This is the story of how Nathaniel, my third baby, entered the world, as told by his mama. He was born naturally at Swedish Medical Center, after a transfer from Mountain Midwifery Center, our fantastic freestanding birth center.
The facts: 3 days of intermittent early labor, 5.5 hours active labor. Transferred to hospital after meconium present in the amniotic fluid. No complications from meconium - APGARs of 8 and 9. 8lb 0oz, 19-1/2 inches of perfection. Born four hours before the equinox. Golden blonde hair like a halo.
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Tuesday, July 21 (30 Weeks, 4 days)
I started having intense, painful Braxton Hicks contractions. I freaked out a little bit. These continued pretty much until the end of my pregnancy. I assumed this meant that baby would come very early indeed, but it was not so. Mostly it was just annoying and exhausting. I spent much of the third trimester running from the chiropractor to the acupuncturist to the massage therapist trying to feel better.
Saturday, September 19 (39 weeks, 1 day)
I was having timeable, crampy contractions about 3 minutes apart. They were very very mild - not painful at all. But they happened all day long. Finally I called the birth center in the afternoon, and after laying down and drinking water and "waiting-and-seeing," the midwife on call and I determined that I should go in to get checked. At the check, I was 1cm dilated, 0% effaced, and the baby was high and not engaged - the same as at my appointment a few days prior. So no new progress.
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| Last picture as a family of four |
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| Last bump shot at 39+1 |
T and I took the opportunity to grab a mattress run night and a final date-escape to the Hyatt Place Denver Tech Center just the two of us. It was very calming.
Sunday, September 20 (39 weeks, 2 days)
Contractions had petered out overnight but they started back up again, regular, timeable and more intense than the previous day. They started to be a bit painful. I called the on-call midwife in the evening. I told her that I'm going to bed to get some rest, but I was sure I would see her later that night. I then slept through the night.
Monday, September 21 (39 weeks, 3 days)
Contractions started up again mid-day, similar in timing and intensity to Sunday's. Determined not to overreact, I didn't call the midwife, instead waiting for them to get more intense and closer together. They never did.
Tuesday, September 22 (39 weeks, 4 days)
Upon getting ready for the day, I lost my mucus plug around 730am. It came with brown blood. I would have preferred to see pink or red, because I wasn't convinced anything was actually happening after three days of teasing. But the timing did remind me of
Clara's birth, and I was hopeful that it was finally time.
Knowing that it would probably be just another day like the previous three days, I went about my business. I had a chiropractic adjustment, got a pedicure, had an acupuncture session, and went to Costco. I had strong intermittent contractions starting around my acupuncture appointment, but they weren't in any sort of pattern. At Costco, I would pause in the aisles pushing my giant cart to let a contraction pass.
4:30pm: I get home from Costco in the late afternoon quite worn out. I sit down on the couch to take a break and expect the contractions to peter out. They don't. In fact they get stronger and I start timing them. They are intense enough that I need to breathe through them and get up and dance through them.
5pm: Travis arrives home from picking up the kids, and I tell him I think this is it. He needs to plan to go to the birth center sometime tonight. And I think we are going sooner than later, so he better hurry up and eat something. The contractions are strong enough that I feel like I want to vocalize a bit - this was a bit of a red flag for me, and I had been planning to make that the decision point for going in.
5:50pm: I call the on-call midwife, Tiffany. She tries to persuade me that it's still too early, but agrees to check me if I come in, and we can go from there. I ride down the canyon laying in the back of the Jeep in a pile of pillows. I have 4 contractions on the way. So much better than laboring in the front seat!
7pm: We arrive at the birth center. My check on arrival shows that I'm 3cm dilated, 50% effaced, baby engaged in pelvis, bag of waters protruding. I labor in the sling, and the contractions intensify. I'm singing, swaying my hips, groaning, breathing, doing horse lips. I feel like a warrior goddess medicine woman. The midwives mostly leave me alone because two other mamas are pushing. I am more than okay with this. In between contractions I get better acquainted with the student midwife and the doula on call. I feel like I totally know what I'm doing.
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| Warrior birth goddess medicine woman |
8:30pm: My waters break (SROM). I send Travis to tell them, smug that we didn't come in too early after all. The student midwife sees dark tinted fluid on the floor and says "meconium." On the next contraction, I pass more water along with a big glop of thick meconium - ew. They break the news that I need to go over to the hospital.
In some cases, meconium in the water means that the baby is in distress and needs out immediately. In other cases (like what would turn out to be mine) baby just gets impatient and can't wait to poop. Regardless of whether the baby is stressed or not, if there is meconium in the water, there is a danger of meconium aspiration that could cause breathing complications after birth. So between the "baby could be in distress" risk and the "danger of meconium aspiration" risk, meconium in the water is generally a case for hospital transfer.
They check me: I'm at 5cm dilated, 100% effaced. If I was at 8cm, they'd let me stay at the birth center and worry about potential transfer afterwards. But at 5cm... I'm moving fast and I'm a third time mom, but they don't know how fast labor will continue. I could stall. So we need to go.
I take the news well at first, take a deep breath, and tell myself I'm okay with this and I can do this. Everything will be okay. This is the best thing to make sure the baby is safe. They start to prepare me. The student midwife places a saline lock in my left arm, and I start to emotionally break down a little. The contractions are stronger and I wonder what I'll do without the sling. I'm kind of terrified they'll make me lay down, and I can't imagine laying down. I didn't write a birth plan because the birth center is the birth plan, so in between increasingly intense contractions, I start to mentally catalog all of the requests I need to make at the hospital. We request that the doula on call, Kari, come with us to the hospital, which is partially what she is there for. Since I'm progressing pretty fast and clearly in active labor, we'll take an ambulance instead of driving over. Midwife Tiffany says she's going to ride in the ambulance with me.
9pm: The ambulance is ready. I walk into the hall and there's a gurney set up. They are like, "We need you to lay down on that." I'm like, "Hell, no." I can't figure out how in the heck I'm going to lay down and get through contractions - it seems like torture. It takes a few contractions to get my gumption, but my rational mind prevails in convincing my primal mind that we really do need to do this, and I lay down on my side on the gurney. Tiffany climbs into the ambulance with me and holds my hand while we drive. Travis rides in the ambulance too, and does counterpressure on my back. Kari drives over to the hospital in her own car.
During the drive I can start to feel sacral/rectal pressure, which means "not yet but soon." I tell Tiffany the baby's in my butt. Tiffany requests the driver "go emergent," which is funny, because it's all of 4 blocks from the birth center to the hospital. They wheel me in through the ER and straight up to the L&D unit.
9:15pm: We arrive L&D. My check on arrival shows 6cm dilated. The nurses and deck doc introduce themselves. I jump off the bed as soon as I can and labor standing up next to the bed. They elevate the bed so I can prop my arms up on it. This works pretty well in the absence of the sling. In between contractions, I tell nurses and doc my "birth plan": I want to labor standing up or on hands and knees. I want delayed cord clamping. I want immediate skin-to-skin with baby, unless there are complications from meconium. Everyone is calm and accommodating. "Yes, we can do that. Yes, we know where you came from - we can do low-intervention birth."
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| Laboring in the hospital supported by Midwife Tiffany and Doula Kari |
I labor standing up until I really feel him moving down in my butt, then Tiffany and Kari suggest getting up on the bed on my knees facing the back of the bed, which they elevate for me. I rest between surges laying forward. I start to roar - I know he's close. Tiffany holds the fetal monitor on my belly and tells me in my ear that she's not leaving me. Typically the birth center midwives have to leave once the patient is officially handed off to the hospital staff in a transfer situation. She says "You're so close," but I already know that.
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| Pushing. I also gave birth just like this. |
I'm in transition or pushing - it's hard to tell at that point, and a lab tech comes in to draw some blood. My hands are shaking so bad and my whole body is convulsing with the force of each surge. But okay, buddy, if you want to try and stick a needle in there, more power to you. He leans across my face to scan my ID bracelet and his scrubs brush my nose - they reek of cigarettes. I throw him out of the room: "Get him out of here! He stinks!" He yells over his shoulder while running away, "Sorry! I'll get someone else!" (Spoiler alert: no one else came.)
Just a couple surges later, baby drops fast again, and his head is right there. I'm still wearing my birth skirt, so I'm pretty sure no one can really see that he's crowning, so I yell "Ring of fire!" to alert everybody in the room that they have about 30 seconds. A nurse calls for the doc to come in. I'm still facing the back of the bed so I can't really see who is there or what is going on behind me. I'm just all business - I want him out. I push his head part way out, and then take that impossible pause for him to get his shoulders around. I pushed the rest of him out in one big effort at 1005pm.
They caught Nathaniel upside down and cleared the meconium, got him to cry out, then handed him to me between my legs. I know I make short cords, and Clara's cord broke after birth because I turned over in the tub as the midwife pulled her up out of the water. Not wanting to repeat that situation by making a sudden movement, I waited for instructions before I turned around on the bed. Once they passed him to me and I was clutching him to my chest, I flopped over to deliver the placenta.
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| Just born |
Doc gently told me, even though it had only been a few minutes, that my placenta had already separated and the cord wasn't pulsing. He asked permission to go ahead and cut the cord. I felt very respected by the exchange. I took their urgency to mean they were nervous about my bleeding and wanted to get the placenta out and the uterus shrinking. Having hemorrhaged after Andrew's birth, I didn't really want to mess around, and knowing that those first minuts of delayed cord clamping are the most important ones, I agreed. Travis cut the cord. I delivered the placenta at 1009pm, and I reminded them that I wanted to keep it.
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| Daddy cuts the cord |
After that everything rapidly calmed down. Since Nate's vitals were great and there was no evidence of meconium aspiration, we were skin-to-skin for an hour before he got his exam. They respected that I didn't want him bathed and I was able to decline the eye ointment and the other post-birth interventions. Tiffany left shortly after birth after giving me a hug. Kari stayed with us until they moved us from the delivery room into the "Family Care" overnight room.
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| First picture with mom and dad |
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| My amazing midwife |
I stayed overnight. The OB cleared me to leave at 7am. Our pediatricians have privileges at this hospital, so Nate got to see Dr. Joe the next day and get cleared for discharge that afternoon.
On the way home from the hospital, we stopped and bought a Dairy Queen ice cream cake. Travis had it decorated "Happy 0th Birthday, Nathaniel." When we got home, we had a birthday party.
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| Meeting siblings |
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| Big brother |
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| Clara calls this "milking the baby." |
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| Birthday cake |
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There's a longer story that precedes this one, a story that doesn't really belong here. I will sum up for context. I came into this pregnancy feeling super confident about birth. Not only had I done birth twice before and had amazing experiences, but I had also gone through a significant personal transformation that resulted in my being more aligned with my own intuition than ever before. Coming from this place, we planned a home birth, despite our home being a slightly long 35 minutes from the nearest hospital in case of backup (not counting potential time to get an ambulance up and down our driveway). I saw a home birth midwife for prenatal care for the first half of my pregnancy, up to 25 weeks.
In the end, several things happened and it didn't work out with the home birth midwife. We joyfully and gratefully ended up back at Mountain Midwifery for prenatal care for the second half of pregnancy. At the time that we transferred care, Travis commented, "What if this is the time that we really need to be near the hospital?"
This whole pregnancy was rough for me. It was not as rough as many women have it, but compared to my previous pregnancies, which I have now discovered were relatively easy, this was rough. Having prodromal labor for three days was just the icing on the cake of it, but kind of summed up the irritating quality of the whole experience.
That said, once labor really and truly started, I felt like a pro. I was so happy to be in birth, to be doing the work, to be standing on the bricks. I felt like a goddess there, laboring in the sling, singing and mooing and knowing that my baby was coming and I was equal to this task. When my water broke, I smiled with knowing - yes, this is how it goes. This is how we do this. I am doing this.
When they said that we had to transfer to the hospital, it didn't even compute in my head.
Overall, it was absolutely the best possible transfer scenario I could have possibly envisioned. Everyone was safe, like a birth center birth with the security of hospital medical backup. Because everything was okay, I was able to get everything that was on my birth plan after all. My planned birth attendants were even able to stay with me through the birthing, even with the change of venue. It was a seamless experience.
But even though I rationally/intellectually know all that, and I am so, so happy with the experience I had, I am disappointed and sad that we had to transfer to the hospital. I cried in the first few days and some of the grief around it came up - that I didn't want to go to the hospital. I don't know if I'm finished processing all of it, but I'm trying to let myself feel the feelings without judgment, and without trying to convince myself that everything was okay.
It was also interesting just the difference in language used at the hospital than at the birth center. Obviously my individual needs and wishes for a natural, low-intervention experience were honored in the hospital, but it was evident that there was a intervention-heavy birth climate in place there.
I had no less than three nurses ask me "When is he going to be circumcised?" Not "Will he be circumcised?" but "when?" Nate was offered a pacifier for his hearing test without consulting me first. I mentioned to the nurse that Nate seemed to be having trouble latching on one side, but no offer of help or a lactation consultant was made.
In the rotating door of staff that came to my hospital room the next day, I had an anesthesiology person drop by to "check my epidural site." I told her I didn't have an epidural. She said, "Oh I know you don't have one right NOW. I mean the one you had for your childbirth." I was like... yeah... didn't have one. She stuttered, "So.. you... went natural? ALL natural? Um... okay... um... cute baby. Have a good day." I feel like I know plenty of people who go natural in the hospital, especially here in Colorado - why is this so shocking? And why can't they disguise their shock? It's so weird.
In the end, it was a wonderful birth experience. I am very glad that we were at the birth center originally, because transferring to the hospital from home was going to suck, and I would have had to do it because of the meconium present. I am very appreciative of the birth center births that I did have, and am even more convinced that out-of-hospital birth is best for me for low risk births.
And I am thrilled to have had the opportunity to give birth again. This is likely, barring divine intervention, my last time doing this. It has been so sweet to experience the awesome power of birth three times, and I'm struggling to find the words to express how much this has meant to me, and to my human experience.
For now I will say that I am super excited to continue to pursue adventure with my family in the next phase of our lives together. Onward!
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| Nathaniel "Nate" Travis |
Links:
Andrew's birth story
Clara's birth story
Birth Reading and Resources
Mountain Midwifery Center
Cocoon Birth, On-Call Doula Services
Doula Kari Gallinger
Misty Rauscher, Placenta Encapsulation
