Baby Girl's Birth

First, I think it's helpful to know who I am (or at least, who I was when my daughter was born). I was almost 35 years old, quite fat (5' 8" tall, 250 before pregnancy weight gain), and a lawyer working in commercial litigation in a medium-sized New York City law firm. On the face of it, I was not an ideal candidate for a home birth: my weight and my age made me a somewhat riskier patient than the ideal, which I imagined was a fit 25-y.o., and my profession made me a high risk for malpractice litigation.

I started with a hospital-based midwifery practice, on the theory that I would get the best of both worlds that way. However, during my fifth month, I went on the hospital tour, and was turned off by the idea of having my baby in the hospital. The idea of a home birth had been brewing in my head for a long time. I liked the idea of being in control, being in familiar surroundings, and knowing that unnecessary medical interventions were not waiting for me in the operating room down the hall. It took the reality of visiting a hospital maternity ward to give me the final push out of the hospital door. It also didn't help that every lawyer I knew in New York who had a baby, had it by c-section. I didn't want some hospital's inordinate concern about a malpractice suit landing me on the operating table.

I quickly found the only licensed midwife in New York City who delivered at home and signed up with her practice. There is also a birthing center in Manhattan, but their transfer rate was around 20%. In my view, they were too rigid and formulaic about transfers. E.g., your water breaks, you don't start laboring within 24 hours, you get transferred, whether or not you are actually showing signs of developing an infection.

I was due Tuesday, June 2, 1992, and I kept working right up to the Friday before. Then I waited. And waited. The midwife was seeing me pretty frequently, but neither the baby nor my cervix was showing signs of being ready. (This is one of the many places where I think the home birth/midwifery care saved me from unnecessary interventions. In a normal OB practice, I doubt that I would have been "allowed" to go so far past my due date without being induced, even with an unripe cervix, which probably would have lead to unproductive labor and a c-section.)

Finally, early on Wednesday morning, June 10, I started have irregular, frequent, painful contractions. This went on for THREE DAYS! I would get two or three contractions that seemed to progress in length and frequency, and then a few longer gaps, and then sometimes a really long gap (20 minutes), and then repeat the cycle. I was jumping out of my skin from timing contractions, and thinking "This is IT!" "No, this isn't IT, yet." "Well, this must REALLY be IT." You get the idea. By Friday, I was getting pretty hysterical from lack of rest and constant anticipation, so the midwife called in the back-up OB to get a prescription for Secanol, a fairly strong sedative. That was a brilliant move, because Friday night's sleep was the last I got until after the baby was born on Sunday afternoon.

Late Saturday evening, my husband and I were trying to distract ourselves by watching a funny movie on the VCR. We kept stopping the tape so he could press my back through the contractions. Finally, we realized that the contractions were starting to increase in frequency and length. We timed an hour of contractions and called the labor assistant (doula) and then the midwife. The doula I was supposed to get was about two hours away at a family reunion, so she sent her partner, who lived around the corner from us. When the midwife arrived, I said to her, thinking back on the days of prodromal labor with no progression: "If I'm not at least 5 centimeters dilated, I'm gonna kill myself," mostly joking. When she looked and said "6 centimeters, I guess you'll just have to live," I whooped with glee.

The pain in my back during the contractions was really awful. The baby was posterior, which meant that every contraction pressed her little bony spine right down on my spine. Ouch! I dealt with the pain by focussing my energy inwards, trying to work with the pain instead of against it, and when that didn't work, I just bellowed: long, low-pitched groans. It felt like a deep internal pressure on the bones in my back and my pelvis. If safe pain relief had been available, I would have taken it in a hot minute! At the same time, I'd take the hours of pain in labor any day over the days of post-operative pain that comes with a c-section, or the risk of a three-day long spinal headache from a botched epidural.

The doula was really helpful. She made sure I had things to drink (I wasn't interested in food, though), she fixed snacks for my husband, pressed and kneaded my back, and said lots of soothing, encouraging things to me. When the principal doula arrived a few hours later, I thought that the partner would leave, but they both decided to stay, out of the kindness of their hearts. I really felt like a queen bee, with two doulas, a midwife, and my husband all trying to make the birthing easier on me. My husband, who is 14 years my senior and a bit compulsive about getting sleep, was especially grateful for the doulas' giving him a chance to steal away from the scene for a cat-nap in the wee hours.

As Sunday's dawn broke over our tiny Manhattan garden, I waddled to the sliding glass door to watch the sun come up over the buildings. The fresh morning air revived me a little. However, I still had a long ways to go.

I continued to labor, progressing ever so slowly, less than a centimeter every two hours. I don't really remember clearly what happened over the next few hours. I vomited, and started feeling a little desperate at some point late in the morning; I suppose that is when I entered transition. I do remember at some point the midwife telling me I should lie down. I resisted because my contractions felt worse when I was lying down, but her take on that was that they felt worse because they were more productive then. It was after I was down on the bed for about an hour that I finally made it from 8 to 9+ cm.

Finally, at about noon, the midwife told me that I had been stuck at 9 centimeters or so for a while. She explained that all that was left of the cervix was a little "lip" on one side. She told me that she could push the lip aside with her finger, and that this would probably get me pretty quickly to the second stage. She also told me that it would hurt, a lot, and that she had to do it at the peak of a contraction. She wasn't lying. The few seconds it took for her to perform that procedure were the worst of the whole process. However, I very soon felt the urge to push, so she was right to do it.

The water didn't break until I started pushing. I had decided that I wanted to birth in a semi-standing position. I was standing at the foot of my bed. The doulas and my husband helped me support my weight as I stood, with my knees bent, bearing down on each contraction. After only forty minutes or so, the baby crowned. I felt a burning sensation around my labia, and the midwife told me to try to breath through a contraction or two to slow down the baby and prevent tearing. Well, the very next contraction was irresistable: I just couldn't help pushing! The baby came out all at once, she never turned, never was half-in, half-out. She was just---SCHLOOOP--there! 2:35 p.m., about 15 hours after we started timing contractions. Of course, if you count the prodromal labor ... but I don't!

The midwife caught our daughter, told me to lie down on the bed, and handed her to me. I held her on my chest, and looked her over. I can honestly say my primary emotion was relief that the labor was over. I really wasn't that interested in her for a few minutes. She wasn't breathing right away, but the cord was giving her oxygenated blood, so there was no big rush or emergency. The midwife gently suctioned the baby's thoat. The Baby coughed once or twice and started breathing. It was all very calm. The midwife tied off the cord about 5-10 minutes after she emerged. My husband then did the actual cutting.

The baby latched on for her first nursing, and stimulated a couple of contractions big enough to help me push out the placenta. The midwife gave her a bath, right on the bed, while the doulas cleaned up the birth mess. My husband's best friend arrived and shot a few minutes of videotape, then he and my husband went out into the yard to bury the placenta under the dogwood tree. I did need some stitches, but the tear was very superficial, and no muscle tissue was involved as is always the case with an episiotomy.

All in all, I would say that home birth was the best option for me. I was not "brave." It was my fear of the hospital that drove me to it. The only thing I could wish different is that I had had some option for safe pain relief at home. I think I would like to try acupuncture, if I should ever have another baby.

Rachael