Saturday, January 2, 2016

Ada Mayme - Birth Story

Ada is 5 months old now and I have finally finished writing her birth story. It's long and involves birth and associated details (and images) so if that's not your thing, please skip this post!
If you'd like to read it, you can find Cora's birth story Parts 1, 2 and 3.

On Wednesday, July 22 at 10:41 pm Ada entered this world and made us the proud parents of two beautiful girls.

L&D Day

My estimated due date had been Saturday July 18 and much to my surprise there were next to no signs that Ada would be making her arrival any time soon. We saw Kathy, my Midwife, the day before my due date and she did a cervical check & swept my membranes. I was 4 cm, 40% effaced but at a -3 station. I wasn't having any useful contractions that would be effective at bringing Ada down, while I was grateful to not be experiencing prodromal labor like I had with Cora, it was frustrating that we weren't seeing any signs that my body was preparing for labor. Earlier that week I had come down with some nasty virus that gave me a high fever (for being 39 weeks pregnant) that I just couldn't kick so I spent a day in Labor & Delivery getting fluids and monitoring baby.

After that ordeal and the fact that Ada wasn't moving a bunch (passing kick counts, but she was always pretty mellow with her movements & my anterior placenta liked to hide them, plus running out of room...) Kathy scheduled me for a Non Stress Test on the following Tuesday (3 days past EDD).
My "guess date"

The weekend, my due date & Monday all came and went with no labor signs to speak of. John decided to work from home Tuesday to be with me for the NST and to hand hold as I planned to also have my membranes swept again, this time by the other Midwife, Holly, who according to Kathy has "magic fingers". Ada gave us a bit of a scare as she totally failed her first non stress test. We were pretty sure she was just asleep, but our best attempts to wake her with Holly pinching her foot, juice and crackers weren't working. Holly & Kathy stood over the NST tape with concerned looks & sent me out for a good lunch and to come back & try again. We found it hysterically amusing and ironic that two midwives who discourage sugary drinks like Gatorade told me I should drink a coke with lunch! After a nice burrito from Chipotle and the coke they really had to twist my arm over, Ada passed her 2nd NST with flying colors. At my cervical check I was found to be at 5 cm, 50% effaced, still -3 station but she could feel my bag of waters bulging. We did the sweep & they talked to me about making sure that I called as soon as I was in labor to give everyone time to get to the birth center since we were all 30 + minutes out. Holly was adamant that I'd go quickly once contractions started.

We went home grateful that Ada was healthy and we weren't faced with needing to induce and give up my natural out of hospital birth. That evening I had some contractions. They were "real" enough to justify timing them but I was pretty sure they were associated with the sweep from earlier that day & knew deep down it wasn't the real deal. I didn't bother to tell anyone other than John.

Wednesday rolled around and Cora was kind enough to let me sleep in a bit. The morning went by uneventfully. I had a few contractions, again like the night before they were real but not close together at all. Nothing out of the ordinary for being 40 + 4. After lunch, Cora and I laid down for a nap together on the couch. As I laid there I started doing a mental kick count but kept loosing track because her kicks were so far apart. I usually did kick counts at nap time since she was usually pretty active after lunch but I figured I'd just try again after I'd slept a bit.

After our nap we got up and Cora
played while I put away laundry and did a few chores. John called at 3:00 and said he was headed home early, that he was distracted and he'd just finish working at home that evening. At that point I had just had 2 or 3 back to back contractions that required my full attention and moaning helped focus so I was beginning to suspect that early labor was on the horizon. I kept with my tidying the house and put dinner in the crock pot (cheese ravioli) to keep my mind busy and was so glad John was going to beat traffic headed home. 

My Dad texted me at about 4:15 to suggest that I hang out at his house the next day. He was nervous that I was alone and an extra 15 minutes out from him if I went into labor when John was at work. I was sure enough that early labor had begun that I admitted the contractions to him. I didn't do that lightly as I didn't want to create any undue worry. At the same time I was getting really antsy for John to get home already (and I was really regretting asking him to stop & get me Gatorade before he got home). I called him but he didn't answer much to my displeasure, he was in the store purchasing my Gatorade and called right back, he was just a few minutes from home - thank goodness!

I hadn't been timing contractions up to this point but decided I should start so I could recognize any patterns to the waves. When John walked in the door I was leaning on the couch, moaning through a contraction as Cora danced around the living room in her diaper with a pair of pajamas on her head like a hat. I quickly drank one of the Gatorade John brought home and knew I needed to get in the shower. Between hydrating and the shower, I knew it would officially be the real deal if the contractions didn't stop. Just before getting in the shower I texted Sarah, my doula to let her know what was going on since she had the furthest drive into us and kiddos to make childcare arrangements for.

John worked on tidying the house and getting bags loaded in the car while I showered. The warm shower slowed my contractions but I was certainly in labor. After I got out I notified the rest of my birth team that I was in labor (6:15). I rode out a couple of contractions but they weren't bad at all. I was able to handle them on my own easily. We decided this would be a good time for John to take Cora to my Dad's house. I gave my baby hugs and kisses as John carried her out the door with promises that "when I see you again, Sissy will be here!".
John hadn't been gone long at all and my very next contraction was really hard. I was beginning to panic that I needed his support and round trip to my dads house is about 30 minutes. I called John & asked him to please hurry. Then I called my dad to make sure that he was waiting for John at the street so John could immediately come home. My next several contractions weren't nearly as bad, but I was glad to have John back. We spent about the next hour with me alternating labor positions standing and swaying or sitting on my birth ball while John finished up some stuff for the office.
(the picture of me above is eating dinner between contractions as I swayed on my birth ball)

In between contractions I was second guessing my labor and myself. I was handling most of them leaning over, hips swaying and quietly moaning. Occasionally I'd have one hard enough to ask John to help with double hip squeezes. It just didn't feel challenging enough. I don't know if it was just that I was better equipped this time around since I had done this once before, or if maybe my labor just wasn't as difficult? Maybe all that red raspberry leaf tea I had drank did its job in making my uterus strong? Whatever the reason, it left me feeling that I didn't need to go to the Birth Center yet, I was pretty sure I hadn't had hard enough contractions to dilate further but I knew my midwives were antsy about how quickly I'd progress, especially if my water broke. I was however worried about the drive to Inanna, the birth center, it's about 25 minutes away and I know from experience that riding in a car during labor is pretty awful.

I picked up my phone to text Kathy that we'd go ahead and come in and saw that she had just texted me at 7:10 saying she needed to go check on another laboring mom and to see how I was doing. I called her back and told her we were coming in but only because I was nervous about the drive & that she should have plenty of time to take care of the other mom. She said she'd call in Holly just to make sure all our bases were covered.  I told Sarah we were headed in & she said she'd see us there. I triple checked that we had everything off the last minute labor grab list, gathered up a pillow to hold on the drive, and a towel and absorbent pad to put in my seat just in case my water broke on the way. I wasn't in any particular hurry, I rode out a couple of contractions leaning on the hood of our car. John finally got me loaded in the van and away we went.

Just off our street I tried texting Kathy to let her know we were actually on our way. My brain was foggy and I couldn't remember if that had been clear in our phone conversation before. As I texted a contraction started and I somehow ended up calling her. Since she got to hear me work through a contraction on the phone she decided she better stay at the Birth Center and another midwife was sent to tend to the laboring mom two towns away (poor momma, throughout the night I'd occasionally hear Kathy on the phone getting updates from a nurse on her. Each time her response was "give it another hour then call me back and we'll see where she is" sounded like a less than fun labor!). On the drive I also texted Kaity, our birth photographer, letting her know we were headed in but to wait until I was checked to come. I was certain this was still going to take a while. 

I had maybe 3 contractions the whole way to the birth center and other than the one on the awful bumpy road that Kathy got to hear me work through, none of them were all that hard. I was beginning to second guess my decision to go in, just sure I was wasting everyone's time. At Inanna, Lauren, my birth assistant (who we know from church as she kept Cora in nursery) met me in the parking lot. She got me inside to Kathy while John got all our stuff inside. Kathy did a check and I was at 6 cm and 80% effaced so progress had been made but I was disappointed it wasn't more. I just wanted this all over with. Sarah arrived as Kathy went to track down a thermometer and to see if the birthing room was ready. Holly arrived somewhere in all of this too. Lauren came and took us into the birthing room and we started getting set up. Lauren put our frozen chicken & dumpling casserole in the oven for my post-birth meal. I told her I expected it to take about an hour and a half in the oven so we might want to wait. Everyone disagreed and thought it aught to go in then, they were all just sure this was going to be quick. There was even a discussion of getting something from a restaurant because the casserole may not be done in time (which I seriously doubted). 

John put on my labor playlist (Pandora's Praise & Worship station), Lauren was tending to her tasks and sang along quietly to the songs. While I went to the restroom, John and Sarah got the essential oil diffuser going (lavender & lemon). During all of this Lauren asked if I wanted her to fill the tub for a water birth. I told her that I'd likely want to labor in it some and definitely do an herbal bath after the birth but that I didn't plan on a water birth. If it happened okay, but my heart wasn't set on it, so she started the process of filling the huge bathtub.

I had contractions here and there but again, nothing all that awful. I'm not sure if they were getting longer/closer because John & I weren't timing them anymore but I didn't notice a progressive change. John would do hip squeezes in contractions, we'd slow dance. I spent a couple on the birth ball with Sarah massaging my back as I read over my birth affirmations on the bed in front of me.

Kathy had me squat through a few, which I found to be pretty uncomfortable, but of course that's because it made the contraction far more effective. She also told me she would break my water whenever I was ready. I discussed it with John and we knew it would speed things up, which I wanted but I also knew it would make my contractions more intense. We decided to give it 30 minutes, see where I was at & decide then. We kept at this for the next half hour. It was a very peaceful environment during contractions, I would chat and cut up with the birth team between contractions. I was content but really felt kind of like I was the watch pot everyone was waiting on to start boiling and I wanted the process to be over with already. 

The half hour passed quickly and about that time I had a couple of hard contractions back to back. John helped me to the bathroom. As I slowly scooted into the bathroom with John's help (I was finally having the frequent, hard contractions I'd been expecting), Kaity arrived and I gave her a quick hello. Movement triggered several more close together contractions. Labor was reaching my "hard" memories.

We left the bathroom and went to the bed. Kathy checked and I was at 7 cm and maybe 80% effaced (I don't remember exactly the effacement).

I didn't feel like I should be beyond that based on the work of my contractions but it's still frustrating to hear you aren't progressing quickly to the end of the process you so desperately want to be finished with. I was also nervous about whether or not Ada had passed meconium in her water as Cora had. If we were going to have potential complications from that I didn't want to find out at 10 cm like before. So, we broke my waters. No meconium!! During all of this I was rather annoyed with my hair on my neck, I suddenly remembered that I'd seen Sarah with her hair French braided and between contractions ask her if she could pull my hair back. We all had a big laugh that my hair is what I was thinking about at that moment. Breaking my waters didn't immediately change my dilation/effacement and I decided to get in the tub for a change of pace. 

Once in the tub I felt much more relaxed. Sarah braided my hair and John poured water over my belly in contractions. At Lauren's suggestion I moved to the other end of the tub to use the shower sprayer on my belly in contractions. That was so helpful!

We labored in the tub like this for what felt like forever. I was definitely in transition and my thoughts weren't bright and happy anymore. I knew what was coming. This was about to get a lot harder and then it would only be more and more difficulty until finally it was over. That was one of the big differences between my first and second labor. I knew what was happening, I feel like I almost knew too much making it harder to get out of my own head and deal with each contraction as it came. 

After a couple of particularly miserable contractions Kathy checked my progress. I can't remember if I asked her to check,or if she offered when she was checking heart tones but I wanted to know my progress. I was only at an 8. This is when birth became much of a mental game. I knew too much. I had too much "book knowledge" about birth. In my mind I was calculating that a rough estimate would be a centimeter per hour so I was thinking that I had another 2 hours of this hard labor. The old saying is true though. When you think you can't anymore, it's because you're right there at the finish line. In hindsight, I only had another 30 minutes or so of labor.

John and Sarah kept cool rags on my neck and forehead. My next few contractions I had to work really hard to hold it together emotionally. I wanted it over and all those painful contractions had only brought me to an 8. I wanted to cry out that I couldn't do this, but I knew I could. I wanted to quit, but the only way out of this is to go through this. I regained some emotional control and had John read me some of my birth affirmation cards while Sarah took over the water sprayer. This helped so much. Listening to him say words of Truth that I will come through this and it is just temporary were such restorative words. I would focus on the lyrics of the worship songs, thinking through them between contractions. I would ride the waves of contractions that we're getting longer and longer requiring multiple breaks to gather more breath to maintain my moan. My internal montra was the same as it had been with Cora's birth "Strength, God give me Strength".

 I told Kathy I was feeling "pushy" after a long contraction. Kathy gave me the go ahead to blow the baby down with practice pushes to help take the edge off the contractions. This helped the pain, giving each wave a tangible purpose that I could work with it. John joined me by sitting in the corner with his feet down in the tub giving me his hand to hold in the waves. It went on like this for several more contractions, I'm not sure exactly how many. I knew I was getting close based on what I felt and I could hear everyone moving and shifting around getting ready for delivery. In a contraction I had an overwhelming urge to push. I wanted to make sure they knew I was really pushing and I couldn't tell if they knew based on my moan. I made a rather loud announcement to the room in general that I was "Pushing!!". 

Kathy and Holly came to the tub, Holly was telling me to get into the pushing position they had told me about earlier when I got in the tub. I could feel the next contraction rising up in me as I began to move and really didn't want to move. I don't know if I told Holly "no" but I was sure thinking it. She reached over to me, grabbed me by the shoulders and pulled me into position as the contraction began. I locked my feet into place grabbed John's arms and pushed with the wave.

As I pushed Holly exclaimed to Kathy that "she's coming!". Coming she was! The contraction ended and I could feel Ada retreating back so I flexed and held her in place waiting for the next wave. There was some chatter about making sure Kathy didn't fall in with me. The next wave came, Sarah reminded me to open my eyes. I used all my might and pushed her head out after a big rupture of fluids. One more push and she was here! Kathy caught her and pulled her right up onto my chest! Her time of birth was 10:41 pm.

I was beyond happy to have my baby here in my arms! I could hear John quietly crying behind me as I settled down In the water holding our baby. She was crying and everything was perfect!!

They draped warm towels over her and we were snuggling enjoying our first moments together. I'm not sure what all was going on in the room but I heard either Lauren or Holly say something about "oh, your placenta is coming already" with an obvious air of surprise. I looked down and sure enough the remaining water was quickly turning bright red. I knew from my doula training and first birth that this was a bit quick to already have my placenta come. 

They checked the cord, it had stopped pulsing and was white so it was clamped and John got to cut the cord. I passed Ada out of the tub to her Daddy's waiting arms and then was helped from the tub.

 There was a lot of blood coming already and I wasn't at all cold but from the moment I stood I began badly shaking (which was probably more hormonal than anything). They got me to the bed and John brought Ada to me to be skin to skin as he laid on the bed next to me. The placenta came quickly but it felt like I was birthing the placenta over and over again with waves of blood and clots gushing out of me. Holly, Kathy and Lauren were constantly working on me to get the bleeding to stop. Sarah stood at the foot of the bed handing my midwives supplies. 

Holly came up to my side and checked Ada's lungs, she was kind of grunting rather than that typical newborn cry. We suctioned from her mouth some and that let Ada cry out like they wanted.

Just a bit later Lauren came up to my side & explained that Holly needed to check me for clots or retained placenta. I have to say, this experience was worse than birth. This is the part I wish I had drugs for the pain. The hemorrhage sometimes indicates retained placenta but it was complete, I was passing some larger clots. Lauren was sweet and explained that Holly would need to put a couple of fingers inside me to check for those clots trying to prepare me for what was next. Well I'm here to tell you that she had those 2 fingers, plus her whole hand and a good bit of her arm in me clearing out clots. I'm so glad Lauren didn't exactly describe what was about to happen.

She cleared many clots but the bleeding wasn't stopping with the manual removal (while my fundus was being pressed on from the outside - a very hard physical massage of the top of my belly). They administered pitocin with an emergency shot to my thigh while Kathy got an IV going in my arm. They repeated the manual removal a couple more times (it's a bit fuzzy I'm not sure how many times this was done) and though I had now received two more doses of Pitocin through the IV my bleeding was still very concerning. I was given two doses of Cytotec which also failed at stopping the hemorrhage. Finally as a last resort before calling for emergency hospital transport a dose of oral Methergine did the trick. 

It's not a pretty picture, but John snapped this shot as they were working on me, I was not handling the pain very well (as you can see...). For the next several days the back of my head hurt from pushing it back into the headboard while they worked on me. I found it amusing to take stock of the sore muscles and random bruises I had acquired and compare them to the ones I got while birthing Cora. It's seriously a full body workout! 

I choose to birth naturally without drugs and only certain interventions but I believe Western medicine has a time & a place. I'm so grateful for the access to drugs we had as they certainly saved my life. It took three separate drugs and about an hour of constant care and treatment to get my bleeding to slow to an acceptable pace and I stayed on the methergine for the next 72 hours. I'm a prefect example of the emergencies that they're fully equipped to handle at birth centers! 

At 12:21 I went to the bathroom since I was finally stable and Kathy did Ada's newborn check.

Ada's birth was so different from Coralie's in so many ways! I loved birthing out of hospital and the freedom that allowed me. I loved going home a few hours after birth and sleeping in my own bed! Birth is such a beautiful and natural thing - I am so blessed to have the opportunity to bring my precious daughters into the world! 

The next morning with both my babies!

I've been asked if I would birth out of the hospital again and I plan to! I have always wanted a home birth but that won't be possible for me. We simply live too far from a hospital and it would just take too long to get an ambulance to us if we needed emergency transport. I absolutely will use a birth center again though and cannot imagine having a hospital birth again! Knowing that I'm a high risk for repeat hemorrhage we will balance some preventative measures that you would find in a hospital setting with some of the freedom of birth center. I'll choose to have a hep lock put into place as soon as I arrive at the birth center in labor so that if they need access for an IV the line is already established. We'll also do some homeopathic prevention during labor. I will drink some very concentrated Red Raspberry Leaf tea (and be religious about drinking it throughout pregnancy with more regularity than before) and there have been some studies that show that Dates are a natural hemorrhage preventative so they'll be a big part of my diet before and during labor.

Even with the complications, this was a beautiful day and I have no regrets. I look back on Cora's birth and have remorse about how certain things were handled under hospital policy. I seriously question whether a NICU stay would have been necessary at all had she been born out of hospital. With Ada's birth I'm confident that the interventions I received were warranted and done with consent. It was a much better birthing experience and I'm already looking forward to when the Lord blesses us with another and that baby's delivery!

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