Birth story

Before I start I wanted to say how vunerable I feel sharing my story as a birthworker- the pressure to have this “ideal” birth is something we put on ourselves. My birth was definitely not perfect, but it was mine and my daughter’s and I have great support. It is a story of advocacy and strength and adjusting the sails. If you are a current/previous/future client- please know my experience in no way changes my views or care for you during your birth, all experiences are as unique as the person, and I support you no matter what you choose- even if it wouldn’t be the same choices I made. xoxo

Background-

Team: Lily (Mom) Carter (Dad) Lisa (doula/work team) Jess (birth photographer/work team)

Providers: midwives at magee as primary care, consulting with generalist OB and Maternal Fetal Medicine (for history of brain lesion to clear me for a vaginal birth and anesthesia if needed, hypertension, depression, and hashimotos)

Labor preferences: shared decision making that is evidence based, calm, informed consent and choice given to me along the way of all of the options, as physiological of a birth as possible. The less intervention the better, but if I get interventions I would like choices presented. Overall we were able to have these things honored, it went nothing like we expected but birth hardly ever does. I’m mourning the experience I could’ve had if I was lower risk. The first lesson of parenting is patience and surrendering control right?

Our trust in our team made all the difference. We were able to adjust the sails of our preferences with support and informed consent and lots of love and hard work.

Medical indication for induction - I have chronic hypertension discovered my first trimester (typically patients like this are induced at 39 weeks) knowing first time parents go into labor usually past 40 weeks, I was hoping to go into spontaneous labor or do a very gentle induction method to encourage labor to start. The biggest worry about this is that you are at higher risk for pre-eclampsia, high blood pressure that impacts organ function and can lead to organ failure. I was walking a fine line as I turned 37 weeks my labs gave signs of concern….

Jumping right in-

Tuesday 7/5 36.9 I went home after being in triage for high BP, and to run pre-eclampsia labs- the doctor’s mentioned if I get a few above 150/100 to call, the labs were holding steady for now.

Wednesday 7/6 37.0

I went to the chiropractor and came home, felt a bit off- I took my BP a few times and got high readings, my midwife advised me to come in for another NST and more labs, they wanted me to bring my things for staying just in case- but knew that I have some high BP issues in early pregnancy which only warranted induction at 39 weeks- unless other indications presented. I called my doula and let her know my gut feeling- cried and released control over the inevitable- I was looking down the barrel of an induction when I had hoped to desperately to go into labor on my own.

- I knew we would be heading into the hospital so we make arrangements for the dog and i called Carter to head home. I got my bag together and my thoughts, reminding myself I can remain flexible and have overarching goals, any birth can be beautiful and I have great support.

We headed to triage at 3pm where I saw a familiar face, Laura one of the midwives at Magee- she re-pulled my labs and knew my wishes were to allow labor to start on its own, I also asked for a cervical check. I was 0cm, but had a soft cervix (70% thinned out) that was more anterior (good), but baby was high in my pelvis at a -3 with likely lots of waters. A decent starting place for a first timer at 37 weeks!

My labs came back, my platelets were dropping and my preeclampsia labs had jumped from the previous day, although not in pre-E ranges yet, it was significant.

Another friend/colleague Dr Zen Rosado came in with Laura and we chatted. I trusted my care team to give me all the options and their honest opinions.

They strongly suggested inducing as things were trending downward- especially platelets (this can be a sign of potential HELLP syndrome) , so we decided to stay for induction around 6pm.

7-8pm I started feeling crampy from the check, which was exciting things might kick off enough to be dilated for a foley balloon (next steps) -We started pumping / having my own contractions every 2 minutes but they were mild. I asked if we could do misopristol to get my cervix a bit more soft in hopes I could get a foley and avoid pitocin if miso was an option, unfortunately it wasn’t an option because I was contracting too frequently on my own.

We prepared for a long night in triage but quickly got room 22! (My favorite to work in as a doula, massive handicapped room at the end of the hall and very quiet)

We ate some dinner and I laid down hopeful that I may get some rest before contractions picked up, thinking maybe they’d check me in the middle of the night, put in a foley and I could rest more.

7/7:

3am i fell asleep after contractions fizzled out, my BP had to be taken frequently and the cuff woke me up every time, I was on continuous monitoring which made me pretty anxious because of the work I do, I was watching for dips in heart rate and high BPs-we decided to sleep a bit more then do a check at 7am when there was a new midwife on for the day. My doulas checked in on me throughout the day and night giving advice and affirmations while i was waiting for my body to get with the program.

6:30a I woke up very anxious in morning, thinking about all the things that could go wrong, baby was okay but i hadn’t gotten rest and was starting an induction on a bad night of sleep, my BPs were climbing from my anxiety and I got a headache from the lack of sleep. Because those are two signs of pre-e they were concerned. I had a lot of anxiety and threw a few high BPs which made our team more concerned.

We did a cervical check and sweep, the Foley was placed at 10:40am

I was 1cm when checked, open enough for the Foley and immediately got much stronger contractions. (More pinchy and sharp than my body’s contractions earlier)

8am-4pm walked the halls, did circuits to get contractions going, called my doula a few times for suggestions, walked in the courtyard with carter and did some of my hypnosis tracks (I am actually certified in HypnoBirthing instruction though it has been a few years since the training, it was so helpful as the foley contractions grew stronger and stronger) Between Lisa and Carter and Jess I felt like i had such great support for my anxiety- any time it creapt in they were great at giving me reminders to breathe or suggestions. 4pm The midwife said my earlier high BP's from this mornings anxiety are concerning and she may want to start magnesium and possibly transfer care to the MFM team.

I advocated to keep monitoring bp closely because i was having anxiety when earlier high BP's were recorded, my headache went away, and I really wanted to birth with my midwife team. Can we consult with MFM and see what they would consider the diagnostic criteria and where the transfer of care must occur, is it a fuzzy line of chronic hypertension and anxiety? We wanted to be reasonable and safe so we all agreed- one more elevated pressure and we could start magnesium (to prevent seizures from high bp) and transfer care. (I had two BPs over 150/110 during my anxiety spell in the morning. One more bp and I was looking at a transfer of care and being put on seizure prevention protocols. )

I was in a better headspace now because I felt like my labor was progressing as contractions got going and my bp wasn’t as high went I was able to walk around outside and calm down.

We do a check, foley is super close to falling out, contractions were very pinchy and felt pretty intense, Foley balloon falls out around 7:30pm with a gentle tug, relief! I’m 3cm! My cervix is doing it! My body is doing it!

We decided to eat dinner before any other interventions were added as I was still laboring on my own without pitocin or miso, so we went for a walk at 8:30pm and ordered some food, I updated family and continued to labor on my own.

1am I got some unisom and Tylenol in hopes I could rest with the peanut ball while still having contractions and making progress (peanut ball can open my pelvis and get baby lower!)

7/8: (a tough day emotionally, labor stalls, lots of talk of cesarean and criteria for failure to induce.)

I woke up a few times throughout the night surprised I was resting through contractions and actually getting sleep.

With unisom I didn’t feel my contractions because they were more mild once I was laying down, midwives are super happy with my BPs and baby looks great/ going to have a solid breakfast, and a walk around the courtyard then kickstart the induction back up with either breaking waters or pitocin (depends on how low baby is if it is safe to break waters that is probably what I prefer) my cervix is super favorable now and receptive to induction, just going to do a cervical check once I’m done with breakfast to make a game plan!

Check showed I was still at 3cm where I was the night before :( baby has a hand by my cervix and isn’t applied well enough to make changes- getting into active labor (6cm) is the biggest challenge for first timers, and I knew going into it- this part could take days.

They can’t break the waters because of the hand (if the hand Came through the cervix id need a section. The midwife pinched baby's fingers in hopes they’d retract- but they didn’t.) so the only option is to go up on pitocin, I cried about the larger need for pitocin being our last choice as I was hopeful to avoid it but realistic that plans have changed and we are needing to get things moving so pre-e labs/BPs don’t get worse. They went up on the pitocin very slowly so I could try to go without an epidural, my plan was to use nitrous oxide or laughing gas for intensity relief originally.

I decided I was open to an epidural if the pitocin was rip roaring and as a tool for progress/exhaustion, but didn’t want it yet.

They also found that My cervix is also behind my pubic bone so that may be another issue why baby isn’t well applied. But I had a ton of water so the babies head is floating not applied. Carter did a forward leaning inversion with rebozo with me so I could hopefully move baby’s head off my cervix and give them room to move their hand. Our beautiful nurse Emily braided my hair and just about every nurse that came in the room guessed “girl!”

Lunch time- Pit is at 4. (Goes up to 40, and can turn up gradually by 1-2 every 30 minutes if baby and mom are doing ok)

Afternoon- I had carter doing some different doula techniques on me that Lisa suggested, I wanted her to come later on because supporting virtually was good for me right now- I knew it could be long even once we were more active. Side lying releases and sifting in hopes it would get baby to come down

We walked the halls, the koi pond court yard, and gardens, things got more intense, we did a “pit break” for dinner and a walk. I saw a few colleagues who would stop by and wish me luck. It was so nice to see familiar faces.

Dinner time- My preeclampsia labs continue to tread upwards, but stay out of range, I’m getting some talk about cesarean if things don’t move which is frustrating because I’ve tried everything, and the contractions aren’t at a point where they are able to make cervical changes right now, so I need to give it a chance- I am not even in active labor yet. I was given feedback they “try not to do super long inductions” so I was pretty upset/ of course I didn’t want it to be long, I agreed to pit, and have been a good sport about intervention so far…

Doubt crept in- Just not sure if because I’m 37 weeks my body will just have trouble dilating past a 3-4cm point? I guess we will see. The pressure to speed things along was also apparent. (Not sure if it was coming down from a management standpoint or what- but it seemed to be a theme that we were going “fast enough”)

That evening we decided Lisa my doula will join me in the morning at 7am for the next check. My body was tired already from a day of pitocin contractions after the foley contractions previously. I was ready for in person support, emotionally and physically I knew a lot hung on this next check. I wanted to try to avoid checks til then unless something feels different, I was still nervous about the nuchal hand and my contractions were ebbing and flowing between bareable and needing to cope- checks aren’t great for my anxiety. I was listening to my gentle birth and HypnoBirthing soundtracks which helped a ton. Still haven’t felt like I needed to use nitrous for pain relief yet as I was trying to save the interventions for later- I did get a shower which was glorious.

7/9:

2:30am Woke up from a little nap feeling a little nauseous and shaky. (Yay? Progress?) Vomited and nurse gave her some Zofran as well as upped pitocin to 13. More BP and testing and blood draws all night long.

I asked Lisa to come in for 7am. I was nervous about this next check and if it would change the game plan

7:15am midwife Stephanie does a check, No more nuchal hand “thank god” I sighed with relief and was so so happy to see Stephanie after a discouraging night 🙏🙏🙏. I was 4cm and more thinned out. My Doula was there now, pitocin is on 13. Lisa and I sent carter to go eat breakfast and take a walk. I was able to have my waters broken so things could get moving with the hopes of not needing any more pitocin and maybe even being able to turn it off, waters were clear- which is good!

Laboring with pit and waters broken, feeling more pelvic pressure with contractions all afternoon. Laboring on the toilet leaned over pillows and got another shower.

4pm the midwife comes in for a discussion about epidurals, this caught me off guard, I was only planning on asking for one for rest or relief when/if I desired it, now they were bringing it up? They expressed a concern with low platelets. Lower platelets - limits the window they could place an epidural, the worry is if they drop more then I need a cesarean, they aren’t able to place one for me….then I’d need general anesthesia and a tube down my throat, I wouldn’t be able to be awake for the delivery and carter couldn’t be in the room.

I told the team- “I’ve wrapped my head around maybe needing an epidural for rest or relief- I’m not at that point yet- and I’ve never considered needing it for platelets so I need to consult someone who knows more about this because it is a weak spot in my knowledge as far as the physiology around the platelets being an issue for an epidural”

6:30p We consulted an anesthesia team member, I really wanted to use nitrous which I realized would be for the table if I got an epidural catheter placed. I wasn’t at the point where I was even considering intensity/pain relief because I had been coping well with hypnosis and my team support.

I decided let’s place the catheter and not set up the continued dose right now. They placed it with extra local anesthesia so I wouldn’t feel as much of the placement, Did a test dose to make sure it worked, then didn’t hook it up to any more medicine. I remembered my neuro team mentioning I was cleared for an epidural as needed- that the risk for paralysis due to intracranial Pressure wouldn’t be an issue. But of course it was all I could think about, luckily we had a great team and the senior anesthesia resident did an awesome job. I told him when I do want the epidural to be dosed for either rest or pain relief from the high dose pitocin- I wanted to control how much I was getting. (Usually they do a continuous drip baseline epidural medication then you can push a button for extra. I asked for no continuous drip and just to program the button push for a partial dose 10-20% or so)

After a small nap from the practice dose, I continued to labor through back to back very intense contractions by morning, I remember feeling very tuned in mentally and spiritually. My birth playlist was crafted of a lot of music from previous births I attended, some of my favorite songs from our wedding, some of my friend’s favorite songs who passed away my first trimester, and songs that reminded me of people I loved. I had affirmation cards and Twinkle lights up and just remember feeling so glad we could make the room our own. (Daughters by John Mayer came in at one point and my eyes ran like faucets as I was working through the contractions, leaned over shoving my face into the CUB birthing stool. I had always had a feeling this baby was a girl, and felt so tuned into her in that moment)

7/10-

This morning- Jess joined us for birth photography and to help with our birth.

At this point- I had so many monitors on I could barely move or turn without getting tangled. Carter was doing a great job getting me water, food, drinks, Lisa was rubbing my back and feet and Carter and Jess were doing hip squeezes with their full body weight into me while leaning over the CUB (inflatable birthing stool/ball) They could not push hard enough- it felt like my pelvis was separating from my tailbone with each contraction, of course with the pitocin this are much more intense. I had hot flashes and begged for a cold cloth and water- I prayed I was in transition.

I remember telling lisa and Jess I wanted the tens unit up higher but they mentioned it was on max. I got the epidural partially dosed- and felt like THIS must’ve been transition (the hardest part of labor) or that the pitocin needed to be turned down because they were back to back non-stop and I couldn’t get above water.

I felt like the epidural wasn’t working- but also it probably was just the combo of the low dose epidural and the high dose of pit that didn’t bring much comfort. (The feedback loop of a natural labor increases your body’s natural pain relief hormones as the intensity of your labor increases- that doesn’t happen when augmenting labor)

This part was really rough… I felt like I was in the thick of it. I remember tearing up and crying to my team, “I dont care if I was too numb to push it felt like my pelvis was trying to rip apart with a vice grip” both of my doulas interrupted me and said “yes you do care if you are too numb to push. You can do this take it one at a time”

Carter squeezed my hands and midwife Laura came into offer a check to me around 10am.

I was really feeling like I was in another dimension. It felt like this hardest part lasted 10 hours but also ten minutes.

Laura announced I was 9.5 cm with a lip of cervix left (a thickening part on one side, I asked her if she can hold it back so I can push during them, it felt a lot better to add pressure during contractions and bare down a bit.) she was able to and we jumped right into practice pushing. My mental block cleared a bit and I didn’t feel as panicked.

I reminded Laura I had a preference for no men in the delivery, carter to catch the baby and announce the sex, and for forceps to be used rather than a vacuum if she decels at the end and doesn’t come back up with positioning chances. . (All reasonable requests and good to discuss prior to starting to push) I wanted to try tug of war pushing, side lying, leaned over the Cub, and get the feedback from my team that I was pushing in the right place. My doulas said I was pushing well on my side, and moved her from 0 station to +2. But I felt much more intuitive when I was leaned over, and felt the urge to be more in a squatting position if possible. After about two hours of pushing- the midwife came back in and said myself and the baby had high heart rates, even after a bag of fluids, she needed me to stop pushing and rest for a while.

I told her we need to have anesthesia come in and push something stronger then for this push break because I cannot NOT push. We did that (right after I lost my mind on the anesthesia resident that tried to consent me during a contraction while I was ripping the bed rails off- read the room) and I was able to catch a small nap before the midwife came in again.

She mentioned I spiked a fever, time to push now, baby looks okay on the monitors- but we need to have this kid soon, and an hour after delivery she/he will need to go to the NICU. 😭 Also the pediatricians will need to be at the delivery as well. We are already expecting her to come out a little stunned, babies take a bit longer to start to cry even though they are doing just fine - if the mother is on a pregnancy safe antidepressant. Which I was, so it wasn’t a shock to me that the peds team would want to take a look at her quickly now with spiking a fever. (Fever was 100.5, cut off for nicu is 100.4 of course) Laura left the room to help someone else in a different L&D push their baby out- so I pushed with my nurse and doulas.

Lisa put the CUB up on the bed so I could sit on it inbetween pushes, during contractions/pushes I grabbed the squat bar and got into a deep squat. My left knee has been injured twice so this didn’t feel great but I felt like muscle recruitment of my pelvic floor was the strongest in this position. After about five contractions I could feel pressure in my ischial spines.

I imagined adding pressure to them in the 3&9 position on the clock, and gave it all I got. The nurse quickly told me to slow down and not push (acknowledging that is so tough) that she could see the head and she paged the midwife and peds all in the same breath.

I blew out horse lips and reached down to feel her head in my hands, the nurse asked me to lean back as midwife Laura walked in the room to help catch bare handed. Carter was asked to hit the staff assist button and because it was so fast he couldn’t catch, he almost forgot to call out the sex too. Lisa looked at Carter as the baby was in Laura’s bare hands (no time for gloves) and said “do you wanna tell Lily what the baby is” and he said “I completely forgot” then looked down and looked at me and said “ITS A GIRL!” With tears in his eyes. ❤️ She was breathing and blinking and pinking up but not crying so they cut and clamped the cord after about 45 seconds and whisked baby off to the warmer to give her a few breaths to help her get started. This part I was expecting so it wasn’t traumatic to see her needing a resuscitation, I knew it was just for a precaution and I asked her heart rate to be reassured she was okay, 110, then a few minutes later- 150. I told carter to go talk to her and he went to the warmer after giving me a kiss.

I was so thankful she was out, the placenta delivered uneventfully, I only needed one stitch (Laura said not even a first degree tear) and Jess did a print of the placenta on the back of my birth plan in the room before they sent it to pathology- due to the fever I couldn’t take it home .

She was born at 6# 9oz 6:06p 7/10 20.5 inches.

After a few minutes- They brought her over and put her on my chest and I immediately smothered her with kisses and raspberries on her neck and held her up to get a good look at her.

I was so relieved she was here, so thankful to have had her arrive vaginally after so many twists and turns, and so grateful she was ours.

We did an hour of skin to skin then went over to the nicu for her evaluation, after about another hour she did skin to skin with dad in the NICU then we all wheeled up to the postpartum floor and started our journey as a family of three!

(I lost 750ccs of blood a bit more than expected so I asked for an iron infusion and labs to be drawn postpartum which I’m very glad I got!)

We got the news back she didn’t have an infection (from the fever the concern is chorio which can be dangerous for babies) and we were discharged in two days. Soaking in our little lady with lots of love and support, warm meals and helping hands!

Amelia’s Birth Story --7.10--