop pushing and pant. I did – I was grateful the OB was protecting my perinium. I was told to push again and the huge thing in me came out. Behind it, the soft slither of a baby’s body, and I waited for sound. I don’t think I breathed until my baby did and I heard baby grunts and whimpers. Zach was still holding my head, and the L&D nurse — curse her, it wasn’t supposed to be hers to announce – said “it’s a boy!” And we laughed and my legs shook and Zach said he wanted to cut the cord. They had clamped it already – they didn’t wait like I had wanted. Zach cut the cord and my baby was handed to me, and he laid all warm and wet and gooey on my belly, and I could see his amazing and bewildered little face. I had pushed for ten minutes. Sweet Jesus after all that he came out in ten minutes.

They took him from me to assess him, wipe him off, weigh and measure. Zach stayed with me and Kristi went with him. My placenta was delivered and I got two stitches to my perineum. Stats were being called out over the robust cries of my son. Seven pound even. 20 and 3/4 inches long. Parents were being called so they could hear the cries of their grandchild. Finally he was returned to me and, skin to skin, I helped him to my breast and this baby nursed like a champion. Pride and relief and joy soothed my fear and eased both the pain of the labor and the pain of being in this place. Del Giacomo Walls was born.

I realize in writing this that I don’t do justice to the people who labored with me. Zach was a rock and there are not words for how grateful I am to him for the his unflagging support and constant presence. My heart explodes with how much I love him. Kristi was amazing – she was all peace and calm and assurance from start to finish and stuck with us through all those hours. She also captured the birth on film and I cannot wait to see her pictures! My midwife, Laura, was warm and calm when we were at home, and did her best to help me though the transition to the hospital. Claudia is the only person on earth who could have commanded me through that no-pushing agony. Even the OB, though her minions in their bland scrubs can kiss my ass, was calm in her assessments of our situation and did not rush to end my labor with a c-section. She kept her head and let me labor and did not take away from me the precious gift of birthing my child.

No one can or should say “whatever happens is ok as long we end up with a healthy mom and healthy baby.” Needless bad things happening is not ok under any circumstances. Conditions which make an otherwise articulate and capable woman feel cowed and submissive to a system even while her heart is raging against it are not ok. The same interventions could have been provided to me without the treatment that left me feeling helpless. I am not disappointed that I ended up in the hospital for the final stage of my labor, no confidence lost by having needed the intervention of pitocin. I knew that if I ended up in the hospital, it would be for a good reason and I trusted my midwife and she was right. But I will never accept that the style and manner of the care given to me was “ok”, or that the mindless adherence to a block of procedures was “ok”. That my son was born healthy is not justification for these things. Care and interventions could have been given that welcomed my capability rather than sidelining it, that sought my voice rather than silencing it, and that maintained my active participation rather than forcing me into a passive position.

Telling all the stories of my birth at once makes a complex story. Life is, after all, complex, and birth is the grand entrance into that complexity. For a baby, and for a mother.

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