Tuesday, September 22, 2009

Ingrid's birth - from an outside perspective

Ingrid has given me permission to post this story. Theoretically, she's also going to post her own story in the near future. It should be fun to read both perspectives!

Ingrid went into labor early Saturday morning. She called me mid-morning to give me a head’s up, and I thanked her for being so considerate as to decide to labor on the weekend! I asked her a few questions and then asked her to call me if anything changed dramatically.

I received a few phone calls during the day, and reassured Ingrid and Clint that I was available to come to them whenever they felt they needed me. At 9pm they asked me to come.

I was so excited. So excited that I nearly forgot to take my birth bag with me. So excited that I stopped to get coffee and “I’m going to help my friend have her baby” just spilled out when the barista wanted to take my order. So excited! And under the excitement, a deep sense of awe, and privilege, and responsibility.

Ingrid was in solid first stage labor when I arrived. One of the first things she said to me was “Hey. Labor hurts.” It made me laugh because yeah, it surely does! She could talk between contractions but when one started, all conversation ceased. She was quiet and focused. Clint was supporting Ingrid and doing a great job, so I spent about an hour mostly observing, then tentatively trying out a few support possibilities, trying to make my insertion into the process as seamless as possible.

Around 11pm Clint was clearly getting tired, so I suggested that he might like to take a nap. Ingrid seconded this, so he went to the living room to sleep on the couch. I spent the next three hours with Ingrid, learning. I held her hands, let her rock against me; we walked, and walked, and walked, and sometimes laughed; I was part of her labor and it was a wondrous, wondrous thing.

Around 3am labor had definitely changed. It was much more intense and Ingrid was displaying some of the signs that signaled transition might not be far away. I was starting to feel that going to the hospital (as they planned to do) was fast becoming the best option. While I knew that Ingrid wanted to do most of her laboring at home, I was also aware that the drive to the hospital would take some time, I didn’t have the experience to properly gauge how long the end of labor would take, and I did not want to end up catching a baby either at home or in the car.

I told Clint that in my very not-trained opinion, Ingrid was heading towards second stage labor in the next couple of hours, and that if I had to guess I’d say their baby would probably show up in early to mid-morning. We started getting ready to head to the hospital.

Triage at the hospital did not go well. Ingrid continued to labor quietly, and I think that the triage nurse may have thought she was just another primip arriving at 2cm. I wasn’t in the room, but Ingrid told me later that the nurse was abrupt and unhelpful. By the time they came out of the triage room, Ingrid’s labor had functionally stopped.

Which seriously surprised me, because she was seven centimeters dilated.

We spent the next seven hours trying to work within the system and get Ingrid back on track, to no avail. Walking the halls could bring on contractions, but as soon as a nurse put her back on a monitor (for 20 –30 minutes each hour) they petered out again. Ingrid was exhausted and frustrated – at one point she said that she just wanted everyone to leave her alone and stop coming into the room to bother her! Not long after that she and Clint decided that it was time to go home.

Thankfully, in the midst of this time there had been a shift change and we had a new set of nurses and a different midwife in charge. They tried to talk Ingrid into staying, but honestly, they didn’t try very hard. They did suggest that they could rupture her membranes to "kick labor back into gear”. I quietly advised against that once the nurse left the room, pointing out that if it didn’t work, she had just put herself on the clock for delivery. Ingrid signed the necessary “against medical advice” forms and we left the hospital. The nurses at the desk waved us off with concerned requests to come back as soon as labor got going again, and our lovely Christian nurse prayed with us briefly, a gesture that surprised and touched me.

Ingrid was pretty discouraged on the way home. She was still having intermittent contractions, just enough to make her miserable, and she hadn’t slept in about 30 hours. She informed us that she could NOT go back to the hospital, and trying to soothe her, Clint said that she didn’t have to. This was the first time when I felt really mixed up and a little frightened, because I knew that without a trained midwife, not going to the hospital wasn’t really a safe option, and I didn’t want to be the only one there if anything went wrong.

At home, Clint called Margit, a friend from college who has a midwifery license, and I left a message for Sue (my own midwife) asking her advice. We got Ingrid into bed, sleeping a little, and I decided to go home. I didn’t feel that I could be of any help immediately (since labor was still definitely in a full stall) and I had been away from Josiah (who was still nursing) for over 15 hours. It was good to go home, nurse him, re-group and re-connect (slightly!) with life-outside-of-labor, and take a desperately needed three hour nap.

Clint called me back in the evening, almost exactly 24 hours after calling me to come the first time. Ingrid was back in a consistent contraction pattern. Please come.

I was glad that Margit was there when I arrived. Although she hadn’t been practicing for a few years, she had knowledge and skills that I simply didn’t possess and I felt better having her around. The previous night Ingrid’s labor had made sense to me, but now it was unpredictable and confusing. Margit wasn’t quite sure what was going on, either – by the end of the process we had counted three “pseudo-transitions” that didn’t quite go anywhere. I don’t think you could call it a “normal” labor pattern by any stretch of the imagination.

We went back to the hospital in the middle of the night. Thankfully, Ingrid had decided that she did in fact want to go back, and this time when we got there we had kind nurses (and the midwife we’d seen in the morning) ready and waiting for us. They didn’t bother with triage but sent us straight up to a delivery room. Ingrid still had to deal with the monitors, and her labor did slow down again, but thanks be to God, it didn’t stop.

Ingrid and Clint had been very clear with hospital staff (and with me) that they wanted a completely natural, drug-free birth. However, as Sunday became Monday, I started to wonder if continuing to pursue that goal was the best plan. Ingrid was so tired. She had been in labor for over 40 hours and her body was simply wearing out. At one point the pupils of her eyes started dilating and contracting randomly, and I was honestly concerned that she was about to pass out. Maybe that would have been a blessing, from her perspective.

At this point Margit asked me to come out in the hall with her to confer. We both felt, at that point, that continuing to pursue “no interventions” might in this case lead to a cesearean for failure to progress or maternal exhaustion. We wanted to talk to each other first and be sure we were on the same page before presenting this potentially unwelcome idea to Clint (Ingrid was no longer able to make decisions for herself.)

Although I firmly believe that natural, drug-free childbirth is generally possible and usually the safest route for mother and baby, I have never been in the “never never never” camp. There is a time and a place for interventions, especially a minor one (some kind of pain management) in the attempt to avoid a major one (forceps delivery or surgery). I was convinced that this time had come in Ingrid’s labor.

It put me in a strange position, however. I saw myself as Ingrid’s advocate and support in labor, which in this case included suggesting pain management. However I was concerned that Clint might see me as their advocate against interventions. So it was with some concern that I suggested that the time had come to ask for some pain relief for Ingrid.

Apparently Margit and I weren’t the only ones who thought so, though, and it worked out ok. Just a few minutes after we made the suggestion, the midwife came in and gently suggested the same thing. And then Clint called Sue (who had been helping us out with advice since I’d called her Sunday afternoon) and she concurred with our assessment.

With everyone in agreement, Clint made the decision to give Ingrid a narcotic, in the hopes that it would dull her pain enough to let her sleep for a few hours. It worked beautifully.

With Ingrid asleep, Margit and I raced for home. I had the family car at the hospital and Gabe needed it to get to work in just a few hours! My body was also reminding me that it had again been a long time since nursing Josiah. When we got there, Margit napped on the couch for ten minutes while I nursed Josiah. You cannot imagine how difficult it is to resist falling asleep while bathed in nursing hormones and having had only three hours of sleep in the previous 40!

Clint called as we were heading back to the hospital, this time with fantastic news. Ingrid was complete and getting ready to push. Margit broke some speeding laws on the way back! We got there to find Ingrid most definitely pushing. The midwife checked her, coached her a bit on how to push effectively, and then suggested that she try sitting on the toilet, which she did. Clint crouched beside her and Margit and I stood back and watched. Margit had brought a small flashlight and used it to check Ingrid’s progress. I was standing ready with the camera and said “Margit, is that the head?” Margit wasn’t sure until the next push, and then she ran out the door to get the midwife. It was most decidedly the baby’s head!

They barely got Ingrid back to the bed – indeed I’m not sure quite how she managed that short walk – before Isaac slid out into the midwife’s hands. She didn’t even get her gloves on.

Isaac Timothy Rothell was born at 4:43am after 46 hours of labor. He was seven pounds, five ounces, and twenty inches long.

And then it was over. The last time I was that tired was after giving birth to Thomas. I went home and slept while Libby took care of my children. It took a few days to get back to normal, and I found myself thinking “how in the world do midwives do this???

Yet while I’m not sure how they do it, I completely understand why. And I can’t wait to do it again.


Ma Torg said...

How exciting! So are you going to train to be a doula then possibly? Or pursue midwiferey?

Amber said...

Wow, what an amazing story - I'm glad you took the time to put together your thoughts and post it. I find the whole idea of being present at someone else's birth awe-inspiring (and nerve-wracking!). That is really neat that you're thinking about training as a doula - and I hope any future births you attend are smoother and perhaps a little faster too! (but not too fast! *grin*)