They moved me into a semi-reclining position and I started with some practice pushes. They were really half-hearted and I wasn't really sure what I should be doing. I was continuing those low deep moans through the pushing, and I figured I was doing it all wrong because it wasn't hurting like I had expected. My doula and nurse were in the hall getting hot water for compresses at one point when they heard a sound I made and they looked at each other saying that this was it. This was a woman about to birth a baby! The nurse was a wonderful help while I was pushing. All I could do was remember how the semi-reclining position that I was in is just about the worst position to birth a baby, but at the same time I didn't really have it in me to get in any other position. I had tried lying on my side at one point a little earlier and the pain on my side was too much. I know that you should listen to your body when it comes to positions in labor and delivery, and my body was screaming that that was not the position for me! I couldn't be squatting because of the epidural, I didn't fully have my legs. My thighs weren't working enough to support my weight. I did try a little to stand earlier, but they immediately collapsed. So I was semi-reclining and in my mind I was remembering that this was bad because it impedes your sacrum so I was trying to hold my bottom up some so my sacrum wouldn't be impeded. I was also pushing the baby right into my pelvic bone instead of back. I had never realized where you needed to push which I now find quite humorous. The nurse was a great help with this. She gently placed a finger on my perineum and told me to concentrate my pushing right there. She also told me to sink my rear into the bed. Oh what a difference that made! It was the exact opposite of what I had been doing on my own during those half-hearted pushes.
It wasn't long after that the doctor appeared and the nurses made sure everything was ready for the baby. The doctor was prepared for the birth, but the nursery nurse suggested waiting for the pediatrician. Because of the meconium, she wanted her there. The doctor said that wasn't necessary because there wasn't much meconium, but we were prepared for the baby to be taken immediately from me to get checked out in the warmer.
The doctor just sat back and let the nurse stay there helping me. I really needed her finger there to get me to concentrate on pushing the baby toward the back where you can stretch instead of up against my pubic bone. It is amazing to me the power one tiny finger has to provide full concentration on proper pushing! The doctor suggested that I tuck my chin against my chest, but that was taking too much out of me so I had someone hold my head down so I was tucked in more. My visiting doula and my mom both took a leg so I could curl up against them, and my doula was holding a little hand-held mirror for me to see, or trying to at least. I remember getting annoyed that she kept shaking the mirror and several times I grabbed it and repositioned it. This hospital really needs to get a mirror on a stand! I was sick of seeing only my thighs. Seeing the baby come down was the most encouraging and most discouraging experience. With every push I could see a little bit of hair sticking up and poking through. But in-between every push that baby's head just disappeared back in me. That was awful! The nurse was encouraging me telling me how great I was pushing. She said another half dozen pushes like that and I'd be holding my baby. I remember saying "Another half dozen? Are you kidding?"
The most discouraging part of this was that while I did have a desire to push, it wasn't the overwhelming desire I was waiting for. Had the doctor not been there and had I not felt like I had to prove to her that I could do this, I would have never been pushing at that point. I had more of an urge at three centimeters than now! I had read about women who go into an energy building stage after transition (which I never really felt, I don't know if it was because I progressed so slowly or if it was because the epidural had enough of an effect to mask that). Some women just sit and wait an hour or more for an urge to push and then easily breathe the baby out. That was what I wanted to do.
I never wanted to do forced and counted pushing like the doctor was trying to get me to do. The nurse and doctor both were telling me how effective my pushing was, but then the doctor was also telling me how I needed to be pushing differently. That did not make sense! She wanted me to hold my breath and push until my face turned red. I felt like my face was popping and she encouraged that. It was not what I wanted to do so after one push like that I went back to what felt right. I pushed when the contractions started and when I ran out of oomph, I let out the breath and took another. This was what the doctor was trying to discourage me from. But since I had control and since I do have a good awareness of my body, I wasn't just letting everything go when I took a breath. I was keeping the baby in place between breaths and just breathing so I could put more behind the next push. I was pushing about three or four times each contraction. I waited until I felt the contraction coming on strong and I pushed a couple of times and then I would add one more push as the contraction was ending. When it felt like it was too long between contractions, I faked it and pushed anyway because the pit threat was brought up again.
The doctor was very quiet and serious and for the most part it was the nurse that was right there between my legs and the doctor was sitting back some observing, but when the baby was starting to crown they switched places. The crowning was painful, but it actually didn't feel much worse than the burn I had been feeling with each contraction. I think I was feeling a bit of that ring of fire with each and every contraction through the entire labor. Plus I was so excited to be feeling everything and experiencing everything that I don't recall the pain now. It was at this point that the doctor told me she had to cut an episiotomy. I really didn't care then although I sure do now! Tom had come back in at that point (he was out in the hall with my dad and Tommy) and put his hand on my arm. I had lectured him before on how I didn't want an episiotomy and here I was telling him it was ok. I found out later that he didn't come in at that moment to comfort me because I was being cut; he came in because he was tired of my dad nagging about how he was missing one of the greatest moments in his life! (My father was at the birth of us kids even before dads were being routinely invited in. He cherishes being there for our births.) I was a little disappointed in him when I found that out, but at the moment when he came in, it was just the encouragement I needed, intentional or not! I still think he was pretty dumb to tell me the truth because he could have just let me think he was a hero for me at that moment. I didn't mind him not being an active part of the birth. He was there in the room through my labor, which was important to me, but I respected his feelings and had planned to get support from others and that was exactly what I got. I can't say enough about the support I got from my doulas (and I'm including my untrained mother as a doula), and of course the support I got from my little man was wonderful as well!
There was quite a bit of blood with the episiotomy, but I didn't feel a thing as it was cut at the right time when the pressure from the baby's head was blocking the nerves to the area. My doula told me to reach down and touch the baby's head so I did. That felt really weird! I expected to feel something hard, but instead I felt hair and something soft and squishy. It was very weird and I didn't like the feeling, but it was encouraging at the same time. The order of things is all garbled in my head, but I do remember at one point the doctor declaring that this would be a VBAC. I was at the point of no return! I could see the baby clearly now and knew the baby was almost here! Around this time the mirror disappeared or was moved or maybe I stopped looking. I know I didn't see the head delivered. I was told the head was out, and I looked down and could see the head there between my legs. I knew that with the meconium there would be extra suctioning. I had also requested earlier, thanks to my doula's suggestion to me privately, that the baby be placed on my abdomen while the cord was being cut. I knew that I wouldn't be able to hold the baby long because they would have to work on him or her to be sure all the meconium was removed, but someone had to hold him while they cut the cord and it might as well be me, right?
I was in quite a bit of disbelief at this moment when the doctor's words suddenly made me concentrate. She told me that I had to push the baby out quickly, all in one push, right when she gave word. I was confused, but this petite quiet woman said it in such a way that there was no way any sane person would argue with her. So when she told me to, I pushed and I felt this little being just slither right out of me! Oh how I wish I could feel that again and again! I don't think I have ever felt something so wonderful! While it felt like an eternity, I was actually only pushing for twenty-five minutes, part of which was very half-hearted pushing. I have been told that anything under two hours for a first timer is excellent!
I saw the tail end of the baby being moved away from me as they carried him to the table at my side to be worked on. Yes, him! My doula had asked earlier who I wanted to announce the sex, and I said I really didn't care so she asked if she could. I saw what he was at the same time she did. She told me to call out loudly to introduce the room to little Sean Emery, and I did just that! I was a little surprised to see boy parts as everyone was so convinced this would be Sophia Elizabeth and not Sean Emery. I guess all the girl confidence that others had had worn off on me even though I had never had a strong feeling on the sex either way.
At some point my doula explained to me why he was taken without me holding him. The cord was wrapped tightly around his neck and the doctor had to cut it. I guess I saw this while his head was out, but I didn't realized what was happening. I did see the doctor reach for a clamp, but it didn't cross my mind that anything was wrong. The doctor did explain what she was doing, but it was said so quietly that I didn't hear it. But that was the reason why she was so urgent in her orders for me to push him out quickly all in one push. With the cord cut he had no oxygen supply. It seemed like forever before we heard him cry as well. During this time we all became very thankful for that nursery nurse who insisted on waiting for the pediatrician. We were all taken aback about how much meconium staining there was. Sean was covered (which I didn't see) and my doula said she has never seen a placenta that was as stained as mine was.
While they were working on Sean, the doctor was doing something I was not very pleased with. She had a hold of the cord and was turning it in circles as she applied traction. I knew I didn't want this, but I just didn't have a voice at that point. She was also saying that there was too much blood and that I wasn't contracting hard enough and I needed pitocin. I wasn't in a state to argue at this point and I don't remember giving the ok, but I think I uttered a meek one. The nurse moved to get it and the doctor put her hand on my belly and said softly, "Oh, actually these contractions are quite strong and doing the job, we won't need it." When I pushed the placenta out it was again such a neat feeling. As it came out, it actually soothed all the pain I had down there and I too wish that it hadn't gone so fast.
A week later I was told by my doula that the nurse still administered the pitocin. I didn't realize this. I still consider it a great victory that I made it through the important part of delivery without pitocin (although I am a little upset that the OB was so pitocin happy that I ended up getting it when it wasn't needed). To me this is a victory of self-confidence. I know my body can deliver a baby without it! My body knows how to have a contraction and more importantly contractions that are productive and do the job, even if it does take longer than the average woman. All told I was in active labor for over twenty-six hours and once I passed three centimeters, I progressed at a slow steady pace of one centimeter every two hours, far slower than any doctor likes to see. I am actually quite amazed that the doctor and hospital let me labor for twenty-two hours with a broken bag of waters, slow progress and a fever over 100 degrees. Had I not been educated and had a doula there to support me, I highly doubt that I would have been "allowed" to. The fever it turns out was not an infection. It went down on it's own shortly after labor ended. I guess my body just responded to all the work it was doing by raising my temperature.
The other interesting thing is Sean's head was perfect. He didn't have any molding which is surprising with a labor that was that long. The OB was so surprised that she brought it up again the next day when she came to check on me. She said that most c-section babies have less perfect heads! I attribute this all to the chiropractic care and attention I spent to my posture. I believe it got him in the perfect position for birth!
I was constantly being told by my doula through out the labor to "get out of my head." I had to know what was going on, and I had to over analyze everything that was happening at every step of the way. She told me at some point shortly after birth that she feared that being this much in my head was going to keep me from my VBAC. I had always argued back with her that I need to be this way, that is just who I am, but everyone she has known who has been this way, unable to just let everything go, has ended up with a c-section. I am very glad that she kept that little tidbit to herself! I did have fears, but through all of this, I really did feel that I was going to have a VBAC. I just knew it was going to happen. In the days leading up to the birth I was faced with a lot of worries and decisions. One thing that helped me get through it was a discussion I had with a dear friend and fellow moderator at StorkNet, Catherine. Catherine also has a journal here and had a wonderful HBAC (home birth after cesarean) in June. She told me that she gave me permission, permission to get the prostaglandin gel, permission to be scared, permission to do whatever I needed to get this VBAC. Because this time she wanted me to have a VBAC, the next time I could have the perfect birth experience. I kept remembering these words whenever anything didn't look like it was going my way. Of course I didn't go into this wanting an epidural or wanting an IV or wanting to be stuck in bed, but every step of the way, it was me making the decisions, not me feeling forced into it (aside from the unnatural pushing, but that I can live with. Next time that will be different though!). This was my VBAC, and while it wasn't my perfect birth, that really doesn't matter at all! I birthed my baby. My body did it! I got to experience everything that I felt I had been cheated out of.
The only part of the experience that I really regret is the episiotomy. My doulas questioned what degree the episiotomy was and the doctor very defensively said it was only a second degree. My second doula later asked if that was only a second degree, what does a fourth degree tear look like? I wish she had actually asked the doctor. She cut me semi-diagonally. The cut extends back even with my anus and is definitely deep into muscle tissue. According to the nurse it was necessary because I was "shredding" inside. It's funny because in the weeks following I haven't hurt at all where I shredded, but the episiotomy has been pure torture! I would rather deliver a baby one hundred times over than repeat those first several bowel movements with that episiotomy! People don't talk about this much, but to me, that was the real pain of childbirth. I was crying in pain for the first two days every time I moved. But even this pain was so much better than the pain I felt with the c-section! The doctor ended up sewing one internal tear as well as the episiotomy. I had to tell her three times that I was feeling every stitch! She just wouldn't clue in to the fact that the epidural had worn off even before they turned it off. Finally it hit her and she gave me a two shots of a local anesthetic when she was almost done. The cut wouldn't stop bleeding, however, so she had to add a few extra close together stitches at the base. She told me that the anesthetic just wouldn't work and she apologized that I would feel these. It was in the area where she added these extra stitches that I experienced the most pain when healing, and it is the only place where I still have pain now three weeks later. The tear and all the dozens of paper cuts, which is how the nurse described the shredding to me, have never hurt me at all. My second doula actually believes that when the doctor had me worrying that I was hemorrhaging (and the thought had gone through my mind that if I was, it was due to her pulling on the cord!), it was actually the episiotomy that was bleeding so much. I also believe she didn't line things up properly when sewing me up as I have a skin tag at the top and bottom on opposite sides. I really hope it doesn't cause a problem later. (I have since had my four week post-partum check and I am feeling much better now. My regular OB said that I had a very large second degree episiotomy, maybe a borderline third degree one. Technically it wasn't classed higher because it wasn't in the anal muscle tissue. It was cut right into a hemorrhoid, however, which is one reason it hurts so much. In addition she explained that the more diagonal the cut the more painful the recovery is. I am doing much better every day at this point and am feeling almost back to normal. My OB thinks the cut will heal just fine as it already looks remarkable.)
