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Week by Week

Clara's Birth

PIH, Home birth, Long labor, Meconium, Transfer after birth.

Clara Agnes McMahan, born 12:13 PM, Sunday, September 7, 1997.

Coppyright (C) 1977, Larry N McMahan. Right to reproduce is granted subject to the conditions that this work is presented in whole and not in part, and that no compensation, monetary or otherwise is asked.

Let's deal with the PIH first, since it was treated early and easily, and wound up having no effect on the birth itself.

Monika'a pre-pregnancy blood pressure had been around 115/60. When her blood pressure at the 30 week visit was 135/85, the midwife expressed her concern and said we should start trying to actively manage it. She suggested red raspberry leaf teas and garlic, and she encouraged us to do our own research on the topic. She lent us her copy of Susan L Weed's _The_Childbearing_Year_, an excellent book about the use of herbs in pregnancy and labor. I also did quite a bit of searching on the web for information on PIH.

We eventually wound up with the following treatment: 2 to 4 quarts of red raspberry leaf tea per day. 2000 mg garlic oil per day. 1200 mg Caltrate calcium supplement per day. 1 pint hops tea per day. 1 pint skullcap tea per day. 2 passionflower/valerian capsules per day. (don't remember dosage) 1 lemon cucumber per day.

In addition we combined the treatment above with rest (2 hour naps during day), walking (2 miles three to four times a week), and yoga/meditation. (30 minutes a day).

The overall results were quite good. Although there were a few "high" readings of 150/95, we consistently kept the blood pressure under 140/90 with the vast majority of reading under 130/80, well within the "safe" range for a normal home birth. Also, there was no protein spillage in the urine at any time.

However, we found that some of the treatment components made a significant difference while others seemed to be less effective. The red raspberry leaf tea seemed to have an alomst immediate effect, and any day that Monika forgot to make it, she would have one of her bad readings. Especially if she combined stress with inactivity or lack of rest. On the other hand, we never noticed a real benefit from the skullcap or passionflower/valerian. Your results may vary. :-)

Overall, we were able to realize our goal. Dietary and herbal control of a condition that could threaten our plans for a normal home birth. After all we were extremely happy with the results.

Now on the the REAL story, the birth itself. I guess you would say that it began on Thursday night, the 4th of September. (You might say that it REALLY began on a long day after Thanksgiving together the previous November, but that's another story)

We had been scheduled for an ultrasound on Friday morning because Monika was 10 days overdue, and the midwife wanted to check on the health of the baby. We had been feeling plenty of fetal movement and weren't worried, but agreed that it would be a good idea. When we went to bed at 11 PM, Monika started having light but regular contractions. When she was still awake having themn at midnight, I decided to time them to see what we had. They were coming about 8 minutes apart and lasting 20 to 30 seconds each. I think we were both too excited to sleep. We tried to sleep off and on, but with not much luck. By 6 AM, they were down to 5 min, but not any longer in duration or any stronger. Still, we were hopeful. We hugged, kissed, and counted contractions for a couple of hours. At 8 AM, I called into work that I would be out, and we got up to dress and eat breakfast. The contractions stopped cold!

We called the midwife, and she said they might not come back for some time and that we should go to the ultrasound appointment. Darn! We puttered around the house doing errands, and finally left for the ultrasound at 10:30.

We specifically asked to not know the sex of the baby. The technician said "No Problem," he couldn't get enough into the screen to make sense at this gestational age. According to the ultrasound the baby was 39.7 weeks gestation and was due on Sept 8, and weighed an estimated 8 lb. His estimates will prove prophetically accurate! He detected no stress at all and suggested we NOT make the appointment the midwife has suggested for the following Tuesday. "Besides," he said, "the baby will be out by then!"

The rest of Friday was uneventful, except for the occasional contraction. Certainly nothing that could be called a pattern. We made love when we went to bed Friday night, and BOOM, back up they started. Now they were about 6 min apart, but the duration was about 40 - 45 seconds, and they were much stronger. Monika couldn't lie down through a contraction. She would lie down to get some rest, a contraction would happen, and boom, she would be on her feet in a minute. We called the midwife. She said call back when they were longer and closer together. :-(

We stayed up all night again. Thank goodness we had gotten a nap on Friday. By 6 AM, the contractions are less than 5 minutes apart and over a minute in duration. Monika wanted to call the midwife. I wanted to get some good timings so that we could tell her EXACTLY how they were going. At 6:30 we called the midwife. She agreed to come over.

The midwife arrives at 8 AM and does an internal. She tells us that Monika is less than 1 cm dialated and that the baby is still in the posterior position. We are VERY disappointed. She says that we need to stop the labor and get some rest. We are EVEN MORE disappointed. The midwife suggests that we use a strong shot of vodka to stop the labor. We balk at that, but we compromise on two glasses of wine. We drink the wine. (Villa Mt. Eden, 1994 Cabernet Sauvingon) It works like a charm. We nap until noon.

When we wake Monika is still having frequent, but irregular contractions. I am scheduled to coach a soccer game at 2PM in Danville (45 minutes away). We don't know whether to go or not. At 1 PM, Monika decides she is not having contractions and that we should go. Off we go to coach the first soccer game of the year.

During the first half, Monika is half sitting half lying on the grass, trying not to moan when she has a contraction (she doesn't want anyone to know it is happening yet). By the end of the first half we are leading 1-0, and it is a close game. During the second half, Monika has forgotten about labor and is jumping up and down on the sideline as we score 3 more goals. We win 4-1. When we get back home, Monika announces that she is starving, and we decide to go to a local California Cuisine burgers and salad place. Monika has the Teryaki Burger.

We get home about 6:30 PM. When we get back to our bedroom, she goes into strong labor again, and immediately deposits the Teryaki Burger in the bathroom sink. We call the midwife. She says to eat. Monika does not want to look at solid food. The midwife is unsympathetic, eat!. Monika comprimises on blended yogurt and bananas. We alternate that with apple juice and the occasional can of chicken broth.

Around 9 PM Monika suggests that I should get some sleep. She is still standing through the contractions, which basically means all the time, since she hates to have to stand after it starts. I am thankful. I sleep until 1 AM Sunday, when she wakes me with a question. Should we call the midwife? I time her contractions, ask how they feel, and say I don't think so. I ask what she has had to eat. Just the apple juice. I make her milk and honey. Back up it came, complete with the bananas from earlier. I brew up two quarts of red raspberry tea, but leave it in the kitchen.

Monika says go back to sleep. I do. She wakes me at 3:30 and tells me the contractions feel different. I ask how. She doesn't know. I decide it is time to get up and be with her. By now it is tiring for her to stand, but he is uncomfortable in any other position. Hands and knees doesn't work. Squatting doesn't work. She she NO INTENTION of even trying to lie down!!! She has to pee after EVERY contractions. A contraction starts while she is sitting on the toilet. Hmmmm, this isn't so bad. Monika decides this is more comfortable than standing.

She had placed a foot stool in the bathroom earlier. I sit on the stool opposite her position on the throne, like a prince before his queen. :-) I ask about how it feels. No, it doesn't really hurt, it's just INTENSE and she can't talk while it happens. But she does vocalize. She moans loudly. She jokes about hoping the neighbors don't call the cops. We talk about talking through the night when we were dating. We joke about what if she is still not dialated the next time we call the midwife. We want to make sure this time!

At this time, she is refusing anything but the apple juice, and I even have to remind her of this. I go out to the kitchen and get the raspberry tea. I am worried about the blood pressure thing, and I don't want it to get out of hand when she has to push.

About 5 AM, Monika says we should call the midwife. By this time I have caught on to both Monika and the midwife. Monika always jumps too early, well before it is time; and the midwife makes up for it by taking a looooong time go swing into action. She knows when to stall. :-)

Judging from Monika's reactions I am pretty sure she is a long way from having to push. I stall. I count some more contractions. Monika asks again in 30 minutes. I stall again. Monika makes a remark about not being able to keep going like this. We don't realize it at the time, but this is transition. I call the midwife at 10 minutes to 6 AM. She says she'll get her stuff together and come right over.

Now Monika is uncomfortable sitting on the toilet. She has a slight urge to push, but is afraid to since the midwife has not tolk her that it is all right. We try the squatting position again, and it is more comfortable now. She alternates between the toilet and the squating position while waiting for the midwife. The squatting position is quite interesting. she hangs off the edge of the sink, pulling hard with her arms while she squats down. Thanks goodness the sink is securely anchored!

The midwife takes FOREVER to get there. We don't know it, but she has decided to shower and have breakfast before coming over. We didn't sound that urgent!!! By 8 AM Monika is about as frantic as Monika gets. Just as I start to call the midwife again, we hear the front door open. The midwife takes one look at Monika and says that it is time to push. Monika squats down and tries a couple of pushes. She says it hurts. The midwife has Monika put one leg up on the toilet and does an internal. There is an anterior lip. The midwife has Monika push in this position while she pushes the lip out of the way. This is quite an acrobatic feat for all involved. Another missed photo op!

By this time, Monika's contractions are coming much less frequently. We have to wait what seems forever for each in order to push the lip up. Finally, the midwife announces that the lip is out of the way and that Monika should try to push again. It is 10 AM.

During the entire process since the midwife got there, she has been pushing the apple juice like an Eskimo selling ice cubes. I feel trememdously relieve that I wasn't being too pushy making her drink frequently during the night.

Monika hangs on the sink in her squatting position and pushes. I am checking with a mirror. There is no baby to be seen, yet. Then we notice that Monika is pushing for about half of the contraction, then coming up and standing through the last half. Both the midwife and I encourage Monika to stay down in the squat and push for the entire contraction. So it goes for quite a while. Stand at the sink and wait for a contractions. Squat down and push until the contraction is over, then stand up and wait for the next one.

Because Monika's contractions have gotten so far apart, we are using cottonroot bark tincture, labor tincture, and nipple stimulation to encourage them. I am standing behind Monika at the sink massaging her nipples, than grabbing the flashlight as Monika goes down into a squat. After three or four contractions, this begins to work. I see a quarter sized medallion of head showing through the opening. And the head is staying down between contractions. Real progress!

At 11:30, the midwife decides it is time to go to the bed and push the baby out. Monika walks over to the bed and sits/lies on her right side and tries to push. After two pushes she is having a hard time pushing and the baby's heart rates is dropping. The midwife tells her to get back up and go back to squatting. (In hindsight we might have avoided this. The baby's back was on the right side for the last two months. We were trying to birth the baby with the back down, better to put it up.)

Once Monika was squatting pushing again became easy. This time we had her push until the medallion of head was the size of a silver dollar. The midwife told her to go back to the bed. She said something about walking with a watermelon between her legs. We helped her walk back to the bed, and this time she sat/lay on her left side. It was noon now. We wasted the first contraction getting everybody into place, but she was still able to push. I was sitting between her legs, with her left foot propped on my thigh. The midwife was standing in front of me at Monika's back. The assistant midwife was seated at Monika's head. and Monika's best friend was behind her, hanging onto her right leg.

We had Monika push, and on the next push the head was born, but it did not last long enough to birth the body. The baby's face turned up so that I could see it. I think I was the first to see the green snot in it's nose. "Oh, shit," I thought, "that's not right." But we had other things to worry about right now. Both the midwife and I had checked the neck and there was no cord, so the next part could be a little more relaxed.

The midwife gave instruction on pushing out the body on the next push. Monika pushed the first shoulder out quite easily, then took a breath and pushed out the other shoulder. The cord was quite short, so I could barely place the baby up on Monika's stomach. The midwife saw the green and immediately started suctioning the baby with a bulb. I just sat and watched. Monika wanted to see the baby's face, but the cord was too short, and the midwife was busy suctioning.

When the midwife had the airway clear and the activity died down, I realized that I still do not know the sex of my child. She was still lying on her stomach. I turned her over and exclaimed "It's a girl." Cailin, a family friend attending the birth says "Monika said for nobody to tell her." I said "I didn't hear her." Everyone agreed that Monika had said it. Monika said "At least nobody but my husband." Love her. :-) We had long ago picked out names for both a boy and a girl. This was Clara Agnes. Hello Clara.

By this time the cord had long stopped pulsating, and we set about cutting the cord. Remember that the cord was quite short. We had the baby lying on the very bottom of Monika's stomach. Monika could barely reach the baby, and couldn't see her very well. The midwife gave me the scissors and grasped the cord in two places, telling me to cut in between. I asked Monika if she wanted to cut. We decided to do it together (just like the wedding cake :-). I positioned the scissors on the cord and took Monika's hand and placed it overy my hand on the scissors. We pressed the scissors together and cut the cord.

Finally Monika could see the baby. She lifted her up and placed her on the breast. At this point Clara was not particularly interested in nursing. She make a couple of half hearted attempts at latching on, but nothing serious.

The midwife listened to the baby's chest with the stethoscope and said it still didn't sound completely clear. The assistant midwife and Monika's friend continued suctioning and percussion to clear Clara's airway while I walked up to Monika to hug her and the midwife checked Monika for tears. Just of couple of skid marks she said. Rug burns, I called them. At this point in time, everything seemed so peaceful. Yes, there were critical activities to be performed, but everyone knew just what to do.

At this time we had to make a decision. The midwife listened again. She said the left lung sounded clear, but she wasn't sure about the right. She suggested we try to get in contact with our pediatrician. I called the medical practice and explained the situation. We had just had a baby at home, and had possible meconium aspiration. We wanted a neonatologist to evaluate. We were told the on-call pediatrician would call us back. We explained to the on-call pediatrician when she called back. She said she would find out what to do. The advice nurse called and said the only way we could see the pediatrician was to be admitted through the ER at the local hospital! This was the LAST thing we wanted, going through ER. Damn medical complications on Sunday!

We continued percussion while Monika got dressed, then we dressed Clara, placed her in her car seat, and headed off to the hospital. It was only a five minute drive away. The midwife took her own car, while Monika and I drove the baby. The midwife went in first to inform the ER people, then Monika and I went in with the baby.

The ER insisted on doing 'intake' first. This involved stripping Clara naked in the cold air-conditioned ER in order to weigh her. When the nurse started to do a rectal temperature, I told her that I did not want her to, and to please do the temprature using the baby's armpit. She icily informed me that they did not have a procedure for doing that and acted as if she were going to continue. It was at this point that I shouted "No Medical Consent" in her face. She backed down, but she wasn't a happy camper. That's OK, neither was I!

The pediatrician had not arrived yet. They wheeled the baby (now in a hospital crib) into a room to wait for a Nursery nurse to evaluate her. Monika had gotten a wheelchair since she was too weak to walk easily. There wasn't space in the room, so we parked her just outside the open door. Monika insisted that I stand right over Clara to protect her from unwanted and unnecessary procedures. We felt very unlucky and put-upon at this point.

Then the Nursery nurse arrived. It was Lori, an old family friend whose son Brian I had coached in soccer off and on for the last ten years. She was flabbergasted that I had had a child. She didn't even know that Monika was pragnant! Having her walk into the room was like a breath of fresh air.

She listened to the baby's chest, and said her lungs sounded clear to her (good news!). She then suctioned her stomach, and got about 15cc of meconium stained mucus (bad news :-(). It was at about this time that the pediatrician walked in. Dr. Witter talked with Lori for a few minutes, then decided to do a chest x-ray. So we had to wait for an x-ray technician. Everything in a hospital is bureaucracy and delay!

After the technician finally took the x-rays (twice! the film didn't come out the first time), Dr. Witter said she wanted a neonatologist to look at the film. We send the film out, and Lori hooked Clara up to a pulsar (?) to monitor her oxygen absorption. This is a measure of how well the lungs are picking up oxygen. The hospital's cut off for acceptable was 94%. Unfortunately Clara was running between 86% and 90%. This means she needs to be kept on oxygen. Uh-oh. Looks like we are not going to be able to avoid the overnight hospital stay. The pediatrician also does not want Clara to feed orally because she might spit up and aspirate meconium.

So the decision is made to move the baby up to the special care nursery. She will be on oxygen and IV glucose overnight. The doctor will make rounds at 10 AM the next morning and evaluate her condition. (it is now 3:30 PM). Lori wheels the crib and I wheel Monika in the wheelchair up to the Nursery.

The special care nurses have their routines too, but they seem much more receptive to our wishes. We get Clara settled in with the four or five other babies in the nursery. Then Monika and I go into the "Mother's room" and Monika pumps 1-1/2 oz of colostrum with the hospital pump. The nurses put it in the freezer. This will prove very useful later.

At 5 PM, Monika and I go home to rest. Jennifer, Monika's best friend has completely cleaned up the bedroom. You would never know someone just had a baby there! We take a nap until 7 PM. A much needed rest.

At 7:30 we are back at the hospital. We visit with Clara for a while, then Monika tries to pump again. The hospital pump is broken, and there is no maintenence person available until tomorrow. Monika worries that she will not produce enough milk if she doesn't get what she has out. But there seems to be nothing we can do at the moment. We go home to get a good night's rest. We have been up for the past three nights in a row. We need it!

We decide not to get to the hospital right at 10 the next morning. Doctor's are alwaays late with their rounds! We arrive at 11 AM, and the doctor is nowhere to be seen. However, Clara is awake and off of oxygen. She is rooting around and wants to nurse. Monika asks. No! Clara hasn't been evaluated by the doctor yet, and is still under orders for no oral feedings. We wait around. The doctor finally arrives about 12:30. After a half-hour of seemingly aimless activity, she pronounces Clara OK and ready for oral foods. But by this time, Clara is sound asleep and shows no interest in nursing.

It is at this point that the nursing staff informs us that hospital rules are that the baby must feed successfully twice before being released. More surprises! We though we were going to go home! We hang around hoping that Clara will wake up to nurse, but no such luck. At this point, Clara is not interested in nursing, and Monika has not pumped in almost 24 hours. We worry some more.

Around 4:30 PM we finally get it clarified that Clara doesn't have to specifically nurse, she just has to feed. We get the hospital staff to thaw the colostrum we had frozen the night before, and I feed it to Clara with a bottle. We have gone back on one of our first wishes, but we just want to get out of there, and besides, it is still not formula! It takes me almost a half-hour, but I get more than 1 oz down her by being very insistent. I show the nurse the used bottle. Hooray, we have one successful feeding down!!!

It is now 5:30. We immediately run out to the nearest baby store and buy the Pump-In-Style. (What if Clara won't latch on, what if we have to bottle feed, we find a million things to worry about). We go home and Monika pumps, gets 3 oz colostrum (worrying a little less about production, now), then we eat and return to the hospital. It is 7:00. We are still worried about Clara nursing for her final feeding in the hospital. The staff says don't worry. We take Clara into the "Mother's Room" to nurse. Clara still won't latch on very well, but one of the nurses has breastfed, and shows Monika how to do it. Clara latches on a little, and the nurses declare us successful. We are not sure Clara has gotten anything, but the hopsital bureaucracy is satisfied. The second feeding is done.

So now, it is time to check out. I had checked Clara INTO the hospital, but only the mother can check her out. So I can't finish up the paperwork while she nurses. It turns out the only thing she has to sign is an idiotic piece of paper that the nurses have told her some things relating to her own health. Sounds like some kind of social welfare bureaucracy you would do for welfare mothers! She signs, and we prepare to leave. But wait. We can't walk the baby out ourselves. We have to wait for the nursing supervisor to finish her work so she can walk us to the door. (We can't even carry the baby down, she has to!!!) She watches as I strap Clara into the baby seat in the back of the car. It is 9 PM on September 8 when we drive off.

Postlog:

The nurses at the hospital had warned us about feeding Clara often enough. The told us horror stories about dehydration. We called the midwife when we go home, and she suggested that if the Clara would not take the breast, we could feed her with an eyedropper (to avoid nipple confusion). So for the next day, we did so. Still, at this time, Clara still was not showing much interest in the breast. The nest day, we talked with our family doctor, who is also the babies pediatrician. "Gee," she said, "it sounds like she is never getting hungry. Just wait until she wants the breast. She is not going to get dehydrated in one day." We did. And it worked. Within 24 hours she was nursing quite successfully.

As I finish work on this story, Clara is 24 days old. She has gained almost a pound over her original birth weight and is quite content and happy. Looking back on the experience, I am quite glad that we had Clara at home. I am now more convinced than ever that it is by far the best place for birthing a child.

I was also thankful that we had the medical community to rely on when the meconium situation arose. I am grateful to all the people who gave their time and effort to assure my daughters continued health. At the same time, I was quite frustrated at the bureaucracy and misinformation I had to endure in order to receive that care. But most of all, I am grateful for a healthy child.

Monika McMahan

Larry McMahan