File this under "childbirth." This may be considered graphic by some, with words like "perineum," but this story is meant to encourage, not scare. BTW, that's me and Joseph in the picture titles "black&white" in this same journal.
The Birth of Joseph William
I woke up Thursday morning, July 3rd 2003, at 5:48 a.m. experiencing my third contraction. I dozed through the first two, thinking I needed to get up and go to the bathroom, when I suddenly realized, these were the long-awaited labor pains. The last few weeks of our pregnancy had been difficult, and I became convinced you would come early. I was certainly big enough. But your due dates came and went with no signs of pre-labor. I was off work for the week of July 4th, and I began to mentally prepare myself for returning to work on Monday, still pregnant. I started joking, I wasn’t really pregnant, just very, very fat.
Starting about week 34, I began suffering from sciatic nerve pain in my right hip, and I could hardly walk. I started getting weekly massages, and they made me feel a little better. Week 37, I went to confession on Saturday, to mass on Sunday, and got the annointing of the sick on Sunday afternoon. We even got a bottle of holy water to sprinkle on the bed for good measure. By week 38, the nerve pain was gone (a miracle?), but my joints and leg muscles ached from your weight and the weeks of inactivity. Finally by Thursday of week 40, I felt my strength returning. Then on Friday, I fell at work and severely bruised my tailbone. I couldn’t sit, and began to worry that the tail bone would cause me excruciating pain in labor. I began to appreciate that you were a little late. It would give me some time to recover.
On Wednesday of week 41, I had my weekly appointment with the midwife. We discussed all the things we would do if you still weren’t here by week 42. Before the appointment, Sarah, my three-year-old, and I had spent a rousing hour dancing and playing instruments to Herb Albert’s Tijuana Brass. I don’t know if it was the music or the conversation, but apparently you decided it was time to come out, so I woke up Thursday morning in labor.
First I searched for a watch with a second hand, but I couldn’t find one. You’d think with months of preparation for your home birth, I would have taken care of this tiny detail. I finally woke up Frank, your Dad, to ask him to find his watch, which he did. We timed a couple of contractions and called the midwife, Karen. She had me call the second midwife, just to give her warning. I was instructed to eat something, keep in touch, and let her know when the contractions were five minutes apart, one minute in duration, and regular. Frank and I rushed around, getting me juice, making me soup, and preparing frozen orange juice chips. We called my sister, Sandra, first because she had an hour-and-a-half drive to get to us. Frank called my friend Julie in a panic, and told her to come right away, even though I told Frank that we didn’t need anyone to rush over just yet. I called Lisa, the massage therapist, and told her to clear her schedule, I was in labor.
Julie showed up first. I told her I was fine, so she left to get breakfast and a cup of coffee. Sandra showed up next, then Julie returned, then Lisa arrived. A period of female bonding ensued as we discussed ex-husbands, current husbands, birth experiences, kids, and home décor. Sandra was convinced she was pre-menopausal and having hot flashes, until I pointed out that she was sitting next to the crock pot with steaming water.
My contractions were strong and effective, but variable. If I sat up, they were four minutes apart. If I went to the bathroom, they came back-to-back, but then they were followed by a short mild one. If I laid down, they were 8 minutes apart. Sometimes they were 45 seconds, sometimes 90, so I didn’t know whether to call the midwife or not. She had told me she had an appointment at 2:30 and would come by afterwards, but around 12:45, I started feeling queasy, and suspected I was in transition. I called her and asked her to come check me before her appointment. She said she was getting in the shower and had to put on her makeup (she still thinks she’s going to make her appointment!). I said, “don’t worry about the makeup, no one’s got it on here!” In hindsight, I should have insisted she come earlier that morning, but I learn something from each birth. Besides we were having so much fun.
Karen showed up about 1:30, checked my dilation, and announced she wasn’t going anywhere, I was eight centimeters. (See, I knew it.) She put my helpers to work, calling the second midwife, heating blankets, setting up instruments, et cetera. I was having contractions, hot flashes, and a little nausea. Lisa massaged, Julie fanned, and Sandra wiped my brow with a wet cloth. I only felt my tailbone injury for a short time during transition as you descended, but it was just an achy, numb feeling, so I felt fortunate there. Soon I felt the urge to push, but you were in a poor position, facing the wrong way.
With my tailbone injury, I could not sit in a reclining position, so I tried pushing in a side-lying position. The midwife grabbed my top leg and sort of wrenched it back and forth, trying to get you to turn. We needed more gravity, so the midwife insisted I get up and told me that she was going to march me up and down the stairs. Well, I informed her that not only was I too nauseous to stand, but there was no way I was walking up and down stairs. (This is the labor talking.) She said not to worry, they were going to support me the whole time. She pulled me up and I struggled to stand, hunched over and nauseous.
Next began the “stair walk of torture”, and I am thinking, this midwife is nuts. Karen supported me on one side, and Lisa, the fortunately strong massage therapist, supported the other. Julie followed behind, holding a chub around my backside. Sandra walked behind, mopping up the mess. (Sandra was the one who thought she’d be too squeamish.) I have no idea where my husband was at this time, but I know he was there somewhere. Sarah, my three-year-old, was blithely watching television in the den. Four times they marched me up and down the stairs. Each time when I got to the landing, they had me squat and push with one leg one step higher than the other. This would be an unnatural position for anyone, but was darned near impossible for someone with 40 extra pounds on their belly. But Lisa and Karen held me up, and I marched, squatted, and pushed, protesting all the while. This trick of Karen’s seemed to work, and you turned around. Just shows you the advantage of having a midwife in a home birth setting. An OB nurse wouldn’t have taken me on such a walk, and an obstetrician would have cut me from stem to stern and yanked you out.
Karen led me back to the bedroom, and I decided I wanted to do the rest on the floor on all fours. They spread a comforter on the floor and covered it with waterproof pads. The rest is kind of a blur. My water broke fairly quickly. It was stained light green, causing me some concern. I pushed until I felt my perineum stretching. I followed the midwife’s guidance on when to push and when to blow. My arms and knees ached. It was hard, but I knew it would be over soon. As you crowned, I reached back and touched your head. Finally, with great relief, I pushed your head out. One more contraction and burning push, and your shoulders came out. The rest of you slithered out quickly, at 3:30 p.m. I turned my head to see the midwives working on you, alternately suctioning your mouth and giving you oxygen. The second midwife had shown up some time during the delivery, I didn’t know when. You weren’t breathing, but I didn’t panic, because I knew that it sometimes takes a minute or so for a baby to take its first breath. You were slightly blue, but a blue baby still has blood circulating. A white, limp baby is much more dangerous – it has neither circulating blood nor oxygen. Your umbilical cord was still attached and functioning. I looked up to see my husband Frank in the bathroom doorway. He looked worried. I looked back at you. The midwives were still working on you. I did not know your sex yet, so I reached back and lifted your leg. “It’s a boy”, I exclaimed. Then finally, you cried and breathed.
Sarah was in the room now. She beheld you just moments after your birth. They wrapped you in a warm blanket and put us in the bed together. I tried to put you to the breast, but you weren’t interested. Another contraction and I pushed out the placenta. I felt it this time, unlike with Sarah. I was sore all over, like I had been through a wringer, and I was still nauseous. They cleaned us up, and gave me a fresh nightgown. Sarah and your Dad got in bed with us, and we all snuggled a while. Still, I was a little disappointed that this birth hadn’t been the easy and relatively painless experience I’d had with Sarah. I didn’t have that same the sense of elation, like I’d just reached the mountaintop; I just felt sick and exhausted.
Thankfully, the feeling soon passed. Emptying my stomach helped. One by one the midwives and friends left, leaving just my sister and my family with me. I was just beginning to get to know you, God’s newest creation, Joseph William.
Conclusions on the Birth
Well, that’s the birth story of Joseph. As you have gathered, I chose a home delivery for my second child. Unlike with Sarah, I knew I was pregnant right away with Joseph. I had been practicing (the operative word here is “practicing”!) natural family planning when I conceived, and I could tell there was an immediate change in the mucous signs. I gave myself a pregnancy test and it was positive. Slowly we told family and friends. And then I procrastinated. I regretted two things from my first birth experience, and I wanted to figure out a way to put my lessons learned into practice. I had pushed too exuberantly with Sarah, causing tiny tears too small to stitch, and found myself in the emergency room in intense pain six days later. I eventually realized that not only was my enthusiastic pushing to blame for this setback, but the seemingly innocuous local anesthetic kept me from knowing when to stop pushing . The second thing I regretted was the early separation between me and Sarah. The nurses put her on an examining table naked, and then wrapped her up in a blanket inches thick before handing her to me. Then they took her away because she was too cold. If only they had laid her on me skin-to-skin and covered us both with a warm blanket, everything would have been fine. I read the books; I went to the classes; I wrote the birth plan; but I still found the medical care wanting.
I sorted through my options. I knew I did not want an ultrasound or amniocentesis, but I did want the alpha fetal protein (AFP) screening, which can indicate neural tube defects, Down’s syndrome, and the presence of twins; and I had a certain window of opportunity to make a decision. I could go the traditional route as I had done with Sarah and hope for the best. I could use the midwife from the same practice, but she might not be available when I went into labor, and I would still be subject to hospital policies. I had heard good things about the midwives at a different local hospital, but unfortunately, that hospital was not in my insurance network. There was another good midwife practice at a covered hospital in the next town, but it was a 25 minute drive, and I had concerns about my husband driving me. He has a neurological disorder, and though he drives, he doesn’t drive particularly well, especially under pressure. Additionally, I had never spent a night away from Sarah, and she still nursed to go to sleep. A hospital birth would entail at least a two day stay. As I had few risk factors, a proven pelvis, no desire for pain medication, and we were within ten minutes of two hospitals, we finally decided that I would get the best outcome with a home birth.
I had met a midwife by chance or fate that previous summer at a bookstore. I had taken her phone number, though I wasn’t even planning on having another child. What with a husband in poor health and working fulltime to support my family, my head knew that I didn’t need another person to take care of. My heart however, longed for a child regardless of logic, and thankfully God read my heart and not my mind.
I called the midwife, and we had a long chat. She explained the services she could provide, what she could not provide, her credentials, her experience with pregnant and laboring women, her experience with emergencies, and our responsibilities. Most importantly, she explained that while it was perfectly legal to have a child at home in North Carolina, it was illegal for her to practice direct-entry midwifery, and she could be prosecuted. Therefore, we would not be able to reveal her name to any health or legal authorities, and we would have to be careful revealing our plans to family and friends.
My husband had some reservations about the home birth, and after much probing I determined that he was afraid I would want pain medication and be unable to get any. I assured him that since I did not need any paid medication the first time, I would be just fine. My own fears centered around the baby – what if the baby needed emergency care, and we couldn’t get him to the hospital on time. I figured that any emergencies concerning myself, such as hemorrhaging or placenta-previa could be managed, but what if the baby wasn’t breathing? My fears turned out to be not completely groundless.
We decided to go with the midwife and the home birth. I was to see her regularly for prenatal care, but I had to find my own doctor for lab tests and emergency backup, and a pediatrician for the baby. First I tried the ob-gyn who delivered Sarah. I met with him, explained my plans for a home birth, and asked if he could provide lab tests, occasional prenatal care, and emergency backup. After consulting with the other doctors in the practice, he informed me that their insurance would not allow them to take me as a patient. I was nearing the deadline for the AFP test when my midwife obtained an appointment for me with an obstetrician about a forty minute drive away. This practice told me that they could not take any new patients, which I did not believe, and blamed their fear of malpractice instead, but they agreed to process my initial lab work. After that, I considered going to the health department and just not telling them of my birth plan, but it seemed dishonest.
After considering several family practitioners for the baby, a nurse friend of mine recommended a family doctor who was new in town and building a practice. He worked alone except for his registered nurse wife, and he had obstetrical experience, though he was not currently practicing obstetrics. I explained my situation to them over the phone, and they agreed to see me. At our visit, I explained that I did not expect them to provide my prenatal care or emergency backup, but only to perform certain prenatal tests at my request and to take the baby as a patient after the birth. They were both fine with this, and I transferred all my family’s medical records to their practice. It was one of the best decisions I ever made.
Would I have a home birth again? Probably. I’m convinced that that the U.S. healthcare system has over-medicalized a natural, normal process. With good intentions, they treat every birth like a major trauma, an accident waiting to happen, when the large majority could proceed with minimal intervention. Education is empowerment. Encouragement is confidence. I still have concerns about emergency care for the baby, but I had no post-partum perineal pain, and I was never separated from my baby, so my two original goals were achieved. I was quite comfortable laboring at home, and though the birth was not the gentle, beautiful experience I had anticipated, the outcome would have been worse in a hospital setting. I would have most likely been in a lot of pain from the episiotomy and the assisted delivery, and the baby would have been whisked away for emergency treatment. Everyone in attendance at my birth assured me that it was a wonderful experience for them, and thanked me for the opportunity.