Liam Noah's Birth

My first pregnancy was wonderful. I had some pregnancy nausea for a few weeks during the first trimester, but I was extremely healthy and low risk the rest of the time. I decided I wanted to have an out of hospital birth, to try to avoid some of the interventions that can happen in hospitals. I chose my local midwife run Birth Center.

I woke up on the morning of February 4, 2011 with a backache and some cramping that felt a lot like my period was coming. I had stopped working 2 days before, as my due date came and went, so I was awakened by my husband's alarm going off so he could get to work. He kissed me and told me to keep sleeping, but I was excited at this new change and told him that today could be the day. He asked if he should stay home but I knew that early labor could last for a long time and sent him off to work. I ate breakfast, took a shower, and started noticing some definite cramp like contractions every 7 minutes. They were not painful, but uncomfortable, so I went about my day and kept my contraction timer open so I could keep track of them. I thought about going back to sleep, but I was too excited to rest. So instead I created birthing playlists, watched movies and tried to relax. The contractions were picking up in intensity and frequency, so I called Matt to come home around 10:30am. Around noon, we decided to head to the birth center since my contractions were "5-1-1", or 5 minutes apart, 1 minute in length for an hour and they were strong enough to require all of my attention and focus when they came. The midwife on call checked me when I arrived and said I was 1 cm and 50% effaced, and I should probably go home and try to rest or nap.

We went home, and I was feeling extremely discouraged. My back was really hurting during each contraction and sleep was not an option anymore. I was already trying to find a labor rhythm, and I slow danced with Matt around the living room and got in various positions with him where he could do counter pressure and practiced breathing through the contractions. We went for walks around the neighborhood. Around 6 pm, we headed back to the birth center and my friend Jen met us there. I was 3 cm then so the midwives said I could stay since I was in "active labor" (after having two more kids, that was the most difficult and painful "early labor" I have experienced, it felt quite active to me). My midwife put a line in my arm with a hep lock so I could receive antibiotics intermittently, since I was Group-B strep positive. Once I had my first dose, I was free to move about again.

Alex Laboring with Liam

I walked around the porch with Jen, pausing during contractions to lean against a bench or wall. There were no positions that felt good during contractions except standing, and if I was sitting, I immediately stood up during a contraction. I melted into Matt or Jen, letting them bear my body weight so I could try and relax and open up during each contraction. I would vocalize to ensure my mouth and jaw were relaxed. Matt made sure I drank and ate throughout, as it was getting late. I labored for a few more hours before the midwife said I could get in the tub, as they did not want my labor to stall in the water. Around midnight, I was 5 cm and she said I could finally get in. Immediately, my body relaxed and each contraction felt so much easier, as though the tension I felt in my body was being released into the water somehow. It also relieved the intense back labor I was having. I felt great and did not want to get out! The student midwife attending said Liam was OP, or occiput posterior, which explained the intense back pain I had been feeling even during early labor. Unfortunately, as soon as I got in the water, my labor slowed down and I needed to get out of the tub and go climb the stairs. Up and down we went; Jen, Matt and I, over and over. I begged to get back in the tub, as now I was loudly vocalizing during each contraction and longed for relief from the intensity of labor. My friend Jen encouraged me that my vocalizations were nice and low, which helps encourage the cervix to open. The midwife checked me again and said I was 7 cm and that Liam was nice and low against my cervix. She asked if I would be okay with breaking my waters artificially, and that it might help me progress more quickly. I hastily agreed, as it was now 3:30 am and I was getting so very tired.

I laid down during a contraction and she used an amnio-hook to break the bulging bag of waters. It burst with a "pop" and a gush of liquid. As soon as it broke, the intensity of my contractions seemed to increase dramatically and suddenly my contractions were giving me no break in between, as they came one after another. I started feeling discouraged, saying "I can't do this anymore!" And they all said that it sounded like I was in transition, and that I was doing great. At about 5:00am, I started feeling some pressure and an urge to bear down. The midwife checked me and said I was 9.5cm, almost complete, but I had a small anterior lip of cervix that would not dilate or efface fully, so I should try to wait for an overwhelming urge to push. I got back in the water and felt like pushing. Matt got in with me, since I needed something to lean against for more support. I started to feel a stronger urge to push and got into a squatting position in the tub. At one point the student midwife said "reach down and feel your baby's head", and I did, he was about an inch away from crowning and in a +1 position. Then the midwife came in to check my progress, and said that because of the anterior lip, my cervix was swelling and I needed to get out of the tub and stop pushing. 

I dried off and put on a robe, and got into a knee chest position. I was on all fours, with my elbows down on the bed and my butt up in the air, panting through contractions with my chin up to try and not push while contracting. This was to get the weight off my cervix to encourage the swelling to go down. In between contractions I laid on my left side to try and rest. This was one of the hardest things I have ever done- panting and not pushing when my body was trying to bear down. During this whole process it felt like time was suspended and I lost all track of time. After about an hour of this, my cervix stopped swelling and I was allowed to get back in the tub. The sky was starting to turn pink from the first hints of the rising sun, and the student midwife attending told me that I should try to sleep between contractions as I was getting quite exhausted. I dozed off a few times, but woke up each time feeling the need to bear down again. My body was pushing, I was not trying to! My midwife checked me again and once again, my cervix was swelling from the anterior lip that would not efface, and so I went back into the knee chest position on the bed for another hour or so (time had no meaning here). Once the swelling went down again, I was still spontaneously bearing down, so my midwife suggested a sitting squat position so she could try to push my anterior cervical lip out of the way while I pushed. This was very uncomfortable and it didn't work. My cervix started swelling for a third time, and I was once again told to get in the knee chest position. At this point it was about 11am and I started crying in pain, exhaustion, and frustration. I had been pushing on and off for about 6 hours! As I laid on my side in between contractions, I told my husband I didn't think I could go on. The midwife had another laboring mom to tend to at this point, so she left me with the student midwife while I cried. The student midwife, Mary, looked at me and told me that this was very atypical labor progression. She said if I wanted to transfer to the hospital, she would support that decision. I didn't want to go and get pitocin and all the other interventions at the hospital, but I was exhausted at this point, so I told Matt to make the decision because I was not able to at that time. Matt, Jen, and Mary talked. Matt came back with my bag and said we were going to get in the car and go to the hospital. Mary and Jen came with us, and we climbed back into the car and called the OB to let him know we were on our way. The CNM was on call that day, so I was transferring to her care, and my midwife gave her the rundown on what was happening. 

As soon as I got in the room, I demanded an epidural. I needed a break to regroup. I wanted a nap. At this point, it was about 12:30pm, and it had been a full 24 hours since I was sent home from the birth center to labor at home because I wasn't dilated enough. The CNM checked me and confirmed the anterior lip and said Liam was still OP, which was why I had all the back labor and intense spontaneous bearing down! She also said I was only 8 cm, because my cervix had started swelling again from being upright in the car ride over (or Ina May's sphincter law is very real and I didn't want to have a baby in the car). The anesthesiologist came and administered my epidural and suddenly, I couldn't even tell I was having a contraction. My CNM gave me some pitocin, since I had already been in labor so long and they were worried I might end up with a c-section. I felt kind of bullied into the pitocin- I wish I hadn't agreed to it, as I don't think it was necessary at that point, but it was my first baby and I didn't know much about hospital procedures so I agreed. Then, I looked at the nurse and said I wanted a nap! They turned all the lights off and me and my husband slept for about an hour and a half. The contractions were definitely longer, and they woke me up, but they mostly felt like tightness or pressure. I was so tired I didn't care, so I went back to sleep as soon as it was over. 

The CNM came back in around 2pm and said I was complete- the lip had finally disappeared! She told me I could start pushing if I wanted to. I told her I couldn't even feel my contractions. My labor nurse looked at the monitors and told me when I was having a contraction and when to push. I didn't like the directed pushing- it was weird to go from being unable to stop my body from bearing down, to needing to have someone tell me when to push. Liam was still posterior, and this makes pushing a baby out much more difficult too. The CNM found somewhere else for my nurse to be, and she turned off my epidural so I could feel a contraction and push when I needed to. She also helped me get in various position to turn Liam- such as hands and knees, squatting, side lying with legs pulled back in a laid back squat. It took a little while, but soon I could feel my contractions again and Liam was progressing down! He was crowning for what felt like hours, and his positioning made it difficult for him to be born quickly. Finally, I pushed hard and he turned a bit to slip under my pubic bone, and he was born all at once! Head and shoulders came out in one fell swoop. The CNM almost missed him, but caught him just in time! He was born at 3:53 pm on February 5, 2011. If you count my early labor (which in this case, I do) I was in labor for nearly 33 hours. About 28 of those hours were quite intense.

He was laid on my chest, wet and slimy and screaming. I held him for a couple of minutes before they whisked him off to be measured and weighed. He was 8lbs, 13 oz and 21.5 inches long. They also did quite a bit of suctioning on him before giving him back to me to breastfeed for the first time. Meanwhile, I was being stitched up from a 2nd degree tear. When they finally gave him back to me, I was shaking from exhaustion, so the pediatric nurse held him to my breast while he nursed for the first time. My labor nurse said his temperature was slightly elevated and that he should go to the nursery to be evaluated. Mary, who had come with us to the hospital, spoke up for the first time and said that she really didn't think it was necessary, and that skin to skin would help regulate his temperature. She ignored Mary, and he was sent to the nursery. I told Matt to go with him since I could not. Mary had to head back to the birth center to attend the other laboring momma, so as soon as they were done stitching me up, they removed my epidural and let me rest. This was the loneliest time for me- I was all by myself, and I had just had a baby! I called and texted Matt, trying to figure out what was going on. He sent me some pictures of Liam in the nursery. They said that Liam was fine, but that he needed to get a bath before he could come back. He was gone for almost 3 whole hours before he came back to me, and by that time he was asleep. We were moved to mother baby and kept overnight. We went home the next day, and we embarked on our journey as new parents, a journey that had just begun.