Sunday, June 9, 2013

Birth Story of Baby Leila

This is a long overdue post, and has been in the pipeline of blog posts for months. I am happy to share a beautiful midwife-assisted natural hospital birth. 

Baby Leila
You may have seen her make an appearance on my blog before. 
Tuesday was much better. Leila’s official due date. One of the chiropractors was out, so I had to keep my original appointment for the following Monday, which surprisingly didn’t make me anxious. I intended to do a lot of work, but I was so tired. The week before I decided to quit my weekly yoga classes until after the baby was born, and I was not in the least tempted to drag my swollen belly through an hour of Forrest yoga this particular morning. Instead I took a leisurely two hour nap in the afternoon and went on a nice long walk with Wrigley. Ben and I had a nice evening together, thus completing the short list of physical activities rumored to induce labor. I doubted that either would work for that particular purpose, but I was hopeful that all was well with our baby and things would progress like they should. Ben was just about to turn out the light when I felt some cramping. I knew I had no other signs of labor and this was probably just my body practicing, but I could not help but feel incredibly giddy. Ben told me to try to relax and get some rest (as he did many times that night), but I was excited and hopeful. I watched our usual episode of Seinfeld and felt my body continue to cramp. When I hadn’t fallen asleep by the end, I tried another episode knowing that was usually enough to lull me to sleep. I was still awake after my second attempt, and I think I might have turned on a third. I cannot remember if I even made it through that episode before I got restless and decided to get out of bed. I told Ben I was still feeling something, and he sleepily told me to try to get some rest. I could not sleep, and I did not particularly want to either. I finished watching the last two episodes of The Good Wife. I felt more comfortable sitting up, but I also felt increasingly alert and started to give up on the idea of ever falling asleep. Even as the contractions increased, I downplayed the possibility that I was in labor. I finally timed my first contraction at 2 am, which confirmed that they were as frequent as they felt, only about five minutes apart. I emailed my friend to cancel our plans for tea the next day, though I didn’t have the courage to admit the real reason.
Done with entertainment and email checking and faced with strengthening contractions I finally asked Ben to wake up and keep me company. Convinced the discomfort was nothing, I hated pulling him out of bed and wasting one of his vacation days. At some point I asked Ben to start timing the contractions. From the first one to the last, they were never more than five minutes apart, and some would only last as long as two minutes. Ben made me some peanut butter and jelly toast, but I couldn’t keep it down. At first I got on my hands and knees through the contractions. I dreaded the fifteen minutes I’d spend in that position during the last month, but somehow it was the most comfortable during the contractions. After awhile I worried that I defaulted to that position longer than the 45 minutes our birth class instructor recommended and transitioned to walking. At first I’d walk from the living room through the dining room into the kitchen and through the hallway back to the living room. Eventually I opened the doors and started doing laps in the same manner that our dog Wrigley used to sprint through the house. Ben offered to go on a walk with me once it got light outside, but by the time that came I was not feeling up for a walk through the neighborhood.
Eventually we decided it might help me relax if we put on a movie. I decided on When Harry Met Sally, my default when I’m not feeling well, but sitting still on the couch was too uncomfortable so I kept making the laps as the movie played. Thinking back on it, the first 12 hours of labor were so tame comparatively, I can hardly believe my struggle with them at the end of the night. Of course, at the time it was all I knew. At around 4 am, Ben started texting and calling. First it was his boss, to let her know he would not be in that day, then my brother, asking him to come by to get the keys just in case he needed to spend the night with our dog. My mom might have been next, warning her we might not be around for the cleaning she had generously scheduled. Thankfully he did not forget our doula Kristi. She suggested we contact the midwives. She also asked that I try switching up my contraction routine and try leaning against a wall while I swayed my hips. Maybe it was the actual move or the natural progression, but it made the contractions feel miserable. As much as our birth instructor had repeated it in class, it was hard to relax into the pain and trust that instigating it instead of relieving it was the right thing to do. Ben called the midwives and at first spoke with the one I saw on Monday. After assessing the situation with Ben she asked him to call back when the next midwife came in at the 7 am shift change. At some point Ben suggested I grab a shower. It brought such blessed relief. Instead of my usual quick ritual I took time to wash and condition my hair and even to shave my legs. I think the shower slowed down my contractions, but I was nowhere near comfortable enough to lie down and take a nap. My brother came by for the keys while Ben was in the shower. I could hardly summon the energy to get to the door. Most of the labor is a blur and I have a hard time remembering what exactly happened when, but I remember at one point early in the morning finally feeling like I could not walk through the contractions anymore and if I could physically talk through them I certainly did not want to make the effort. I’m not sure how much I actually did, but I just wanted to cry – out of excitement, out of pain and out of sheer fatigue.
As much as I did not want to make the trek to the hospital only to be returned home, I felt like I could not stay home much longer. At one point I demanded Ben vacuum the living room rug because the sight of Wrigley’s fur embedded in the fibers was driving me utterly nuts. I could not concentrate. Ben called the new midwife on call. I can’t remember much about what she asked me other than if I’d slept and saying something along the lines of fatigue being the enemy, which made me feel even wearier. She told us to come to triage because after my appointment on Monday, she did not think I was very far along. Ben packed the car and we left for what we assumed would be a short trip before we were sent back home. I had at least three contractions on our way to the hospital. Houston traffic is miserable in the best scenario, let alone while laboring. Ben said it took 45 minutes to an hour for us to make it to the medical center, what should have been a 15-20 minute drive. Then it took us awhile to figure out how to get to the St. Luke’s entrance. I wanted to be frustrated, but I was too tired. I struggled not to cry as we left our car with the valet. I was excited and nervous to walk through the hospital doors, still very unsure of what it would mean for us. We left our bags in the car and made our way to L&D. Kristi was there when we arrived. They were going to hook me up to a monitor but they let me finish a contraction first. When they came back they told us they were moving us to a room because they were pretty sure I was in labor. I stopped by a scale on the way to the room and could not have cared less had it read one million pounds. Once in the room, they wanted me to hook up to the monitors but another contraction had already started and brought me to my hands and knees. Thankfully our nurse was gracious and accommodating and worked around me. I anticipated the nurse being a random appendage in the whole process, but ours was an integral encouragement throughout labor and delivery. When my midwife came in to check me I was 4-5 cm dilated and as I remember 80-90% effaced and at a -2 station. I could not believe it. Leila had been working all night. The discomfort was not for naught. I was in labor. It was enough for them to keep me in the room.
Things were moving along, but Leila needed to turn. My midwife had me turn on my side and labor in that position, with one leg outstretched and the other bent up to aid in her turning. It was miserable. Unlike walking or leaning there was nowhere for me to physically move through the contraction. I just had to lie with it. After awhile in this position my midwife asked if I’d like to labor in the tub. I wanted to, but I was worried. I asked her if it would slow things down. She assured me that nothing would slow things down at this point, which was the most reassuring thing I could have been told. The tub felt wonderful. At first I struggled through the contractions, but they showed me how I could turn on my side. As nice as it felt, eventually even the tub ceased to be a comfort. They helped wrap a towel around me and I leaned against Ben and did a laboring slow dance. It was so comforting to have him hold me. I wanted to fully appreciate how amazing Ben was, how attentive and prayerful and loving, but the whole labor I had no words. I had no desire to talk and I had no desire to be spoken to – the only thing I could tolerate was brief encouragements to breathe or change positions. My midwife would feed me words of encouragement, telling me that I “couldn’t be doing it any better” or how natural I was. The simple assurances were so comforting. I could not connect to anything beyond what was going on within my body.
The lights remained dimmed, and the room felt like a cocoon. I labored in this sacred space, shared only with this small tribe of the most amazing women and loving man. Prompted by Kristi or my midwife I moved from one position to another. Despite hours spent squatting in yoga, unable to move my inflated body into more limber positions, I physically could not squat through a contraction. My midwife checked me at 6 cm/100% effaced/-1 station and 8 cm/100% effaced/-1 station (when Leila still hadn’t turned) and 8 cm/100% effaced/0 station again (when Leila turned into position). I felt discouraged to hear I was only at 6 cm and that I’d remained at 8 cm. After one of the checks Kristi asked me what I was thinking and I confessed I was thinking about “the thing I didn’t want to think about.” It was not that the pain was unmanageable, but rather the fleeting fear of how much longer this might last. My midwife quickly asked what we were talking about.
“Are you talking about an epidural? That’s okay. Just because you’re talking about it doesn’t mean you’re asking for it.”
It was exactly what I needed. The freedom to let the thought enter my head without the fear that it would lead to a sitcom inspired scream for drugs. I no longer needed to entertain the thought.
I eventually asked if it would be okay for me to return to the tub. This time it brought fleeting comfort. I spent most of the time bent over the edge of the tub, working through a contraction. I would sit halfway back before I felt the need to lean over again. At first I thought I was misreading the end of the contraction, but then I heard my midwife say that I was “coupling.” After about half an hour I got out of the tub and again danced with Ben before moving back into the room. The next two hours felt much longer. My midwife moved me to my side again. I didn’t want to be present in the agonizing contractions, but there was no other choice. They needed me to stay in bed and remain hooked up to the monitors. Eventually I had to move. I got on my knees and leaned over the bed. In the last thirty minutes of transition the pain was so agonizing it literally took my breath. I wanted an epidural, I wanted a c-section – I wanted to know this was going to be over immediately. Through every breath I kept waiting for the guttural change that signaled I was ready to push. I tried to will my body to make the noise, but the contractions were too intense for me to do anything other than survive them. A few times I said I couldn’t do it. It was not so much the labor but the breathing. I would hear a chorus of encouragement to breathe. I needed it. I begged for my midwife to come back in the room and check me. I was 9.5 cm and she thought I could start pushing. She asked me if I felt the need, and I remember hesitating and deciding to answer yes even though I wasn’t sure. Later Ben told me that he caught my hesitation and worried I was lying to my midwife. I prayed desperately that the pushing would only last 20 minutes. I could not imagine enduring two more hours, my body was so fatigued. During the last leg of contractions my leg would shake violently. But it was true was our birth instructor told us, pushing was a relief. I felt so relaxed after my first round of pushing. I only remember pushing four or five rounds, but by the end the constant breath holding made me start to feel dizzy. I wanted to ask if she was close, but I knew it was best to stay focused on each breath. At 6:06 pm, after almost exactly 20 minutes of pushing, Leila made her full appearance. Ben looked at me with tears in his eyes and announced her arrival with wonder. They threw her up on me for a second before taking her across the curtain to be checked by the pediatric team. When my water finally broke there was a lot of dark meconium, so my midwife wanted to make sure that everything was okay. I could tell she was really conflicted about it, but later I realized that it was a blessing. Ben was able to bond with Leila while I could lie back and let my midwife help me through the last part. I will never forget seeing Ben walk out from behind the curtained divider holding our baby as if it were the most natural thing in the world and then tell her he loved her. Our midwife said in 21 years she has never heard a father welcome their baby simply with “I love you.”
Finally I was ready and Leila was ready and they laid her on my chest to breastfeed. I saw Ben overcome with emotion the second she entered the world, but it was the moment that we physically reconnected again that I felt teary eyed and was overwhelmed by what those 9 months and 20 hours and 6 minutes meant. I am a mom, and this is my daughter. My absolute favorite scripture is Isaiah 41:10 – “So do not fear, for I am with you; do not be dismayed, for I am your God. I will strengthen you and help you; I will uphold you with my righteous right hand.” I felt that verse in my soul as this most beautiful baby readily took to my breast. I was filled with an overwhelming sense of protection and trust, and gratitude. Later a friend asked me if being a mom was the best thing ever. I told her I didn’t know yet, but I did know that I had never felt more grateful for anything in my entire life.
By 8 pm we were finally ready to be wheeled over to our postpartum room. I felt regal as they wheeled me to our room, holding Leila, the center of the universe. All of the grandparents and aunts were waiting for us. It was a nice reunion. Later Ben and I ate the hamburgers our parents bought. Ben said it tasted like the La Sierra burgers we used to eat when we lived in Kigali – it was not so much how amazing they actually tasted but the context that made them unbelievable. Later that night neither one of us could sleep, so we stayed up reliving the entire labor and delivery experience. It was one of the sweetest nights I’ve ever had in my entire life. If God ever asks me what two days I want to relive, I will say our wedding day and Leila’s birth day. Hands down.

Sunday, June 2, 2013

8 Red Flags that tell you that you need to run far, far away from your OB

As a doula, I feel it is important to be familiar with the birthing climate in the Houston area. I consider it a privilege to get to know and become friends with other birth workers. I enjoy attending births all around the greater Houston area. I love to attend the occasional hospital tour to get a feel for what to expect at a hospital at which I've never joined a family for their special day. I also like to read the websites of various health care providers and hospitals, especially when they so generously provide a detailed Frequently Asked Questions section. However, every now and then I want to take a big red marker and say, "No! No! No! Red flag! Red flag! Run far, far away!" The following is a list of just a few red flags that I have collected after reading several provider websites. And because I am a fan of silly memes sometimes, you get to enjoy my silly sense of humor. 

Red Flag #1: Your doctor (or midwife) does not recommend birth plans.

By now, we all know that birth PLAN is probably not the best name for what a birth plan actually is. Everyone knows that birth does not always go according to plan. It is pretty unpredictable. It's exciting, thrilling, awe-inspiring and sometimes annoying, scary and heartbreaking that way. Sometimes a natural birthing mama ends up with a Cesarean because her blood pressure went through the roof at the end of her pregnancy, or a mama looking forward to her relaxing epidural birth ended up with a super fast natural birth. There is plenty that goes against the best and most carefully considered plans. There is plenty out of our control. However, there is plenty that is NOT out of our control, such as birth location, care provider, whether or not we accept or decline an induction, whether we accept or decline the epidural when that nurse in triage asks you if you want one when your husband and midwife left the room for that split second, what you wear during labor, etc. There is more that SHOULD be in your control, but often is not due to reasons such as hospital policies, such as position during pushing, eating and drinking during labor, laboring in water, etc. If a provider scoffs at your desires to have a birth plan, or makes fun, or tells you that you do not need one, that's a red flag. There are plenty of providers in Houston that do not mind them and actually encourage them.

Red Flag #2: You're not allowed to say no. 

If your doctor (or midwife) recommends an intervention, and you are made to feel like you are not allowed to decline, that's a red flag. Ask questions about why the doctor is recommending an intervention (such as induction, Cesarean, etc) and gauge the reaction. How is the doctor treating you because you've asked questions? Do you feel rushed? Stupid? Safe? Excited? Scared? Like just another number? If your doctor seems annoyed that you are asking questions, let that be a red flag. If your doctor says on her website, "if we recommend XYZ, we EXPECT YOUR FULL COOPERATION," let that be a red flag. The first time I came across a website that said that, I was completely floored. 

Red Flag #3: VBAC is not an option.

VBAC (Vaginal Birth after Cesarean) is sort of a huge deal these days. Many many MANY women are seeking VBAC and many women are getting them! How is that possible? Because they are finding VBAC supportive doctors and midwives! (Or are forgoing the whole care provider thing all together) If they don't give the option of VBAC, what other options are not available? If you are seeking a VBAC, there ARE options available in Houston. Just not with everyone.

Red Flag #4: Your doctor (or midwife) uses scare tactics to try to persuade you to choose her recommendation. 

"You don't want your baby to die, do you?"
"If you do that, your baby could die."
"Your baby could die if you don't do what I am recommending."

Let's just use VBAC as an example. There truly is a risk of uterine rupture with VBAC. There is also a risk of uterine rupture with a woman who has never had a previous Cesarean. I've read websites from practices that do not offer VBAC and offer the explanations as to why they do not offer them by using lengthy scare tactics. This is unacceptable. Perhaps these providers do not feel comfortable with VBAC. This is fine. There are plenty of care providers in Houston who DO! Maybe they do not feel trained enough. That is fine as well. There are plenty of care providers in Houston who DO! I've got names. Even ACOG (who I don't always agree with, but usually OB's tend to) doesn't completely ban VBAC. 

Red Flag #5: Your care provider recommends induction at 41 weeks.

Ok, I'll concede a little one this one. Sometimes it might be a good idea to induce at 41 weeks IF, big ole fat IF, baby and/or mom are not doing well and the benefits of induction outweigh the risks. But to just recommend it (remember, there are some practices out there that say once they recommend something, they EXPECT YOUR FULL COOPERATION), "just cuz" does not sit well with me. 

Red Flag #6: Your provider recommends that you get induced to fit their schedule. 

Of course, you are allowed to schedule an induction to fit your schedule. It's your life, your baby, and your body. If the risks are worth it to you, by all means, do it. But it is NOT ok to be pressured into an induction because it fits into your doctor's schedule. Because you know why? Besides the fact that doctors usually only come in once the birth is imminent, meaning you're pushing and baby is coming soon, someone WILL be there to catch the baby. Why change your life around to fit such a short amount of your doctor's time. Why increase the risk of fetal distress, jaundice, c-section, etc to convenience your doctor? 

Red Flag #7: Doulas are not allowed.

I'm sure you've seen that famous misspelled sign. You know the one. Ask your doctor how s/he feels about doulas. If s/he says they are not allowed, or that they had a bad experience with doulas (which may actually be true, but not all doulas are created equally), if they don't want you to have whomever you want at your birth, like they are going to be there the whole time like a doula would anyway, let that be a red flag. When I was pregnant, I had a midwife tell me that doulas are a luxury and that I wouldn't need one. That was a red flag for me. A tiny one, but a red flag nonetheless. Of course, I like doulas. I AM a doula. I think every woman should have a doula if she wants one.

Red Flag #8: You feel like you need to run far, far away, and as quickly as you can, from your OB (or midwife).

If at any point you feel like you should switch providers, you should probably switch. It may be really hard sometimes because most of the time they are sweet, caring and truly do want to help you. Not all OBs are like the ones that make you say, "Huh? How in the world did you get in this business?" But those instincts are there for a reason. If it doesn't feel quite right that a certain person, whether it is an OB, midwife, doula, mother, mother-in-law, sister, best friend, photographer, or even your other children, attends your birth, then they probably should not be there.

Every now and then, you'll get a red flag with even the most cooperative care provider. One red flag doesn't necessarily mean to run. Two, three or even thirty-three red flags doesn't mean you've picked the wrong care provider if you still feel certain that you've picked one you can trust. But if you start seeing these red flags occur, if you start feeling like maybe you don't trust this person, that maybe they don't really care about you, in short, if you feel like Number 8, then it may be time to interview some other providers. 

I have a list waiting for you if you need it.