Leo's birth story (IV and done).

Parts I, II, III.

V___  checks me and says, "You've got a bit of a cervical lip."

"Oh, no, not THAT again," I grumble fiercely.  In two of my previous labors, J____ manually pushed aside the "cervical lip"  -- an edematous bit of cervix persistently blocking the baby's descent -- while I screamed through contractions.  It's the worst part of any of my labors.  I brace myself for V____ to tell me that's what she's going to do next.  

But instead she says, "Just try to breathe through the next one, try not to push.  Just breathe through it."  This is novel.  I pant and try to stay open, neutral.  I carefully skirt the reflex that hovers on the edge of my consciousness.  It doesn't hurt not to push, it doesn't frustrate, it's just difficult.  I almost make it, but at the end my control peels away and the push spills over.  The expulsion reflex distends me, and distends my voice as I say, "Oh, sorryyyYURGH--I can't help it."

"It's fine, you did fine," comes V____'s voice from behind me.  "It's almost gone.  Try that again with the next one."

I do, losing control at the end again, and:  "It's gone, you're all done.  The lip is gone."

I'm so pleased not to have had to endure the lip-shoving again that it doesn't quite sink in that I am, so to speak, cleared to push the baby out.  But it is not many more contractions before I know we are almost there.

I made the notes only five days later, and oddly enough by that time I had already forgotten the pain of crowning.  I remembered the stretching, but not the pain.  The baby crowned to the brow over the course of one contraction and stated there till the next one, and that was new and intense -- staying there so wide and full, and me expecting the next push would bring me past that.  That moment of waiting.  And the next one did bring me past that:  his head was out.  I hoped for the shoulders to follow.  They didn't.

Here we are.  This is what I had been expecting from the beginning.

Mark told me later that he wasn't worried at that moment, because what he saw was that the baby had turned; he was not anterior anymore, he faced up as I labored on hands and knees.  Hannah told me later that she saw no sign of worry on the midwife's face, that she set her face as if to say, "you're coming out, baby!" and then she got to work.

Put your knee up.  I put one knee up.  Mark comes to my side to help.  I reach out to Hannah and cling to her and push again.  My face is in her hair. My breath comes in and out in prayers, my body pushes out the prayers too, I could not stop them if I tried, it is good that my lips have formed them so many times before.  V_____'s hands are working on the baby. (Later she told me:  "I really got in there and lifted your sacrum up.")  I picture a ship in a bottle, rattling against the neck.  I can feel his bones sliding and pushing against mine as she works on him, turning and adjusting this living key in the lock.  It occurs to me that I should try to push harder, so I do.  

It takes a couple of minutes. They are long minutes for me.  Hannah and Mark are able to see that V_____ is still firm and determined and unworried, and so they aren't worried.  I can't see this and although it has not risen very high in my mind, because not helpful, I am a little afraid.  Still there is a certain peace in that there are no decisions to be made, no possibility of doing the wrong thing, only to do what I am doing as hard as I can, and there is no possibility of doing it less than as hard as I can.  From here on out, it's not possible to make a mistake.

I push hard, trying to keep my balance, and clutch at Hannah's hands.  My eyes are tight shut.  I can feel V____ wrangling with us.  Finally, with a last violent yank he is freed, and I fall a bit forward onto Hannah and kiss her hair and say, thank God, thank God, thank God -- and the baby squawks immediately, loudly, and I can't say anything but thank God, thank God, thank God, and then my head clears a little bit and it's as if my own good self wakes up, and I say to Hannah, "That's a command, you realize," and she says "I know," and then oh, how I enjoyed listening to that baby squall.

The cord is very short and I am kneeling on my bathroom floor.  I can't see the baby, he's behind me.  We can't quite pass him forward between my legs.  After some struggling I am maneuvered over the baby onto my back leaning on Mark (the floor presses painfully against my lower back and tailbone) and the baby is on my belly, squirming hotly, while V____ busies herself between my knees, doing I know not what.  There is a picture of me from these moments, my face is relaxed and blissful and radiant, more than anything else relieved and tired.  

I am really uncomfortable, but it is difficult to maneuver with the cord so short.  We decide I will stay where I am until the cord is cut, and then I will make it to the bed.  After it stops pulsing, I watch V_____ carefully clamp it in two places, bring the curved sharp scissors around it (I resist the impulse to tell her to be careful of his toes) and cut.  Then it is time to move to the bed.  I release the baby to Hannah and am helped to my feet.  

While we are working on getting me upright, Mary Jane wakes up sleepily. She stares up at Hannah in bemusement and asks, "Hannah?   Why are you here?"

Hannah tells her, "I'm here to meet someone new in your family.  Who do you think this is?"  Hannah whispers to her, lifting the bundle to show her.

Mary Jane decides, "It's Hazel," who is Hannah's 5-year-old daughter, and she drowses back to sleep.

Meanwhile, I hobble to the bed; the bottom has dropped out of my lungs and my breath is ragged and shallow, a familiar sensation.  Turn, sit gingerly on the bed (watch out for that cord).  I stay near the edge of the bed to deliver the placenta.  I say to someone, "I'll feel better when the placenta is out."  For some reason I'm worried there will be a problem with the placenta too.  But it is not much time before I feel it appearing between my legs, and I push it out with a last and very satisfying grunt.  "OH that feels SO good," I tell everyone.  And it does.  Better even maybe than getting the baby out.  It feels like being DONE.

With help I crab-walk backwards until I can collapse at last on the pillows and be covered with warm blankets.  Somewhere in there J_____ arrives.  The baby is examined briefly.  I get my baby in my arms.  It is a little bit difficult to connect with him, I feel as though our messages are zinging past each other and not quite registering.  It seems as if it has been too long, as if we've missed those "moments after birth."  But I don't think I could really cope with anything except my own tired hurting body until just now.  I am sorry we missed some of that, but I know he was in good hands, between his father and our friend Hannah.  We have plenty of time to get to know each other.

I put the baby, who is red and cross-eyed, to my breast and he latches on immediately and hungrily -- I peer at his lower lip and announce that he has a perfect latch.  

A happy, happy end at four in the morning on January 29th.

(Postscript:  Hannah took all the pictures, stayed till late in the morning, let us sleep in, and made breakfast for our family before going home to get some sleep herself... for which we are very thankful.)

Comments

[Jamie]

Oh, SO satisfying. Thanks for taking the time to write it all up, Erin.

[ambrose]

Great series. I have to hand it to you home-birth mamas. You are amazing

[rachel]

Sorry, forgive me if this is - what? inappropriate for a rare commenter? - but your face in the picture, it's stunningly beautiful. I remember thinking that when helping a friend in labour, and I then remembered my husband telling me so about my own labours: that these are the moments when you are so stripped of anything else, only beauty comes through.

[Mark]

Rachel, thanks -- not inappropriate at all. I was sort of stunned to see that picture myself.

Don't I almost look -- made up? I suppose that the look women are going for, when they apply color to lips, cheeks, eyelids, is something like that -- labor is an emotionally and physically arousing experience (using the word "arousing" broadly).

[bearing]

Oops, that was me, not Mark, posting. HE doesn't look made up.

[Alicia]

Thanks for sharing. FYI, you missed omitting your midwife's name in the paragraph before the picture.

[Jenny]

This was a great set of posts! One point that stuck out to me was that you had forgotten the pain of crowning. That's one bit of labor that I will never forget and I know exactly why I won't forget it.

Before my oldest was born I discussed with the doctor how I didn't want an episiotomy. She gave some minor reassurance about how she wouldn't cut unless necessary and I took her at her word. Famous last words.

During the pushing phase with no epidural, I was having a general hard time figuring out what to do. Of course they had me on my back and the baby wasn't descending very quickly. When finally the baby was beginning to crown, I was having a very hard time pushing her out. So the doctor starts in on how she has to cut. I am obviously not going stretch and cutting is the only way. I am arguing with her to give it more time. She is impatient and wants to cut. I am in pain and discouraged that I'm not getting it done. After several back and forths and unproductive contractions, I relent and she cuts me from here to there and then the baby is born two or three pushes later.

It took forever to heal! And in retrospect I don't know what her big hurry was because my entire pushing phase was only 45 minutes even as I wasn't doing a very good job of it. And in every subsequent birth, I have torn exactly where she cut me. So I apparently get to live with her impatience with every child I have.

Anyway, fast forward to the next pregnancy with a different doctor in a different city. I again tell her that I don't want to be cut and she looks at me like I'm strange and basically says why would I cut you?

I again am laboring with no anesthesia and working through the pushing stage. I was doing a much better job if I do say so myself. And then the moment she begins to crown comes and I am SHOCKED by how much it hurts. Really shocked and completely unprepared.

I had already given birth. I was supposed to know how it feels, but I hadn't felt anything like it giving birth the first time. I start to panic a little and am really pulling back from the intensity of the pain. The nurse leans down to me and says, "You can do this. You are almost there, but you can't pull back from the pain. You must push through the pain." And two or three pushes later, my baby was born with no scalpel assistance from the doctor.

After the fact I realized what the difference was. My first doctor had already decided that I was going to need cutting and had completely numbed the area before the baby had even descended. I don't know when she did it and I don't remember consenting. That's why I was so shocked by the pain of crowning because in reality I had never felt it in the previous birth, but I thought I had. That numbing agent is why I had such a hard time pushing out my oldest. I couldn't feel what I was doing! I had nothing to push against and was getting no encouragement from those who were supposed to be helping. Even with the numbing agent, I might have been able to do it if I were getting real help instead of arguing with the doctor about consenting to surgery under duress. UGH! It makes me angry now just thinking about it.

And that's why I will never forget.

[bearing]

Ugh. It's like laboring women aren't allowed to make decisions for themselves. I'd say your story is horrifying except that I hear stories like that all the time.

The sensation of pressure in the perineal area is one of the things that prompts the pushing reflex. With limited sensation in that area it is not surprising that pushing would be difficult.

[Jenny]

Agreed. It happens way to often to be horrifying. Just another anecdote about the sad state of American childbirth.

[Jenny]

*too* often