Wednesday, April 3, 2013

Maxwell's Birth

On Easter day, April 8th, 2012 my husband Mark and I found out we were expecting our 2nd baby. I was thrilled and a little shocked that I had gotten pregnant the very first cycle trying and immediately messaged my midwife Paula on facebook wishing her a happy Easter and letting her know that we would be seeing her soon. Our first son was born at home in water and we were planning the same for our second child. This pregnancy was much easier than my first (which was also a pretty easy pregnancy) with no complications and very little discomfort once the nausea went away at 10 weeks. We were very excited to keep the sex a surprise until birth with this one (we were not planning on any ultrasounds unless a medical need arose) and had a lot of fun throughout the pregnancy guessing what we thought the baby would be. Initially I was having very vivid girl dreams but after about 16 weeks I was absolutely sure baby would be a boy. So sure that in my mind the baby being a girl was not even a possibility.

During my 37 week appointment Paula said she was having a hard time determining baby's position and asked if she could do an internal exam to verify the position (it was my first internal exam of the pregnancy as I was planning on no cervical checks unless there was a true need). She did the exam and said she definitely was not feeling a head, despite baby being head down since 30 weeks, and that it felt like a foot but she wanted to send us for an ultrasound (our first) as soon as possible to confirm the position. I immediately started crying and she gave me a big long hug and said we had plenty of options and also plenty of things we could do to encourage baby to turn. The next day we had an ultrasound with Paula's backup obstetrician Dr. Jochim and confirmed that the baby was in fact frank breech (butt presenting) and it was also suspected, but not confirmed, that he had a 1x nuchal cord (which did not surprise us as our first had a 4x nuchal cord and a 48inch long cord). While we were not happy baby was breech I was relieved that he was in the frank breech position as it is the most favorable for a vaginal delivery. I called Paula immediately after the appointment and went over all the information we had found out. She was happy about the frank breech presentation but said the combination with the breech and possible nuchal cord made her uncomfortable to do the birth at home by herself because of her lack of breech experience due to politics. She told us she would call around to some more experienced midwives and see if they could help with the birth and gave us some things to try at home to get the baby to turn.

Over the next 2 days I tried various things to get baby to turn. Mark and I also did a lot of talking about our options and started putting backup plans in order. One of our plans was to travel out of state where breech home births are "allowed" (we live in Arizona where midwives cannot legally attend a diagnosed breech birth) provided we could find an experienced midwife willing to accept me at 38 weeks. I had a list of midwives from Albuquerque, San Diego, Utah, and Oregon that I was getting ready to start making calls to. However, on Friday I had an appointment with Paula to go over a breech script together, and before going over the script she checked on baby and did another internal exam and discovered that the baby had almost certainly turned head down. I was sent for a second ultrasound that same day and confirmed that the baby had indeed turned. I was ecstatic and called Mark right after the appointment to tell him the good news. I also called Paula to let her know and she told me how proud she was at how well I worked with my baby to get him to turn and said that baby had been so low when she did the internal exam that she did not think he would be able to turn again. That night Mark and I went on a 2 mile walk in the dark to celebrate and try to get the baby to engage even more in order to make turning impossible.

At my 39 week appointment baby was in an occiput posterior position and Paula gave me some things to try to get him to turn into a more favorable position. She also told me she was not worried about it and joked that it might actually be the thing we needed to make sure she made it to the birth in time (my first birth was under 6 hours and we now lived over an hour away from her.) Over the next week or so I tried religiously to get the baby to rotate out of OP and into a more favorable position hoping that I would go into labor very soon after if I could get him to turn. I was having tons of prodromal labor and braxton hicks and was ready to meet my baby. Some days the contractions would be 5-7 minutes apart for up to 11 hours but not getting stronger. I never experienced so much warm up labor with my first and it was exhausting (and lasted for 2 1/2 weeks)! After about a week and a half I got frustrated and completely gave up on getting baby to turn out of OP. I figured if the baby wanted to he would move on his own, otherwise we would just deal with an OP labor if that is what he decided to do.

Starting a couple months before my estimated due date I started telling our almost 3 year old that his baby brother or sister would come after we put the Christmas tree up to give him a general idea of when the baby would be born. I never once mentioned snow but from that point on he always said that it also had to snow first and there had to be snow outside before the baby could be born. December 15th, the day before my EDD my son was talking all day about the snow and how the baby would come when it snowed. After hours of this and him constantly checking outside for snow I got curious and looked up the weather forecast. The next day, on my EDD, we were supposed to get 2-4 inches of snow! I was excited and thought it would be amazing if he was right and the baby was born the next day while it was snowing. The next day it did snow while we were in town (about 30 minutes) away but we got no snow at our house and my estimated due date came and went, just like with my first son who was born at 41+4. I had expected the entire pregnancy to go to about 41 weeks so I wasnt very surprised..although maybe a little frustrated. I looked up the predicted forecast for every day until January 6th and no more snow was expected.

After talking it over with my husband we decided that we would ask Paula at our next appointment (41+3) to do a membrane sweep, despite me saying I would never do one again after having it done with my first. The night before my appointment my husband made the comment that if we did have her do the membrane sweep it was going to end with her telling us the baby was breech again. I thought he was joking and told him not to be so pessimistic. At my appointment at 41+3 we talked it over with Paula and asked her to do the membrane sweep. While she was feeling my cervix to see if it was favorable she suddenly said that she would not be able to do the sweep. Baby was no longer head down and she was pretty sure she was feeling feet. Exactly what Mark said was going to happen. I guess he had felt for a while that baby had turned breech again, but never said anything because I was so sure baby was still head down. We talked about our options again and Paula let us know, while she would not abandon us if we absolutely refused to go to the hospital, she was in no way comfortable doing a footling birth at home..especially when the nearest hospital was 30 minutes from our house. She gave us a breech script to do together at home and told me to resume doing the other things I did when the baby was breech the first time.

Mark and I talked a lot that night about what we wanted to do. We knew it was too late to go out of state this time and also knew neither of us were really comfortable doing a footling breech birth at home..especially with an inexperience care provider and the hospital so far away. We decided we wanted to get an ultrasound the next day to confirm what position of breech the baby was in, and if it was a butt presenting we wanted to continue with the birth at home and if it was feet we were thinking we'd probably go to the hospital and try to deliver vaginally. The one thing we were completely sure about was waiting until labor started before making a final decision.

We went to bed around midnight that night and I was having some pretty strong contractions. I told Mark that I wasnt sure they were still the braxton hicks I had been experiencing the last couple weeks, and that I kind of thought it might be actual labor starting. I knew we needed sleep though and told him we should just go to bed and if it was the real thing I would wake up and we'd go from there. Right at 8am I woke up to incredibly strong contractions. Strong enough that I could not lay in bed any longer and got up and went to the bathroom where I found I was having bloody show. I immediately knew it was the real thing and woke Mark up and told him we needed to get ready and also pack a hospital bag just in case. I called Paula and told her I was having hard contractions 5 minutes apart and also some bloody show. She asked if I felt like the baby had turned head down and I told her no. She reminded me that she was not comfortable doing a footling breech at home and asked what we wanted to do. I told her I wanted her to check which part was presenting and that we had decided if it was a butt we would continue at home and if it was feet we wanted to transfer to the hospital. We agreed to meet at her office in about 40 minutes (which is about a 30 minute drive away). We quickly got ready, got our 3 year old dressed in pajamas and gave him a banana, threw together a hospital bag and headed out.

Right around 9am we got to the office and by that time my contractions were about 3-4 minutes apart. We were the first to arrive so we hung out in the car where it was warm and I labored kneeling and leaning over the back of the passenger seat. About 5-10 minutes later my midwife's two assistants, Deborah and Kate, arrived and we followed them inside and I let them know how I was feeling and how things were progressing. Deborah asked if she could check me and I told her yes. She said she thought I was around a 7 or 8 and that it definitely did not feel like a head to her, but that she wasn't very experienced determining position and we should wait for Paula. (Mark later told me that she had told him she felt the baby kicking her when she did the internal exam. I did not know that at the time.) By this point I was having contractions every 1-2 minutes apart so she called Paula and told her what was going on and how I was doing. While we waited Deborah asked if there was anything she could do to make me more comfortable. I told her I just needed some water because I was incredibly thirsty and she got some for me.

Once Paula arrived she checked me and said it was definitely feet and I was 6cm. She asked what we wanted to do and I told her we wanted to go to the hospital. She asked if I thought I could make it to the hospital with her backup OB, an hour away, or if I wanted to go to the local hospital which was only 10 minutes away. While the local hospital was a lot closer they are incredibly unfriendly and horrible to home birth transfers and Paula tries to avoid transfers there whenever possible. I asked if Dr. Jochim could safely do a vaginal footling birth and she said yes and that he had done many breech births but wasn't technically allowed by the hospital to do them. I told her I could definitely make it an hour to the hospital if there was a chance of having the baby vaginally (at the local hospital there would have been absolutely no chance). We all headed out Mark, Tyler, and I in the lead car, Deborah and Kate behind us, and Paula behind them. The hour drive was on an incredibly windy road through the mountains with speed limits of 25mph (sometimes 10mph around certain corners). It was terrifying and I kept yelling at Mark "Oh my God, SLOW DOWN. SLOW DOWN AROUND THE CORNERS!" He was driving just fine and was never speeding LOL. It was actually kind of nice because the fear of the drive made my contractions slow down to 3-5 minutes apart which was a relieving break since I could not move or change positions in the car to better cope with the contractions.

Halfway through the drive Mark says to me "LOOK!! There is snow EVERYWHERE...Tyler WAS right!! We are having a baby today, and there is snow!" I never thought we would transfer to the hospital so in my mind the snow Tyler talked about was supposed to be at our house. But he was right, there was snow the entire drive to the hospital. Paula also called about halfway through the drive to give us a heads up: "The hospital just called and are setting everything up to do a c-section as soon as you get there. DO NOT sign any consent forms until you talk to Dr. Jochim and have him check you. I am about 10 minutes behind you guys so you will get to the hospital before I do, so I just wanted to give you a heads up on what they are planning."

Near the end of the drive we had to pass through this tiny 1 lane town. The entire drive through the town we were stuck behind a semi going 5 mph. Mark joked saying "I wonder what they would think if they knew they were slowing down a laboring woman trying to get to the hospital." Shortly after that, with about 10 minutes left of the drive, my water felt like it started leaking. With every contraction there would be a small gush of fluid and I started having the urge to push. I started panicking a little and kept asking Mark if we should pull over and just have Paula catch up and deliver the baby on the side of the snowy road. I kept asking him "What if my water is about to break and the cord prolapses? Maybe we should just stop so she can help you think i should call her?" I had this overwhelming feeling that my water COULD NOT break or the cord would prolapse, I couldnt shake that thought.

Once we got to the hospital I refused to go to L&D until Paula got there. Deborah and Kate walked with me into the lobby and the doorman got a wheelchair. I asked Deborah if I had to sit in it and she said no. The man was insistent so I figure I would give it a try and started to sit down. Halfway into the seat I yelled "No I cannot do this, it hurts too much. I need to walk and move". The man insisted even more saying "No, no, just sit down it will be alright. You have to sit down. I'll get you a taller wheelchair!!" He would not listen to me so Deborah yelled at him "She said she DOES NOT want to sit. It hurts her, she wants to walk. LEAVE HER ALONE." She had to yell at him 3 times but he finally stopped and just stood there holding the wheelchair worriedly watching us like a hawk as we stood there in the lobby for about 10 minutes waiting for Paula. (the whole time my water kept leaking with every contraction and I was still feeling like I needed to push though it wasnt as bad once I was able to stand and walk).

After parking the car Mark met us in the lobby with Tyler and Paula arrived shortly after. On the walk to L&D we stopped for every contraction and I leaned onto Deborah holding her around the neck and she talked me through contractions. I was so thirsty so Paula told Kate to run and buy me a bottle of water, though I never did get it in time and wasnt able to drink it. When we got to L&D everyone was dressed up in OR scrubs and waiting for me. "Come in here and we will get you ready for your c-section" was the first thing the nurse said to me. I looked at Paula with a "what the effing hell?" look. She told me to go in the room and we would talk to Dr. Jochim. The nurse gave me a gown to put on and I went in the bathroom. I peed and while I was sitting on the toilet I started thinking "I should just start pushing in here and by the time they realize it will be too late and they will have to deliver vaginally". I started giving a couple little pushes and then the overwhelming thought of the prolapsed cord came back and I stopped. I told Mark to get Paula and she came into the bathroom and talked to me as she helped take my bra off and put the gown on.

Once we came out of the bathroom Dr. Jochim walked in and told me to lay on the bed and he would check me. Before I was even completely laying down I started having another strong contraction and he started doing the internal exam. I said to him "No, no. Dont do it yet, I'm having a contraction. Please dont do it, wait a minute! It hurts!" He did it anyway and it was the only time during the labor that I was incredibly vocal and moaning in pain. It hurt so much. He told me I was complete with bulging waters and the baby was feet first. He told me he would not deliver a footling vaginally, if it had been a butt he would have done it despite hospital policy, but not feet. I asked him if he was SURE it was feet first and he had the nurse quickly get an ultrasound machine. "Turn it around so everyone in the room can see what I'm talking about. See this is your baby's head up here and here are the feet coming first. I will not deliver this baby vaginally, what do you want to do?" I told him I did NOT want a c-section and he snapped at me "You have 2 options. I can do your c-section right now or I can put you on a helicopter to Phoenix and they can deliver vaginally. Though you WILL end up delivering on the helicopter before you get there, you are already ready to push.". I asked him if I could have a minute to decide with my husband and he got mad and said "NO, you do not have time to talk about it. I want to know NOW what you want to do." At that point Paula stepped in looked him in the eye and calmly said "Dr. Jochim can you please leave the room and give me 2 minutes to talk to them. Just 2 minutes." He walked out of the room and Paula told us that of all people she would push for a vaginal delivery whenever possible but she no longer felt it was safe in this case. I asked Mark what he wanted to do and he reminded me that we had already talked about it last night and agreed if Dr. Jochim would not deliver vaginally that we should go ahead with the c-section. Paula also told me "Despite our best plans sometimes our children decide to take their own path. It does not mean we have failed."

Once I agreed to the c-section everyone rushed in and started shoving consent forms at me and had me fill out medical forms and questions. My lovely nurse Irene was very attentive to me though, and as soon as a contraction started she would tell everyone "Leave her alone she is having a contraction. Wait until it is over!"  I was never bothered during a single contraction thanks to her. She also talked me through contractions and told me to focus on doing what I needed to do. The anesthesiologist came in and examined me. Blood was drawn to do a quick CBC and my IV was started. I was given something to drink that I was told was to neutralize my stomach acid in case they had to put me under general. I asked Irene if I could have skin to skin with my baby in the OR. She told me no. I asked if one of my hands could at least be freed once baby was born so I could touch him/her. she told me she would see what she could do. I told herI did not want eye ointment for baby and I wanted the Vit. K shot to be delayed until we got to nurse and have skin to skin and she said she would make sure it happened. I also told her we didn't know the sex and asked if my husband could announce it. She said absolutely and told everyone over and over during the c-section that we did not know the sex and that everyone was to keep quiet until my husband announced it.

Once everything was ready I held Tyler for a minute, he knew something was going on and was scared and started crying and telling me to get off the bed. I told him everything was ok and he would have a baby brother or sister soon, but that he needed to go play with Paula while Dr. Jochim helped the baby come out. Once it was time Mark took him into the hall and handed him over to Paula and she watched him the entire time until he was able to come back once I got out of the recovery room. She even bought him breakfast and a toy, bless her. They wheeled me to the OR and I tried with everything I had not to cry as I listened to my 3 year old scream bloody murder and hysterically cry as he try to follow me. I was helped into a sitting position onto the edge of the operating table and Dr. Jochim held my hand while the spinal was being prepared. At one point after a hard contraction he jokingly said to me "Now dont squeeze my hand TOO hard, I'm gonna need that here in a minute. NAH, I'm just kidding, squeeze it as hard as you need to!" Both him and the anesthesiologist talked me through the spinal and then helped me lay down. The curtain was put up, I was shaved a little bit and a catheter put in once the spinal had taken effect. After making sure I was numb they started the c-section. "Please dont let me bleed to death!" was the main thing running through my mind and I also started wondering what it would feel like to die from blood loss. I smelled my flesh as they cauterized something. When they started I asked the anesthesiologist where my husband was and said I was told he would get to be in here. He asked the nurse and she started yelling "Someone get her husband, he is supposed to be in here with her! HE IS GOING TO MISS IT!! Someone get him!" He came in and sat on a chair beside my head. I kissed and, smiling, told him we were about to have a baby. As I laid there I heard the doctors say "the amniotic sac is still intact, I am breaking it now. Meconium in the fluids. Cord around the legs. Cord around the neck." The nurse called the time of birth at 11:41am. Dr. Jochim told my husband "Stand up and see what you have" and then jokingly "I bet it will be DIFFICULT to tell". Mark chuckled when he saw and asked me if I wanted to know. "YES of course, tell me!" I said. He told me "It's a boy!!" I immediately burst into tears. I knew he was a boy! I was so happy.

They took him to the warmer and had Mark follow them over there. I could not see him but heard him start to cry loud and healthy sounding. Oh how I wanted to hold him. I cried more as I heard him cry, unable to see my baby. Unable to see what they were doing with him. Dr. Jochim never held him up over the curtain for me to see. Why didn't he hold him up? It still pains me to know that I will never know what he looked like fresh from the womb before he was cleaned off and swaddled. I heard the nurses talking to him "what a beautiful baby. He is so big! It's okay baby boy. Look at all that hair!! Oh wow look, he has a big birthmark on his back!" I asked the anesthesiologist "When can I see my baby?" and he told me they were just finishing up with him and they would bring him over soon. Several minutes later mark came over with him swaddled with a hat on and put him by my face. Irene made good on her promise to see what she could do and my hands were NEVER tied down at any point. I was able to hold my baby up by my face with a little help from Mark. He was awake but his eyes were squeezed shut as if he was trying to block out the scary world he was just born into. I kissed him and felt his soft face on mine. Mark said to me, "Just talk to him, he needs to hear your voice right now." And so I did. I told him how much I loved him and how long we waited to meet him. I told him how beautiful he was and how he had an amazing big brother that was excited to finally meet him. And I apologized to him. I told him how sorry I was that he had to be born that way. I told him I was sorry he didn't get the gentle, peaceful birth I had planned for him, the birth he deserved. As I talked to him he slowly, slowly opened his eyes and looked at me as if upon hearing my voice he knew he was finally safe. We officially named him Maxwell right there in the OR.

I was able to hold him for most of the repair and then the last 15 minutes or so Mark and the nurses took him to the recovery room to weigh and measure him while they waited for me. Once they were gone I closed my eyes willing time to go faster so that I could finally hold my baby properly for the first time. The anesthesiologist talked to me and told me what they were doing and that it wouldn't be much longer. When I was put back together they lowered the curtain and I heard a suctioning noise for several minutes. Finally I got curious wondering what they were doing and looked. The nurse was suctioning all the blood off the bed beside me. I was moved onto a rolling bed and finally taken into recovery at 12:28, nearly 50 minutes after the birth.

In the recovery room Maxwell was naked except for a diaper laying on the warmer. "You'll never guess how much he weighed!" Mark told me. When I asked how much he exclaimed "9lbs 4oz. He is also 20 1/2 inches long." WOW. A whole 2lbs heavier than my first. He never felt that big to me and was estimated to be 7 1/2 to 8lbs by both ultrasound and by my midwife palpating. Irene helped me undo my gown and got him skin to skin with me. Immediately he started rooting around and I just watched to see what he would do. He crawled over to the breast and Irene started reaching for him and asked if I wanted her to help. "No, just watch him. He can do it by himself, you will see." And he did, he crawled over and after a couple minutes latched on the the breast for our first nursing experience. I was ecstatic, and it was the happiest moment of his birth. I had been so afraid how the c-section would affect our breastfeeding relationship but he is and always has been a natural from the start. After our first nursing session the baby nurse came in to give him his Vit. K injection (the only thing other than the hearing test we agreed to, and we were never harassed or had anything pushed on us by the nurses. Our wishes and decisions were completely respected.) She asked if she could take him over to the warmer for a minute and I told her no and asked if she could do it while he was on my chest. She said she had never done that before but had no problem giving it a try. I refused the glucose water for him and told her if he was upset after the shot I would nurse him again. Irene told her that her favorite way actually was to do the shot while the baby nurses and that she rarely has them cry when it is done like that. The younger nurse found it very interesting and I think she took it to heart. I held him close and cuddled him while she did the injection. He made a pained face but did not cry. While going through my midwife's notes Irene suddenly got worried and said "You guys wanted the placenta? Oh no, I will run and go check for you and see if they still have it!" While I was originally planning on encapsulating it, I told her not to worry about it.

After an hour I was moved to my postpartum room and Tyler finally was allowed to come in and meet his baby brother. Paula and her assistants came in briefly to congratulate us and we told her how big he was and about his cord (we found out after the birth his cord was wrapped around his legs, up between his legs, across his body, and around his neck trapping an arm up by his head). She was amazed and said she was very glad we did not try to do it at home. The next morning Dr. Jochim came in to check on me and said we were extremely lucky my water never broke. That since his cord was around his legs (which we did not know until they were doing the c-section) his cord would have almost certainly prolapsed if it had...confirming the fear I was having during my labor. We stayed in the hospital for 2 days and the stay was wonderful. All of the nurses were kind and respectful and Maxwell was never taken from me except for his hearing test and Mark was able to go with him for it. We spent 2 days with constant skin to skin and nursing and he was never taken to the nursery. That first night Mark asked Irene what the hospital's policy was on where the baby should sleep (ie were they going to freak out if they found me sleeping with him). She told us the hospital recommends the baby be put on his back in the bassinet to sleep but that they were not going to tell us what we could and could not do with our baby. So he slept with me the entire stay (and still does now at 3 months old) and nobody ever said anything about it. Several nurses told me that there was no reason I could not VBAC if I wanted more children. They told me that that particular hospital would not do it but told me of some that would. It is now illegal for my midwife to attend any of my future births at home. Although this was not the birth I had planned for him it was amazing and beautiful nonetheless.

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