Paula’s story about the birth of Mary Madeleine
Giving birth was an amazing experience of both ultimate vulnerability coupled with the opportunity to discover a depth of inner strength I could not have otherwise known I had. The term empowered may be overused, but yes, giving birth can accomplish that – I have a confident feeling of awe and satisfaction about myself that I think I will get mileage out of for the rest of my life! The video shown during The Midwife Center’s orientation had an inspiring thought; that the greatest secret about birth is not that it is painful, but that women are strong. I entered my birth experience hoping that I would be able to be strong. Having done some reading, attended classes, and enlisted the help of a friend as a labor coach, I felt reasonably prepared.
My primary objective in choosing The Midwife Center for my prenatal care was to avoid unnecessary interventions. I knew little about natural childbirth, but thought that the number of women I personally knew who had had surgical deliveries was too high. I was secretly terrified that pregnancy would require a C-section and I would not know if my potential major surgery really had been needed or was just convenient for other people. In my 1st trimester appointments with an obstetrical practice, I realized that skilled medical care was only one facet of what I needed during pregnancy. At these appointments, I felt rushed, inadequate, and unable to communicate frankly about my fears and concerns. I was afraid that I could have a birth experience in which I did not get to participate in decisions, or would be pressured to have procedures I did not want or fully understand. I did not question the competency of the ob/gyn practice, but did not want to feel sidelined during my pregnancy and birth.
From my first appointment with a midwife, I was greatly satisfied with the woman-centered approach to care that would allow me to be an active participant in decisions regarding my birth. I appreciated that questions were asked about my well-being apart from the pregnancy, and that I was asked in an open-ended way about what was most concerning to me. I was able to bring up a matter that I usually keep to myself due to the potential for misunderstanding. I found a range of familiarity with the topic, but what mattered was that I could talk about it with the midwives. I needed this looming “what if” in my brain to be acknowledged as part of my prenatal care. I loved the lending library, too; the immediate availability of books helped me get past my good intentions and actually do some reading on topics of interest.
As a side note, we took three classes offered by TMC: Childbearing Essentials, Breastfeeding, and Newborn Care. We learned that regarding many aspects of birth “there is a wide range of normal” but that an understanding of the process would reduce fear; that with education and support breastfeeding is very doable; and that an “all or nothing” attitude about early parenting decisions is as unnecessary as laboring under false guilt about them is unhelpful. Relevant to this birth story: instructors/nurses Priscilla, Cheryl, and Paige, in addition to their teaching skills, coincidentally, were familiar and thus reassuring faces during non-stress tests and eventual labor at the birth center.
My pregnancy was fairly uneventful. I did have some difficulty emotionally connecting to the idea of a baby, since my first pregnancy had ended in loss at 8 weeks. So, my favorite part of every appointment was listening to the baby’s heartbeat. I was truly glad things were going well, but was painfully aware that being pregnant one week didn’t guarantee I would still be the next. The first trimester was almost over before we told anyone that I was pregnant.
When we learned we were expecting a girl, name discussion began in earnest and fairly early on we decided we would name her in honor of Patrick’s late mother. I also made sure my husband knew that during the labor and delivery, his presence was a non-negotiable! As the time of the birth approached, since neither of us had any birth experience, I wanted a support person who did. I realized during a 2nd trimester conversation with our friend Stacy, that she would be ideal. She had attended two very different births, and had a range of personal experience from four births of her own. When about a month before my summer due date, she mentioned having a dream in which she had to deliver my baby, that was my cue. I asked if she would be willing to provide labor support for us, and she eagerly accepted.
My August 21st due date arrived, but I was mentally prepared to miss it, and even hoping I would. Having learned that labor for a first baby usually starts later, I made plans so I wouldn’t be waiting around for it to happen. I worked through the week of the due date, and then decided to start my leave because my swollen ankles had become simply unbearable. Week 41 rolled around and I had my first non-stress test. I then became concerned about labor starting within the week, as our discussion with the midwife turned to things we needed to do to be sure the baby was doing okay, things the midwives could do that might encourage labor to start, and the possibility of having labor induced at the hospital if it had not started by Week 42. We had liked UPMC Mercy hospital when we took the tour, but really hoped I would be able to deliver at the birth center.
Labor started Friday, August 30th. I had been waking the previous few days with contractions that went away as my day got started. So, I told Patrick about them but I thought we should go ahead with the plan for the day: 7:00 am ultrasound at the hospital and a late morning non-stress test at TMC. The biophysical profile confirmed the baby was doing great, so we went to DeLuca’s for their “best breakfast in the Strip” and it was really good! I didn’t know at the time, but that would be my last substantial (as in, fully digested) meal until following the birth. I started writing down the times I had contractions since they hadn’t stopped. We walked around the Strip District to pass the time until going to TMC. The non-stress test went well, and the midwife (Kellie) told me to ease up on my counting. Take a break, and only count for 20 minutes every four hours. So, we went home. I sent a text message to alert Stacy that this might be the day, took Benadryl and had a good nap (a tip from the Childbearing Essentials class!).
In the early evening, things were picking up. I took a bath to relax but soon lost the little bit of dinner I had managed to attempt. That put me off my game a bit, as I couldn’t recall that being something to anticipate as a normal part of labor from my reading and classes. Around 8:00 pm, we paged the midwife on call, who estimated it would be at least 4 hours before I would be ready to be admitted to the birth center. We updated Stacy; she arrived at our house around 10:00 pm. The timing couldn’t have been more perfect, having vomited for a third time and with the increasing strength and frequency of the contractions, I was starting to panic. She immediately began coaching me to relax by taking deep breaths, and encouraging me to vocalize in as low a tone as possible to lower tension. (I would want/need this coaching for all the contractions to follow. Time had not been on my side to learn about hypno-birthing or other techniques to relax, but I knew I have generally been good at taking direction. So during my labor, I just focused on really trying to do whatever the person helping me was suggesting.) At about 11:00, although I wanted to stay close to the bathroom, Stacy encouraged me to go downstairs as this might become more difficult. Around midnight, we called the midwife again, and got ready to leave.
A sweet memory about laboring at home was about the behavior of one of our typically aloof cats. Now, Oliver must have been hiding somewhere or at least staying away. But Noel, during those several hours, seemed to be aware that something was up and to check in on me every so often. Most of the last hour, he had curled up by my feet on the bottom of the blanket wrapped around me. Before we went out the door, I insisted on changing. Labor was no excuse to have anyone see me wearing pajamas in public! The last thing I saw leaving our house, was Noel curled up on the clothes I had just tossed on the couch.
So, now it was Saturday, August 31, with several hours behind us I still expected to have an August baby. I begged Patrick to drive slowly. I couldn’t bear the thought that I might be sent back home if I was not 4 cm dilated. (At this point, I would like to suggest an item be added to the list of things to have in your car toward the end of pregnancy in case you are driving in the evening hours: a sleep mask. I kept my eyes closed to focus on breathing slowly through the contractions, but in my reclined position I really hated the glare from the streetlights and headlights.) At the birth center, Annie met us because Kellie was at the hospital. We got settled in the Ocean room, and birth assistants Danielle and Megan were just wonderful. It was quickly determined that I was rather dehydrated, no surprise since I had not been able to keep anything down for hours. An IV was started for fluids and anti-nausea medication, and I was offered Nubain, which I gratefully accepted, and slept blissfully for two hours. When first examined, it was confirmed I was at 4 cm. I think Kellie said I had a roomy pelvis, and that I would have a baby that day.
At 7:00 am, Annie came on duty and, spoiler alert, we would be on the receiving end of her competent care, for the full 24-hour on-call shift. Paige and Jessica were our next amazing birth assistants. Saturday morning of early labor, I remember as reasonably pleasant. I felt so well taken care of, so supported, and continually reassured that the baby was doing fine. I ate half of an English muffin, with the Nutella I had brought along. I enjoyed conversation, listening to one of Stacy’s playlists (mostly Chris Tomlin, I think), and the peacefulness of focusing on labor during a quiet holiday weekend. Stacy and Patrick gave each other breaks. I tried standing, sitting on the bed, and using the birth ball. Patrick was able to observe how Stacy and the midwife or nurses were helping me, and got on-the-job training as a labor coach. It was exciting to get to 7 cm, but a bit deflating that further examinations kept showing no additional progress. Annie suggested rupturing my membranes, which I really had hoped to avoid happening artificially; I asked if I could try a bit longer. The baby was still doing great. A few hours later and no further dilation, I agreed.
Annie ruptured my membranes around 3:00 pm Saturday. The good result of this was learning that the amniotic fluid did not appear to have meconium. The challenging result was that the contractions became much more painful. The baby was in posterior position and I was experiencing back labor. I needed constant counter-pressure on my hips and lower back. If I said, “you can’t push too hard” once, I said it a hundred times. I might really have said it one hundred times! It became more and more difficult to fend off my rising panic and fear. I focused on holding someone’s hands, deep breaths, low-tone vocalization, etc. to get through each contraction. Exhaustion was a real factor. I was now aware, no longer of everyone in the room, but just of whoever was directly interacting with me. By this time, I really could not think about the baby. I knew the birth assistants were making sure she was doing well, and I needed to be entirely focused on my labor. I finally got the okay to use the Jacuzzi tub, but was so uncomfortable and weary by that point I am not sure how helpful it was to me. When I got out I was still at 7 cm. At some point, I was offered honey, I think I managed two spoonfuls. Cheryl replaced Paige and Jessica around 7:00 pm. Some time after 9:00 pm, Annie initiated the conversation about a transfer to the hospital, as I had labored almost all day with no progress. It seemed that the baby’s head was cocked funny or something, and there had been no additional dilation for over 12 hours. Since I was so tired, my contractions were less productive. She was recommending the transfer so that I could get an epidural that would allow me some rest, while Pitocin could help my labor. She did offer an option, Nubain for the 2nd time, which I chose still hoping we could yet avoid the hospital. I got some rest during the 2 hours, but this go-around woke up for every contraction, clenching Patrick’s hand.
Near midnight, still at 7 cm, I was at peace with the idea that the hospital transfer needed to happen. I remember feeling such distress that no one would be able to hold my hands on the way to UPMC Mercy as Stacy, Annie, and Patrick would all be occupied with driving. Twenty-four hours after our trip to TMC, this time I couldn’t comprehend caring how I looked or what strangers might see or think. When I wasn’t working through a contraction, I was weeping from sheer exhaustion. We neared the parking garage entrance to the hospital and I thought Patrick might drop me off to go park the car (nearby), and I couldn’t tolerate the idea that I would be alone for even a minute. I think I said, “Please don’t leave me,” and I don’t know exactly when or how the car got parked appropriately, but he didn’t. Extra thankful now for that hospital tour, with the help of a wheelchair, we made a beeline for Labor & Delivery. With one stop, so I could stand up for a contraction leaning on him while he applied the requisite counter pressure on my lower back/hips.
Reflecting back, the hospital transfer was rather quick and efficient, impressively so, although in the moment it seemed longer. I remember wondering why the anesthesiologist had so many questions and was explaining so much to me. Since everyone in the room was busy with something or other, Stacy held my hands and kept eye contact through the contractions until she and Patrick were asked to leave the room for the epidural procedure. I remember being told I could not move during the procedure, and knowing I could not possibly be still if I had a contraction. Of course, I’m sure they waited for one to be over before starting! Patrick and Stacy could tell from the hallway how quickly the Fentanyl began to do its work, as they could hear me talking and laughing with the doctor, nurse and other staff.
At some point, the really nice nurse, once the flurry of activity had passed (epidural, Pitocin, electronic fetal monitor, not necessarily in that order), made a point of looking me in the eyes to say directly, “I know this isn’t what you wanted, but do you have a written birth plan with you?” I didn’t, but I was amazed by this sensitive gesture. If anyone at the hospital thought I was foolish to have wanted a birth without medical interventions in a non-hospital setting, I never detected a hint of it. Although it was a different environment than the birth center, we still had a midwife supporting us and coordinating my care, and I had been given the time I needed to mentally accept the change of plans. We thanked Stacy, who had been with us so many more hours than expected, and she went home to rest. Patrick settled into a recliner to get some sleep. I really wanted to eat now, but of course, only ice chips were permitted. The epidural medication made me feel itchy, and after I was given Benadryl, I was very interested in sleeping. Annie told me that she would try to gently turn the baby, and that we would see where things were at 5:00 am.
I fell asleep, and thus was not using my full “allowance” of pain medication, so I woke up having contractions, which lasted for a bad several minutes. I sat up and Patrick helped me through them until the anesthesiologist returned. When he realized the reason for the problem, I was sternly instructed to not forget to push the button! (Although how I was to do that, and sleep at the same time, I still don’t understand. Patrick was happy to help with pushing the button for the Fentanyl, which would allow extra medication about twice an hour.) At 5:00, Annie told me I was fully dilated, but she would like me to rest a bit longer since the pushing phase would be a lot of work, and I was more than happy to do this. At nearly 7:00, I was introduced to a new nurse (also nice, in a drill-sergeant kind of way during the pushing, but wonderful in her brisk and efficient care following the birth), and Annie told me that Kara would be taking over. They told me I would have a baby today (you’ll understand I was a bit skeptical about that by this point). Kara and the nurse asked if I was ready to begin pushing. I really wanted to sleep some more and said so, but, it was time. Patrick pushed the button again and the nurse barked at him not to do it anymore. However, since some of the anesthesia had worn off when I was asleep and not pushing the button, I had feeling and control of my feet and ankles. So perhaps that whole forgetting to push the button thing was a blessing in disguise.
I began pushing at 7:45 am; when the baby’s head was visible Kara had Patrick come see it. His reaction was something like “I hate to have to tell you this, but it’s going to take a lot longer.” The nurse watched the fetal monitor for the contractions and pretty much yelled at me each time I needed to push. I was somewhat taken aback by this, but focused on whenever she affirmed I was doing the right thing, putting all my energy into it. Since I couldn’t feel a thing, I had to sort of visualize what I thought needed to be done. The breathing was so different than for contractions (holding my breath rather than long, slow, deep breaths) that Patrick, after hours of having coached me otherwise, wanted to correct the nurse. She was pretty no-nonsense about not being corrected on this matter, though!
Kara asked me if I wanted to reach down and feel the baby’s head. Even now, it still didn’t seem real. But by 8:06 am on Sunday September 1st, Mary Madeleine was born, and it was as real as it gets. She was placed on me right away, and she was so alert. I can’t remember what I first said to her, but “hello” seemed the most appropriate, so that was probably it. At 7 lbs 7 oz, 20 inches, an entire human being, it was overwhelming in the most beautiful way. I couldn’t begin to look at fingers or toes, just the wholeness of her. I was surprised she didn’t have a cone-head. I was pleased that her 1 and 5 minute Apgar scores were good. When the umbilical cord stopped pulsing, Kara asked Patrick if he wanted to cut it, so he did.
Kara and the nurse were talking about how fast the pushing went, and I learned they were expecting perhaps two hours, not twenty-one minutes. I later wondered if the nurse had known how compliant I was, if she would have been a bit friendlier during the pushing! I also wondered later if I could have felt the pushing, if it would have taken longer, and if maybe I wouldn’t have had tears. Who knows, I read a lot during pregnancy relative to the amount of “free time” I had, but never quite got as prepared as I intended. Kara brought over an OB, introduced us and explained to me that I had two 2nd degree tears, but one of them was sort of complicated. So while Patrick and Mary Madeleine and I were getting to know each other, Kara and the OB were attending to my “repairs.” He explained what he thought should be done, and they worked together as a team.
The post-birth hospital experience was great. Nurses, attending pediatricians, hospital lactation consultant, cleaning and dietary and administrative staff, to me everyone and everything was wonderful, I was in a cocoon of kindness. One of the nurses was a gifted teacher, and we appreciated her explanations, including showing us how to bathe a newborn. For not having wanted a hospital birth, it is only fair to say that I really loved having a few days to recover there! Having everything I needed brought to me, and just getting to enjoy a lot of privacy with my baby. I had a great debrief on Monday with Kellie, and we celebrated that my most important objective of avoiding C-section had been achieved. She thought it likely that in other circumstances I might have been pressured to have one. Each midwife I spoke with following the birth assured me that the long labor just experienced, would not be repeated in the event of a future birth: “You will never have to do this labor again.”
Just following the birth, as we waited a short while for a maternity room to be ready, I remember Patrick’s shocked expression when I said very deliberately, “I did not have a bad experience.” For me, the specific memories of anything unpleasant started to fade the instant I met my baby. I think it is really quite nice that although I vaguely remember labor was really long and difficult, my strongest take-away from my birth experience is the feeling of “oh yeah” triumph. From my perspective, I had been an active participant in my birth and treated with respect throughout. We are deeply grateful to The Midwife Center for such wonderful support and care, from prenatal to birth to postpartum.