Just Powers

William James Carvalho joined us on Thursday, March 19, 2009 at 5:32 pm. He weighed 7 pounds 3 ounces and was 19 3/4 inches long. Like his sister, his labor was uneventful if pretty short - 6 hours of very light contractions that allowed me to drive myself to the hospital, ending with the doctor breaking my water which brought on 40 minutes of very very hard labor before Will entered the world in one push. We had the most amazing nurse in the world who made the whole experience the polar opposite of our experience delivering Emma.

One week later, we are all doing great. Emma is going through what seems like a pretty typical 2 year-old adjustment period, requiring extra patience and love from us, Will is sleeping and eating and doing everything else newborns do (no prediction here about his temperament, lest I jinx it), and Mike and I are just beginning to figure out how to juggle it all.

I have been trying for months to get the story of Emma’s birth posted here. Over at Sarcastic Mom, Lotus has finally been able to get my rear end moving on this with her Birth Story Carnival. This story is really really really long so, you know, schedule some bathroom breaks in here somewhere.

I am a planner. I like having a plan. The thought of going into a weekend with no idea what I am doing fills me with dread and confusion. I don’t need every minute planned, but I need a rough outline please. It soothes me. Over the years I have worked very hard at decreasing my need for plans all the time, and have done better, but it is still, at my core, who I am. I knew when I got pregnant that my planning tendency would be put to good use, but I also knew I would need to PLAN to throw out everything when the birth actually happened.

As soon as I found out I was pregnant I started the planning, but to be honest it seemed pretty simple to me. I had a plan A: no epidural and a plan B: epidural. I knew I didn’t want an epidural but also knew that I had no idea what I was really getting into so an epidural in the end might be my best friend. That was pretty much all I knew about my birth plan.

A friend of mine used the Bradley method when she gave birth to both of her kids. She swore by it and even though it was years ago now, I remembered it when it was my turn to think about how I wanted to give birth.

The basic philosophy behind the Bradley method is that with the right preparation, education and support women can give birth naturally. The preparation part focuses on nutrition during pregnancy and exercises that help strengthen all the necessary muscles. The education part teaches relaxation techniques and also what happens during the birth process, with the idea that if you know what to expect you will be less afraid and less likely to ask for an intervention you might not need. The support part helps the coach - usually a husband or partner - know what to expect and how to provide the right support to the woman in labor. All of this is taught in a once a week class for twelve weeks that both partners attend.

So I did the research and decided we would definitely go with Bradley. I checked the Bradley website and found a teacher near us and signed us up. Little did I know that this would be the single most important thing I would do during the entire pregnancy.

A few weeks before our Bradley classes were scheduled to begin Mike got offered a new job. It was a really good job with a popular Governor running for re-election and possibly (probably) a higher office after that. It was the kind of opportunity that really only comes along once in a while and when it does, you don’t turn it down.

Only problem was, it was in a different state. Not only a different state, but a different climate and time-zone too. Together we decided he had to take the job and that I would be fine, especially since my family lives in the area. Plus, since it was an campaign and would be over on election day, he would be back well before my December 31 due date.

So Mike went across the country and I went to Bradley class. Normally Bradley classes have 3-6 couples in them, so I was a little apprehensive about being the only single there, but figured it would be fine. Turns out I needn’t have worried. The two other couples who were scheduled for the class backed out leaving, yup, just me.

So I got my very own private Bradley sessions once a week. Ninety minutes of uninterrupted me time. My instructor Maria was wonderful and I couldn’t wait to go to class each week. After class I would call Mike and tell him what topic we covered and if there was homework we would do it together. By together I mean that I would do it and tell him about it and he would say “cool!”

Being alone during the pregnancy was much harder than I imagined it would be. Mike was gone from 24 weeks to 34 weeks. It’s bizarre to write that it was only 10 weeks because it felt like 10 months. It was the daily household things that were the most difficult, especially because most days I just wanted to come home from work, sit on the couch and fall asleep. Taking the trash out? Hell.

Mike finally came home and we started doing little things to prepare. He was able to attend a Bradley class with me and the plan was that Maria would continue to see us for a few weeks after our 12 weeks were over to make sure he was caught up.

One of the things that we discussed over and over in the Bradley class was the idea that intervention begets intervention. Because of this, I knew that I wanted to try to stay away from any intervention for as long as possible, and in fact, planned on staying away from the hospital for as long as possible. I had wonderful images of laboring at home for hours, listening to music between contractions, possibly going for a walk, and then finally going to the hospital, giving birth on my own, cheered on by my husband and a supportive medical staff.

We went to two Bradley classes together and I bookmarked a couple chapters in the Bradley book for him to read. On the morning on December 4 we went to my 36 week check up. The doctor did an internal exam and said that everything seemed fine, that there was no dilation and no indication of anything out of the ordinary. She also told us that I had tested positive for Group B Strep, so if my water broke, I would need to get to the hospital ASAP so that I could receive antibiotics that would protect the baby from an infection. I was devastated that my plan to stay home until the last possible moment was not going to happen, but reluctantly began to rethink my birth plan since keeping the baby safe was the priority. One thing I talked to her about was that I didn’t want an intravenous line that would restrict my movement. She said they would need to have access to an IV but that they could do a hep lock, a little thingy the IV attaches to if it becomes necessary. “Cool, a hep lock, that’s what I want” I told her, and she made a note of it on my record.

That night I picked Mike up at the Metro, we picked up some dinner and went home. At about 7:45 I was leaning down to pick up something and I had the sudden sensation that I had wet my pants. “Huh” I thought. I went to the bathroom and although it didn’t feel like I had to go, I figured I had just entered another glorious phase of pregnancy - one where I could no longer control my bladder.

When it happened two more times in the hour and I couldn’t stop the flow of liquid, it dawned on me what was happening. I told Mike that I thought my water just broke. He looked panicked and grabbed the Bradley book. “I didn’t do my homework…I’m not ready” he said. I assured him he was ready and more importantly, it didn’t matter, this thing was happening. I called a friend and told her my water broke, and also that I was positive for Group B Strep - as she had been with her son. She reminded me that I needed to get to the hospital and I broke down crying. “But I’m not ready to go” I wailed.

We decided to wait to call the doctor. It was very important to me to hold on to that small period of time I had to be in control of the process. I knew once we called the doctor and went to the hospital that I would no longer be in control, as much as I wanted to be. I also, of course, didn’t want to put the baby at risk by waiting too long to call the doctor, but I reasoned that an hour or two would not make too much of a difference.

So Mike and I put the baby’s bassinet together, we packed for the hospital, (both things we thought we had a couple more weeks to accomplish) and I took a shower and shaved.

Once I was ready to go, we called the doctor who told us he didn’t expect anything to happen tonight but that since my water broke I would be admitted and he would probably stop by in the morning and get a pitocin drip started. I figured I would argue with him about the pitocin in the morning, at this point I would just be the model patient. He told us to head over to the hospital, and our adventure began.

We arrived at the hospital with my contractions about 8 minutes apart and almost a minute in duration. We checked in at 11:45 and sat in the lobby until 1:00 waiting for a free bed in triage. I didn’t mind because we were the only ones there and I just walked and walked and stopped to lean on Mike and breathe when a contraction started.

We finally got into triage and the nurse made me get into bed, strapped me to a fetal monitor and told me not to move. Weeks before I had told my doctor that I wanted the minimal amount of monitoring required so that I could move around as much as possible, to which he said “Fine!” and noted in my medical record. When the nurse attached the monitor, I started to object, and then figured it was probably necessary since I was in triage after all and she probably needed a sense of what was happening. At this point I would just be the model patient and do what she asked of me.

For the next 30-45 minutes the nurse asked me a huge list of questions and she kept repeating “If your water broke then we will admit you.” In between contractions I kept saying, “my water did break” and she kept saying, “well, we will see.” It made me wonder if she gets a lot of women in there claiming their water broke just so they can spend a little extra time at the hospital. So weird.

She did an internal exam and declared “Your water broke!” Huh, you don’t say!? She also said that I was dilated one centimeter and that it was “going to be a looong night”. I knew my contractions were getting closer together and they were definitely getting stronger but I didn’t argue with her. I just focused on my breathing and started to envision waves going in and out at Salomon Beach on St. John, a memory that brought me great peace and calm.

Once the nurse was finished with my intake she told us we needed to wait for a bed in labor and delivery and that she would come get us when a bed became available. She left the room and I lay flat on my back, strapped to the monitor - not exactly what I had planned. Waves. Beach. Palm trees.

Finally at 3:30 am they moved us to the labor and delivery unit.

Once I arrived in L&D, my nurse, Pat, started to strap another fetal monitor on me. By now my contractions were really hard and I was tired of being the model patient. I told her that I wanted intermittent monitoring and that my doctor had made a note of it in my medical chart. Pat told me in no uncertain terms that the monitor was going on, that I had no choice and that if my doctor showed up he could give permission for the monitor to be taken off.

Mike and I looked at each other, completely stunned by how little Pat even pretended to treat us as if we had a say in the process. We were both completely bewildered and didn’t know what to do. Pat knew what to do however, stick an IV in my arm, of course. Now I was mad, as mad as I could be while breathing through contractions.

I stopped her from inserting the IV and both Mike and I told her that we asked for a hep lock just that morning and that our doctor had said it was fine. She repeated that I had to have the IV and that my doctor could change it if he came in. Because I had gone into labor three weeks early, my medical records had not yet been delivered to the hospital, so all of those nice notes my doctors had written about what I wanted were nowhere to be found.

We could tell we were fighting a losing battle, and frankly I needed to focus on my labor, which felt like it was progressing pretty rapidly, so we gave up the fight.

Pat proceeded to ask me the same series of questions the nurse in triage had asked me, and then I heard the words “…when you get the epidural..” come out of her mouth. Here is sort of how the conversation went:

Nurse Ratchett Pat: …so when you get the epidural…”

Me: Oh no, I am not having an epidural.

Nurse Patchett: OH!???? You know there is no prize for bravery in here, you don’t have to feel the pain. You should have an epidural.

Me: Ok, thanks. I think I will be ok. But I guess we’ll see huh!? (nervous laughter)

Five minutes later. Me, strong contraction.

Nurse Patchett:So, if you do decide to get an epidural, just don’t wait too long. Some women wait too long and then it is too late.

Me: nnnn…nnnn…..uh huh ok thanks….I think I’m good…

Ten minutes later. Me, really intense contraction.

Nurse Patchett: You know, I hate seeing my women in pain, and if you don’t get an epidural you will scream and when you start screaming I am going to have to just go in the other room and do paperwork so I don’t have to listen to you scream.

Me: speechless

Go do paperwork so I don’t hear you scream?? Are you for real? I truly didn’t know what to say.

When I was preparing for giving birth I spent a lot of time envisioning what my ideal birth would look like. I also spent a little bit of time thinking about my fears and concerns about giving birth. Without a doubt, my biggest fear was encountering unsupportive medical staff. I was mostly concerned about the doctors, that they wouldn’t listen to me or respect my decisions. But in my head the nurses were always on my side. It had not even crossed my mind that they would be the ones I had to battle.

At this point I realized that Mike and I were on our own. If I was going to give birth naturally it was going to be because we made it happen.

Pat finished with me and after telling me it was going to be a long night, she left the room to go assist with another labor. I don’t know what time it was, or how far I had progressed, since no one had checked me since about 1:30. I laid in bed, still flat on my back and did my thing. So much for the squats I had practiced. Pat came in on several occasions to yell at me for moving during the contractions.

The pain was indescribable and overwhelming at times, but I never got to a point where I felt ready to ask for the epidural. When I could start doing deep breathing before the contraction started I found I was a lot more successful at getting through it. Sometimes though the contraction would come on so fast and so hard that I felt like a fish gasping for air and I would try desperately to relax and get on top of the wave before it came crashing down on top of me.

Mike was worried about me, I could see it between contractions. He hated seeing me in pain and I think he felt like there wasn’t anything he could do to help. At one point he said “what do you think?” and I knew that even if I wasn’t ready to ask for the epidural, he was ready to ask for me. I told him I was ok for a little longer and let’s just see how it went. I also told him to keep doing what he was doing - that he would never know how important it was for me to have him right there next to me, whispering in my ear to breathe, breathe, relax.

As labor progressed I could feel the massive muscle known as my uterus pushing the baby down into the birth canal. At one point during those contractions I let out a sound like nothing I have ever heard, and it literally made me stop and laugh out loud at the noise. “Was that a cow? Oh my god I sound like a cow” I laughed. Mike agreed that yes indeed it sounded like a cow and we laughed together, until the contraction took over again.

Not long after the cow incident I started feeling like I was doing everything wrong. I wasn’t breathing, I was tensing up, I was definitely NOT doing Bradley right. I started crying and apologizing to Mike. “I am so sorry, I am so sorry” I sobbed “I am doing it all wrong.” “What? What are you doing wrong?” he asked. “I don’t know, but I am not doing it right, I’m not, I know it” I cried. Mike assured me that I was amazing (I know, isn’t he the best?) and that I was doing everything exactly right. Somewhere in the back of my head I remember thinking “huh, I wonder if I am in transition” (the stage of childbirth that occurs right before stage two - pushing!) Being emotional and tearful is pretty typical of transition and when I looked back later I realized that was exactly what I had been going through. Because a few minutes later…

…I felt the overwhelming need to push. Mind you it was now about 4:50 AM. I had only been in the room for a little over an hour so OBVIOUSLY I didn’t really need to push. So I fought it. Except, I really needed to push. I thought I could almost feel the baby crowning so I reached down to see if I could feel her head and I didn’t feel anything, although I had been bleeding some. The fact that I didn’t feel her told me that I was wrong, that I had hours and hours of labor to go.

Pat came into the room at 5:00 to see why the fetal monitor had stopped working and to tell me to stop moving around so much. I mentioned in passing that I felt like I needed to push and she said there was no way I had to push since I was only one centimeter and that I would “tear myself up” if I pushed. It was going to be a long night after all, and we were still at the beginning of it. When I insisted she grudgingly agreed to check me.

She checked me and a look of disbelief and, dare I say, horror crossed her face. I was 10 cm and fully effaced.

All of a sudden she was telling me not to push unless I wanted her to deliver my baby. And, irony of ironies, because she thought it was going to “be a long night” she hadn’t finished administering the second of two doses of antibiotics I was supposed to have for the Group B Strep. She started on that as my mom arrived.

My own doctor could not get there in time so the doctor on the L&D floor came in to deliver Emma. He was wonderful and as soon as he got there told me to go ahead and push. My mom held one leg and Mike held the other and I pushed with every ounce of energy I had. After the first push I asked if Emma was crowning and the doctor said to feel for myself. I reached down and felt her little head and was amazed. After I pushed a second time one of the nurses who had arrived when Pat called the cavalry looked at me and said “Is this your first? You are doing an amazing job!” Whew, I was doing it right. While I was pushing I told Pat and Mike and my mom to put Emma on my chest as soon as she came out. I didn’t trust that Pat would follow through with my wishes and I remember clutching Mike and begging him to make sure the baby was placed on my chest.

The third time, I closed my eyes and held my breath and PUSHED and when I looked up I saw Emma fly across the table, with such a force that I swear the doctor almost didn’t catch her. I reached out for her and they placed her on my chest and I snuggled with the teeny little life that had just arrived. She didn’t nurse yet, but she found the target, which just reaffirmed for me that not only was she gorgeous, she was smart too. Mike cut the cord and they gave me a minute or two more and then they took her to clean her up.

The second Emma arrived, the second I saw her for the first time, I was completely overwhelmed with how beautiful she was and how completely in love I was with her. I remember saying over and over “Oh my god she is so beautiful, she is so beautiful.” I kept looking at Mike in astonishment, and he returned the look, his eyes filled with tears.

My doctor showed up at the same time Emma did - I looked up and he was standing in the doorway in his street clothes. He scrubbed up and took over to deliver the placenta - which, OW, was honestly more painful than the birth (not the labor, but the birth). The cord had pulled away from the placenta, so he had to massage my abdomen to encourage the delivery. He was ready to give me an epidural at that point so he could go in and retrieve that stubborn placenta - a procedure that I guess would have been more painful than I could handle. I was actually ok with the idea of the epidural at that point but I asked him to try one more time, which he did, and the placenta was delivered.

They cleaned Emma up, wrapped her in a blanket and gave her back to me and Mike and I were in awe. They moved us to our room a little later and once we settled in I knew I should sleep but I couldn’t. I watched my little family as they slept and knew that all was right with the world. We spend the next couple of days sleeping and eating and snuggling and learning how to nurse and it was wonderful.

In the end it is true that our nurse was really NOT GOOD and I did have to labor entirely on my back (turns out Emma was posterior, so really, being on my back? Worst position possible) and I did end up with an IV and constant fetal monitor which I had been clear about NOT wanting. Despite all of this, we both know that it was the Bradley method and accompanying education that gave us the knowledge and strength we needed to end up with the birth we wanted. I gave birth with no epidural, no pitocin, and no episiotomy. I gave birth on my terms, to a healthy beautiful baby, with Mike by my side offering more support and love to me than he will ever know.

I haven’t talked much here about the story of Emma’s birth. It was the most affirming and powerful experience Mike and I have ever had and also the most disappointing and enraging. The positive parts of the experience for us came in spite of the way the medical establishment treated us and the whole thing has made us wonder what we will do if there is a next time.

Which brings me to a movie I am very interested in seeing - “The Business of Being Born”. The movie reportedly looks at the process of birth in our country and how, in spite of it being a natural part of life, it is also a business. Ricki Lake, whose home birth is the focus of the film, discusses in this clip that the film isn’t about everyone having a home birth, or hating hospitals, but it is about women being respected enough to be given a choice in their birth process and being educated enough to make that choice. Sounds good to me.

The international premiere is September 30 at the Zurich Film Festival and according to the film’s website it will be screening in the DC area at the Arlington Cinema and Draft House, the Washington Ethical Society, The Family Room and the Thurgood Marshall Center. Check this list for screenings across the country. In November you can rent it from Netflix and the DVD will be released in March of 2008.

Just watching the excerpts from the film on the website made me tearful. If you have ever given birth, think you might ever give birth, or know anyone who has ever given birth you should see this movie.