Short Story: The Midwife

This is just a short story I wrote a while back and found recently. Hypothetical future. Enjoy.

The Midwife

“Oh, Zoe, I'm so happy for you!” Kristen exclaimed. She sat forward and took Zoe's hands, sharing an excited smile. Her smile faded as she braced herself for the answer to her next question, as she always did. “So, have you contacted your OB?”

Zoe's eyes shifted to the side. She leaned over and turned her phone off. Kristen's spirits rose immediately. This was what she was always afraid to hope for.

“I'm not filing an Intent to Birth,” she whispered. Really, there wasn't any need, but people feared what could happen if they were caught talking about a natural birth. It wasn't allowed.

“You understand the risks, of course,” Kristen said, lifting her cup of tea and drinking. Zoe nodded, taking a drink of her own tea.

“I don't want to move to Norway,” Zoe said. “I don't like the cold. And my whole family has lived here since before the American Revolution. I shouldn't have to move just to have a baby,”

“I agree, obviously,” Kristen said. “I thought you might feel that way when you told me you'd applied to have your birth control system removed.”

“I had heard that... that you know of a midwife,” Zoe said softly.

“Oh, yes,” Kristen said. “I do.”

Zoe looked at the piece of paper with the address on it and double checked it against the number on the house in front of her. Part of her was so afraid that she wanted to run. Then she imagined the alternative, and she found the courage to knock.

“Now, I can't get in trouble, right?” Zoe asked. The midwife smiled. This was usually the first question asked of her.

“If you do not enter into an Obstetrical Contract, you won't fall under penalty of law if you deliver out of hospital. All of the risk is on me. If you tell anyone about what I do—”

“Oh, I would never do that!” Zoe said, taking her hand. The midwife patted Zoe's hand comfortingly.

“I know, dear, and we'll go over all the possible scenarios where you might need to transfer care later, along with stories to avoid culpability. But if anyone were to discover me, I would be arrested on charges of felony medical infringement and face a sentence of five to thirty years.”

“That's ridiculous!” Zoe snapped, her face flushing with anger.

“I know,” the midwife said with a sigh. “When my grandmother had my mother, women still had a choice in where and how they gave birth in most states. When my mother had me, women still had the choice of how. It's only been twenty years since the Mandatory Cesarean Act passed, and the population is already down ten percent.”

“Ten percent?” Zoe whispered.

“Well, Population Control would really like to see it drop another ten percent, but with it still illegal to perform any invasive procedure without written consent, they're reduced to fining people for having more than two children per couple. And then, of course, there are loophole kids.”

“Yeah, my husband and I aren't comfortable with that,” Zoe said. “We've talked about it, but we're really okay with two children. While it's unusual for a man to challenge for custody, it's been on the rise lately with black market adoption rates going up.”

“There's a bill in the House trying to eliminate that practice,” the midwife told her, “Although it's unknown if it will pass.”

“How?” Zoe asked.

“It provides that a man who sues for custody cannot put his child up for adoption. If he's found to have done so, he faces a twenty-thousand dollar fine or even more. The problem is that Pop Control is fighting it because the way things are now lowers the number of loophole babies for the exact reason you stated.”

“Wow. Well, if it passes, maybe we'll reconsider.”

“Even if it doesn't, there's a loophole to that problem anyway. Right now, a man can sue for custody of his child and automatically win if two or more children are already present in the home. However, if you have your loophole child before you have biological children or between your one allotment and your husband's allotment, he won't win.”

“I never even thought of that!” Zoe exclaimed, laughing. “That's brilliant!”

“I should warn you that if you need to transfer with your second child, you will be required to choose a permanent birth control device,” the midwife added.

“Is there no way around that?” Zoe asked.

“Some obstetricians are willing to do a five year survival clause in their OC, to provide that you aren't required permanent sterilization until your youngest child reaches their fifth year alive, at which time, you have a year to sterilize,” the midwife offered.

“That's sick!” Zoe protested. “It's like some kind of morbid warranty.”

The midwife nodded sympathetically.

“If you choose a vasectomy, you have two options still. If you're willing to pay the third child fine, you can try to conceive immediately, as soon as your husband feels up to it. After all, it takes vasectomies a while to take. That also leaves you open for a loophole baby. Of course, if you transfer during a loophole birth, many OBs make you sign a hysterectomy release for your c-section,” the midwife warned.

“This just all feels so wrong,” Zoe said. “Why is Norway the only place in the world, except for tribal areas, to not make birth into a legal situation?”

“According to my grandmother, it started out small. A few states criminalized midwifery when it was on the brink of becoming socially acceptable. OBs fought hard—buying studies, skewing outcomes—to prove that midwives were dangerous to mothers and babies. The cesarean rate was rising every year and then the ACOG gave the green light to start Obstetrical Contracts, which women were required to sign to use the practice.

“Originally, it was to guarantee exclusivity. The woman couldn't transfer care, but she knew exactly the care she would be getting. It didn't seem like a big deal, since that matched OBs with mothers who wanted their kind of care. Then the standard of care started shifting. There were no OBs that offered births without contracts, and then some hospitals stopped having rooms for labor, advertising as 'c-section only.'

“Next came the bill that legally defined childbirth as a medical procedure. That was the beginning of the end. They used it by the same logic that got midwives out of legal practice. Then came full practices offering nothing but cesarean delivery. Then, the mandatory cesarean act was passed. At this point, midwives were totally illegal and just coming out to protest drew the attention of the law. So we faded into the night. Women didn't want to risk being caught and trapped into an OC or lead the law back to their midwives, so they were afraid to make a lot of noise, too.”

“That's awful,” Zoe said, shaking her head in outrage. “Why did Norway stay separate?”

“They always have,” the midwife answered. “So, do you wish to hire me?”

“What's your fee?” Zoe asked.

“It's five thousand for prenatals and birth.”

“That's it?” Zoe asked, shocked. “It's fifty thousand to birth in a hospital!”

“Surgery is expensive,” the midwife said with a shrug. Zoe sighed.

“Do you accept payments?”

“Of course!” the midwife said cheerfully. “And if five thousand is a real hardship, we can work out barter if we need to.”

“Oh, no, I can afford it,” Zoe said with a smile. “As long as it's not all at once. How much if I have to transfer?”

“It depends on how far you get,” the midwife said. “Usually, we detect the need for transfers at five months, so that would be two thousand.”

“I can't believe how cheap it is!” Zoe said.

“We aren't out to make profit,” the midwife said. “Almost all midwives have some kind of side business to live on. Now, what month are you due?”

“According to the online calculator: October first.”

“Good, I don't have any clients in late September or any time in October right now, so I have no problem taking you.”

“I'm glad,” Zoe said, visibly relaxing.

“Remember that you cannot announce your pregnancy in any public forums, social media, et cetera. If you get followed to me, I'll be out of business, and you'll end up with an OB.”

“Got it,” Zoe said. “Can I know your name?”

“No, I'm sorry,” the midwife said. “But you may call me Ann. And of course, all payments must be in cash.”

“Of course,” Zoe agreed. “How many babies have you delivered?”

“I've caught around three hundred babies,” the midwife answered. “I've been doing this for twenty-five years. I started apprenticing when I was sixteen. I was amazed when I saw my first vaginal birth.”

“How do OBs stop women from having accidental vaginal births?” Zoe asked.

“All mothers are sectioned at thirty-seven weeks, unless they show signs of labor before that. That's why NICUs have to be so advanced. Many babies who are supposed to be thirty-seven weeks along are actually thirty-five and even thirty-seven weekers aren't always ready. Plus, just the cesarean itself raises the risk to the baby's lungs and digestive system.”

“Wait, you mean pregnancy isn't thirty-seven weeks?” Zoe asked.

“Yes. Oh, you didn't account for that?” the midwife asked. “I should have asked. Silly of me. You'll actually be due October twenty-second, then.”

“Wow, that's almost a whole month!”

“It could be even two or three more weeks after that,” the midwife warned.

“Really?” Zoe exclaimed.

“You'll be most likely to go in almost November. Changing your mind?” The midwife gave Zoe a teasing smile.

“No! No, I'm... just surprised is all. I didn't know pregnancy was... forty weeks long!” Zoe shook her head in surprise. “Even forty-two or forty-three? I've never heard of that!”

“Oh, I've seen two pregnancies that went forty-four and forty-five weeks respectively,” the midwife said. “I was really nervous about the forty-five weeker, but her baby, while a bit overcooked, was still nice and healthy.”

“Do... do I have to go that long?” Zoe asked, a small tremor in her voice.

“No, but it's better to let your baby decide when it's time,” the midwife explained. “If you get really uncomfortable and go to forty-two weeks, there are things we can do to tell baby it's time.”

“Oh, good.” Zoe stood up and the midwife stood up as well. Zoe offered her hand and the midwife took and shook it. “Thank you, Ann.”

“You're welcome, Zoe. That's what I'm here for: the truth. Unfortunately, that's something most people are scared of anymore.”

“Oh, I'm scared,” Zoe admitted, “but I want to do this.”

“I'm so glad,” the midwife said. “Do you have an ereader?”

“Of course,” Zoe said. “Why?”

“I have some books that you should read. You don't want to go near most of the books in the bookstores—they just focus on preparing you for surgery and obeying your doctor. These are really old books from the days back when women birthed vaginally seventy percent of the time.”

“I can't even imagine that,” Zoe said. “I'll bring my ereader at the next visit. It's been a pleasure meeting you.”

“It's been a pleasure meeting you, too. Have a happy and healthy nine months,” the midwife wished her. Zoe shook her head in amazement. Nine months! Everyone else she had ever met had always said eight months, except grandmas, who didn't talk much about birth at all.

Maybe they knew as little as she had. She was amazed at the knowledge that time could steal and the cleverness of humans in preserving old information thought to be lost to time. Now if only that wisdom could help her do what she believed her body had to be capable of doing.

She hoped that the ability to give birth hadn't been bred out of her. Zoe supposed Population Control would be happy if it had. Sometimes she wondered just how far they would go to maintain their quotas.

Now that she knew more about the statistics, more than just a fear of surgery drove her. No, now it was a duty. A service to the human race, to remember that biology was as important a science as technology. It only made sense that she, as a biology student, was part of a movement to prove it.

She only hoped that some day, she could share her knowledge with the world that so desperately needed it.

Due Date For VBAC Not an Expiration Date

This was originally posted on truebirth.com but has disappeared and due to difficulty finding a copy, I'm reposting it here because it is good information. None of the following content is mine, though I certainly back the sentiments (and I inserted an asterisk for a footnote).

 

Due Date for VBAC: Not an Expiration Date
By Danell Swim April 27, 2008


Being a woman with a prior cesarean, I’ve become extremely supportive of women who choose a vaginal birth after a cesarean (VBAC) like I did. It seems that my support is often falling on deaf ears, as time and again, women are coerced into repeat cesareans for ridiculous reasons. The latest of which, is women who are pregnant after the due date.

I just read of another woman who is “attempting a VBAC” with her doctor. She’s desperately hoping that she’ll go into labor before her Estimated Due Date (EDD), because if she goes even a day past, the caesarean will be scheduled immediately.

This is happening all too often, as doctors seem to believe that an EDD is actually an expiration date. To back up this ideology, they use ridiculous claims to coerce women to go along with these scheduled c-sections. They say that the stillbirth rate increases after 40 weeks, that the number of successful VBACs is lowered, and that the baby will get too big which will make a vaginal delivery too dangerous. There is no evidence to back up these claims, yet doctors continue to practice according to myth and rumor rather than clear medical information.

Despite evidence to the contrary, doctors are still insisting that women only be allowed to attempt a VBAC if labor occurs before the EDD. And, they sell this policy as an actual attempt is made to give the woman an opportunity to have a VBAC in this manner. But how likely is it that a pregnant woman will go into labor before her due date? For that, we have to look at the information regarding EDDs.


About your Due Date

The first piece to understanding your estimated due date (EDD) is the origins. No doubt when the due date calculators online, plus your doctor’s office and any wheel chart all calculated your due date, you assumed some scientific equation that averages out all births? You’d be wrong.

How would you feel knowing that the man who invented the 40 week pregnancy due date, was born… oh, about 230 years ago.* Other notable events in the year of 1778 were: Captain Cook’s discovery of the Hawaiian Islands, England’s declaration of war on France (again), the Revolutionary war raging on, and Franz Karl Naegele’s birth in Germany.

It is called Naegel’s Rule:

           The rule estimates the Expected Date of Delivery (EDD) from the first day of the woman’s Last Menstrual Period (LMP) by adding a year, subtracting three months and adding seven days to that date. This approximates to the average normal human pregnancy which lasts 40 weeks (280 days) from the LMP, or 38 weeks (266 days) from the date of fertilisation. Example, if LMP was 8 May 2007, then +1 year = 8 May 2008, -3 months = 8 February 2008, +7 days = 15 February 2008; whereas precisely 280 days would be 12 February 2008.

It is remarkable that in such an archaic time of obstetric knowledge, someone was able to come up with a method of dating gestation that is still used today. The only problem with that is that it’s terribly inaccurate, yet doctors continue to use it as gospel.

A study was published in 1990 that examined the average length of pregnancy for white women. Essentially, they found that if you take the date of the LMP + 1 year - 3 months + 15 days (if the woman has not had a prior vaginal birth). If the woman has had a vaginal birth, you add 10 days instead.

So if I were to have my LMP on May 8th 2007, I’d jump ahead to May 8th 2008, then subtract 3 months to February 8th 2008. If I’d already had one baby vaginally, my EDD would be February 18th 2008. If I’d not had any prior vaginal births, my EDD would be February 23rd.

That’s a far cry from February 15th, as Naegel’s Rule states.

Due Date Theories        Previous Vaginal Birth       No Previous Vaginal Birth
280 Day Rule                      February 12th                        February 12th
Naegel’s Rule                      February 15th                        February 15th
Avg White Women              February 18th                        February 23rd

Information is limited as to other ethnicities, but one study in England found that Black and Asian women had a gestation approximately 1 week less than white women. In addition, they found that “preterm” black and Asian infants were less likely to exhibit signs of being preterm, which gives more evidence that those babies are more developed than white babies. In layman’s terms: they’re fully cooked. However, previous deliveries, ethnicity and familial traits are never taken into account when estimating a due date. Which is what makes it so unfair that doctors are treating these estimates as scientific evidence.

What this means for VBAC Moms

Let’s assume that Jane Doe is planning her VBAC. Her doctor supports her, but says that she has to go into labor before her due date. Let’s suppose that Jane is white, and hasn’t had any children vaginally before. Her doctor uses that handy dandy chart to predict her due date as May 7th. But, odds are that she won’t go into labor until May 15th.

Poor Jane, has a doctor that was just humoring her with promises of a VBAC. When in reality, he could have predicted all along that she’d end up with another c-section. After all, these are the doctors, they’re the ones that are supposed to be reading the studies and keeping up to date on things as trivial as average gestation.

The VBAC rate is plummeting in this country to less than 9%. Part of this is due to the malpractice fears, and the (soon to be revised) American College of Obstetricians and Gynecologists recommendations, but it’s also due to so many doctors refusing to treat VBAC women as anything but a ticking time-bomb. And, they know that with threats of shoulder dystocia, uterine rupture and placenta accreta, they can scare these women into repeat cesareans if they don’t meet the impossible deadline of their false estimated due date.

Unfortunately for women who desire a VBAC, there’s little you can do but to keep looking for another care provider. Keep looking until you find one that truly understands how the normal human body functions, and is most concerned with giving the patient the birth that they want and need.

Doctors just don’t seem to understand this. And that’s why they keep amusing themselves by allowing women to attempt a VBAC under these circumstances. It’s disturbing how many of them are insisting that VBAC patients deliver before 40 weeks, and it’s ridiculous that women are allowing them to make those decisions for them.

Because let’s face it: having a VBAC isn’t about proving anything, or becoming a “real woman” as so many would like to believe. Having a VBAC is about making the choice to have a healthier birth, a healthier mom and baby, and a healthier reproductive future. It’s about being able to hold your baby without pain.

That’s worth finding another doctor (or midwife).


References:
Overdue? (more info for calculating your due date)
Plus-Size-Pregnancy
Wikipedia on Naegele’s Rule
The length of uncomplicated human gestation.
Does gestation vary by ethnic group?

Written by Danell Swim · Filed Under Editorials

article archived here

*The creator of the EDD was actually Harmanni Boerhaave, a botanist who used the Bible to create the due date system (he found evidence in there that human gestation is supposed to be 10 lunar months... and then he did the math wrong). So not only was his method created hundreds of years ago, but it was by a botanist... who messed up the math by 15 whole days. Naegele merely publicized the idea and got the "rule" name after himself.

Don't Schedule Cesareans for Breech babies!

Breech presentation is not a valid reason to schedule a cesarean. Yet, whenever a care provider finds a baby in the breech position in the last few weeks before the EDD, they ask the parents to pick their baby's birth day.

Now, people consider breech presentation one of the main reasons to have a cesarean. However, while I'll agree that with the prevailing ignorance of the average obstetrician in catching breech babies, in the hospital, it may be safer to have a cesarean--if the baby is presenting breech in labor.

Babies can turn in the womb as late as in active labor, into a vertex, or head down position. So, scheduling a cesarean is foolish, especially if it's scheduled before your EDD. An EDD is not a good measure of when the baby is coming, unless you see it as the middle of the average: 38-42 weeks. So, scheduling a cesarean for 38 weeks is not a good idea unless you have full placenta previa or another reason that labor must be avoided.

Ideally, you should go on with a breech pregnancy with the belief that baby will turn. You can use the techniques at Spinning Babies to help a stubborn baby point in the right direction. If you are approaching the big day and you've tried positions, inversions, chiropractic care, shining a light down low, etc. and baby is still breech, many obstetricians can perform what is called an external cephalic version.

A version should be a last resort, as it is uncomfortable and comes with its own set of risks, including PROM (premature rupture of membranes), premature labor, bleeding and fetal distress leading to the need for an emergency cesarean. The success rate is around 65%.

Ideally, you will have a care provider who is trained in breech vaginal birth, which 70% of breech babies are candidates for. This is not a 'new' thing. In fact, it is an old skill that has been virtually lost with the popularity of the cesarean. A transverse baby is a definite risk out--you can't birth a baby shoulder first! Footling breech is considered too dangerous by most care providers to attempt a vaginal breech birth. Baby breathes through the cord and it can become dangerously compressed in a breech birth. The likelihood of this in a footling breech is 15-18%.

Frank breech is the ideal for a vaginal breech, as the baby's legs protect the cord. In full-term, vertex babies, 0.4% suffer from cord prolapse. In frank breech, 0.5% will experience this complication. So, you can see the rate is very similar. The next risk comes with complete breech babies, which have a compression rate of 4-6%, a significant rise, though not as dangerous as footling breech.

Ideally, you should give baby time in labor to finally turn vertex. At the worst, if you end up with a cesarean due to an unsafe breech position that will not resolve or you are uncomfortable with the risk of breech vaginal birth, you will have given your baby all the time he or she needed to 'cook' and even a brief trial of labor can give the baby the benefits of labor, which prepares the baby for life on the 'outside.' At best, your baby will turn in early labor and you will go on to have the birth that you desired and that gives your baby the best start in life.

At the very least, you should research your options and remember that you have the right to make this choice! A cesarean is major abdominal surgery. As common as it is, so are complications--for both you and baby. Scheduled cesareans may be more convenient, but they are not safer than vaginal birth (except when labor would be dangerous in the first place).

Happy Birthing!

Risks To Baby From Cesarean Section Birth

Originally published Nov 6, 2008 at 12:08 AM on Cafemom

So, I read a surprising comment today--someone believing the risk of amniocentesis outweighs the risk of a cesarean to the baby. She said that a cesarean has its risks, but amnio could be the end of the world.

Do people really think a cesarean is that SAFE? I'm sorry, but it's not. And while, yes, the risks to mom are higher than risks to baby, just because those risks are frightening and include horrific infections, infertility, death, etc. does not make the risks to baby insignificant (and they are still greater than to a baby born vaginally and include a 3x increase in risk in death).

Here's just the short list, so you don't have to drag through all the papers and sources I have.

image courtesy of stockxchng

Risks to baby from cesarean section birth

Breathing problems^[1]

weakened immune system^[2]

digestive problems^[3]

fetal injury^[4]

diabetes (risk is 20% greater for babies born by c-birth)^[5]

asthma (risk is 50% greater)^[6]

neonatal depression (from anesthesia)^[7]

hospital borne infections (rate is higher due to the longer stay after a c-birth)^[8]

neonatal mortality (risk rises from .62 to 1.77)^[9]

and increased risk of SIDS^[10]

Low APGARS^[11]

There's the list of the most common side effects. I know that most people aren't aware of them, so that's why I compiled a list here. I couldn't find a comprehensive list anywhere else. I may expand this journal with a short synopsis of each condition at a later date.

My daughter was born by cesarean, beautifully, APGARS of 9, no side effects that we know of. But that doesn't negate that these risks are real and any baby born by cesarean could be affected in one of the ways above. It's important to be informed about the potential risks in any procedure being performed on you or your baby.

image courtesy of stockxchng

^[8]Pai, Madhukar. 2000. “Medical Interventions: Caesareans Sections as a Case Study.” Economic and Political Weekly 35 (31): 2755-2761.

Lilly's Birth Story

So, here's my (graphic and long) birth story for my first baby, Lilly. It was written about a month after I gave birth and this is the version with names removed (some of my feelings have changed since then, such as knowing that the cesarean was iatrogenic, most are the same) and Lil's pronouns corrected:



At 5:30 am on Saturday morning, October 14, 2006, I woke up after two hours of restless sleep. Contractions had pulled me into consciousness and I tried in vain to roll over and get back to sleep for a half hour before their intensity and frequency caused me to start moaning in frustration. I was sure that they were false labor contractions, yet again, or perhaps just revenge from the Mexican dinner I had the night before. I curled up onto my hands and knees for a little while, then got up to whine around the house because I was tired of looking over at the clock ever four minutes to time them. It was actually the first time I'd actively timed my contractions from the onset.

I sat on my labor ball and went online to whine some more and express my frustration and fears until I couldn't think through the pain anymore and went back to bed. My whimpering and moaning woke hubby up at about 10 am and I asked him to run me a bath. When it was ready, I happily sunk in up to my chest and marveled at how the pain vanished. Before, I was sore between every contraction that I had no relief from the pain; it was constant and intense. Now, though, the pain was not only manageable, but I was able to relax and feel good between contractions.

Things were continuing so well that hubby was getting things ready to go to the hospital and calling people to say that we were pretty certain I was actually in labor this time. I, meanwhile, moved around in the tub from a sitting position, doing butterfly exercises in the water, to lying on my tummy and floating and to an all-fours position. I got out to pee every fifteen minutes or so, but quickly hopped back in because it felt so good to be in the water.

While I labored in the tub, hubby made me food and called my doula and a few other people to let them know that I was in labor and this time, it seemed to be certainly the real thing.

At 11:15, my water broke. I felt a relieving pop and warm fluid rushing into the cooling bath water and knew what it was instantly, although I simply enjoyed the feeling for a moment, as it was wonderful. Then I looked down.

"S**t," I cursed upon seeing the yellow and green stream pouring out. I could see clearly that my water was full of meconium. "That's s**t," I said redundantly and loud enough to get hubby's attention. He quickly came and I asked him to empty the water since I needed to get out, but was in the middle of another contraction, so I couldn't safely stand, but didn't want to float in the dirty water.

I stood up and turned on the shower to clean up and the moment I turned it off, the same amount of fluid poured out of me again. So I called to hubby to get me a poise diaper and turned the shower back on. I slipped when my water poured out again as I tried to step out of the tub, but caught myself and didn't fall. I had managed to avoid getting any amniotic fluid on myself this time and quickly got into the poise before more could rush out and turned the shower on the tub to rinse it out. Hubby, upon my request, had been calling Labor and Delivery to tell them we were coming in.

Now I knew that this labor was real, I was excited and tried to go over every small detail before we left. We fed and watered all the animals and gave the kitties a can of wet food as a treat as well. I put two of the open-cage-door parrots in their cages and latched them, feeling bad about how long they would have to be in there, but satisfied that they would be safe and gave them extra toys. I had to keep going back to the bathroom to change the poise pads as what felt like gallons of water emptied from my womb.

We finally got out the door and piled everything in the van and went to the hospital, a fairly uneventful drive during which I called several people who had asked to be called when I went into labor--the ones that hubby hadn't called already, that is. It was a comforting distraction through the intense contractions.

We arrived and checked in and were set up in a room, where I changed into a hospital gown, happy to have not ruined my clothing or stained anything with the mess I could have been making everywhere. We met our nurse and then my doula arrived as I was being monitored to see how baby was doing. We went over a few things that would have to change from my birth plan due to the meconium, such as the fact that I would need to be constantly monitored. However, the pleasant surprise was that constant monitoring no longer meant being stuck in bed.

I did spend quite a bit of time in bed, as it was easiest for the monitoring and being on my back allowed me to feel the baby moving down a little. They brought in a labor ball, but I didn't get to spend much time on it as it interfered with the heartbeat monitor; which was really too bad since I felt myself making progress when I was on the ball (and it irritated me when everyone tried to adjust the monitor to hear, so I just abandoned the ball).

I was at four centimeters when I was first checked and five during the next. It made it look very promising to be a quick birth. I realized I was staying the bed too much and decided to try dancing/swaying, so I got out Deftones' White Pony CD and my discman and started to enjoy it quite a bit. During Feiticiera, the first song, I tried to use my (attempted) soft singing to move things along during contractions. I was really into the dancing and singing by Digital Bath--a song that has always felt like a birth song to me and was the first dance at our wedding--when the nurse came in so frequently (as they were changing shifts and introducing me to my new nurse--who said "Hi, my name is [] and I've had six natural births and been a Bradley Instructor for 12 years.") that I had to stop too many times and sadly, gave up trying to listen to music.

Much of the next few hours were spent with routine exams, contracting and breathing or moaning through them with my doula gently leading me through the breaths and encouraging me. I had a habit of forgetting to breathe or getting so relaxed that when the next contraction would come, I'd start to panic, but my doula was there, breathing next to me and it would pass in seconds. I had many visitors, which I enjoyed throughout the whole day. My mom snuck me in a cheeseburger and I ate some Jell-O I hid and brought with me. The food kept my strength up, since I started with so little sleep.

During this time, though, hours passed with each dilation check being the same: five centimeters. Finally, it was time to talk about pitocin. My contractions had slowed and seemed to no longer be effective (they weren't even really painful anymore, even). They hooked me up and my contractions came back. While not more intense than the earlier ones, they were more frequent, like they were in the morning, so into the jacuzzi I went.

The water once again helped with the pain, but I had to roll so my belly was out enough that the monitor wasn't under, as all it could hear was water. The nurse tried two different mediums to get the monitor to pick up under water, but no luck. I stayed in until it was time for another check and was still at five cm.

During this time, I had been having trouble with my fluid drip stopping. I'd had two doses of penicillin and was okay with them, although the second was a little achy. Well, while I was laboring in the bed after the check, I had a whopper of a contraction, thanks to the pitocin.

From my perspective, what happened is that I was doing okay in the beginning, but breathing wasn't doing it, so I moved into moaning. But the pain just seemed to keep going on and increasing and eventually, it tore a scream out of me, I couldn't handle it. Then the nurse was putting an oxygen mask on me, saying the baby needed oxygen and everyone was telling me to breathe. The nurse was also saying they had shut off the pitocin. I was a little confused, but thankful that the pain had stopped and wondered when the baby had been checked. Hubby made a joke about my Darth Vader mask and I joked back.

What I didn't know and was told a couple days later was that there was three to four minutes between the scream and the mask. Hubby said that my eyes rolled back in my head and I went limp and stopped breathing. The baby's heart rate started dropping, then they lost them on the monitor entirely. They finally turned off the pitocin and I came to. I have no memory of it at all. But I scared everyone and no one told me, since I didn't need more to worry about.

I guess what had happened was the my fluid drip stopped dripping and the pitocin had been increased a few times before it did, so I was delivered raw pitocin and my body didn't like it. So once they figured that out, the pitocin went back on at half the dosage. I tolerated it just fine, my contractions were just more frequent and while there were still a few that I couldn't just breathe through, it was all manageable.

I had visitors all day and it really helped me get through the day--it seemed to fly by and I probably spent more time in bed than I should have, but I started out depleted and didn't really get better, except for a few hours after I ate.



The nurse came and talked to me about how things might have to change if I still hadn't progressed and then she did the check. Eight centimeters. I cried with relief--all those contractions WEREN'T for nothing. A little while later, my equipment malfunctioned again and the penicillin that was supposed to take about 30 minutes to empty into me emptied in 8 minutes. The pain was so intense it totally stopped my contractions and left me with the strong desire to rip my arm off and beat the IV stand with it. They kept telling me to calm down, but I was in so much pain that I couldn't. It was hands down the worst pain of the entire labor, pushing phase included. When the bag emptied, the pain stopped. Again, no one bothered to tell me that there was a malfunction; they just let me think I was a wimp. My mom yelled at the nurse when I was yelling about the pain and she was unsympathetic. I wonder if she cared later when she found out I wasn't reacting to a normal dose.

I don't remember a lot from there, just that a short while later, things started to change. The contractions became harder and I threw up (Jell-O--it was actually very easy to handle, although I still yelled about it--I REALLY hate vomiting) and when I was checked again, I was at ten centimeters and fully effaced. I was told I could start pushing as soon as I felt the urge to bear down.

She said it was important to push now because the baby was still so high up and of course, the clock was ticking since I was 15 hours from when my water broke (only 18 hours was allowed for GBS+ mothers--stupid and defeatist). So at the first urge, I started trying to push.

It wasn't long before things felt wrong, though. I felt my body fighting me and every time I tried to push, the baby didn't get lower and the pain became immeasurable. I couldn't keep up the entire ten count that the nurse tried to get me to push for--I even tried to say that wasn't how I wanted to push, but things were very confused and I couldn't really form complex thoughts.

I moved from position to position--squatting worked the best, but I didn't have the strength to maintain it. At this point, I had been going on two hours of sleep and a couple five to fifteen minute naps for over twenty hours. I was exhausted, in tremendous pain, trying my hardest to push while my body fought me and kept telling me to stop, but the nurse kept telling me to go and everyone was saying I could do it.

After an hour, I knew they were wrong. My body was telling me, over and over, that I needed to stop. Something was wrong and I knew I couldn't get my baby out the way they went in. But all I could communicate was the physical--"I'm tired" "It hurts" and finally, "I can't do this." My support misunderstood and tried to cheer me on, but I really felt like I couldn't go on and I was getting scared because the feeling that something was Wrong was growing until it was all I could hear from my body anymore. Another nurse even came in and tried to help me, encouraging me to get back into the squatting position and moving around, but it was finally too much. I was flashing from moment to moment, having difficulty focusing on anything and all I could think of was the need to sleep and the need to get the baby OUT.

I want to note here that if it weren't for my doula, my husband and even the nurse, I couldn't have made it through feeling as good as I did. As bad as things got, they kept me going and believing in myself until my body told me "good job, but this has to stop."

Finally, to express how serious I was, I got in the bed, lied down and just gave up and cried until they understood that I didn't mean it was just the pain and exhaustion. I was reminded that the alternative was a cesarean and in my head, I was answering with "Yes, I know, I NEED HELP," but I couldn't get it out. A nurse offered an epidural quietly and I wanted to say yes, but the words wouldn't come out. The things I WAS saying were awful, but I wasn't in my right mind by any means (why no one recognized this as transition is beyond me). After I had made the decision to have the cesarean, I was depressed and terrified and didn't care about anything. I was panicked and hated myself.

The worst feeling I had was that I let everyone else down, that I'd wasted their time. I felt like a failure and that everyone was just going to either be disappointed in me or say, "I told you so." But at the same time, I was thinking of my baby and that I wanted them to come out while they were still doing so well inside me and be healthy.

Now that I had nothing to distract me but my own feelings of guilt and failure, I was screaming through the contractions, barely conscious of anything around me until one nurse grabbed my face and told me to be quiet because I was scaring the other patients. I told her I didn't f***ing care. Then it was a blur until they were taking me into a room and telling me that my husband couldn't go in with me, so I started yelling at them. They ignored me (except to tell me to be quiet again) and yelled at me to get up on the table and sit still.

All I wanted was my husband's hand to hold while they shoved a needle into my spine, but at least I was "allowed" to have him stand in the doorway. They were worried about him making the anesthesiologist 'nervous.' Why the hell should I care and why should he be nervous if he's doing his job right? No one seemed to give a damn about me anymore, which reinforced my feelings that everyone was angry that I'd wasted their time and now they just wanted me out of there. This was the worst part of the whole ordeal.

They gave me a spiel about how I needed to be very still, even if I was contracting. So of course, my body started contracting HARD, when I had finally been in a lull. I had three contractions (and the first real urge to push) while the needles went into my spine and I held onto the nurse in front of me, desperately trying not to move. My whole body was shaking and I heard the anesthesiologist cuss and I thought he was mad at me (turns out, he was cussing about a piece of equipment breaking) then I felt what seemed like warm water all over my back and I was told I needed to lie down. I was barely able to understand them and then everything started rapidly going numb and I laid back.

Everything started to clear then. The pain, the confusion, the psychosis. I could think and finally relax. I was wheeled into the operating room and moved to the table. I saw the straps on the arm board and quickly reminded them that I'd stated no restraints in my birth plan and they responded that I needed to keep my arms on the boards then. Fine, I'm so phobic of being trapped that I had no problem complying.

They put up the blue screen, the doctors came in and I was tested to see if I could feel anything--I could feel something, but not pain. A minute later, I asked if he had started and he said he'd started 30 seconds ago. I asked a lot of questions, made jokes and enjoyed listening to the doctor hum as he worked. I kept reminding hubby to keep the camera primed (it has a delay I didn't want interfering with good shots) and asked a lot of questions which the doctor answered. Then, about five minutes after asking if he'd started, he warned me that there would be a strange sensation like someone sitting on my chest.

Indeed there was, but the feeling of something being pulled out of my tummy--which is what was happening, followed it. It was the oddest sensation of my life, but then nothing mattered because I heard the baby cry. It was the softest little voice, so deep and quiet and I started crying. It was my baby. Hubby was snapping pictures over the screen. Then, without warning, their head appeared above me and I looked into their eyes briefly as a drop of blood fell on my face, then they were whisked away and I shooed hubby off to follow them. I lied there and listened to them cry as I cried my eyes out. At 3:56 am, October 15th, 2006, my child, Lilly Rose, was born by cesarean birth.

(pictures: birth emergence WTF just happened?)

That was my baby. They came from inside me. They were real and really there. Even now I can't think back on it without crying, the emotions were so strong and powerful, which is so rare for me--I have a delayed response to everything. Not this. For once in my life, I felt at the moment something happened, not later.

Everything after that was just relief. They were safe and healthy. I heard the doctor say, "That's a big baby." And they were talking about their head being too big to fit. But they were also complimenting them and then they were being held out to me. Again, I was filled with that overwhelming mix of feelings--all positive--and just marveled at how soft their skin was. I wanted to take them, but didn't feel strong enough to ask. They were rooting already and time was frozen for a few moments and I got to touch them much longer than I thought they would leave them with me before they said it was time for them to go get their tests.



I told hubby it was okay for him to go with to the nursery and after he grinned lovingly at me for a few moments, my "Go, go!" got him to scoot off after them. I wanted one of us there for all of their first moments of life outside of me and I was okay with the two doctors working on me. One of them I personally liked and the other, the one who was doing all the work I had two positive opinions on and had found that I liked him upon meeting him earlier in the day. Now that I wasn't nuts anymore, the nurses were treating me completely differently--maybe they understood that I wasn't myself earlier and that I was just panicked.

I asked if I'd be able to try for a VBAC next time while the doctor was stitching me up and he said it shouldn't be a problem. I asked a nurse for Lilly's weight and length and she said that they were 8lbs, 7oz and 19 inches long. I asked after their APGARs and she said 9 and 9. I was later told that they just had purple hands and feet (which are still their cold spots).

It was about twenty minutes of stitching and stapling and then a few minutes of other tests and they were ready to send me to my room. They told me that they were going to roll me and it would feel like I was going to fall but not to panic or move because I wouldn't. Then they tilted me and it felt like I was stiff as a board and not like I would fall as they put a blue board thing under me, then moved me into another bed and wheeled me to my post-partum room, where my doula was waiting for me.

After a little while, Lilly was brought to me and after the third try latched on and sucked like a hoover! To me, they're perfect--more than I ever dared to hope for and the best thing I've ever done in my life. I love them so much I can't find the words. Recovery was hell, but every time I saw them, it was such a tiny price to pay.

There are always maybes--maybe if I'd waited an hour to push, I'd have been ready and could have done it. Or maybe if I'd waited, I'd have been too tired to do the pushing I DID manage. Maybe if I'd done all this at home it would have taken longer, but ended in a vaginal birth. Or maybe I never would have progressed without the pitocin. Maybe if I'd got up and moved around more things would have been different. Or maybe it would have worn me out faster. Maybe they would have come out if I'd been induced two weeks earlier. Or maybe things would have ended the same, only with me traumatized by the cesarean because I had too many interventions.

I don't care about the maybes, or at least, I'm trying not to. What matters is that I did 22 1/2 hours of natural labor and pushed for an hour and a half of it. I let them come on their own time and didn't end up induced. I decided when it was time for a cesarean and thought no one pressured me into it. Sure, I'm not happy being part of that too high cesarean rate in this country, but I'd have been even unhappier if something had happened to Lilly because I didn't listen to my body/instincts. They came out and blew their tests out of the water, outperforming most babies, vaginal or otherwise. I believe very strongly that it was the time I gave them inside and the time I spent laboring and trying to get them out that gave them such a good strong start in life.

All in all, I'm satisfied that I did my best and they did their best and we are here together now and they're so amazing that I still can't believe it. I love my little Lilly.




(Having had my VBAC, I now know that my body needed to progress past a 10 with Lilly and I was 'encouraged' to push too soon, which lead to the cesarean. Yes, maybe they really were too big in their hard skull--at 3 years old, it's almost the same size as mine--but I don't really think so)

(This has been further edited to fix Lilly's pronouns, as they were assigned the wrong gender at birth)