By Patricia Blomme
I have decided to begin the birth story of my third child while waiting the active phase of my labour. At present, I have begun a slow process of contracting. Which is far different from the progress of my first two children. Needless to say, the phrase "no two labours are alike" plays out well here. But then again, this whole pregnancy has been so very different.
I sit here at my computer try to figure out what I want to remember about this pregnancy. It has been a very interesting one thus far, and only lately have I felt that primal readiness for it to end. Maybe this is what the slow start is all about. It is giving me time to reflect on all the feelings that I have encountered while growing this little person.
I found out I was pregnant less than an hour after handing in my last assignment of a two year perinatal nursing course I was soon to graduate from. The last semester was the most difficult, emotionally, and the one that challenged my birth beliefs the most. Being one who highly values the natural birth process; it was VERY difficult to see the medical model of birth so prevalent throughout this particular birthing system. I viewed my pregnancy as an example of how well and natural the process could be. I enjoyed being pregnant, and looked forward to the coming child, using the pregnancy as a model was not right.
My baby has decided to stay breech since about the 20th week of pregnancy. Every morning I wake up and feel that hard little round head bobbing just below my breasts. I have come to accept that this is the position that baby has decided to come out. During my 39th week I have tried various alternate therapies to encourage babe to turn, making sure that it is not my body that is impeding babe's rotation to a head down place. Regardless of what I do, baby stays as is (I will note that I refused an external version at 35 weeks due to the risks I know are involved with the procedure.) I have until the end of the pregnancy left baby alone to turn of his/her own free will. I also believe that baby knows the best way to come out.
This ultimately is a planned home birth. However, due to regulations, my midwife is not allowed to attend me if baby's preferred position to enter this world is butt first. That means transport, in labour, to a medical facility, where my main attendant of birth will be a physician. This does not make me the happiest camper. But, in working out my feelings about this over the last few weeks, the personal growth I have had to do, prior to birthing this baby, has evolved. The trust I have acquired in the baby and in myself has grown. I am coming to accept that what will be, will be. I am learning that in birth (in everything) there must be trust regardless of the situation. I am not talking about blind trust without education!!! I am talking about trust in myself to birth this babe the way I know I can, and the surroundings do not matter. As well, trusting the system (doctors and nurses) mean only well when they offer the care that they do. It is claiming my beliefs, and not allowing those beliefs to be smothered by fear (mine or anyone else's). I am learning that, it is by faith that I can accomplish anything. Even an unassisted breech birth if that is the case, or on the other hand, a hospital birth where by I will have to dodge the system's policies and procedures to maintain my autonomy in birth.
So for now, I sit here on the 10th of March 2000, in my 41st week of pregnancy. Waiting for the time when my body picks up the pace and speeds my child to my awaiting arms. I can hardly wait!!!!
March 11, 2000
Cathy and I were very jovial as we drove the distance home. Laughingly, we had a packed bag in the rear seat of the car, in anticipation of a highway birth. We were prepared for anything and the fact that my contractions went no where during the entire trip was a bit of a let down (just kidding). Actually, we would have been thrilled to birth in the car just the two of us!!!! Getting home we let everyone know that baby was still heads up and the day progressed as usual, dinner, bath time for the boys, and bedtime for all. I must have fallen asleep for a while after reading stories.
Labour began at about 11pm. I awoke to a contraction. I moaned through it. After two more, I got up to get Patrick's watch to time them. 11:27; 11:38; 11:47; 11:58. I call Cathy. It's time. 12:07 I call Sharyne. She says she is on her way. The contractions are about 60 seconds long, but who's counting. Labour has started, that is a given.
I woke my sister to let her know that the baby is coming. She has never been around birth. The closest she has ever come is the video of my second son Matthew, and that video was taken after he was born. She was overwhelmed, I think the intensity of the contractions was alarming to her. Seeing someone alternating between normalcy and pain can be overwhelming to watch, especially when it is someone you love with all your being. I had always wanted her at my births to help her see that birth can be wonderful. I have come to the understanding that I can not use my labours for anyone's good but my baby, and myself. This labour is not to be a lesson for anyone but me, just as the pregnancy could not be. In reflection, I see that it was best that she was with the children at home while the birth team went to the hospital.
Cathy (my best friend and doula) arrived, it was around 1am. I had already called Lynda too, and she was at the house soon after Cat arrived. Lynda documented the birth on film (and what a great job she did!) and was one of my labour support persons as well as a very close friend. Sharyne (my midwife) arrived at about 1:30am. All the women around me during this birth had spent many hours listening to my concerns and worries. It seemed that at every turn I encountered a stressor. This was a time of letting go. A time of acceptance. I needed all of them with me. I had anticipated having more women support attend me, but at the time I went with my feelings and only called the women that were most intimately associated with this event. I had also decided to have the boys present for the labour, my oldest stayed asleep during the labour, but my little one was awake. My memory of him is him standing at the bed room door with his hands over his ears saying "mommy you're too loud!"
Patrick (my hubby) was tending to the boys and just hanging out in the back ground letting the women do their "birth thing" while he nursed his flu. He has always supported my birth choices. From the birth of our first child to this one, he has always been there for me and never questioned my choices. He knows that home birth is safe. He knows that midwifery care is far superior for prenatal care of both emotional and physical well being. Patrick's role during my births is to just be there for me and share in the experience. I think in all it would be too difficult to put the task of labour support on him. So I never have.
During the early part of the labour, I was using a reliable comfort technique that I had used with both my previous births. Hands and knees. I had used this position during my first birth after being told that I would avoid back labour that way. Well as it turned out this was the only position I had to refrain from using due to the fact that baby had yet to engage in the pelvis, as was determined by Sharyne. She also assessed my cervix to be about 4-5 cms and very stretchy (stretchy to eight cms). My membranes were also bulging and, with no part engaged, the possibility of cord prolapse was increased. It was 2:30am. We decided to transport to hospital.
The choice of hospital was easy, and oddly enough, I had the choice. I had originally intended to go to the level 3 tertiary hospital close to my home. My big fear of that place was being viewed as a freak show just because I was birthing a butt first baby. I knew if I went there I would be treated as an abnormality and keeping the unwanted away would be a fight. I did not want to fight for my rights. I avoided another hospital due to personal reasons and opinions. Resigning myself to the fact that the birth would happen in hospital was when I had to place my faith in myself and the birth process completely. This is when I had to take all my beliefs and apply them. I was about to be surrounded by all that I warn other pregnant women about. I had to go inside myself and birth my baby regardless of the surroundings. Birth happens within a woman. The outside environment effects her only if she does not know how to go inside herself and find the path that will lead her through the birth experience.
I was very comfortable during the ride (except during contractions). Patrick lost his way a bit on the way there. Arriving at the hospital, which I believed to have the most liberal opinion of birth, and "checking in", was a hard thing to do. I, the home birth guru, was in hospital to birth. I did not want to be there. We got into the LDRP room at 3am. My birth plan was presented (and honoured about 98%!). I now regret not getting the room with the tub. It was nice that I was still with it enough to settle and get acquainted with the surroundings before the labour really got "Rockin' and Rollin'". There was no hustle or bustle at all. Mind you there was too much furniture for the room and I wished I had my king sized bed (which would have filled the room!!).
We waited a while for the medical team to acknowledge our arrival. The nurse, Carol, I remembered from a doula birth Cathy and I had attended last year. I had never met the OB before. The doctor assessed me, and Sharyne's assessment was re-confirmed. I was 4-5 cms dilated (still). The OB did a portable U/S scan (one of my small concessions at this point and I was really beginning to not care too much). He stated the babe was huge and suggested a section (what else!). I told him that I was not agreeable to his suggestion and that I would continue with the labour. A remark that he said made me somewhat scared but I over rode it with my faith. He said I was high risk and "what if the head gets stuck, then what will you do?" I remember telling him that I understood the risks, that I had spent a great amount of time researching this, that I was a perinatal nurse and not an idiot. "I will continue my labour" I stated.
It was the most intensely painful experience I have ever had. One hundred times worse than I thought it would be. I had back pain with every contraction and symphysis pain that felt as if I was being sawed in half. The back labour started about four a.m. I had to continue staying as upright as possible so baby would engage. This was not easy. I growled through each contraction. Always remember in to keep my face loose and voice low. It was hard to not tighten up down below when the sensations were so intense. I went to the shower a couple of times. It would feel good for awhile, but then the contractions were just not soothed by anything. I alternated the shower and kneeling on the bed. While on the bed I would try to sleep during the breaks. I remember actually being woken at one time by the contraction onset. Other than growling, I can only remember the words out of my mouth being "here comes another one"!
Amazingly, enough the labour was not much longer than that of my other labours (approx. 5 hours). The difference was the intensity. I believe that the labour was a bit more difficult because of the place and the restrictions it entailed (space, furniture, and the woman in the next room). I also believe that if I had been at home my mind would not have kept wandering to the great big medicine chest they were more than willing to lay open for me. At one point, even the caesarean section was beginning to look good. I drifted away from that fantasy with the thought of having to spend time on the postpartum ward (No thank you). I just wanted it all over with. I was getting tired and I stated that to my birth team. All I wanted to do was sleep.
At the height of transition, I began to have thoughts of sympathy for all the women who have laboured in hospital who experienced what I was going through, and did not have the committed birth team I had. I, at that point, understood the futility of birthing in hospital and staying drug-free.
My team was incredible. I could do what I needed to do, calling out as I pleased for something, never having to wait. I am sure they all went home with sore arm muscles, from having to place counter pressure on my hips and lower back for what seemed hours and hours. There were times that they actually hit the spots so right on that the contraction sensations were dulled to a warm sensation in my pelvis. I can truly say that these women are the ones that carried me through the last part of my labour. Their commitment to my wishes, and me was outstanding. I can hope that other women will find such support when they birth their children.
My biggest concern birthing breech was that I would have the urge to push before my cervix was fully dilated. (This, as I have researched, is the one main reason the head of a breech can get hung up (stuck).) I remember Sharyne kept commenting on how well I was dilating with just the bag of waters applying the pressure to my cervix. I could feel my bag of waters bulging inside my vagina when I reached down to check myself. I remember feeling grunty when indulging in the shower for the last time (Sharyne had to get me out of bed as I had been there for over an hour). My time and space is very blurry about events during this time. I did eventually get back into bed after awhile, the grunting continued. Giving into the urge to push when it hit. At one point, it hit and during the contraction, I pushed out my bag of waters INTACT. It was the weirdest feeling. It did not break until two contractions later. The fluid was clear. The doctor came in to assess me and found my cervix to be completely dilated. HOORAY!!!!!! I could now push, the end as near. I continued in a kneeling on the bed position to labour, eventually getting up and standing at the bedside.
I began "active" pushing at 7:30 am (as in I could really feel baby moving down). INTENSE. My most favourite position was, standing at the side of the bed with one leg up on the bed; the other planted on the floor. I was reaching across the bed, hanging onto my hubby's hands, and pulling as I was pushing out the baby. During the pushing, everyone had to play tiptoe through the meconium!!!!! I was all over the place so everyone really was at risk!!! I kept feeling the sensation of baby rocking back and forth with each push. I would get babe to one point and then feel her retreat. It felt like I would be pushing forever.
Once babe was on the perineum, I was guided onto the bed. The doc needed me to be in the "usual position" on the bed to do his part. This was not easy. My back hurt so much; I had Cathy place her fist under me to give counter pressure. During some of the pushes, I grabbed her so hard I think I hurt her neck. Sharyne was guiding me verbally; her voice was so distant. It seemed like everything was so distant, except for the burning sensation down below!!! I just remember pushing and pushing and pushing, the burning would just not stop. I now wonder what it would have been like if I was upright. This was the only part of the birth where I really feel that I wanted assistance. Because the only person with this experience was the doc, I again had to concede to the position that the physician needed me to be in to birth the child the safest way he knew how. I am very curious as to how it would have gone had I been at home with a midwife experienced with breech birth.
Once the body was born, (She came out mooning everyone in the room!!!!) I felt such relief, only to be brought back to my senses when I looked down and realized I still had to push out the head. I remember thinking of the doc's comment about babe's head getting stuck. I could not feel a contraction coming, so I gathered up every piece of strength left in me and without a contraction, I pushed the head out. I birthed her with no injury what so ever (not even a scratch down below!!) to her or I.
Angela Lorren Blomme entered the outside world at 8:05 am. Her full length is 21 inches she weighed 8 lbs 11ozs (3948gms).
Angela was shocky and they wanted to take her to the resuscitation team. I refused to allow them to cut the cord. However, as the video shows as soon as I was not looking, the doc clamped the cord. I called out to Angela that she was beautiful and I encouraged her. She lay on my chest looking at me with deep pool eyes. She was with me. We were still one. It took a few minutes of stimulation to get her to fill her lungs. The relief in the room was very apparent. She stayed on my chest while everybody left the room. She was assessed after a few more minutes, dad watching over and comforting her. I was made comfy and Angela was put to breast. She nursed as if she had been doing it all her life, and continues to do so today. At 48 hours old, my milk supply was already at maximum in the one functioning breast.
Of note, I would like to mention that during the pregnancy I kept having an odd feeling. I did not know what it was about but stated that when I saw it I would be able to identify it as such. Well, I thought it would be baby being breech. What it ended up being was the cord had a velamentous insertion (which means that the cord inserted into the membranes with the bare arteries and vein coursing through the membranes and then into the placenta). I do not know if this was the reason Angela did not turn, but I bet it had something to do with it.
I am thankful to the hospital personnel. They honoured my birth plan to a degree that impressed me. I know I had to make some changes to my wishes, but I am very happy with the experience as it was (I still wished it had been a home breech birth). I do not blame the doctor for wanting to perform the caesarean; his faith in birth is that of a medical mind. I understand that and I have no regrets about his care of me. He cared for me, as he knew how. The nurses were wonderful and, amazingly enough, they were not strangers to me. Though I did have to have a new nurse for the last half-hour of my labour, (no, not all nurses stay when the end is near). In addition, I was given no opposition for wanting to leave as early as I did (4 hours after the birth). But, then again, I had my team around me.
I have evolved from this experience. I can truly say that the women that I teach from this point on will benefit from my birth. My empathy for their experiences, past and present, has grown. My passion for assisting women to have empowered birth is even greater. I have learned what it will take to change a system that is stifling the natural forces of birth.