Week 40: Birth

The birth story of my second child had its beginnings in many places – in the birth stories I heard from my dad who was a natural birth advocate and family doctor in the 70s and 80s, in my mom’s telling of her three births, in my doula work, and the coaching and guidance I have given to women to help them understand, observe and love their bodies’ power.

This story also originated in the abuse I endured during my son’s birth two and a half years ago. That experience shook my belief that others would view me as a full person and treat me as if I were a person. I was yelled at and my body was manhandled and injured as if it were nothing more than an ordinary and disposable object. All of a sudden I understood how many ways our society treats women as not fully human – in feeding rape culture and domestic violence, in denying women basic health care, in perpetuating the pay gap and female poverty and then blaming it on women themselves – but I also understood that other groups are also systematically denied humanity. Children, mentally ill people, people of different colors and religions, trans people, anyone with a bit of gender nonconformity – the list goes on. I suddenly had a small glimpse into the kind of treatment these people face every day.

I couldn’t help but see the issue everywhere I went and it made me want to act. I wanted to make an impact for other people, but I also I knew I wanted a second child and would have to confront this in a very personal way, possibly before I could do any work for others. I started blogging every week of my pregnancy, and I determined to see it through although I did not know what kind of birth I might end up with. I strongly considered that unassisted birth might be the only way I could protect myself.

As you can read in the posts I wrote over the last 40 weeks, I thought hard about what was important for my safety, and I thought about what might be more important than safety. I did birth art and meditation, and wrote affirmations. I interviewed nearly every midwife in the area, and grilled a hospital OB on informed consent. Eventually I came to trust my midwife and her assistant on a level I have trusted few people in my life – my rock climbing partner, my wrestling coach, and my high school English teacher come to mind. And after all that, I gave birth, and wrote this story.

***

I had been having Braxton Hicks for over a week, and occasionally one or two felt a little crampy, but none of them felt real. One night I felt a few that were more crampy, and thought I might go into labor that night – but I got in bed, fell asleep and woke up in the morning like normal – as I’d been doing all week.

That morning I felt weird, almost hazy, and the Braxton Hicks continued. This was a little unusual since they usually happened at night, but I had been getting signs of impending labor for so long, I ignored them. I did feel distracted, and asked my boss if I could take the morning off because I was feeling “weird.” I texted with him and decided to accompany my husband and son to the morning playgroup.

When we got to playgroup I started chatting with someone, but soon realized I could not concentrate on anything she was saying. I arched my back, eyes glazed over. I said, I don’t know how long I’ll last here! And I laughed a little. Two contractions later I did not laugh and I said we have to GO NOW. Our friends said they’d watch our son until the end of playgroup and we said we’d send a neighbor to pick him up.

As we left I burst into tears. I felt like a supernatural force was gluing me to where my son was and I couldn’t believe I was considering leaving him, at the same time as I knew I had to get home. All I wanted to do was hold him and not let him out of my sight. I felt despair, down to the bottom of my being, at leaving him there. I wanted him with me, wanted to protect him, I felt afraid of what was about to happen, and the memory of trauma rushed through me as I feared for my life and his. But somehow I tore myself away and tottered down the block, crying and holding on to my husband. In the car I started moaning and thanked God it was only a 10 minute drive home. I told myself to trust our friends, our neighbors, and the wonderful people who had promised to watch my son while I labored.

Once we got home I made a beeline for the bath, stripping as I went. My husband had a list of tasks: call the neighbor to pick up our son, call the midwife’s assistant, call the midwife, turn the heater on, turn up the hot water, make a fire, etc… He only managed to make the calls. Even then I was in denial, unsure if we should ask the midwives to come yet.

By this time I was lying on my side in the bath between contractions, moaning and growling, doing horse lips, anything I could. He pressed on my back but the counterpressure wasn’t as helpful as it had been during my first labor. It seemed like nothing eased the sensation for longer than one or two contractions. Pouring water on my back helped for exactly two contractions; counterpressure helped for another one; horse lips helped for about three; changing positions helped for another one; a gloriously passionate kiss got me through two more; more hot water helped; and they just kept coming.

I got out, thinking that peeing might be a good idea, but I couldn’t pee. I saw some bloody show and flashed back to a birth I’d done as a doula where the woman arrived at the hospital and saw bloody show, and thought she was in early labor but was actually in transition. I couldn’t be there yet, I thought as I watched my arms and legs shake uncontrollably.

I got back in the bath. My husband did whatever he could, he answered the phone and the midwife said she was on her way, he poured water on me, he did everything. He made noise and stopped when I told him to, turned the water on, turned it off when I told him to. He was a hero but I was barely conscious of him. Then all of a sudden I reared up out of the water kneeling – “it’s pushing!” Something inside me bore down, it wasn’t even me, and I took shuddering breaths to try to slow it down.

The pain bloomed through my back again and again, I caught my breath and tried to ease the pressure of the beast that made me grunt and hold my breath. I tried to breathe instead of grunt, relax instead of squeeze. But something was squeezing ME. The bearing down happened at the top of the contraction, and my muscles worked hard, hard. The midwives might not make it, I thought. I put my hand over my vagina, and it felt perfectly normal – I thought, ok, so maybe it won’t happen for a while. There’s nothing inside there!

Then a monster wave rushed over me and I chanted “surrender, surrender, surrender,” over and over. In the darkness deep inside my body, a sliver of a sphere began to emerge, like the light of a planet coming into view from dark, lightless space. It was a sliver, a half moon, deep inside, I barely felt it with my hand, my perception of it was extrasensory. It was otherwordly. It was a thing not myself.

It came pushing down, pushing itself forward like a sprout growing up through the dirt or the sun coming over the horizon. It burned fire through my bones as it spread them apart, and I surrendered, surrendered, surrendered. It had a purpose and a direction. It began to flow into my hand, round and slippery and textured, like the earth coming into being. It’s going to come out I thought, I don’t want it to come out. And it suddenly filled my existence, pushing my bones apart and filling my entire hand, as time stopped.

Time held still and I floated there for an eternity, the unknown consciousness paused on its path towards the world, as my fingers explored, slowly under water, all the way around the enormous circle that my vagina had become and the texture of this slippery sphere. I felt my smooth, stretched tissue with wonder. It’s not going to tear, I thought. Is it? No, it won’t. I breathed in slowly and it slid out with a sucking sound.

The midwife and her assistant walked in. I looked over my shoulder to see her beautiful smile, and I said “I love you!” She sat beside the bath and I feared her gloved hands. “Don’t touch me!” I said. She didn’t. “And don’t touch my baby” I added. She breathed and sat. The assistant smiled at me. “I love you too” I said to her.

The  midwife asked, “Can I touch your leg here, so this muscle will relax?” I said “Ok, you can do that” and she stroked my leg with the gentlest touch. An arm came slithering out. “Don’t touch my baby!” I said. “I’m not touching it, it’s coming out,” she said. “Relax this muscle, right here,” she said. I felt the other arm come out, so soft, so slowly. More of the body came slithering out in a slow motion tumble, silky, velvety. I felt a pull. “Don’t touch my baby!” “It will fall, can I help guide it so it doesn’t touch the water?” “Yes, that is ok,” I said, and the whole body came out, round-limbed, and the little foot was the last part I felt inside myself as it slipped through.

“I want my baby! Give me my baby!” I said and it was handed like a warm gray animal through my legs, my eyes half open. This is how life begins.

***

My healing from my first birth has been a constant process since the day my son was born. Many pieces of me had to be put back together. I wasn’t counting on my second birth to heal that experience, change my feelings about my first birth, or have anything to do with it – I thought the two experiences would remain separate. But this second birth has healed pieces of me I didn’t realize were still broken.

It is like for the last few years, I have been looking at the world through a cracked glass, and I became so accustomed to it that I stopped noticing the crack. And now the crack is gone and everything is so gloriously whole in a way that I had forgotten it could be.

The way I inhabit my body has been healed. Sadly, as a result of the abuse I came to view my body as something that others with power and authority could gain access to at any time, for any reason. I walked with fear in my body, especially in cities. I felt that there was no way I could ensure protection, I felt anybody could be a threat. In a way, my body wasn’t mine anymore. I knew in my mind that it was strong, but in my heart I felt it was fragile.

And now I know why it was so important for me that the midwives did make it to the last two minutes of the birth. I am also certain that this healing is not a result of circumstance, the relatively smooth labor or luck. Even if I had had a complicated pregnancy and birth, my midwife still would have upheld my autonomy as she did. And that was the key that unlocked the sacredness of my body and the fighting spirit to know that while living is dangerous, I am still a person worthy of respect. It unlocked a sense of my body as MINE and allowed me to reclaim it, and to reclaim completely my ability to say yes and to say no.

Even though I know to the depths of my being that I can always say yes or no, having someone else demonstrate that she values this as much as I do gives it more meaning in the wider world.

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Week 39: Midwifery vs. OB models of care

I am shocked at the differences between midwifery and OB care. The 39 week appointment is always a time of trepidation for me as a doula and for my clients. It’s the appointment where providers order ultrasounds to check for low amniotic fluid and to measure the baby, or more often, talk about results of sizing ultrasounds done the week before. It’s the time when they start talking induction, big baby, possible c-section if the baby seems “too big.” It’s the time they evaluate cervical dilation which always ends up being not enough, no matter whether it’s 0cm, 1cm, 2cm. It’s when they schedule that 40 week or 41 week induction. It’s the time they start warning that the baby hasn’t dropped yet or hasn’t engaged, or is posterior, or isn’t in the optimal position.

There is a lot of work for a doula to prepare a client for this onslaught. I always try to have a conversation with clients to suss out how they feel about induction, to remind them the sizing ultrasounds and dilation checks are their choice, to find out if there are important questions they want to be asking about any of these interventions the OB might be scheduling. This often leads to long phone conversations on these topics, emailed articles from Evidence Based Birth or VBACfacts.com, discussions of evidence if they are interested, explanations of what induction might entail, lists of questions to ask the provider. The debrief after the appointment is often disappointing because they only had 15 minutes and didn’t get to talk in depth about what they wanted, or because they simply agreed to all the procedures out of fear, fatigue or not wanting to rock the boat so late in the pregnancy.

I have had midwifery care before but have never been to the 39 week appointment because I had my baby early. I had that appointment this week. It is striking how laid back and easygoing it was, and I can’t help going over and over in my head the raw emotion I would get from my clients after their OB 39 week appointment. The midwife measured my belly, listened to the baby for a second, and took my blood pressure. After that, we chatted about life, how I was feeling, possible heartburn remedies. She asked if I wanted a reminder on how to know when to call her when I was in labor. And then, we ended early and I went home.

I can’t believe these two types of providers are seeing people for the same thing.

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Week 37: informed consent

Informed consent.

I had the GBS screen but didn’t have the results yet (later came back negative), and I asked my midwife what her recommended protocol was if it should come back positive.

She said this: “I don’t have a protocol. I will tell you what the standard of care is here in the US, and I will tell you what I think the benefits and risks are to that approach. We can talk about alternatives, and I will tell you what I think the benefits and risks are to those alternatives, and we will talk about your preferences. Then, you can think about it and let me know your decision.”

What if every OB said that for all the things they recommend, induction, sizing ultrasounds, etc. It would be amazing.

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Week 36: A flashback

People talk about how the birthday of a child born violently can be triggering and traumatic – but I have not had this happen with my toddler’s birthdays. It seems to me that his birthday is his day, and my trauma is elsewhere.

Well, I seem to have found the day where it resides. Today – week 35, day 5. That is the exact gestation when I went into labor with him and now this pregnancy has reached that same day, and I can’t stop thinking about his birth.

I feel out of control, depressed, on the verge of tears. I keep having flashbacks to my labor, to that spiraling, out of control, terrifying feeling of having black vultures flapping their wings all around my head and razoring me with their beaks.

And when the vultures were gone, my broken, bleeding body all alone, my baby elsewhere, isolated, fed by an anonymous nurse from a bottle. Like Chinese water torture, they would bring him to me and I would hold him, not knowing if I would have an hour, or two, sometimes three, before they would come and take him again. Not knowing if he would be gone for one, two, or five hours.

I don’t know if it would be better or worse if there had been any actual medical problem with him or with me. Would I feel better, knowing that he needed life-saving procedures? Would I feel better, knowing that the hospital was the only way one or both of us would come out alive?

I don’t know – maybe I would feel worse. All I know is how I feel, which is that I was beaten and lacerated and violated, and my baby taken from me, as a part of standard hospital practice when NOTHING at all was wrong with either one of us. That, for me, is the most frightening part.

I can only hope and pray it will be different this time, but again I am terrified to have people around me.

I just don’t want anyone around me.

I had done so much work, good work, to overcome the fear and build trust. But now I am so flooded I don’t want to see anyone, I don’t want any person to be near me when I am in labor.

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Week 35: No big deal

Amazing – I had the GBS test and the midwife had me do it myself. No big deal.

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Week 34: Don’t touch me

I’ve been introspective over the last few days, ever since I realized that much as I trust my midwife, I’m not ready to let her touch my vagina, and may never be. And even I have had to convince myself that that’s ok.

This may sound strange to many people, especially in the US where birth is highly medicalized. Even in less medicalized circles, the vagina is still a central focus of pregnancy, labor and birth. Except in the rapidly growing number of countries where c-sections make up a majority of births… A whole separate topic…

But although the vagina is the passage through which the baby comes, it’s just one part of the entire process, a full-body, full-mind dance whose complexity is not completely understood. Just read Sarah Buckley’s recent publication on the intricate hormonal changes of late pregnancy and birth.

Assessing cervical dilation is the most common reason women allow OBs and midwives to touch their vaginas. I could write a whole blog post about why dilation isn’t always the best way to judge labor progress, and I could write another post about how the action of judging progress, even if it were reliable and accurate, isn’t helpful or necessary in many labors. Luckily, someone already has: https://sarahvine.wordpress.com/2010/03/07/how-dilated-am-i-assessing-dilation-without-an-internal-exam/ and http://midwifethinking.com/2011/09/14/the-assessment-of-progress/.

There are other reasons people put their hands there. An asynclitic head position, or otherwise problematic lie can be diagnosed and even ameliorated by an experienced practitioner. Sometimes a nuchal arm is preventing descent and can simply be moved out of the way. Breech maneuvers are sometimes necessary to deliver a trapped fetal head. And hands can prevent tears, particularly in a speedy or uncontrolled delivery.

Back to me… I started to get very nervous when I considered my upcoming prenatal appointment during which I am supposed to have the screening lab test for Group B Strep. It’s a simple swab of the vagina, done with a q-tip, and some providers swab the anal area as well. The closer the appointment got, the more anxious I felt. My history doesn’t allow me to just let a medical person touch me there – it seemed ludicrous in retrospect that I had been assuming that 34 weeks of pregnancy would have erased that trauma. It also started to seem ludicrous that simply being comfortable with someone and having developed trust over those 34 weeks would likewise eliminate the re-triggering potential. It didn’t. The trust is there now – but the old triggers are still there too.

I do want to be screened for GBS. I want the opportunity to make a decision about antibiotics for me and the newborn if I should screen positive. I then found out that many midwives and even some OBs have their clients self-swab if they choose to. And I realized through this thought process how insanely important it is to me that I have the choice to do it myself. I’ll be asking to do the swab myself, and if my midwife is opposed to it for some reason, we’ll have to have a long talk about why.

Nothing is absolute and I love my midwife for helping me realize that too. She is perfectly happy to respect my boundaries and also gently brought to my attention possible situations where I might want her hands on, like some I mentioned above.

My real epiphany came when I started thinking about a potential hospital transfer. The most important thing to me is that no one touch me there, including as I am catching my baby. My husband thinks it’s a little unrealistic to expect that my wishes would be respected in a hospital, but I actually trust my backup OB and have heard from at least one other person that he is trustworthy. My midwife also has privileges.

Perhaps it is unrealistic, but I do imagine being able to create a protective buffer zone around me; I have my “affirmations” and statements at the tip of my tongue; I have my hospital birth plan – really need to print those – and I have something I didn’t have before this whole GBS freak-out. I have conviction. I have the conviction that there are very few reasons to let someone into my vagina, and that it’s a part of my body that I can plan to protect, that I am absolutely allowed to NOT ALLOW anyone into.

I have the conviction that preventing myself from being triggered or re-traumatized is worth it, is worth going to the trouble to get something that so few birthing women think they can have, or want. I have the conviction that it’s OK for this to be of paramount importance, and that it’s also OK for others to think that’s absurd. I have the conviction that if a situation arises where a midwife or OB’s hands on my vagina would be in my interest, that I myself can make the decision in the moment. I have the conviction that barring an emergency, this is something I can accomplish no matter whether I give birth at home or in a hospital. And that gives me immense comfort.

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Week 33: A trigger

Ok, now I am freaking out just a little.

I was sort of psyching myself up to the GBS swab for this entire pregnancy, and also sort of ignoring it.

Now I found out there is not only a vaginal but an anal swab too. I don’t think I can handle letting someone do that, and thinking about it just makes me feel completely triggered and like I want to avoid the entire thing.

I don’t know if my midwife will be ok with it, but I am feeling now like the only way I could handle doing this is to do it myself.

What are my options? I could:

– Forgo the whole thing. This means I won’t know my GBS status and if I transferred to the hospital they’d assume I was positive and dose the baby. If I had it at home we would keep a close eye on the baby for symptoms, just as we would if I were positive and declined antibiotics (which I feel like I might).

– Ask to do it myself. She could say no.

– Skip it this visit and try to do it next time. If I went into late preterm labor then this might weaken an argument for having a 35-36 weeker at home. Would it?

– Just do it.

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Week 31: Poem for mother blessing

In the form of a pantoum and whimsically adapted from some birth plan musings:

 

Song of Welcome

 

This is my song of welcome

Where once I walked alone

I ask you for protection

I want you to hold my space.

 

I once walked alone

And I still make my own way

But please still hold the space

For my monkey mind, my goddess.

 

I will make my own way

Help me surrender to life

To my inner goddess, monkey mind

Help me give in to nature.

 

Help me surrender to life

And protect me from birds of prey

Help me give in to nature

Keep away rapists and lightning.

 

Protect me from birds of prey

Don’t cut unless we are in danger

My body, my baby, my choices

Honor me by letting God in.

 

Nothing will be cut unless there is mortal danger

I long to know birth without violence.

Honor me by letting God in –

Autonomy, spirit, community, then safety.

 

This is my song of welcome and love

With you I feel safe

I long to know birth without violence

I want you to hold my space.

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Week 30: More birth art/meditations

IMG_2133

Me as a tree

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Me as a mountain

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Me as the atmosphere

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Week 29: Transformation

I want to explain more clearly why I have been considering unassisted birth. I have considered it to be my safest realistic option because I have not trusted birth attendants, and while I fantasized about finding someone trustworthy, I acknowledged that it may not happen. I believed it probably would not happen. I interviewed every midwife in this area and chose the one I had a good feeling about, and embarked on prenatal care hoping that she would prove herself to be trustworthy and that we could develop a relationship where I would desire to invite her into my birthing space.

I would never commit and be “dead set” on unassisted birth at all costs, the same way I would never be “dead set” on out of hospital birth. There are scenarios, such as the scary zone of prematurity combined with viability that I mentioned before, in which a hospital would be my choice. There are also scenarios, such as with a birth attendant who upholds my autonomy and acts as a trusted advisor, in which an attendant would be my choice. Up until this week, I believed that in the absence of a medical issue requiring a hospital, the safest thing for me would be to birth unassisted with just my husband and perhaps a trusted friend.

I believed (and still believe) that the meddling and intervention of professionals following guidelines and protocols without my best interests at heart could potentially create danger for me and my baby. Certainly my previous birth, in which my baby and I were put at grave risk and I was seriously harmed, colors my perception of how likely this would be. Still, observation and assessment are not benign and even a trained midwife, in the absence of relationship, would not necessarily have my interests at heart.

At the same time, I believe in supported birth and I believe in the training and skills of a midwife. If I believed that a midwife would be there primarily to help me live my values, rather than protect a license and run a business, I would absolutely want her there. But my standards were very high. I was looking for the kind of relationship that could be compared to a climbing partner you’d trust with your life; I’ve only had one of those. A coach who deeply inspired her star athlete to push herself – I’ve also only met one of those. I didn’t think I could find a relationship of this quality and depth in a mere nine months.

So, a miraculous thing happened.

I can’t say exactly what moment or statement made me realize it, but after the latest prenatal visit I understood to the depths of my being that my midwife and I had created a relationship. We talked about various aspects of birth and what she does – hands on or hands off, what she encourages women to do or not do. It became abundantly clear that she understands what I need and that she is constantly seeking to understand what I need in each moment. It also became clear that she loves me. I don’t think I’ve received this level of care and attention from anyone other than my closest family and friends.

So I’ve decided to consider inviting her into my birthing space when the time comes. I also am going to plan a Mother Blessing ceremony because I finally feel that I am ready to welcome the blessings of others.

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