One of the reasons I'd wanted to avoid an epidural was my fear that I'd be confined to the bed and unable to move around. The most efficient way to push, I'd been told, was to be upright and to let gravity help you along. I wanted that option, the option of moving around to find an optimal position for pushing.
At this point, however, my uterus had been contracting for well over 24 hours. It, and I, were pretty pooped. Though I didn't note it at the time, my contractions were coming further and further apart although they were lasting longer. This allowed me some time to relax and regroup between contractions. And the place that seemed to be calling my name? The birthing bed. I would drink water (and apple juice, when forced) between contractions, have cold compresses applied to my head and neck, and gear up for the next contraction while lying down. It was GREAT!
And I'm not kidding - the pushing was awesome compared to dilating. I could USE the contraction and work rather than just enduring it. It was a joy compared to the earlier part of labour.
The next few hours are a bit of a blur for me. I know that with each contraction, I would bear down and have 5 or 6 very long pushes. The doulas and Dave would alternate holding my legs during this, and they'd all cheer me on. A few moments stick out - Dave handing me a cold cloth for my head that was full of ice (and me making fun of him for it), Erin the midwifery student arriving and me greeting her, periodic progress checks. Ann and the doulas kept commenting on how calm and lucid I was, making jokes between contractions and having lengthy conversations. I just felt so great at this point - thank you, hormones! Eventually, a third midwife arrived. Melanie was there to minister to the baby and she was adorable and totally enthusiastic; she joined in as part of my cheering section. They offered me a mirror to check out the progress - I glanced down to see a bit of dark hair peeking out.
Unbeknowst to me, the midwives started to worry a bit that my contractions were slowing down. They suggested I get up on the birthing stool. I did, but it was so uncomfortable sitting there, so I begged to head back to the bed. Eventually, Ann let me know the score -- she was worried that the contractions were slowing down too much. "I know that you wanted to avoid pitocin," she said "but I think I'd be really useful right now so you can push out the baby and deliver the placenta."
"Ann," I told her, "I wanted to avoid pitocin early in labour because of the possibility of additional interventions afterward. It sounds like I need it now, so I'll do what you think is best." This became important as right about then, I started to bleed. Ann headed out of the room immediately to get a nurse to start an IV. As soon as she left, Melanie jumped right in. "Sarah," she announced, "you've been working so hard and I know that you can push this baby out on your own. I have an idea for a leg position where you can lie down and push more efficiently. Let's try it and I bet we can have this baby nearly out by the time Ann gets back!"
I shifted slightly and started pushing; Melanie's advice worked. By the time Ann got back with the nurse, the baby nearly crowning. And all I have to say it OWWW! The nurse was inserting the IV as he crowned. I let out this almost primal scream, as I could feel everything and the fact that I was bleeding.
One more terribly painful push later and I could feel the baby's head emerge. The bleeding intensified at the same time. It was the strangest sensation. I could here the baby making noise and feel the bleeding, but I hadn't delivered him yet. It was at that point that my uterus stopped contracting entirely.
Ann sensed this. "Sarah," she said. "You have to push even without a contraction. Erin and Melanie are going to push on your abdomen at the same time."
Once the baby's head emerges, the team has 4 minutes to get the rest of the baby out before an emergency c-section is required. We used 1.5 of those minutes, but an emergency team got called in just in case. By the time they arrived, though, it was all ok. It was 11:01.
I pushed with all my might, Erin and Melanie pushed down on my belly and Ann managed to haul the baby out. All of a sudden, he was crying and slimy and on my chest, where he let out a lovely meconium poop all over both of us. It was an odd sensation - he was there, but when I tried to pick him up I pulled too much - his cord hadn't been cut and the placenta was still in situ. I was still bleeding, too, so that was distracting. But he was doing great. Dave cut the cord and they covered both of us with a blanket where we could snuggle. His apgar score was taken - 9.
The bleeding continued, however, and all of a sudden my uterine contractions became horribly uncomfortable. The pitocin, not used at all during Teddy's delivery, was needed to help with the placenta's delivery. Blah! The placenta emerged after 5 minutes, and Melanie took Teddy over to the warming area to be weighed and checked out, so Dave headed over there. He weighed in at 8 lbs, 4 oz and was 21.25 inches long.
Ann was cleaning my up - no tears, just shearing so only 2 minor stitches - while Teddy was getting evaluated. His second apgar score was a 10 and there were no problems. It was then that Dave took this picture, one of our favourites:
"What...just...happened??!?!? Where am I?!?!?" he seems to be saying.
The cleanup continued - complete with catheter to empty my full bladder. Not a highlight, but a necessary evil I guess. The bleeding finally stopped, but Ann felt I'd lost too much blood to get up. She told me that I'd have to stay in the bed for a few hours at least, and then they'd re-evaluate.
Within a few minutes, they brought Teddy over so that he could try his hand at breastfeeding. He appeared to latch on to both (note the 'appeared') over a 10 minute period. We checked out his massive hands (just like Dave's) and marvelled at his head full of hair. It was crazy - he was here! Dave snuck out to make phone calls to our parents; mine headed to town to check in on our cats (we caught them en route and told them to come to the hospital).
At around noon, Melanie and the doulas headed out - Melanie to office hours, the doulas to sleep. Ann gave Teddy a quick bath to get the meconium off of him, and she showed us how to swaddle him. We filled out more paperwork, then nursed a bit more. Ann let me know that she'd check back in regarding my discharge - possibly that night, possibly the following morning This was longer than the hospital stay we'd hoped for; had I not bled we'd have headed home later in the afternoon. She and Erin left just as lunch arrived. Boy - was I ever starving. Hospital food was mediocre, but I didn't care.
Not long after, my parents arrived. They marvelled over the baby and we made more phone calls. I LOVE this picture -- I'm on the phone with my Aunt Pat and it's only 3 or so hours after I gave birth. Hard to believe, no?
I had to stay overnight - boo! The day nurse was lovely, but the overnight nurse was totally overbearing and not at all helpful. Oh well - can't win them all. The next morning, additional blood was drawn and my platelet level was declared fine. Mei - our other midwife - came by to check on us an on breastfeeding (which appeared to be going ok...more on that later) and we were discharged by noon.
Man - I had such a great experience. Dave's support, the support of the midwives and of the doulas was so incredibly amazing. It went better than I'd hoped. It was difficult, but totally doable. And if we're blessed with more children, I will use midwives and doulas without a doubt!
And just for fun - here's a shot of Teddy, taken just over a month ago.
We love the little button. Thanks, Aunt Beth, for the t-shirt.