Pampered Pregnancy – Blissful Birth

40 weeks came and went for Valerie. Then 41. 1 day shy of 42 weeks was her scheduled induction date. I joined Valerie and Brendan a few hours after they checked in to find Valerie comfortable on a low-dose of pitocin. Valerie is the perfect doula student – she had read every hippy trippy birth book out there (which we love). She watched all of the required documentaries (The Business of Being Born, Orgasmic birth). She took all of the classes we offer at Get Babied and was as educated about her choices in birth as any mom could be. So Valerie knew the pros and cons of medical inductions, epidural anesthesia etc. She hoped that a little pitocin would get her to a place where her baby would be low enough for an artificial rupture, and the AROM would stimulate her own oxytocin where she could turn the pitocin off. This was the plan, and the plan worked beautifully. By mid afternoon Valerie was off of the pitocin, off of the IV, and off of the continuous monitoring, free to walk the halls and labor as she pleased. She was about 6cm and contracting regularly. Things looked beautiful for Valerie and the spiritual birth experience she was hoping for.

Val liked three positions for laboring – sitting on the toilet, walking the halls and taking contractions leaning against the wall, and doing a hands and knees position on the hospital bed using a ball at her head and Brendan and I at her hips for counter pressure. She would labor in a position for a good 15 minutes, and then as soon as she needed a distraction, she would choose a new position. Her positions were all different and used gravity to her advantage to get her cervix open and her baby down. Her hospital room was also set up so peacefully. She chose to have the lights turned low. She had yoga-meditation music on her ipod dock. Lavender aromatherapy lingered in the air.

Valerie entered transitional labor in a calm, peaceful, inwardly reflected, deep breathing state. When a contraction (we called them rushes in honor of Ina May Gaskin’s Spiritual Midwifery, which was preferred reading material in early labor) started she would breath deeply, close her eyes, and choose a mantra with the words open or relax or similar in her head. When the rush reached it peak she would use her voice in a very low grounded bovine (again thanks for the reference Ina) moan. She moved progressively to a cervical exam that put her at 9.5 centimeters. 9.5 is my pet peeve of the week it seems (Val is the third mama of ours this week with an issue of incomplete dilation). As a doula I knew that anterior lips and cervical swelling without pushing are often an indication of occipital posterior (OP) position of the baby – “sunny side up”. Immediately we employed positioning that would take any pressure off of the cervix (like squats and such) and moved to positions that created the most room for baby to rotate – hands and knees, lunges, and side lying. Valerie took each position in stride.

Brendan was a wonderful birth partner. He would hug and kiss Valerie to help maintain intimacy throughout her labor. When Valerie was having a difficult rush he would give her relief by doing a double hip squeeze, and when it was my turn to take over double hip squeezing he would be at her head scratching her scalp and playing with her hair, something she found soothing and relaxing. When the peaks of the rushes were intense, he would moan along with Valerie and remind her to take deep breaths, and to keep her voice low and body relaxed.

For most people transition labor (8-10 cm) can be between 30-90 minutes. Intense, but brief in relation to the journey of labor. For Valerie it was over 4 hours. Not once did she feel she couldn’t manage her pain. Not once did she ask for pain relief. She didn’t look at the clock. She just stayed in her zone and hoped that time would be on her side to get her baby turned rotated and engaged in her pelvis. After 4 hours Lisa Carlisle the midwife (of OBGYN North) actually recommended the epidural. Valerie continued on past this recommendation for an hour or so, but ultimately decided that it was time to change plans. The midwife was hoping the epidural would give Valerie a rest – she had been working hard for 15 hours and a rest might help her body relax. She also recommended turning the pitocin back on – while resting this would turn her contractions up a notch, and might also help in finishing that dilation. With a quick cat nap under her belt and within the hour, Valerie was feeling the uncontrollable urge to push. Her epidural was perfect – took the pain of the peak of her contractions away, kept the pushing pressure sustained, and she had full feeling and mobility of her legs.

Valerie pushed for about 45 minutes in alternating positions. She pushed on hands and knees and side lying – two positions that were comfortable for her, but also kept maximum pelvic room to keep the baby rotating. 45 minutes of pushing brought no progress. The midwife recommended another hour break, where Valerie could rest and the pitocin/epidural combo could keep working for her to labor baby down without Valerie getting exhausted. After another hour, Valerie needed to push again. This time we tried even more positioning; hands and knees, side lying, lying on back and pulling against a rebozo, and pulling out the squat bar to squat “Indian style” while pushing. 45 minute more of strong effective pushing still did not bring baby in to the pelvis. Val’s cervix was swollen even more, and the top of baby’s head was starting to swell.

Valerie working the squat bar

Valerie knew she was essentially out of options at this point, but I have to respect the nurses and midwives at NAMC – not once did any medical staff member even mention the word ‘C-section’. After the 23rd hour (literally) of labor the midwife told Valerie she could keep resting, and keep pushing – baby on the monitor was tolerating everything very well. If Valerie had the energy, she could continue as long as she wanted. But she was also a realist with Valerie – she said Valerie had tried everything she possibly could to get this baby out – and all of the things she had implemented one would think that this baby would be dropping out by now, and that more of the same might not make any difference.

It’s a beautiful thing when a C-section isn’t an emergency, and isn’t an ultimatum (“you can push for 2 hours and then it’s a C” – I seem to hear that attitude or tone from other doctors). Valerie had all of her options on the table, and it was her choice to elect to have a C-section. Many of us consider a C-section the end of the world. But to Valerie it was an empowered decision she chose. Valerie went in for the surgery around 5:30 in the morning, and baby Lilah Mae was born at 5:57, about 24 hours after Val had checked in. The C-section did confirm our suspicions – Lilah was OP and was not engaged in the pelvis. She was 8 lb 9 oz, pink, chubby cheeks, calm, peaceful (just like Valerie’s labor had been).

I met Valerie in recovery to talk about her experience. She felt that from beginning to end she had a spiritual and empowering experience. She had full freedom to labor the way that she wanted to. She discovered things about herself she didn’t know – how she had it within her to labor with intense pain and manage it on her own. She rediscovered a beautiful intimate connection with her husband whose hands were on her the entire time in a loving and supportive way through the end of her c-section. She felt a connection to her baby throughout labor and delivery and had time to get skin to skin contact with her right after her c-section delivery, and for a full hour of successful breastfeeding within a few minutes of arriving in recovery. I am so grateful to have had this learning experience, and to be reminded that a C-section can be a graceful, empowered and spiritual experience.

Lilah Mae Sterne born July 31st 2010