Friday, September 7, 2007

Sedona's Birth Story

Yes, this is incredibly long, but given my line of work, there are an awful lot of people interested, so I'm just gonna post it:

Repeat after me…fetal malpositioning is not your friend. To be more specific, asynclitic presentation is not your friend. What is asynclitic presentation, you ask? According to one website, it’s when “baby is head-down and probably anterior but the head is slightly tilted to one side or 'off' in some way so that the head does not move down into the pelvis smoothly. Usually the side of the head or 'parietal' bones present first instead of the crown of the head, making the diameter much larger.” In short, it’s a big pain in the…well, you know.
Of course, Sedona’s birth story starts a whole 3 weeks before that point. Or maybe three years to be more accurate. I can’t tell you how many times I’ve counseled moms that “every pregnancy is different and every baby is different”. Funny how much harder that is to believe when it’s your own pregnancy and your own baby. Since Sierra was born a month early and Sedona’s pregnancy had gone much the same way as Sierra’s, I was sure I’d be having a baby the first week of July. Sure enough, I started having weak, but very regular contractions the night of July 1. Since I already had an appointment scheduled with my midwife for the morning of July 2, I decided to sleep when I could and wait for her to come instead of calling her. When she showed up, she checked me and let me know I was 100% effaced and 4cm dilated. Unfortunately, I also had a UTI, which is what was causing the contractions. By July 6, I was 5cm and 100% effaced and there I stayed. I had a short episode of incredibly strong contractions nearly every day, but they never went anywhere. My appointment on July 18 showed that everything was the same and I was becoming convinced I was destined to have an August baby.
On July 19, Josh and I went to bed around 9:30 or 10. At 10:20, I got up for one last potty break. Identical to what I experienced with Sierra (ironically, it was even 10:30 at night for her), I felt a strange, small pop. I had gotten my hopes up too many times about those little pops, so I just thought to myself that it was weird my back popped when I hadn’t moved. Then there was a louder pop (the “carrot breaking” as Josh and I say, because it really does sound like a raw carrot snapping in half and other people can hear it) and a big gush of amniotic fluid. Finally, I was having a baby!!!!
Josh called Toni (the midwife) and I started calling family and friends. Toni lives in Brenham, so she had a 45 minute drive to get to us. The first person to arrive was Veronica, who was our baby-sitter for Sierra. Sierra was already in bed, but we wanted Veronica there just in case she woke up. Close behind her was my co-worker Karen. She has two grown kids and a grandchild of her own and had been SUPER excited and positive about my pregnancy and birth choices, so we invited her to observe the birth. I paced the living room for a bit and the contractions hit at 10:40. A little more pacing and talking to Karen and Veronica and then I got out the birth ball. I kept talking to them through the contractions, figuring it was as good a distraction as any. Toni showed up around 11 or so and Josh helped her and her assistant (her grown daughter since the apprentice midwife was out of town) set up all the birthing supplies in our bedroom while I continued chatting. Finally Toni came in and listened for fetal heart tones. They were a tad lower than they had been, but baby wasn’t kicking much and it was her usual sleep time. Toni asked if I wanted an internal exam and I said no—I didn’t really want to hear I was STILL 5 cm like I had been for three weeks. So Toni settled herself on the living room floor and did some paperwork (we quickly went over my choices such as whether to take cord blood after delivery, what hospital to use in case of transfer, etc…).
At 11:30, Toni reminded me that laboring women should try to empty their bladder every hour and I had been in labor for a little over an hour. I walked to the master bathroom, peed, and had a contraction with an awful lot of pressure behind it. I told Josh I just wanted to lay on the bed and that he should get Toni. I only lasted another 2 or 3 contractions before telling Toni I really felt like I should push. She said she should check me and I consented and found I was at 9cm! I went through another contraction or two with Josh applying hard counter pressure to my back to relieve the pain. Toni gave him a rice sock she had microwaved to wrap around my back and that was heavenly, but I still felt like I needed to push. Toni checked me again and said I had a small anterior lip of cervix left. She explained that she was going to keep her fingers there until the next contraction and if the lip pulled back with the contraction, I could go ahead and start pushing. It did, and I did! I was laying on my side in bed and very un-inclined to move anywhere. I tried a few pushes in a semi-reclining position, but I was very uncomfortable and Toni suggested I move to the birthing stool (she brings one with her).
I have no idea how long I was on that birthing stool. I do know that we tried 2 or 3 different positions on it, Josh supported most of my weight most of the time, and Toni was right there for every contraction. For each and every push, Toni applied warm compresses (when your midwife requests you to have a crock pot and two dozen washcloths available for the birth—listen to her!) and some sort of pressure to muscles around my pelvic floor (I found out from talking to her later that I apparently have more extensive damage from Sierra’s birth than I was ever told by my OB at the time). Her assistant regularly applied olive oil to help everything stretch. Despite this and pushing and pushing and pushing, I didn’t have a baby! I only had to push 30 minutes with Sierra. They were a hard 30 minutes with back to back contractions. This was totally different. I was pushing as hard as humanly possible, getting really spaced out contractions and some weak contractions, and seemingly making no progress. Toni explained that baby was having a really hard time “rounding the corner” to fit between my tail bone and pubic bone (this is where we tried a few other positions). I had a feeling things were really getting serious when somewhere through the labor haze, I heard Toni (who’s very religious) mutter, “Lord, please give her the strength to push this baby out”. All I could say was, “I just want to lay down and sleep”. Someone (Josh later told me the assistant and Karen) kept wiping my face with a cool washcloth because I was dripping sweat---note to self, having a baby in July in Texas isn’t the best of ideas. At some point my mom came in, but I’m not sure when. I also noticed I was suddenly hearing my friend Erin (who had driven from San Antonio) in the room—she had been invited to observe the birth too, but we didn’t really think she’d make it in time. For some reason it didn’t occur to me at the time that the fact that she made it meant this was taking longer than we’d expected.
Throughout pushing Toni monitored fetal heart tones, finally measuring them with every contraction and deciding to put the oxygen mask on me. Then she told me we really needed to make some progress and it was time to try another position. She wanted me to get on the bed again, which I was pretty sure was just about impossible. Josh just about picked me up and put me on the bed. I was slightly propped up, but mostly flat on my back and Toni had Josh and my mom each hold one of my feet for me. Never in a million years would I have predicted it, but that’s what finally convinced Sedona to join us. Maybe two good pushes and she was crowning. Toni told me repeatedly her head was out and I could rest, but from my end it felt like I was having the never-ending contraction and I couldn’t have stopped pushing if my life depended on it. When Toni put her on my stomach, I grabbed her up and she looked at me like, “what the **** was that?!?” and all I could say was, “me too, baby girl, me too!” Unlike her sister, Sedona immediately latched on and nursed well for about an hour. It was a very peaceful birth, I don’t remember Sedona even crying, but I was never worried about her because she was in my arms and I could see she was doing well and pinking up. We all realized right away why pushing was so hard—poor baby had really significant moulding all towards the right side of her head: asynclition! In the days following her birth, the moulding went away, but she was left with a significant bruise and finally a sizable blister that eventually scabbed over.
I loved having a home birth. Toni’s skill at midwifery saved me from any tearing. This annoys me a little every time I go to the bathroom or take a shower—the recovery for this birth was INCREDIBLY easy, due in large part to the lack of stitches, despite the fact that Sedona’s head was 1.25 inches bigger than Sierra’s, Sedona’s chest was bigger than Sierra’s head, and it took three times as long to push Sedona out. Somehow Sierra’s birth left me with two pretty bad second degree tears and Toni got me through with no damage whatsoever. Makes me tempted to make a little visit to my old OB. In the days after the birth, Toni and I talked about the experience and agreed that there was a good chance I would have had at least a vacuum extraction if not a c-section had I delivered in the hospital. Simply the fact that I was 5cm dilated so long would have gotten me labeled “failure to progress” and pushed to induce even though my water had not broken and Sedona was doing fine. One of my biggest “guilts” is the time Sierra spent in the newborn nursery—I keep imagining her there alone in a cold room with bright lights laying in a plastic box. Sedona was given straight to me, only taken because I decided I didn’t want to take her into the shower with me, and hasn’t left me since. She was not given vitamin k or any vaccines and her newborn screen was delayed until day 5. Toni did a complete exam on her at birth, 24 hours, 5 days, and 12 days, so there was no need to go to the pediatrician until 2 weeks. If I were to have another baby, I would definitely go the homebirth route again, assuming there was a midwife nearby that I was comfortable with. Following Sierra’s birth, the only thing I could think was “at least I never have to do that again”, but this time around the experience has left me thinking, “that certainly wasn’t fun, but it wasn’t so bad”.
Back to that asynclitic thing...just for kicks, let’s review the signs of fetal malpositioning:
• Days of tiring pre-labor or 'false' labor before ‘true’ labor; mother may begin labor exhausted
• A tendency towards post-mature (long) pregnancies and ‘overdue’ babies
• A baby that does not engage before or even well into labor
• Feeling lots of hands and feet in front by the mother's belly
• PROM - Premature Rupture of Membranes, or the bag of waters breaking before labor starts
• Difficulty finding the baby's heart tones where you usually would find them
• 'Stalled labor' - labor that stops between 4-7 cm and does not progress
• Prolonged labor, especially in the pushing stage
• 'Back labor' - painful contractions felt mostly in the back; common with posterior labors because the baby's back is pressing against the sacrum (low back); also found with the arm across the baby's face because the arm is pressing on the mother's sacrum
• High need for pain medication, since the pains are abnormally difficult
• 'Early transition' - showing the signs of transition (nausea, chills, high pain levels, shakiness, etc.) between 4-7 cm instead of between 7-10 cm
• 'Fetal distress' - baby's heart rate has problems because baby is stuck and gets stressed; this may also increase incidence of fetal meconium in labor
• 'Early pushing' - feeling the urge to push before being fully dilated
• 'Anterior lip' - dilating to about 9.5 cm but a small 'lip' of the cervix is stubbornly left
• 'Stuck baby' - a baby that gets stuck before passing the ischial spines (0 station) and does not descend even after hours of pushing
• Great pain with pushing, especially on one side or another
With Sedona I experienced 11 out of 16 of these signs. With Sierra I also experienced 11 of them—I feel baby and I both came out of the situation happier and healthier the second time around. After the fact, Toni told me she suspected malpositioning when I was pushing so hard with no progress, but she really thought it was going to turn out that Sedona had a hand by her face.
In the end, I had a perfect, 7lb 9oz 20in long baby girl and a birth experience that was much easier and more satisfying for me than what I experienced in a hospital birth.

Update: I’ve come to a realization that Sedona has never had her “days and nights mixed up”. This is so prevalent among newborns that I work with that I’ve come to assume it’s a normal side effect of pregnancy. We tell moms all the time that because they are up and walking around all day, they rock the baby to sleep, then when they lay down at night, the baby wakes up. We explain that babies stick to this pattern for a bit after they’re born. Even though I spent 3 months on strict bedrest with Sierra, I still accepted this bit of information as fact. But Sedona sleeps at night. She always has. It’s occurred to me that she was born at 2am and we went to bed at 4am that night. We got up around 6:30 (when Sierra woke up) and therefore turned all the lights on. The next night, we turned the lights off and went to sleep. Sedona has always been in bed with us, so she’s been exposed to the same cycle we follow. I feel like this natural light/dark cycle is responsible for her good nighttime sleep habits. I’m beginning to think those nursery lights that are on 24/7 for the convenience of the nurses are what really get the babies mixed up. In our town, babies can’t even stay with mom at night unless someone is awake in the room (which usually means a light is on). Just a thought…

1 comment:

Anonymous said...

I remember that night so well. And I will always be thankful and grateful for allowing me the opportunity to share such a special time with you & Josh. I witnessed a miracle that night!

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