Tuesday, August 11, 2009

Week 1

So I have successfully navigated the first week of motherhood. At least it seems to be a success, although I don't really feel like I should be taking any kind of credit for that fact, since he has been a ridiculously good baby.

I still have to wake up in the middle of night for feeding and changing, but he doesn't wake us with blood curdling screams. Usually he just let's out a little cry when he is ready. He only wakes 2-3 times a night and generally goes back to sleep after being fed and changed.

During the day, he is happy taking his naps in the crib or co-sleeper. On a "fussy" day, he likes to sleep in your arms, but again, no screaming fits about it.

He seldom cries when we change him now, and he actually seemed to enjoy his first bath.

I've joked already that if he stays this way I can't possibly have another kid - I've been too spoiled with this one.

Maybe this is a reward for enduring such a long labor :)

Friday, August 7, 2009

Fresh out of batteries...

...but still making noise...

The following post is a semi-detailed account of the arrival of Jonas Gabriel West. Since this is an account of how he got from womb to our arms, the passageway does involve my personal "business", so his travels could be considered graphic. You have been warned.

In preparing for labor, I read lots (and lots) of books and websites, all preparing me for what signs to look for, and giving me some idea of what to expect. So to start, here is an example of how it should all begin, courtesy of mayoclinic.com:

Early labor
During early labor, your cervix will begin to dilate. You may feel mild to moderately strong contractions during early labor. They may last 30 to 60 seconds and come every five to 20 minutes. As your cervix begins to open, you may notice a thick, stringy, blood-tinged discharge from your vagina. This is known as bloody show.

On Wednesday, I noticed that I was having crampiness in addition to the Braxton Hicks I had been having for weeks. It wasn't terribly painful, just a nagging sensation, like the feeling I would get when my period was on its way. Crampy, uncomfortable, but not in pain. It was late in the afternoon that I realized that the discomfort had a pattern, and that evening I used the bathroom and found a blood tinged discharge - the bloody show. This is one of many things related to labor and birth that have names that sound much more horrible than they are. (Somewhere in this time period, my older brother and I discussed having a band named "The Mucus Plug" and the opening act would be "The Bloody Show".)

Recognizing that the show and the regular cramps were a sign of contractions - the real kind - I called the midwife to confirm whether I or not I could be entering the first stages of labor. Since I had an appointment the next morning, she recommended I come in as scheduled and they would check to see how I had progressed.

I went in to be checked and found that I was 85% effaced and 1 cm dilated. According to mayoclinic.com, I was on my way!

How long it lasts: You may need to be patient. Early labor is unpredictable. It may last for hours or even days, especially for first-time moms. It's often much shorter for subsequent deliveries.

So...I apparently forgot about the part here that states that early labor could last for hours or EVEN DAYS. In my case, it was days. From Wednesday evening to late Saturday/early Sunday.

What you can do: Until your contractions increase in frequency and intensity, it's up to you. For many women, early labor isn't particularly uncomfortable. You may feel like doing household chores, taking a walk or watching a movie. Or you might simply continue your daily activities.

Also apparent at this point, I am not many women. My contractions increased in intensity, but not frequency. I could not go about my routine. Every 6-9 minutes I was in a considerable amount of "discomfort" (I was still refusing to refer to it as pain...I had grand plans to trick my brain into thinking that this whole labor business wasn't going to hurt a bit!). The discomfort was enough that I was unable to sleep through the night. On Friday the midwife suggested some Tylenol PM to help me sleep - the first Tylenol I took my entire pregnancy. Unfortunately, it didn't work. She called in a prescription for something that could relax me safely - but still no luck. Forget chores, movies, etc...I couldn't do something as simple as sleep.

I coped with warm baths, calming music, and breathing through the contractions. Breathing was quickly my best friend in the process. Deep breaths in, slowly exhaling through the height of the contraction really did seem to expel the pain with the breath.

By late Saturday night, I was exhausted and frustrated that the contractions, while still intense, hadn't increased in frequency. Desperate, I had J call the midwife in hopes that she could tell me something positive. She recommended that we work at getting the labor going, if I was up for it. So the first of my many birth helpers arrived - April, a student midwife, showed up at our house at 1 am. My mother, J, April, Dudley (the dog) and I then set out to walk the neighborhood, in an effort to "work" the contractions. In my nightgown and sneakers, I headed out, determined. At every contraction we stopped and I squatted, breathing and bouncing through the peak of each, then pulling on J's arms to hoist my massive self back up to walk again. I couldn't help but wonder what the neighbors would think if they happened to look out their window. I honestly didn't care too much at that point, but I did find the idea humorous.

After we got back, I was checked again, and I had made some progress! The contractions were a bit closer together and I had dilated another centimeter or so. I was so excited - I was in the next stage. "Actual" labor!

Active labor
Now it's time for the real work to begin. During active labor, your cervix will dilate to 10 centimeters. Your contractions will become stronger and progressively longer. Near the end of active labor, it may feel as though the contractions never completely disappear. You may feel increasing pressure in your back as well. If you haven't headed to your labor and delivery facility yet, now's the time.

Your initial excitement may wane as your labor progresses and the pain intensifies. Don't feel that you're giving up if you ask for pain medication or anesthesia. Your health care team will help you make the best choice for you and your baby. Remember, you're the only one who can judge your need for pain relief.

The real work? I don't like the implication that me walking my neighborhood and doing squats like some crazed fitness nut at some obscene hour on a Sunday morning isn't work...but here we are.

Since this was a home birth, there was no need at this point for me to pack my bags and head somewhere else. I could thankfully squat, breathe, sway and whatever else in the comfort of my own home. I could also lay semi-conscious in my bathtub.

The increasing intensity and pressure in my back was definitely there - but the frequency still wasn't consistent. It was at this point that time became absolutely meaningless to me. Time passed as breaths to get through the pain (I no longer had the will to call it discomfort). The midwives (there were now a Licensed Midwife, Diane, and an LPN, Shannon, joining my crew) came in and out to check the baby's heartbeat, my blood pressure and temperature, constantly ensuring that Jonas and I were healthy. Every heartbeat check reassured me that I was doing the right thing for my baby, letting him leave the comfort of his home for the past ten months with as little intervention as possible. It made me feel better about giving up the ability to turn and ask someone to shut off the pain. He would be here soon and none of this would matter.

Also helping me through the pain at this point was absolute exhaustion. I would breathe through the peak of my contractions, then basically fall asleep for a few minutes in between. Although I could feel the intensity of each one, my tired brain seemed to only be able to focus on my breathing, so I couldn't obsess over the physical discomfort that had now become a regular occurence.

How long it lasts: On average, active labor lasts up to eight hours. For some women, active labor lasts hours longer. For others — especially those who've had a previous vaginal delivery — active labor is much shorter.

This is where all the books and websites and stories failed me. Looking at averages, I thought to myself, even if I labored for 12 - which sounded like a horrendous idea - I could make it through. Somehow. I could do it.

No one told me that I would be so far from average. But then if I had known that it would be a 26 hour active labor, I may not have ever thought I could do it.

What you can do: Look to your labor coach and health care team for encouragement and support. Try breathing and relaxation techniques to combat your growing discomfort. Use what you learned in childbirth class or ask your health care team for suggestions.

I had already discovered the value of breathing long before the contractions were beyond intense. But something that I hadn't considered was the value of someone talking you through each one. For me, this person was Shannon, the LPN on my team. From the outside, I probably would have thought the repetition of phrases like "You are such a strong woman" and references to "riding the peak" and working with my body would have done nothing for me, even annoyed me. But in the moment, each contraction greeted with the same phrases, guiding me from start to finish, through the rise and fall of each, I felt completely relaxed as each contraction ended. I really did feel like I was strong enough to do this. And I really did feel like I was getting that much closer to meeting my little boy.

As the day continued to disappear, Diane was concerned about my level of energy, and the lack of progression. I had been working so hard - walking, squatting, bouncing on the birthing ball, most anything that was suggested I did, no matter how hard or painful. She recommended that we break my water, as my dilation had seemed to stall. At first, I refused the suggestion. I felt like I had worked too hard for too long to do anything that might make Jonas' entry into the world more difficult. I could only think emotionally and just remember saying I wanted to try some more. Give me something to try. I'll do it. For some reason I felt like I was giving up by saying yes.

I did more walking and swaying and squatting. Still no progress.

J spoke to me quietly, asking if I shouldn't consider letting them break my water. He spoke rationally, trying to find out what I was afraid of. As it turns out, my fears weren't relevant. When we were preparing for what labor would be like, I read about hospitals that broke the water when the baby wasn't in the proper position, causing difficulties with the birth. Jonas was "locked and loaded" - engaged and in the perfect position to be born. And I trusted my midwife. I knew that she wouldn't recommend something that could possibly hurt either of us. I was afraid of the increased intensity that would come after the waters broke - but that fear too, was irrational. The labor was going to get more intense regardless. At least this way it could progress too.

My mother came in (she came in often in the process to check on me and reassure me) and gave me some sublingual B vitamins for energy, someone else gave me a spoonful of honey, and I think a straw was put on front of my face with something to drink. I had a relative surge of energy and told J to get the midwife in the room. Let's do this.

Diane came in, as well as others (so much is such a blur) and had me lay down. The other girls helped me to remember to breathe through the contraction as she broke the bag of waters. The gush was almost a mental relief. I'm getting closer, I told myself.

I got up on the birthing ball so I could work the next series of contractions. And they were intense. The support I received to get me through them was amazing. At various moments J was there to hold my hand. My mother was massaging my legs and back. And April and Shannon were vocalizing with me. Teaching me to let out a low "Hoooooooooooooooooo" when I let out my breath, forcing my body to relax with the pain. The three of us were a funny chorus to those outside the door of my bedroom I am sure (my sister joked with my oldest brother that we sounded like a pod of whales at times, and they were pleased when we somehow harmonized) but in the moment having these two women howling with me was the only way I was going to get through this. Sometimes my sounds would waver, as the pain got more intense, but I just had to keep focusing on my breath, on the sounds.

I got in the tub, thinking that I must be close. I wanted to be there and ready to go. I continued my low (but increasingly louder) moans and at this point was told that I could get used to the feeling of bearing down into a contraction. The bearing down was a relief at times, and I thought for sure that the pressure on my cervix must have me ready. I must be at 10 cm. It must be time.

The midwife checked me while I was in the tub. 8 centimeters. 8 lousy centimeters. I wanted to cry. Why wouldn't my body progress? I was doing everything, EVERYTHING.

I got out of the tub - I am pretty sure at the suggestion of Diane - and she began to massage evening primrose oil on my cervix. I don't know how long it was, but it seemed like it was moments that I was now 9 centimeters. Then maybe 9 and half.

The 10 cm mark continued to seem elusive and I was being asked to change positions. I did whatever I was told, and I remember someone remarking how polite I was for a woman in labor. I would apologize if I was told not to arch my back, or to relax my pelvis. I think at some point I even made a joke. ("Who says you lose your sense of humor in labor?")

Diane continued to work with the baby's head and my stubborn body. And then I was asked if I felt I could do some pushing on the toilet. This was not the kind of water birth I had in mind! Off to the toilet I went. There, in a squatting position fit for the kind of pushing needed, I was able to get Jonas to crown. "You can feel his head!" Diane told me.

I was getting so much closer. I waddled from the toilet back to the bed. This was the final lap. I could do this. I could do this. My mother and husband were holding my hand. She was telling me loving momlike things that make you cry when you are coherent. All three women on my "birthing team" were there - holding my legs, helping me breathe. My sister had even entered the room to watch (she was around for the labor as well, bringing me juice and water and taking care of me, but quietly).

With every contraction, I pushed as much as my body would let me. I kept anticipating a greater pain than I was feeling. It was going to happen soon. Just keep going.

I was told that the endorphins would be kicking in, and perhaps it was the endorphins that made me see the little fish from "Finding Nemo" in my head sing songing, "Just keep swimming, just keep swimming..."

At this point in the pushing I felt what they refer to as "the ring of fire". This is the point that your vagina is being stretched to accomodate the widest part of your baby's head. When I was reading about labor, I had decided that when I felt this, I would take a moment to rest, then push again in the next couple of contractions. I didn't want to overpush and tear. I had it all planned.

As the midwives put warm compresses on my vagina, which was quite a relief, and I sang Johnny Cash in my head, the next contraction came. All thoughts of taking my time through the ring of fire went out the window. All I could think was that this was the home stretch (literally) and I wanted to be done. I pushed and grunted and groaned and pushed some more. And his head was out. And I, from what I am told, was out too. I basically was passing out from exhaustion between pushes. I remember being told not to push and just breathe...and then I remember lots of voices saying "Amber, look, look, here's your baby!"

And there he was. The sticky, alien thing. They set him on my chest and I was so relieved to see him. There were no tears. Just relief. And calm.

I survived. And there was a healthy little baby boy to show for it. J cutting the cord and the details that happened at this point all just blend - I really don't have a clear memory of what happened.

I do remember feeding Jonas, waiting for my uterus to contract some so I could deliver the placenta. It was relatively quick, but after all that pushing, the one push I needed for this task seemed to take forever.

And then there was stitching. Remember the aforementioned moment where I decided to push through the burn of the "ring of fire"? I tore a little as a result. After everything I had been through that day, the suturing was nothing. I sat in the bed, naked, eating a peanut butter and jelly sandwich while being stitched up (sidenote: my dad ate a peanut butter and jelly sandwich while my mom was being stiched after the birth of one her five kids).

Then that was done. I asked if I could rinse off in the shower - I needed to feel clean and like myself again. I wobbled with baby deer legs to the shower, rinsed, put on a clean nightgown and a sanitary pad that had been fetched from the freezer (my birth ladies knew what they were doing...) and laid back in bed, which had been cleaned up and dressed as well. I climbed into bed, gently, with "mermaid legs" (keeping them closed so as not to disturb the stitching), and then I was handed my boy again. I sat there listening to instructions on what I needed to do over the next few days. I don't know that I took much in.

Then there were hugs - from my parents and sister to the midwives, from the midwives to me, from my family to me and J and the baby.

And then everyone was gone.

The three of us laid in bed, exhausted, but I didn't even care about sleeping. I just wanted to stare at this little person who had just endured the most exhausting couple of days in my life with me. It was the happiest I have ever been to see someone I just met. :)

I have been asked if I would choose to birth at home if the option arose again. Without a doubt, I would. The support I received from this amazing team of women and from my family would not have been available to me in a hospital. And I wouldn't have seen so fully how wonderfully we are designed, with such strength that we aren't even aware of.