Wednesday, March 17, 2010

Elizabeth's Home Birth Story: How Having My Midwife Probably Saved My Son's Life

By Elizabeth Hoskins

For my entire life I have wanted nothing so badly as to be a mother, but for some reason I have always viewed myself as being "unlucky." Not unlucky as in “oh my life sucks,” but more like a “Nothing incredibly exciting ever happens to me, I will NEVER win the lottery,” sort of way. Why? I really couldn't tell you, it is just a feeling I have always had. Because of this feeling of unluckiness for my whole life I thought I couldn't and wouldn't ever be able to get pregnant. Since I wanted nothing more than to have a child and since I was also "unlucky" such a miraculous and wonderful thing of course could never happen to me! Completely irrational I know, but it is how I felt nonetheless.



As soon as I moved in with my husband, before we were married, it took us all of about two months before I was pregnant. For two months I didn't have a period and had all the early symptoms of pregnancy. Sore boobs, a little bit of cramping on and off, fatigue, and all that fun stuff. We took a total of about 5 pregnancy tests and they kept coming out negative, so of course I kept telling my husband that I was not pregnant but merely about to start my period. On the fifth test he stood in the bathroom while I peed on the stick and instructed me that I needed to "point the test down while you pee!!" My husband took the test and  watched it as I cleaned up, and then with the biggest smile told me I was pregnant!

I decided that a home birth was the way to go and my husband supported me 100%. We found our wonderful midwife Paula, an absolutely amazing woman. She is so caring and gentle and loves her job so much. She has also attended over 2000 home births in the last 30+ years, so I felt completely safe in her care. At the first appointment we found out I was 10 weeks along and got to hear our baby's heartbeat for the first time. It took everything I had not to start bawling when I heard that precious beat of life.

(ultrasound picture at 16weeks)

Fast forward a bit since I had a pretty uneventful pregnancy other than some mild nausea (puked about 15 times total), hip pain, and itchy legs. My due date was December 26th, 2009.  My mother drove down to Arizona from Oregon on Christmas for the birth, and was supposed to leave around January 5th or 6th. For nearly two weeks after my due date we waited, and waited, and waited. Every day my mother would say to me, "Aren't you going to have that baby already? I have to leave soon, I'm never going to get to see my grandson!" and things similar in nature. I also had people from my husband's side calling and texting daily asking if I had had the baby yet and asking why I was still pregnant. My mother in law was wanting daily updates, even though there were no new updates, and texted us at 4:30am one day saying she was worried cause she hadn't heard from us (even though she knew my mom, mom’s fiance, and my sister were staying with us) and that if we didn't call her she was going to send someone over to check on us. WHAT?!?! We found out the next day she had meant for us to find the text in the morning when we woke up, not at 4:30am. So due to all the pressure from family and the deadline for my mom's departure quickly approaching I felt like I needed to do whatever I could naturally to make the baby come.

After talking to my midwife about natural induction I went into her office after hours on January 3, 2010 so
she could strip my membranes. It was incredibly painful, but I didn’t expect anything less. She then talked to
me and my husband and gave us a paper of instructions about inducing labor naturally, and said that it doesn't always work but that there was a good chance it 'would. At 3am January 4th My husband made me a castor oil shake with 2oz castor oil and vanilla chocolate chip ice cream.  For the record, vanilla chocolate chip is by no means a strong enough flavor to even come close to disguising castor oil! Within an hour the dreadful stuff started working.  Needless to say, I only got about four hours of sleep on and off. At 8am my husband made me another shake with 2oz more of castor oil. For the rest of the day every hour on the hour I drank 1 dropper of both blue and black cohosh in grape juice, followed by a hot shower, followed by nipple stimulation by my partner, rinse and repeat. All the while having diarrhea about every 10-20 minutes, and attempting to go for walks whenever it wasn't too bad. I was exhausted, a part of me was hoping this wouldn’t work because I was afraid of having a long labor and I was already worn out. At the same time though, I did NOT want to go through all of this and have it not result in a baby. By the evening I was having somewhat regular contractions, so Paula came to my house to check me. Nothing!  NO change! All that work, all that diarrhea for nothing! All it got me was false labor, exhaustion, and 14 hours of the runs!!  She told me to stop doing everything, take a warm bath,  and relax for the rest of the night.

The next day I went to my midwife appointment which had been scheduled the week before.  I was 10 days past my due date. Being unlucky and all , I was doomed to be forever pregnant!  Of course the baby was never going to come, what had I been thinking! I asked Paula what would happen if I went 2 weeks past my due date. She said that I needed to get the baby out in about 5 days or else I would have to fire her and go to the hospital. Something about Arizona laws and midwives not being able to care for a patient who goes 2 weeks over the due date. She also said if I hadn’t had the baby by Friday (it was Tuesday) we would try castor oil again over the weekend and that she was nearly positive it would work this time around! I went home  feeling worried and a bit depressed. I so so so did not want to birth in the hospital, but it was looking more and more like that was where I was headed. “I’m so unlucky I can’t even go into labor and have a baby correctly“, were my thoughts that night! My husband told me that he felt like that was going to be the last night I was pregnant.  I prayed so hard, the hardest I ever have that this would be true.

I woke at 9 am on January 6th when my husband got up for work, and I felt weird. I cannot explain it. There were no contractions. I didn't feel anything different physically.  Just.weirdness. I had this strange feeling that I would be spotting when I went to the bathroom and sure enough I was. I had also passed the mucous plug during the whole castor oil fiasco. Since I wasn't having any contractions I decided to go back to sleep, but told my husband to be prepared to come home early from work. I woke up again a little before 11:30am and went downstairs to make some chocolate milk.

As I was drinking my chocolate milk and talking to my sister in the kitchen it came on all of a sudden. Strong painful contractions, nothing like the Braxton hicks I had been experiencing for the last 2 months. My sister and I went for a walk while my mom was out doing laundry since we didn‘t have a washer and dryer at the time. After the walk I decided to time the contractions and attempt to play mahjong on the laptop. In the birthing classes my husband and I took they talked about having a “labor project” at the beginning of labor to take you mind off of it while you can. I figured mahjong would be mine, but I couldn’t even get through one level because of the pain! Contractions were about between 4 and 6 minutes apart and I was only able to time them for about 40 minutes before it was too hard to concentrate. I called Paula's office and talked to her assistant Deborah since they were having appointments that day. I explained the situation and she told me they really couldn't leave the office to come check me and that I would have to come to them. I went to the bathroom and there was more blood than just a little spotting. Was this normal, should I be bleeding this much? Was I dying? I started to panic a little and called my mom and told her to come pick me up NOW and take me to Paula's office.

We got to the office at 2:30, 3 hours after the contractions began. Paula checked me during one of the contractions and told me, "It looks like we are gonna be canceling the rest of our appointments and heading over to your place to have a baby! You are a generous 7."  After only 3 hours of labor I was already at 7 almost 8 centimeters dilated!! My little sister called my husband and told him the news and to get home ASAP! When we got home my husband was already there and heating huge stew pots of water and toping off the birthing pool with a little more air, using his mouth no less since we didn’t have a pump for it! Paula and Deborah arrived at our house within half an hour and started helping my husband get everything ready for the pool. I was calm, lost within myself as I breathed through the contractions. My mom helped rub my back and held the bowl as I puked a few times (3 total and my husband also held the bowl at least one of these times) during some particularly painful contractions. Let me tell you, grape juice with chunks of salad floating about is really quite nasty, and as I was throwing up my mom told me to just shut my eyes and not look at it!  I remember after a particularly painful contraction looking at my mom and informing her that this wasn't so bad, I could handle a lot more! Much better than I had thought it would be! As soon as my mom, who is an E.R. nurse, found out about the home birth plan she started telling me horror stories about her natural birth with me and how unbearably painful it was, and that I didn’t know what I was getting myself into not having an epidural. She says having me was so painful, to the point of her passing out between contractions. She was 16 when she had me.
Finally, finally the pool was ready! I got in and it felt so warm and nice. So relaxing, almost sleepy. After about 30 or so minutes of laboring in the warm confines of the pool with my husband helping me through contractions, I tell Paula I feel like I need to go to the bathroom. I am helped out and she tells me not to worry, she will wait there by the bathroom and make sure everything is ok while I push through a few contractions and try to poop. It wasn’t happening. I tell her I feel like I have to but I just can't! She asks if she may check me. "You are a 9 and the baby's head is just right here, that is what you are feeling," she tells me. I get back in the warm peaceful bliss and continue to labor as my husband comforts me and breathes with me.

 Not long after returning to the pool I start having a strong urge to push. I tell Paula and she says that that is wonderful and to just listen to my body, and I do! The pain of contractions was completely gone! Instead of pain during the contractions there was merely an urge to push! It was such a nice break! I pushed! I pushed as slow as I wanted. As hard as I wanted. Whenever I wanted. I listened to my body, and did what it commanded me to do.  My water ended up breaking naturally in the middle of the pushing phase, and was a bit meconium stained. There was no chanting of "push push push." Just total silence as my husband, mom, Paula, and Deborah watched the miracle of a woman listening to her body and giving birth in peace as nature intended. It was WONDERFUL! 


Once it was starting to get close to the baby's arrival Paula stood behind me and gently massaged my perineum while Deborah started listening to the baby's heart rate with a small handheld, waterproof, fetal heart rate monitor. I was on my knees in the pool with my upper body resting on the edge of the pool and one hand bracing myself on the bottom of the pool. With every push Paula would tell me that I was doing a beautiful job, and how amazing I was doing.  All the while Paula kept asking Deborah what the baby's heart rate was.


"145"
"wonderful, right where it should be"
"120"
"good"
All the while massaging.
"135"
"excellent"
"75"
"Alright Elizabeth, stop pushing and take a few deep breaths for your baby so he can get enough 
oxygen"
"back up to 125"
"good"
With the next contraction and pushing
"70"
"keep monitoring and lets see if it goes back up after the contraction"
"I'm having trouble finding the baby's heartbeat"
"Just keep looking, everything is ok"

At this point I knew something was very wrong as did everyone in the room. After his heart rate kept dropping to around 70 during the pushing and then when they couldn’t find it again this  overwhelming thought raced through my mind that my baby was dead. He died. I was so close, minutes away from seeing him and he died! I had waited so long, my whole life, and I was going to deliver a dead baby! The whole pregnancy, the whole labor, months and months of dreaming about what my son would look like, dreaming of holding him in my arms for the first time,  it was all just a cruel trick. For those 60 seconds or however long it took to find his heart beat (seemed like a freaking eternity) I died inside. I completely gave up. I didn’t want to go on. Just cut him out of me, what was the point now?

"122"
Thank you, thank you!!
"Lets put her on some oxygen, the baby isn't getting enough, and it should help."
Someone put the oxygen mask on me, I am not sure who. 


All I know is I was holding my husbands hand and pushing, but backing off every time I felt the burn. I was scared. I could feel that I was going to tear. (which I did, a small tear on the inside of each labia minor, but not bad enough to need stitches.)  I didn't want his head to come out! BUT, I wanted to see my baby so badly, so I kept going. With the next couple contractions:

"73"
"120"
"70"
"75"
"73"
"78"

Suddenly Paula tells me that it is time to get the baby out, he has to come out now! For two contractions she tells me, "Push Elizabeth, give it everything you have. Keep going, keep going! You can do it!!!" She also tells my husband to come back there and help catch his son. I was later informed by my husband that I was holding on to his thumb so hard he had to jerk it away from me when Paula told him to come help catch. I don’t even remember holding his thumb or anything!

I wanted to jump out of the pool, jump away from the pain as my son's head came out. With the next contraction the rest of my son slid out into my husband's hands. The room went completely deathly silent as everyone but me looked at my son. I could not see him since he was behind me. Paula told me in the calmest, almost cheerful voice so as not to scare me, "Everything is okay Elizabeth, the cord is just wrapped around his neck a little bit. Let me just unwrap that and you can turn around and I'll hand your baby to you." They help me turn around and I am handed my baby. 

He was completely blue and purple, but the most beautiful thing I have ever seen. He was so soft. The softest thing I have ever felt. I had never imagined how soft he would be fresh from the womb, and I was amazed! It took him a minute, but he finally started to cry. Once he started breathing and crying it didn’t take him long to pink up. He was fine, we did it! Paula talked to him soothingly as my husband and I stared at him in disbelief. This tiny, beautiful, perfect being came out of ME! I held my baby for about 10 or 15 minutes in the water with my husband right beside me outside the pool, umbilical cord still connected. Then my husband cut the cord. Paula gently took my son, wrapped him up, and gave him to my husband to hold for the first time while she helped me deliver the placenta.


I completely believe that if my midwife had not been there at my son’s birth with all of her knowledge and experience that my son would have died or had some ill lasting effects. We would not have know his heart rate was dropping to 70 while I was pushing with every contraction. I would not have been put on oxygen. I would not have pushed him out as soon as I had. I NEEDED the demand and encouragement my midwife gave me to get my son out. I was afraid. I did not want to do it. When my son was born the cord was wrapped around his neck FOUR times! In all her years of experience and many, many births (over 2000), Paula had never seen a cord around the neck more than three times. He had a 48 inch long cord and every time I would push during a contraction it would strangle him. My midwife knew what was going on, and knew the cord was around his neck when his heart rate started dropping. He was very distressed and ended up passing meconium while he was being born. My midwife told me later that he probably lost about 4 ounces in meconium during the birth. 

Tyler Philip Hoskins was born at 5:20pm on Wednesday January 6th, 2010 after only 6 hours of labor including 30 minutes of pushing. 11 days after my due date. He was 7lbs 6oz and 20 3/4 in  long. A 48in cord wrapped around his neck four times and a heart shaped placenta! 

(Tyler at 2 months old)

I am lucky. I have the most precious, beautiful gift in the entire world. I am a mother. 
For once in my life I no longer feel unlucky!

9 comments:

Lauren said...

Oh girl, so happy you had a good birth!!!! :)

Domestic Housewife said...

I guess it's a good thing I never had your number or I would have been one of the many people texting you!

Diana J. said...

Many congratulations!

Our birth this past fall was almost identical. Everything went just fine until pushing, when our baby's heart rate dropped to the 60's. Our midwife also had to coach a faster pushing phase to get him out quickly, and it took several minutes for him to start breathing. Thank goodness for wonderful midwives!

Lilly Rose said...

So many of the things you said were so familiar... the "being unlucky", not being able to believe you could get pregnant or that you were (my test was positive, but I was sure it was a tumor giving me a false positive until I heard her heart--but I'd been trying for 18 months). That bit about the softest thing you'd ever felt and that you made this tiny perfect person (and wow is your son beautiful!), I feel you. It's so amazing that life actually grew and came like it did, isn't it?

My birth wasn't anything the same, though (it started at 41 weeks, 6 days and she came at 42 weeks on the dot, though). I didn't get my midwife attended homebirth, my baby never went into distress and she was cut out of me. I'm sorry for your moment of fear. In my birth, I was gone for 3 minutes and didn't know it. I thought I blinked and then they were calling me, getting my attention and putting oxygen on me, saying the baby needed it. They were losing her, too, but apparently, I'd stopped breathing. I didn't know until the next day. When they took me in for my cesarean, I was convinced that this was it, I was going to die and never see my baby and I mourned and was yelled at for it. So I know that feeling of "all of this... for nothing?" too.

Your story was so awesome, thank you for sharing :) It's still something to strive for, for me. MY VBAC was good, but I know my HBAC that I will eventually have, will be better.

justine said...

It looks like we were doing the same exact thing on Jan 6th! I was post-dates with our guy, too, and was really, really frustrated! He is my 5th baby (and my 4th VBAC), so I thought for sure that he would be "on time" ... but he had other plans! All 11 lbs of him was born safely and gently at home with our incredible midwives! I have some birth pics up at my blog: http://www.StateoftheHeart.net and will have a video of the birth up soonish!

A million blessings! I <3 your birth story!!!

Jill said...

Oh, Elizabeth! What a magnificent story. Many parallels to my own homebirth with my second child. He was born purple and unresponsive. Limp with eyes rolling around in his head. We aren't sure why - I was contracting very hard very fast at the end of my labor, barely enough pause to catch a breath, and maybe that distressed him. Everyone was a little panicked, myself most of all - I remember a horrible sick feeling of thinking, "He's dead, I killed him, what the hell was I thinking, this is all my fault." But with a little invigorating, a little room air and some gentle aspirating (he'd been born in a huge blast of meconium that stained my midwife's jeans), he came around just fine. The next day, we convinced him to have his first hearty cry, and that finally cleared his lungs. I shudder to think of what would have happened if he'd been born in the hospital (assuming I would have even had him vaginally - he was a VBAC baby, and I had to get into a deep squat in the pool to push him through my narrow pelvis). He surely would have been taken from me, we both would have been traumatized, probably he would have gone to the NICU for observation. But instead, he never left my side, and was able to go right to my breast and stay there all night long. And as it happens he is at my breast again as I type this 19 months later. I was able to give him a gentle, respectful birth and you did the same for your baby! Many congrats to you and your family!

Lisa said...

beautiful! I'm crying. Dang hormones! lol I'm due for my second homebirth next month. :)

ShannaFae said...

Sometimes I wonder do you home birth mothers even weigh the possibilities that your child might need emergency intervention or that something MIGHT go horribly horribly wrong? As a neonatal RN i see the things that can and DO go wrong everyday. I beg you to please please do your research not every delivery is smooth sailing with out complications or results in a healthy baby. Study the facts and do the math there is a reason that infant mortality rates have decreased over the last 100 years. Science medical advancement and proper education.

I'd like to propose a new way of thinking about preventable death at homebirth. A more accurate description might be "failure to rescue."

This phrase is used in analyzing quality of care in various aspects of medicine. It refers to the deaths that could have been prevented, either by more careful monitoring to recognize an emergency, providing appropriate care, or providing appropriate care in a timely fashion.

Not all homebirth deaths represent a failure to rescue. Some are caused by abnormalities incompatible with life. However, most homebirth deaths are caused by failure to rescue and it is easy to see how that happens. First, by the very nature of homebirth, it is impossible to provide appropriate care for an immediately life threatening emergency. Cord prolapse, massive abruption, and fetal bradycardia will result in perinatal death in the majority of cases. Simply by choosing homebirth, parents ensure that no one will be able to rescue a baby in immediate danger of death.

The lackadaisical monitoring, and the minimal knowledge base of most direct entry midwives dramatically increases the risk of failure to rescue due to failure to recognize the problem. That's why there are unanticipated homebirth deaths. The midwife has literally no idea that the baby is in serious trouble and therefore does nothing to prevent the death. A dead baby drops into her hands, a situation that is virtually inconceivable in a hospital setting.

The third type of failure to rescue, inability to provide appropriate care , is also more common at homebirth. Even if a DEM recognizes a problem, she often cannot handle it appropriately, and more importantly, she lacks the knowledge and equipment to perform the expert neonatal resuscitation that may be needed. Problems in this category include shoulder dystocia and breech with trapped head or nuchal arms. Most of these babies will simply die at home.

The key advantage of the hospital is the ability to rescue babies who need to be rescued. Parents choosing homebirth are simply betting that their baby will not need rescue. Unfortunately, if it does, the baby will most likely die as a result of failure to rescue.

ShannaFae said...

Jill, the NICU saves lives it does not traumatize lifes it gives parents the opportunity to be parents and it gives babies the gift of life.

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