Saturday, April 12, 2014

Planning For a Preciptious Home Birth

Precipitous labor is defined as a labor that is accomplished within three hours of onset. According to my history, every labor except my first fit this description. In my midwifery studies, the chapter I could find on precipitous birth was a short and simple paragraph, outlining that in these cases, the woman and her family needs to be prepared for taking responsibility for the birth and considering that they may in deed be the only available providers of care. (Well, that's helpful!) So though I didn't have too many concerns about having a completely unassisted birth, my husband and children did not like the thought of that being plan A, so we set in place a birth team plan that included a birth photographer, a very experienced doula who also had midwifery experience, and a licensed midwife, in addition to my husband, and two older daughters age 16 and 14 who would function as midwife assistants. Plan A was then to get my whole birth team present at the birth, and plan B was to be in contact by phone, as we had at my last birth.
I wanted to make sure that each member of my family was prepared for the sights and sounds of labor. I took my two oldest daughters to Valerie's Midwife Assistant Class that was one night per week for 2 hours, lasting 12 weeks, and ending just the week before I was due. I spent a lot of time with my 4 year old discussing sounds I might make while pushing out a baby, and we even filled the tub and 'practiced' having a baby so that she would know how she would need to act if she was in the tub with me (which was her adamant desire). My husband and I attended a summed up Bradley Method birth class - we could have used a few more of those - but he did a wonderful job giving me just the support I wanted from him. Perhaps my 9 year old was the least prepared, but also she didn't want to talk or think about 'gross' things. So overall, I felt my family was as prepared as they could possibly be for a birth that I well knew may once again end up as an 'unassisted' delivery.
What causes precipitous labor? This is something I would really like to study and figure out. But the best I can come up with is this: precipitous labor probably only proceeds in women who no longer have any personal fears about birth. The women know for a fact that they can have a baby, and have no great traumas attached to that fact. They are certain that their bodies are strong and capable of childbirth, and they are not afraid of it. This is the highest peak of childbirth without underlying fears. I have often heard it taught that fear increases pain and pain perception. That fits my definition here. I also presume that the woman with precipitous labors has an adequate and generous pelvis, with a baby in a favorable position (although my last birth did not include a very favorable position). But this time, I also recognize that I had every person that I needed and wanted present (okay, one of them was via plan B); I was where I wanted to be, feeling comfortable in my surroundings and safe to proceed with birthing in the way that I desired without being criticized or directed in anyway.
So my theory is 1) no fear of my body's performance and abilities, 2) being in the safe environment of my choosing, and 3) having my chosen birth team present, and perhaps 4) having a generous pelvis and experienced uterus.
* * * * * * *
Pregnant women are good at two things; being emotional and worrying about details. I was no exception. 
My greatest concern for this birth was being able to recognize that I was actually in labor, have my family all present, and be able to get my birth team to my home in time for the labor (hopefully) but especially for the birth.
Because of the point I was at in my midwifery training, I wanted to catch my baby, experience a water birth (75% of the births I had been present at were in the water), and have very little intervention or even monitoring, (after all, I realized there probably wouldn't be time for it anyway), unless my daughters wanted to perform it.
That being said, every braxton hicks contraction from March on I felt concerned; I wondered - is this it? Is this how labor starts? How will I know? I remember several different nights mid-March when I would awake about once an hour due to a contraction that woke me up, use the restroom and then be able to go back to sleep until the next one hit… how many days would these continue before I would awake and truly be in labor? I was hypersensitive to every little movement of my uterus and trying to figure out what would happen next. Hypersensitivity is not a fun way to live for a day, let alone a month. On March 18th I even thought labor was beginning enough to use the ipod to time four contractions that were all closer than ten minutes apart; and that, too, was just more nothing but nothing. On March 22nd, I tried to stimulate labor with clary sage, and a few other things, which got contractions going every 10 minutes for about 2 hours; and then it all died away...

Well, I am sure you are ready for the real story; it will probably take you nearly as long to read it as it did for me to experience it.

Wednesday April 2, 2014

4:30 a.m. Roused by a good contraction I awoke and used the restroom and retired to my bed again, then realized I was having another contraction.  I took out my phone in order to time duration and length of the next contraction and fell asleep with it in my hand only to awaken to another contraction after 5:30 a.m. (so I didn’t bother-just more of the usual).
7:40 a.m. Got up for the day and said “I should eat a really good breakfast today.” My attentive husband kindly made me breakfast. I was feeling a bit happy and excited, due to the fact that I had not had any contractions of any sort for the previous two days.
8:00 a.m. Before the girls left for school just after 8 am, I asked my 9 year old “If I have the baby while you are at school today, would you like me to call you home?" 
“No, I really like school - I’d rather stay at school,” she responded.
I told my 14 year old to feel my tight stomach, and she sensed that I seemed excited about it.  She asked if I was having real contractions and I told her I didn’t know.
I drove my 16 year old to school and told her to text me at lunch and stay in touch-it might be the day.
9:36 a.m. I texted Valerie Hall, CPM, to let her know that I seemed to be having contractions about every 20 minutes but I hadn't timed them yet. She called me and reminded me that this pattern is how most labors begin and I should really pay attention to any and every little change, and let her know. I told her I would time them and promised to send her any info about changes of any sort. My hand written note of when contractions occurred (9:42, 10:05, 10:29, 11:20, 11:38-all hand recorded contractions were under 20 - 30 seconds long, and it was impossible for me to tell whether they were just braxton hicks).
10:35 a.m. I texted Tina Chavez, my Doula, and mentioned I was having discernible contractions every 20 minutes.
11:05 a.m. I texted Valerie to let her know that contractions had spaced apart, the last ones were 40 minutes apart and then one hour; but just then I had used the restroom and noticed bloody show, I also texted Tina that info. 
At this point I decided to get my hair and makeup done (this was one of my top priorities if there was any chance I was in labor - I wanted to look good in my birth photos!) and texted with my photographer Allie White to let her know that something might be going on.  I set up a play date for my four year old daughter to go up the street and play for a few hours.
12:13 p.m. I walked my four year old up the street, visited with my neighbor and timed three contractions while I was gone, all under 30 seconds.
12:44 p.m. I returned back home,  had some more bloody show and my Mom called on the phone. While I spoke with her I had three contractions during our 20 minute phone call and prepared the bassinet.  She pointed out that I ought to call my midwife as contractions seemed much closer than 20 minutes apart.  We got off the phone and I insisted Jason get off his phone and call to check my 14 year old out of school, and I called Valerie to report.  Valerie told me that another of her clients was in labor and filling their birth tub and sounded concerned about being able to come. I told her that I was going with Jason to Franklin Middle School to pick up my daughter.  My mom called back to see if she should get my 16 year old to come home and I said ‘yes.’
12:49 p.m. First timed a contraction with the iphone at 1:01 minutes long.
12:58 p.m. Second timed contraction lasting 48 seconds.
1:03 p.m. Third timed contraction lasting 58 seconds.
*** At this point I seemed to have stimulated some serious adrenaline and fear that I would not be able to get my older daughters home in time - that it was not a safe or good time to be in heavy labor - in hindsight I think this is what caused a large pause in the labor pattern during the car ride. ***
1:11 p.m. Jason and I left the house to pick up our daughters from school.
1:15 p.m. Picked up my 16 year old daughter from school - worried that I had jumped the gun in getting her - maybe, after all this was just more braxton hicks contractions again...
1:20 p.m. Texted Tina I was picking up my 14 year old and contractions were more frequent.
1:23 p.m. Fourth timed contraction lasting 1:11. This occurred in the car on the way to the middle school.
1:28 p.m. Picked up my daughter from Franklin.
1:33 p.m. Fifth timed contraction lasting 26 seconds, second contraction in the car. I was now concerned that I had really jumped the gun getting the girls out of school. A 26 second contraction? Sigh...
We were nearly home now and I talked with the girls a little bit about the stages of labor and where I possibly might be.  The only sign that I might be in active labor was that I was starting to be annoyed with Jason’s jokes and felt a little ‘labor land like,’ however from our discussion we determined that the contraction pattern looked more like early labor.
Jason then told the girls “Well, this is your mom we’re talking about, so if she’s in early labor now, by the time we get her into the house she’ll be in pushing stage.” (We were less than two minutes from the house).
1:42 p.m. Sixth timed contraction-now at the house- lasting 1:52 minutes.
1:44 p.m. My 16 year old started filling the birth tub.

1:47 p.m. Seventh timed contraction lasting 1:28 minutes.
1:48 p.m. Texted Tina “Come now?”
1:50 p.m. Tried to call Tina, texted that ctrx were q. 4 min around 1 min. long
1:51 p.m. Eighth timed contraction lasting 54 seconds.
1:57 p.m. Ninth and last timed contraction lasting 1:36 minutes.
Noticeable break in contractions, I felt hungry and was debating getting into the tub. Realized that I may be in the pause after transition and before second stage began... but how could that be?
1:59 p.m. Sent my 14 year old to go pick up my 4 year old from the neighbors house.
2:05 p.m. Mom and 4 year old got into the birth tub after using the restroom.
2:08 p.m. Allie arrived, and I had my 14 year old call the elementary to have my 9 year old come home. (I wanted to give her a second chance to make her own choice on being present at the birth - so she could not hold any future grudge against me for not telling her.)
2:11 p.m. Water broke with second contraction in the tub - noticed some meconium in the water. Someone used my phone to text Tina about ROM-she was en route.
In between contractions I gave my daughters preparation instructions including "glove up," "open the ambubag," and "get on the stethascope." I also assessed how each of my daughters and husband were handling the birth - particularly their emotions and perceptions of my behavior.
During contractions I was consumed by the powers of birth; shaking almost violently, breathing, and trying to give up all resistance. I was aware that I was groaning, making deep, throaty, appropriate birthing type noises, which I would have shut off immediately if I perceived that anyone in the room was really bothered by them. It was so freeing to feel that I could express the birth energy however I wanted, and everyone present was comfortable and trusted that all was well.
2:21 p.m. Jason got Valerie on the phone for the duration of the birth. This brought some relief and peace; at least it was plan B. But I also recognized that I was seriously holding back - I did actually want a midwife present for the birth and immediate postpartum assessment.
2:22 p.m. 9 year old arrived and then chose to go back to school.
There was no longer any doubts in my mind, this was pushing stage, and I could feel the baby descending-but I was not ready to really push yet! I remembered that pushing is not necessary and the baby will come with or without my conscious efforts (as I learned from my previous birth) and so determined that I would 'breathe' my baby out.
2:25 p.m. Doula Tina Chavez arrived, and I began to push with contractions. During the next break between contractions I decided to check my baby's station. I was able to put my finger about 1/2 - 1" inside before I encountered the baby's head...
For the next contraction I declared "I'm climbing away from this one." As that is exactly what I was doing, and I wanted my girls to note what that looks like when a mother does that during pushing stage. (Chin up, arched back, rising up and away from the core).
During the next contraction I felt with my hand as crowning and burning occurred, cradling the head every so gently as it began to slowly emerge. I did not push anymore at this point, but let the contractions ease the baby out on their own (they were plenty powerful enough).
For the last contraction I felt with my hand as the crowning grew, widened, filled my palm and then my whole hand. "Head" I said. "Head is out." But the moment I knew it, the moment it filled my whole hand and I felt the soft contours of the baby's face, I had to let go, the sensations I was feeling were plenty without also having the sensation in my hand, but I knew that my baby was beginning to rotate, and I didn't want to stick a finger in its' face, etc.
2:33 p.m. Head out
I immediately began the move I had "practiced" before, moving from forward leaning over the side of the tub, lifting my right leg, and sitting back. This is when the birth occurred, and though I was not touching the baby during it, I easily and smoothly brought the baby up out of the water all in the same movement.
2:34 p.m. Birth. I greeted my baby with "Hello baby, that was a tight squeeze, wasn't it?" And then asked my husband to come around the tub and be next to me, as I had just moved. My baby cried just the right amount to allay any concerns of heart rate or respiration's and I soothed and assessed her all at once. As it neared one minute I asked my daughters, "Well, what is her APGAR's?"
One minute APGAR 9 (1 off for color), baby alert, crying and vigorous.

By my own admission, this birth hardly seems fair. Not one of the contractions previous to pushing seemed to overwhelm or overpower me. But completely surrendering to birth and your body is the name of the game. My greatest cognizant thought was "there is just no way I am that far into labor yet."
I did make a lot of noise while in the tub, the sensations of a baby moving through ones pelvis is hardly pleasant, nor is that easily definable feeling of crowning the head and the burning stretch of tissue that you just cannot escape. 
Each of my daughters seemed calm and fairly confident. I am excitedly awaiting the professional birth photography pictures which will hopefully be available towards the end of this month.
My husband seemed the most nervous of the bunch, but mostly due to "not knowing exactly what to do." I tried to explain to him that partner labor support is just as much being present and in the moment; staying in close proximity, and in the same frame of mind. His support this birth definitely made it my best birth ever, he gave me that close, intimate support I had always wanted, but had never been able to define for him. For most men I don't think it feels like "doing" anything, and that is kind of accurate - the best labor support a man can give his wife is "being" with her, in proximity, mind, physical support, emotion and in that place of love that creates families.

My older daughters both wrote of their views and experiences during this birth; I am not going to post them on this blog, if you are interested in reading those I will email them to you.

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