The birth of Luke Alexander: Home birth after cesarean (HBAC)

This will be the final post on this blog. However, I am continuing to blog about issues surrounding cesarean and VBAC on the ICAN Twin Cities Blog.

I swore I'd never have any more children.

Why would anyone choose to go through this again?

I would never consider giving birth at home. I could have died the last time.

These were all things I thought or said at one time or another after my traumatic cesarean birth with my first child. How things change given the right support, time to heal, and empowering education!

My contractions with Luke began around 11:30pm on Sunday night, May 25th. My "due date" had passed that Friday and I was continuing to struggle with fear that I would not go into labor. This was a powerful fear for me, because I was induced with Micah and so had never experienced going into labor on my own. It was one of the ways I felt like I had failed the first time around. I had been having similar contractions at about the same time each night, but they would go away after three or four intervals of 20 minutes, so I really didn't think much of these. Until they didn't stop...

I laid in bed resting, watching the clock and noting that the contractions were about ten minutes apart. I really didn't believe I was in labor. At about 1:15am I decided I would wake Jerry up if they hadn't stopped by 2:00am.

At 1:30am, I woke Jerry up.

The contractions were coming just a few minutes apart now and were getting more painful. Jerry asked if I wanted him to call our midwife. I said yes. He also went downstairs to start filling the birth tub. I moved to the bathroom and the contractions were coming hard and fast now. I started having bloody show. Jerry, on the phone with the midwife, asked if I wanted her to come now. I said that I did, but asked if she (our midwife) would be upset if it ended up being nothing. I laugh at this now, because I know now that I was in transition at the time, but in that moment I really still believed that I wasn't really in labor!

Around 2:00am, our apprentice midwife arrived. I think I was back in bed by this point. I think she may have taken my vitals and listened to the baby and started jotting notes while we waited for the midwife. At 2:30am, the midwife arrived.

While we were waiting for the birth tub to fill (I could not wait to get in that thing!), I filled our bathtub with some water and spent some time on all fours in the tub. For some reason, I also liked kneeling on the floor outside of the tub with my hands in the water. Something about the water was really calming. While in the tub, one of the midwives massaged my tailbone. It felt miraculously soothing and so calming. At one point, I asked the midwife, "What do you think?" She said, "Well...I think this is probably going to be a pretty quick labor." That was my feeling as well, especially since I had gone so quickly from pretty moderate contractions to transition in just a few hours.

I'm not sure exactly what time it was, maybe around 3:30 or 4:00am, I started pushing. No big deal. No cervix check to make sure I was dilated to ten (in fact, I did not have one single cervical check the whole labor, or the entire pregnancy!). It was so simple. I just said to my midwife, "I think I'm pushing." A few minutes later I heard her say to the apprentice, "She's been pushing for a while now."

Finally the birth tub was filled! The walk downstairs from the bathroom to the tub in the dining room was excruciating. I had to stop once in the middle of the stairway to push - legs shaking and my midwife holding me up. Once I got in the tub, I was relieved. I needed that water to contain my labor, contain my pain. I felt safe in that pool. The idea of pushing any longer outside of the tub scared me. I'm not sure why. But it would have taken wild horses to pull me out again!

There was, however, some discussion over the temperature of the water. It wasn't quite as warm as my midwife likes it to be for birth. She was concerned that it would be too cold for the baby. The midwives boiled water on the stove and (I think) Jerry brought buckets of hot water up from the laundry sink. Throughout it all, I was aware that the controversy was going on, but not worried. As I said, it would have taken wild horses to pull me out of that tub! Eventually, it seemed to reach a temperature that was agreeable.

Pushing went on for three and a half hours before Luke was finally born. I never really worried about it. The whole time I was just pushing as the urges came in the tub. The midwives and Jerry were all very encouraging. The most amazing part, to me, after not feeling a thing during my first labor due to the epidural, was that I could actually feel the baby moving down the birth canal. So, I knew that what I was doing was productive; the baby was coming.

I spent most of the time in the tub on my knees with my arms over the side of the tub, squeezing someone's hand (usually Jerry's) when the contractions came. It was quite painful! The volume was definitely turned up on my vocalizations over time. At one point, my water broke and it scared the daylights out of me. It was during a push and it just burst into the water. I said, "Oh my gosh, what was that?" One of the midwives said, "I think your water just broke." Oh, of course! I forgot that hadn't happened yet!

Throughout the process, my midwife would periodically listen to the baby's heartbeat using a waterproof dopplar. Each time it was reassuring; the heart tones were strong and of the right beats per minute. Upon one listening, I remember our midwife saying, "Well, you're just not at all bothered by labor, are you?" to the baby. Since drops in fetal heart rate are the #1 sign of uterine rupture, this was a big relief.

Finally, at around 6:30am (maybe a little earlier), the midwife got up and came to check the baby's head position. I'm not sure what she was seeing in my labor process; it felt to me like she knew something was happening or needed to happen at that point. The baby's head was very close. She said, "You've got lots of room," which gave me confidence that I could birth the baby. Another of my big worries after my cesarean was that my baby would be "too big" to fit through my pelvis since my first son was so large (10 lbs, 14oz).

The midwives encouraged me to change positions so that I was squatting with my back against the side of the tub and Jerry supporting me under my arms. At first, I was resistant. It hurt a lot to be in that position. This was probably a sign that I needed to be in it to get through the final pushing process. I'm not sure if we were stalled out in my previous position, but it was clear that there was more action after I moved.

Soon I heard the midwife say, "We have our first crown." It was excruciating. I knew the end was getting close, but it hurt so much. My vocalizations got even louder, and probably a bit more desperate. My memory of what all happened from here on is a little fuzzy; understandably so, I guess. I remember the head being born and my midwife saying she was reaching to check for the cord around the neck. Then I heard her say something like, "We have fingers." At this point, I was hollering quite a bit with my pushes. I heard the midwife say, "Sarah, I need you to focus all of that energy down to push your baby out." So I tried. Soon, I felt the baby come completely out. I have a hazy memory of reaching down to pull him to my chest. The midwife said that the cord was plenty long, so it was no problem for me to have Luke in my arms. I was in utter astonishment that I had done this, and totally blissed out to be holding my baby in my arms fresh from my womb.

After things calmed down, I learned that Luke had had a nuchal arm. That is why the midwife felt fingers when she reached to check his neck. She had to take Luke's hand and pull it up and out in order that his shoulders could be born. Once she did that, he slipped right out. No wonder I was in such pain and pushing took so long! The little guy was trying to be born with his fist at his neck. It made me realize that had I been laboring like this in the hospital, they probably would have wanted to operate. But there was really nothing wrong! Luke and I worked it out together with our midwife's added wisdom and experience. Amazing how simple it was!

Here our our fist moments after Luke was born (grab some kleenex):


While still in the tub, we called all the grandparents and my sister to share the news. Providentially, my parents had Micah, the brand-new older brother, up at the lake cabin with them. So, we never had to worry about what to do with him while I was in labor. Everyone was amazed that it had worked out so well and happened so fast. I had just talked to my mom and sister the day before when nothing was happening.

Birthing the placenta was a breeze. After Jerry cut the cord, once it stopped pulsing, it was time for me to stand up and get out of the tub. I handed off the baby for Jerry to snuggle against his chest while I got up. The midwives simply held a plastic bowl under me while I stood up and out slipped the placenta!

I made my way upstairs to the bathroom. At this point, I did start to feel quite lightheaded, as if I might faint. My midwife gave me some Emergen-C as well as some herbal tinctures under the tongue (I'm not sure what they were). Then I moved to my bed and felt better lying down. Under inspection, it was clear that I was bleeding from inside fairly heavily. I asked the midwife if I was in trouble. She said no, that my uterus just needed to clamp down. It would help if I could empty my bladder. Problem! I have terrible performace anxiety about this and my perineum was stinging quite a bit. So, I wasn't able to. But the midwife reassured me that I would be fine, massaged my uterus and taught me how so that it would go down. Later in the day, I was able to empty my bladder and there were no problems with excessive bleeding.

Despite Luke's hefty birthweight (9 lbs, 5 oz), I had only one, very minor tear. No doubt the water and my midwife's gentle coaching in pushing helped keep me from more significant tearing. Here is our little man having his first exam:


The rest of the day was spent laying in bed, cuddling with Luke, and welcoming family as they came to visit. I was so proud of myself, I could hardly stand it! I felt victorious, vindicated, redeemed! No longer defined by the scar on my belly; a women who CAN birth her babies, even if they are big!

Here is the moment big brother Micah meets his new little bro:




And our new family:

Thinking Outside the Bottle

For the past couple weeks, I've been sweating how on earth it's all going to work out when I go back to school in September. In particular, I've been worried about Luke getting the milk he needs while I'm gone since I'm his sole source of it. With Micah, I stayed home for eight months and by then he could go for longer periods without nursing and I didn't worry if he didn't take a bottle so well. In Luke's case, I had vowed that I would get him started on a bottle sooner since I'm going back to school when he's so young (three months).

Well, we've been trying to introduce the bottle for a few weeks and he's not so much into it. So, I started getting even more anxious about this fall and even thinking maybe I shouldn't go back to school. But then last night I picked up my copy of The Complete Book of Breastfeeding hoping for some ideas about how to get your baby to accept a bottle.

What I got was a reminder that bottles, like many things, are simply a socially accepted means of delivering milk to a baby, not an absolute necessity. There are several other ways that Luke can get milk, including a cup (yes, even babies drink from cups!) or an eye dropper/medicine dropper. More tedious to deliver, perhaps, but might be easier for Luke to take.

It was a forehead-slapping moment for me. Of course! Sometime in history, someone decided to create a pseudo-boob, which we now know as the baby bottle, to feed babies. But that doesn't mean it's the only way to feed a baby when a breast is not available. What kind of sociologist can I expect to be if I can't even see the social relativity of my own child-rearing practices? Doh!

Here's what the Book had to say:
"In our society we have generally assumed that babies who are not breastfed need to get their milk in a bottle. But in many countries around the world babies who cannot be nursed receive all their liquid nourishment in a cup, sometimes right from birth. United Nations agencies do not distribute feeding bottles at all even to babies who cannot be breastfed." (p. 232).

Jerry tried it this morning and it worked pretty well, though a bib is definitely a necessity. Luke was content with the couple ounces he got and it gave me more confidence about leaving him for a few hours when I have to. This way, too, he'll save all his good nursing just for the two of us!

Opinionated

I haven't had much time to blog lately...somehow I thought I would with a newborn baby. Ha ha. But I did have a chance to sound off on on home birth in the Star Tribune. I made it in as a "Netlet" online, alongside my friend Heather from ICAN. Click the link or read it below:

Her well-informed choice

As someone who has experienced both a hospital and a home birth, I can attest to Jennifer Block's assertion that hospital maternity care is not supportive of the natural labor and birth process. My first son's birth began with induction via Cytotec and ended in a c-section. My second son, born just seven weeks ago, was delivered on his own terms (and mine) in a birth tub in our dining room. I chose my second son's birth setting based on the sound research Block cites as well as my own experience: that medical practices and hospitals are making it next to impossible for women to have vaginal births after c-section (VBACs) without unnecessary and intrusive interventions based on fear of malpractice suits.

I am a highly educated and highly responsible woman -- that the AMA should suggest otherwise because I choose to birth at home is not only ridiculous and insulting, it demonstrates an irresponsible disregard for scientific evidence. I wanted both a healthy baby and a natural birth process; generally, the two go hand in hand. For me, the only place to get that is at home.

SARAH SHANNON, MINNEAPOLIS

Mixing sociology and birth

I had a great time this morning talking with Rachael Kulick, a fellow grad student in sociology whose dissertation research is titled, "What will I do with the placenta?: The social meanings of home birth in the United States and the Netherlands." I heard through the grapevine about Rachael and her project and just had to meet her!

Our conversation traveled down many paths, some of which I can't share due to confidentiality (the home birth world is a very small one!), but one well-traveled topic was that of socialization - that in our culture we are raised to believe that the hospital is the safest place to give birth, home birth is scary and unsafe and "granola," etc. What most people don't know is that these are notions that science simply does not support for normal, low-risk births. Here are a few scientific studies from reputable, peer-reviewed journals that establish the safety of home birth (as cited in a recent newsletter from Ten Moons Rising):

The change to planned hospital birth for low-risk pregnant women in many countries during this century was not supported by good evidence. Planned hospital birth may even increase unnecessary interventions and complications without any benefit for low-risk women. Cochrane Database of Systematic Reviews 2008 Issue 2

Planned home birth for low risk women in North America using certified professional midwives was associated with lower rates of medical intervention but similar intrapartum and neonatal mortality to that of low risk hospital births in the United States. BMJ 2005;330:1416 (18 June)

Home birth can be accomplished with good outcomes under the care of qualified practitioners and within a system that facilitates transfer to hospital care when necessary. Obstet Gynecol. 1998 Sep;92(3):461-70

Home birth is an acceptable alternative to hospital confinement for selected pregnant women, and leads to reduced medical interventions. Birth, 1997 Mar;24(1):4-13

...under certain circumstances, home births attended by lay midwives can be accomplished as safely as, and with less intervention than, physician-attended hospital deliveries. The Safety of Birth: The Farm Study, Am J Public Health. 1992 March; 82(3): 450-453.

... in a self-selected, medically screened, low-risk population, home delivery with medical facility back-up can be a reasonable alternative to hospital delivery. Mehl et. al, Journal of Reproductive Medicine, 1977

Rachel's study will certainly shed some interesting (and much needed) light on home birth from the perspectives of those who have experienced it and the midwives who help facilitate it in two very different settings: the Netherlands, where approximately one-third of all births take place at home and the U.S., where only 1 % of all births are at home. She will be traveling to the Netherlands this coming academic year as a Fullbright scholar. I can't wait to hear (and read) about what she learns!

A tale of two births: In pictures

Micah's first moments of life after his c-section:














Can you even find the baby in the sea of gloved hands?

Micah's first moments with mommy (two hours after birth):














Luke's first moments of life AND his first moments with mommy:














Micah meets daddy:














Luke meets daddy:














The new fam #1:














The new fam #2:

One month!

My baby boy is officially one month old today. The midwives were here on Tuesday and took his measurements. He now weighs 13 pounds, has a head circumference of 15 inches and is 23 inches long. That's an increase of 3 lbs, 12 oz in weight, 2.5 inches of circumference, 2 inches of height! So, I guess you could say that he's eating and growing just fine.

We're doing really well. My biggest challenge is being content with the day to day activities of babyland, which are not particularly intellectually stimulating. It's hard to go from full engagement in academia to stay at home motherhood. On the whole, it's good. I'm trying to remind myself that these early days go by so fast, he won't be so little forever, and it will be back-to-school in the fall before I know it...

Feminism & birth

My friend Heather D. published this commentary in Minnesota Women's Press:
http://www.womenspress.com/main.asp?SectionID=2&SubSectionID=2&ArticleID=3100

She raises the issue of feminism: how is it that we women who consider ourselves feminist - educated, empowered, and capable of any career or life we choose - completely lose this mindset when we get pregnant? All of a sudden, the doctor, not our body or our instinct, knows best. Many of us are perfectly willing to fight for our reproductive rights when it comes to abortion, but giving birth? How could we possibly do that without an expert, more than likely a male one, to help us? To tell us what is right or wrong about our bodies, our labors, our babies?

Eek.

It strikes me that there are two ways that women might look at birth, both claiming to be feminist. The first is to step completely out of the medical birth mindset, like I did, and strive for natural, homebirth, rejecting the perceived (or real) oppression of the patriarchal establishment. The second is to embrace medical technology as progress and seek to use it to your best advantage, such as the use of epidurals and other drugs for pain relief. Believe me, after Luke's natural birth at home, I get the appeal of epidurals all the more now! Why shouldn't women be free to capitalize on the best that modern technology has to offer?

Both options come with their own pitfalls, fears, and potential risks. It's obvious from this blog which one I have chosen. But here's the deal: I think women ought to be able to give birth wherever they feel is the best place for them. If that's home, great! Homebirth ought to be legal and non-stigmatizing to those who choose it. If it's a hospital, great! Hospitals ought to provide laboring women with evidence-based (not fear-based) care and support and women should be free to choose how they birth (what position, with or without drugs, in or outside of water, etc) within the hospital environment. Unfortunately, hospitals do not currently practice this way, especially not for women like me with a scarred uterus.

This is what I strive for. I want birth, wherever it happens, to be the best it can be for all women and their babies. The two go hand-in-hand.