A Home Waterbirth VBAC
Day One - February 29, 2000
The only thing worse than a pregnancy that goes on forever is *labor* that goes on forever! On February 29 -- six days after my due date -- at about 3 am, I started having hard contractions which were starting to cluster up at 3-5 minutes apart. I got out of bed and started timing them and they were lasting about 45-60 seconds. I timed them like this for two hours and while they never intensified (my first clue), they didn't go away either. I started passing a lot of blood-tinged mucus. While I could tell this wasn't active, active labor just yet, I truly thought it was just around the corner.
At 6 am, I called my midwife, Nina, to get her take on the situation. She said it sounded like things were gearing up and that she'd call the other midwives and they would mosey on down, but to page if I needed them more urgently (hahaha). We hung up and contrax remained steady. I was getting very excited and also testy, because these contrax were hurting. We started filling the tub and also called Tony's mom. I decided that if I was going to labor through the day, I couldn't deal with the girls being here the whole time... wide awake and needy. The midwives arrived at about 8:30 am and Shirley arrived for the girls right behind them. Tony turned off the phone ringers, because it was ringing way too much already.
9:00 am... contrax suddenly get further apart (10-13 minutes), BUT more intense. We all thought it was a new plateau and that they would cluster at this new level, but they did not. It was a new plateau all right, one that lasted for 20 hours. I continued to have lots of show, though... a good sign.
After two hours of this (11 am), I requested my first cervix check of the pregnancy. I was 3-4 cm, 90% effaced, baby at zero station, but cervix still slightly posterior. Not as good as we'd hoped, but very encouraging. It seemed we were right; that the active phase could kick in any moment. My midwives had a ton of paperwork from the previous week and decided to hang out awhile longer. Throughout the morning/afternoon, I nibbled off and on, had a bowl of soup for lunch and stayed well-hydrated. Nothing changed though. I took a shower, which made me incredibly sleepy. I'd only had a few hours of sleep the night before. Gawd, this was just like my labor with HM. I decided to have another check to see if there had been ANY progress. None, zero, zippo. I was SO discouraged. Here I am breathing through some very intense contractions for HOURS for no good reason :-(.
My midwives gave me a pep talk... all the stuff I knew... this is normal; they could tell me hundreds of stories of labors which start off like this, etc. This isn't false or prodromal labor, simply early labor and it can last for days sometimes. An early labor pattern that SUCKS, but I do have a history of it. (WAHHH)
At about 4:00 pm, they went home. I stayed in holding pattern and was getting more exhausted by the hour. I tried to nap, but it was just too hard to handle the contrax lying down. I tried out the pool to see if that would stop the contrax enough for me to sleep. It did not, but wow... did it ever help me relax through the ones I was having. It is so deep and blissful. The contrax still hurt, but it was so much easier to stay relaxed through them. At 9 pm, I decided to try to sleep. Nina called just as I made that decision, gave me another pep talk and recommended some wine to see if that would slow contrax down enough for me to sleep. Thankfully, it worked! I slept, quite deeply, from 9:30 pm to 1:30 am before the contrax started waking me up again. Lots more mucus plug was lost during that time.
Day Two -- March 1, 2000
Well, no Leap Year baby for us! At 2:30 am, I was up and out of bed because I couldn't handle the contractions lying down. I sent off an email updating my friends on the labor... these contractions were about ten minutes apart, so I'd type in between. I was much refreshed after getting all that sleep, but despairing of another day like the one which had just passed. Shortly after that, the contractions acheived a new level of intensity and were coming closer together more quickly. By 3:00 am, the contractions were four minutes apart and I was having to devote quite a bit of concentration to get through them. Tony called his mom at 7 am to get the girls. Even if I didn't go into active labor that day (at that point I was still in denial that I might be in active labor), I was way too edgy to inflict myself on them.
I called Nina at 8 am, telling her that these contractions were not only closer together, but causing a lot more back and rectal pressure. I was so concerned that everyone would come down and my labor would stall out again that I was afraid to say positively that they should come. I suggested maybe having them check in with me by phone again in a couple hours. At that point, I had a contraction and told Nina it sure would have been nice to have support people here for that one and she said, I think we'd better come down... she wasn't comfortable being so far away.
Nina arrived at 9:30 am, with Kelley and Tanya not far behind. My contractions were holding steady in the four minute pattern and I was discouraged, sure that I hadn't made any progress. I asked for a cervix check right away and was shocked to learn that I was 6-7 cm, fully effaced and anterior. Suddenly I felt recharged! My body was doing it, just at it's own slow pace. I was confident that I could do this and that it would probably be just a few more hours before I was holding my baby. Transition was just around the corner and that is supposed to be the hardest and shortest part. Since I had made progress, I got into the tub for some relief. Unfortunately, that slowed my contractions down again to about ten minutes apart. It was so frustrating!
From 10:30 am until about 2 pm, I alternated between pacing the house and resting in the glider rocker. The contractions were still far apart... about 4-5 minutes. I was so tired and didn't seem to be getting anywhere. The spacing of the contractions was a curse and a blessing. The nice thing was that I had ample time to rest and recover between them. The bad thing was that I had plenty of time to dread the next one. I never went out of my rational mind during this labor; rather, I was aware of every passing moment and irritated by that fact. At least if the contractions would have come faster, I would have been forced into that primitive, coping mode that might have helped take a little of the edge off. I was also VERY annoyed that I couldn't use the tub for relief. Water is known to help speed up labor for many women, while also providing pain relief. But not for me. I was feeling pretty put out by that.
At 2 pm, I requested another pelvic. I thought I was going to cry when I learned I was at the exact same place, the only thing that was different was that there were more forewaters, which was a likely culprit of my stalled labor, because the baby's head wasn't as firm on the cervix as it needed to be. We discussed options... cohosh to help strengthen the contractions, AROM to get baby's head more firmly applied to the cervix -- even the possibility of transfer for an epidural and pitocin. The midwives felt strongly that I needed to put gravity to work for me and recommended starting out with walking between contractions and squatting during them. I was willing to try that first. I definitely wanted the lesser interventions before even considering a hospital transfer (not to mention the idea of driving for an hour in this kind of pain... ack!). I did tell myself that if I was still stalled out by the evening, that we would transfer. I couldn't fathom another night and day of this.
So, I started walking, though I couldn't manage a full squat, I did lean onto the back of a chair during the contractions and focused very strongly on relaxing my entire body, visualizing my cervix opening. The contractions immediately picked up to two minutes apart and were very intense. I needed support for these. Tanya applied counterpressure on my lower back, which helped immensely, and Kelley helped me with relaxation and visualization... reminding me to relax my shoulders and bottom, keep my knees flexed and see my cervix open like a turtleneck going over the baby's head. After 45 minutes, I was dying. It was incredibly hard. I requested another pelvic; I HAD to know if there had been any change after this hell. So at 2:45 pm, a check revealed that I had made progress to 8 cm! It was hard, hard work, but it was working!
I did another 30 minutes of walking, walking, walking and dying, dying, dying. At 3:15 pm, I announced that I couldn't do it anymore and was getting into the tub. Once I did that (oh, the bliss as my belly submerged during a contraction), of course, the contractions seemed to space out a little and didn't seem as long. The pool was so relaxing though, it was hard to tell if it was really slowing me down, or if I just felt better. While I shared that information with my midwives, I suddenly had the most powerful contraction of the entire labor. I would have been writhing on the floor in agony had that occurred out of the tub; it was bad enough in the water! The next three contractions were also very strong, though definitely spaced out to 4-5 minutes apart. Then, in the middle of the next contraction, I felt that wonderful, amazing pushing urge.
The midwives all jumped into action, pulling on gloves and making final preparations. I looked at them kind of disbelievingly... it didn't seem to me that there was any need to rush. I still felt somewhat hopeless about whether this baby was going to come out or not. Looking back, I'm amazed at the bad attitude I had for most of my labor. After having such a long labor with Hannah Mac, I thought I had paid my dues in that regard. I was not at all happy to be enduring the same thing all over again. I realize now that I had not prepared myself for this contingency at all. I guess I really expected an easier time this time and when I didn't, it put me in a pretty bad mood.
Anyway, during the next contraction, Nina checked my dilation. Still only 9 cm... I had some more work to do before the pushing could begin in earnest. After three more contractions, she checked me again and there was just a lip left. She was able to hold it back while I gently pushed through that contraction. I was complete! At 4:07 pm, I was given the go ahead to push anyway I felt like. I was able to put my hands inside between contractions and feel the bag of water and the baby's bony skull. That was so amazing and incredibly motivating. I couldn't believe how small the head felt! But that was only because of molding and the fact that I wasn't feeling the full surface of the head.
At 4:17 pm, I felt my membranes rupture (finally!) and I kept working on getting baby through the birth canal. After a couple of contractions, I felt the baby's head crown and shouted... "Fire!" The midwives were so encouraging during this part... reminding me to puff through the fire while pushing to give my perineum time to stretch. They never touched my perineum; apparently the water provides enough counterpressure to support the perineum through the birth.
This part was not as easy as I remember it being with HM. I never felt the urge to push until the middle of the contractions and so that meant I had about 30 seconds of coping to do before the relief of the pushing urge kicked in. I was able to get about three pushes in for every contraction and even though she slipped back in between contractions, the midwives said that more of her came out with each push. I lost count of how many contractions it took to push her head out, but she was born at 4:37 pm. Her bottom shoulder seemed a little stuck, so the midwives helped maneuver her on the final push and there she was. I looked down to see her "swimming" up to me with her eyes wide open. My goodness, there really WAS a baby. Without a second thought, I reached down to lift her out of the water and to my chest. She didn't breathe right away, but was marvelously pink within seconds. After a few moments, she started to cry with little gasps.
Miranda Ellen was born March 1 at 4:37 pm
8 pounds, 12 ounces; 20 inches long
Apgars: 9, 10 and 10
Her cord was a quite short, so we had to revise our plans for delivering the placenta. I sat on the edge of the tub holding her until the placenta delivered. We were going to cut the cord if it had taken much longer, but just as we said that, out it came into the bowl Kelley was holding beneath me. Then someone took the baby while I got out of the tub and walked over to the couch (covered in plastic, sheets and chux pads). She nursed right away (and has barely paused for a moment since ;-) and after about 45 minutes of being left alone to bond, Tony cut her cord with a little help from Nina.
A check of my perineum revealed no swelling and only one tiny superficial tear along the line of the episotomy I had with Hannah Mac. No stitches, no pain. I'm a little tender down there, but it's amazing how much easier it is to recover from childbirth and care for a newborn when the perineum stays intact! We are doing well, getting just enough sleep to not be miserable and I think my little nonstop nurser is ready for my milk to come in. Bailey and HM are pretty impressed with having a new little sister, but I don't think they completely realize yet that she's not just visiting. :-)