Epic Birth Journey and the Midwife's Bag of Tricks

   The longest day of the year was celebrated in high style at Sacred Ways Homebirth, with one of the longest home births of the year.  Much congratulations and love to Ajay and Walker, who have given me permission to inspire others with their heroic journey into parenthood.  
    There is usually a big difference between the labor of a first time mother (primip) and that of a second or third or fourth time mother (multip).  Once you have given birth to a baby, the next one is remarkably faster and easier.  This spring my assistant Amber and I attended several multip births where we arrived, set up, hung out for an hour or so, and the baby came out.  Lovely, beautiful births;  happy families; midwife home for dinner.  Then came our first-time mama Ajay's birth.
   Ajay began her labor on Sunday afternoon.  Contractions were 10 or 15 minutes apart and Ajay did exactly what was best for her;  carried on with her day alternating between activity and rest.  She tried to "rest" at bedtime, but by then they were a consistent 10 minutes apart.  By 2 am she was uncomfortable and in a regular labor pattern, and made the call to us.  When we arrived I could see that her contractions were strong and in a good labor pattern, but that she had a way to go.  She asked if I would check her cervix, but I procrastinated and put her in the birth tub instead.  I had a hunch she was a small amount dilated, and I didn't want her to get hung up about that.  (Midwife trick #1)
    The birthing tub was just the thing for her.  She relaxed beautifully between the contractions, and moved through the water during them.  Walker got in the tub and held her.  It was dark, with candles lit.  We gave them privacy;  they got sensual and snuggly. (Midwife trick #2)  The contractions got stronger and closer;  a sign that the labor was progressing well.  At 6 am she got out of the tub and I checked her - 7 cms!   An hour later she felt "some pressure"  and wanted to get back in the tub one more time before pushing.  Two more hours of hard labor went by.  We checked again and found  - 8 cms.  That is only one centimeter more in three hours- ugh.  Ajay's progress had stalled.  I could feel that the baby's head was not down against the cervix because the bulging bag of water was in the way.  We decided to break it, which would bring the baby's head down and hopefully help finish the dilating.  (Midwife trick #3).
    With her waters broken, Ajay walked around and worked with the intense sensations.  I could tell she was losing steam.  We fed her miso soup, a whole bottle of Recharge, and put her back in the tub.  She was so tired, she started saying things like "I can't do this anymore.  This isn't working.  The baby won't come".  I knew that the baby could come.  She had in her favor:  1. The baby in an excellent position, NOT posterior.  2. an excellent labor pattern of strong, long contractions.  3. She had stayed well hydrated.  4.  The baby was doing great;  perfect heart tones, clear fluid, and movement.   But I needed to change her mindset, because I could feel that emotionally I was losing her.  I told her we would not make her do this forever, but let's give it one more hour to get to complete dilation.  I gave her a homeopathic remedy, caullophylum.  (Midwife trick # 4) Then I gave her affirmations to say with me, instead of  "I can't."  They were something like "I am allowing body to open.  My cervix is opening now."  I said it with her, Amber said it with her, Walker said it with her.  As she repeated the words, she relaxed and became centered again.  It worked.  (Midwife trick #5).  At noon there was just an anterior lip of cervix remaining.  I had her push mightily while I lifted the rim of cervix up and over the baby's head.  (Midwife trick #6) 
     Ajay is a strong woman, an Enloe  nurse I might add!  She munched some chocolate covered almonds (Midwife trick #7), downed another bottle of Recharge,  sat on the birth stool, and pushed.  She felt the pressure and she pushed and pushed and pushed.  She got up and pushed on the toilet, (Midwife trick #8) tried several different positions including standing lunges (Midwife Trick #9), and pushed and pushed and pushed.  The baby did not really budge.  At all.  After two hours.   In the hospital, this would be called "arrest of descent"  and a cesarean would be done for the baby "not fitting through".  Hmmmm.   I sorted through all the files of past births in my brain, to find one last trick.  I remembered a birth many years ago.  "Ajay, "  I said.  "Stop pushing now.  Let's have you take a break and just stand in the shower for a little while" (Midwife trick #10)  Ajay enjoyed the hot water coursing over her, and I guess she grabbed something and squatted during her contractions because after ten or so minutes alone in the shower she yelled " Something is bulging in my butt!"  Eureka - that something would be the baby!   I popped my head in, saw that progress had been made, and kept her in there another ten minutes.
     Back on the birth stool, we could see the baby's head peeking through.  The baby had come down through the bones, and was almost here.  With each push now, progress was made, although it was still slow.  We heard a deep drop in the baby's heart rate for the first time. We heard it again.  It recovered, but I told Ajay that it was time to just have the baby now.  Finally, finally, the head came through, the baby slipped right about, and Ajay's nine pound baby arrived.  He was dusky and his  breathing was labored, so we rubbed him up, talked to him, and let the pulsing intact cord keep providing him oxygen. (Midwife trick # 11) We gave him blow-by oxygen and his color turned a rosy pink (Midwife trick #12)  Once it stopped pulsing we cut the cord to take him in the steamy bathroom with the hot shower running full blast.  The hot vapor did the trick, and his breathing was easy and regular by the time he was ten minutes old  (Midwife trick #13). 
        Then Mom, Dad and Baby cuddled into bed.  Chicken enchilada casserole was warmed, and things were quietly tidied while bliss and bonding occurred in the family bed. 

  With that twinkle in her eyes and glow of her grin, would you guess Ajay had just labored for 24 hours?   Would you guess it took her 6 hours of labor to get from 7 cms to 10 cms?   If she had planned a hospital birth, she would be in surgical recovery, instead of here.  This is why home birth is important.  The truth is, women are stronger than one would ever believe.  Birth works, folks.   Now I am off call for a month, for family time.  Happy Summer!  

Letter to a First-Time Mother

  Dear New Mother-to-be,

   Your life is full of excitement right now;  joy and expectation.  You are feeling new life within you and when you tune inward, you can sense that you are a part of the great mystery of creation.  Many parts of your life may need shuffling around, requiring re-arrangement to make way for this new human, who will be joining our world soon thanks to your hard work.  Perhaps there is more stress in your life than you would like, in which case I pray for your peace of mind, and for easier times.  Taking good care of yourself is the number one job of an expectant mother - getting enough sleep, eating wholesome food, and cultivating joy and relaxation, all help to grow a healthy baby ready for a good and straightforward birth.

   Our culture is so complex and information-saturated right now, that you are facing all sorts of important decisions right from the get-go!   Will you find out the sex of the baby mid-pregnancy or not, will you have genetic testing or not, should you take hypno-birthing or Bradley classes, and on and on...  All the choices feel confusing  The biggest birth-related choice, the one that will provide the framework for all the other decisions and details of your birth experience, is this:   Should you use a hospital based provider (doctor or midwife) and give birth in a hospital, or hire a homebirth midwife and have your baby at home?

    Maybe you are just now realizing that you even HAVE a choice.  It is likely that your own mother went to a hospital when she had you.  Her mother may have given birth in a hospital as well but you can bet that your Grandmother's mother gave birth at home.  Hospitals were not used for birth until the 1910s in urban areas and the 1940s in rural areas, just so you know.  Before that babies were always, everywhere, born at home.  For ages, since the dawn of humankind.  But when you were growing up, birth in the hospital was the norm, and if you were like me, you never even HEARD of a midwife as a kid.

   But now, you are a grown woman, and a pregnant one.  Times have changed  again and homebirth is suddenly something to consider.  You are healthy and have taken relatively good care of yourself thus far.  You may have a vague distrust of doctors and the medical system, which you have heard is driven by the engines of the pharmaceutical and insurance industries  You may have relatives who have gotten sicker while taking drugs or treatments prescribed by doctors.  And now that you are pregnant you are noticing that SO MANY of your friends have had hospital inductions that ended in c-sections.  And if you ask around, you hear that in most U.S. hospitals there are 70-80% induction rates and that 32% of U.S. births end in c-sections.  This is probably true of the hospital in your neighborhood.  It is true of the three hospitals in our area.  Yikes!  In 1970 the c-section rate was 5%.  And we all turned out fine!  But what is homebirth all about?  Is it really safe?   It is hard to know where to turn, whom to trust.  What is the "right" choice?

   One thing I have learned in my work as a midwife is that there is no one-size-fits-all answer when it comes to pregnancy and birth. You are a unique woman, that baby inside of you will be a unique individual, and this birth will be uniquely your own experience.  Your task as a blossoming new mother, is to learn how to take in external information and then turn inwards and listen to your own inner wisdom.  That is right -YOUR  WISDOM.  You may think you don't know anything about this stuff, but your body knows everything it needs to grow your baby and give birth.  Say you close your eyes and imagine giving birth easily in a pool of water  and then picking up your baby and kissing her;  your body tells you something right?   It feels good, your body can almost feel what it would be like to hold your new baby.  And say you hear about a scary emergency surgery where the baby was barely saved, you can feel the fear and the anxiety in your body, right?  Pregnancy makes everything feel deeper, giving you the opportunity to really feel into your choices.  So I ask you to not just THINK about your choices, but FEEL into your choices.