Thursday, January 5, 2017

Empowered to Birth Naturally in an Alabama Hospital


Newborn Bo snuggles with Mama
by Erin Mize, guest blogger

At midnight, with fast, irregular contractions, I called my doula, Hannah.  My body felt wildly out of control.  She was calm and reassuring, telling me to take a shower, relax, and if they persisted, to call her back.  If not, she encouraged me to try to rest.

My heart was racing with excitement as I got undressed to get into the shower.  I caught a glimpse of myself in the mirror; cheeks flushed and out-of-breath from the struggle to remove my socks.  I stopped, turning my bountiful belly straight-on to the mirror and smiled.  I marveled at my body’s miraculous work, swelling to accommodate and sustain this new life.  I felt strong and capable.

After a few minutes in the shower, sure enough, my contractions slowed.  Before I even knew it, my mind had quieted and I decided to dry off and try to rest.  Fortunately, I was able to sleep until about 3:30 AM when I awoke to 10 minute-apart contractions that weren't really any stronger than before, yet I intuitively knew these were purposeful.  The whole of my uterus would tighten, not just the top like during Braxton-Hicks, and my sacrum down through my thighs ached. 

I was tossing and turning in our king sized bed so I quietly moved into the living room, leaving Andy asleep.  I didn't wake him just yet.  He would need to be rested to take care of our 3 and 4 year old children, and to be perfectly honest, I wanted to labor free from his concern.  I needed to let go and succumb to this process, so I took advantage of the quiet. 

In my sleepy, yet excited state, I went to the shower.  I knew the hot water would help.  I immediately relaxed.  I breathed in the steam slowly as I propped myself against the shower wall letting the full force of the spray concentrate on my sacrum.  I thought about my baby, Bo, working right along with me.  As I rocked my hips slowly back and forth, I visualized him descending through my body while I intentionally relaxed my mouth, shoulders, arms, back, and pelvis.  “Here we go, little one,” I whispered.  I wanted to make his descent as easy as I could.

When I returned to the living room, the TV was on, and one of those cheesy infomercials selling '60's music CDs played.  I wasn't watching it.  I just needed it on to give my mind some distraction.  I curled up on the couch and was even able to sleep a little between contractions.

All of the lights were out in the house except the glow from the TV, and it was otherwise silent.  I continued in this early stage of labor peacefully as my family slept.  I was in total control, calm and comfortable.  I wasn't afraid.  I didn't feel alone.  I felt safe and able to relax into my labor in my home, relishing this time with my baby, just the two of us, doing our work together.

As my labor progressed, I was no longer comfortable lying on my side through contractions. As one would start, I would get up and stand with my head on my arms, resting over the arm of the couch and swaying my hips back-and-forth through the contractions, consciously relaxing my mouth and muscles and visualizing my baby easing down. 

After my second trip to the bathroom, I recognized that my body was “voiding” and I had a feeling it was time to get everybody up and on the road for the 40 mile trip to the hospital from our home in Hartselle.  I did not look forward to the impending road trip or the bright, unfamiliar hospital delivery room, full of strangers, that awaited me.  Would my doctor be on-call or would a stranger deliver my baby?  Would I get a nurse that was educated about and supportive of natural birth?  Would my birth plan be respected?  It would have been so nice to have made one phone call and had a midwife show up at my door with the same supplies that a level one hospital stocks, but unfortunately, assisted home birth remains illegal in Alabama. 

Andy and Hannah helped Erin maintain her focus.
I'd like to take a brief detour here for a moment to point out that actually, home birth is legal in Alabama.  More specifically, unassisted home birth is legal in Alabama.  Oddly enough, I could have had my baby at home, but I most certainly could not have had a trained attendant, like a Certified Professional Midwife, on hand to ensure that my baby and I remained healthy and safe.  Just for being present she could be charged with a class C misdemeanor.  Additionally, because Alabama does not license or regulate CPM's, she could not have easily transferred my care to a hospital or carried the life-saving equipment that she needs and can use legally to attend home births in 31 other states.  Therefore, after laboring at home without incident, I woke my family up to go to the hospital so my birth could be attended by an OBGYN, a specialist. 

Before I woke the boys, I made their chocolate milk, just as I did every morning; except this time, I paused to work through strong contractions while I rested on the kitchen countertop.  I made my way into the boys' room and with muted excitement said, “This is it guys!  You're going to meet your baby brother today!”

I woke Andy and told him it was "for real" and we needed to get to the hospital.  I called and let Hannah know how it was going.  After I paused our conversation to work through a contraction, she confirmed what I suspected, that my labor was advancing nicely.  She expertly advised that we meet at my parents’ home prior to going to the hospital so we didn't arrive right at shift change.  I agreed, and Andy and I loaded the boys up and got on the road.

It was about 5:30 in the morning, pitch black, and starry.  I remember the boys sleepily singing "twinkle-twinkle little star” as my contractions came and went.  This time, however, I didn't have the luxury of moving around to work through them.  I pulled at the seat belt to move it away from my taut abdomen and writhed and twisted in a vain attempt to alleviate the pain in my back.  Each passing mile marker seemed a reminder of my distress as Andy raced to our destination.  I was beginning to panic.  It took everything in me to suppress my instinct to move my body freely through these contractions. 

We finally rounded the corner in my parents’ neighborhood, and I was filled with relief at the sight of Hannah’s car parked in front of their home.  Andy got the boys out while I went up the stairs as quickly as I could to labor in the shower until we would go over to the hospital. 

I turned the water to almost as hot as it would go.  The relief was immediate.  Slowly breathing in the steamy air, I began getting my labor back under control. I visualized the water softening my tissues and gently encouraging my baby out as I slowly swayed through the awesome pressure.  How I would have loved to have had a water birth! Unfortunately, hospital policy in my area prohibits the practice.  But, I knew that I would be allowed to labor in the tub or shower until my water broke.

Thank God for Hannah!  She took the lead on thinking out the timing of our arrival.  All I had to do was labor. 

We pulled up to the valet stand, and I remember feeling strange about the security guard approaching me with a wheelchair.  I got out of the car looking behind me for the patient that needed this apparatus, even willing to help him or her into it.  Then, of course, it dawned on me that it was meant for me.  Even though it felt rather unnecessary, and I certainly didn't identify as a “patient,” I obliged the helpful parking attendant.
First Feed

While I couldn't help but feel like a diva waving a birth plan with a lavender-scented, birth stool-carrying Doula in tow, the hospital staff and nurses never treated me as such!  We were greeted warmly and taken straight into a labor/delivery/postpartum room.  I had pre-registered and therefore was able to get through the intake paperwork quickly with Andy's help.  To my amazement, my labor and delivery nurse was actually trained as a Certified Nurse Midwife!  And let me tell you, the care she gave me exemplified a midwife's model of care.  She was respectful and supportive of my choice to birth unmedicated.  She read my birth plan diligently and then asked before she did anything including waiting to start my hep-locked IV until after a contraction. 

My doula was calmly unpacking her bag-of-tricks and making the room more comfortable by lowering the lights, playing soothing music, and starting the lavender.  Hannah’s presence calmed the frenetic pace of the hospital, and her attention to detail made the unwelcoming hospital room homey.  In a way, she represented my conscious self that, in the throes of labor, I had distanced myself from.  Her presence of mind was invaluable.

I continued laboring unencumbered from an IV or continuous fetal monitoring.  I drank when I was thirsty, remained in the clothes I came in, and moved about freely.  In fact, I didn’t get into the hospital bed until after I had given birth!  Andy sat at the foot of the bed and I rested my arms and head across his lap between contractions.  I was most comfortable on the exercise ball and during contractions I would roll my hips in big circles while Hannah applied counter pressure to my sacrum and Andy gently encouraged and loved on me. 

My nurse asked if I'd like my cervix checked for dilation and being that my water hadn't broken yet, I allowed her to examine me.  Believe it or not, I was actually a little concerned that the exam would reveal that I was only a few centimeters dilated. Much to my surprise, I was fully dilated!  However, I did not feel the strong urge to push as I did during the birth of my second child and I speculate that it was related to the fact that my membranes (and amniotic fluid) were still intact.

My nurse indicated that she would call the doctor, and that she may break my water upon her arrival.  My doula sensed my hesitation and encouraged me to discuss with the doctor the risks and benefits of doing so.  Interestingly, my doctor never brought it up.

At some point I remember saying "I could push", emphasis on the could.  Hannah asked if I'd given any thought to what position I'd like to push in.  Believe it or not, it wasn't until I hired her for the birth of my 3rd baby that I learned there are many pushing positions a woman can assume to birth her baby, the least efficient of which is lying flat on her back with her feet in stirrups and knees in the air. 
Big Brother gets to hold baby Bo

I had learned through my research that an upright birthing position would allow gravity to aid in bringing my baby down and out as well as allowing my uterus to contract more strongly and efficiently.  Staying off of my back would keep my aorta from being compressed and, in turn, help my baby to stay oxygenated.  Also, it would allow my sacrum to expand backwards, increasing my pelvic outlet.  Hannah gently encouraged me to go with what felt “right,” and I confidently replied that I'd like to use the birth stool.  She went straight to work getting it prepared.

It was no time at all before I took my place on the vinyl cushioned wooden stool.  I was sitting with my knees a comfortable distance apart and bent to slightly less than a 90 degree angle.  My OBGYN patiently sat cross legged in the floor in front of me, my doula behind me, and Andy at my side with my nurse observing attentively.

And then we waited.  I was eager to meet my baby, my third son, and in stark contrast to my other unmedicated birth, I just didn't have a strong urge to push!  I knew to wait for my body to “do its thing” but I was growing impatient!  Hannah reassured me that I was “laboring down” beautifully so I closed my eyes and waited patiently. 

My water finally broke as my OBGYN was doing perineal massage with mineral oil and applying a warm compress.  At this point my contractions began to intensify. 

I believe it was about eight contractions later that I began feeling pressure on my perineum and Andy commented that he could see the top of Bo’s head through the amniotic sac, and yet I still didn't have a strong urge to push or a ton of pain as you might think.  Now don't get me wrong, it was no walk in the park, but once I resigned myself to the necessity of the contractions, that they were working for and with me to bring my baby to me, I embraced them as part of the physiological design.  

My favorite part of my labor happened next:  Hannah whispered to me, “reach down and feel your baby.”  I tentatively reached down and felt my baby’s velvety soft head beginning to emerge. 

As I pushed along with a contraction, I heard my doctor quietly and calmly say, "his head is out.” I was shocked and caught off guard.  With renewed purpose I let out a primal groan with my next, final contraction and all 8 lbs, 12 oz of my baby boy was out and on my chest!  I remember hearing someone exclaim, “He's big!” which surprised me because I didn't feel like I had worked that hard to get him out. 

Bewildered, I questioned, "that's it?"

Hannah helped me out of my dress so I could get Bo skin to skin.  I had my baby in my arms.  He was so calm.  He stared right into my eyes, never breaking his gaze, as mine filled with tears.  I'll never forget this moment.  In a strange way, I recognized him.  I'd never laid eyes on him, of course, but I felt like, “oh, there you are.”

My body had not only created and grown this little life, but brought him forth into our world, or earth side, as Hannah affectionately said as she welcomed him. 

I felt as though I had come full circle.  Rather than handing the process over as I had during the highly medicalized and, for me, detached birth of my oldest son, I had embraced the process.  Instead of placing my childbirth in the hands of the hospital staff, this time I had a plan and then trusted my instincts and my body to do what it was Divinely designed to.  I learned that I could not put the burden of a safe childbirth squarely on the shoulders of my chosen birth attendant.  I must be accountable for educating myself and then carefully choosing who would attend my birth.

If my three radically different childbirth experiences taught me nothing else, they showed me that there is no "right” way to birth, but there is a right way to treat a laboring woman: with respect.  There are many factors at play, and sometimes the choices are very limited. The most important part is that we are informed and respected in our choices

I evolved with my experiences to guide me, and my expectation of birth changed. I learned what it could be with the right preparation and careful consideration of who was present at my births. 

I found the Alabama Birth Coalition about six months postpartum as I continued to process the impact my first two children’s births had on me and our family.  That's when I learned that for more than 13 years, ABC has fought to give families in Alabama the right to choose Certified Professional Midwives for their maternity care and safe home birth. 

Everybody is so happy that Bo is here!
I had three hospital births:  a medicalized, an unintentional unmedicated, and finally a planned natural birth.  Many variables aligned in my favor to achieve the above described birth.  Yes, with careful preparation and crossed fingers, you can have a beautiful, natural hospital birth. However, consider one thing: hospitals by their very nature are not designed to embrace healthy physiology.    On the other hand, they expertly save the lives of high risk mothers and babies every day, but the anticipation of abnormality is palpable for a healthy laboring woman and unfortunately can often lead to unnecessary interventions. 

I believe that the future of maternity care in our state can and should include out of hospital birth options for healthy women   Home birth isn’t for every family, but we owe it to the futur
e of birthing women in a our state to at least allow them this choice.  I firmly believe I could have easily had my baby in the comfort of my home had I been able to do so safely with a CPM. 

I am proud to now be a part of the Alabama Birth Coalition and their effort to introduce legislation that will finally let Certified Professional Midwives legally attend home births in Alabama and thereby give us real choices regarding our maternity care. 

Educate yourself, know your choices, and hire a Doula!


For more information, please visit the Alabama Birth Coalition’s website at http://www.alabamabirthcoalition.org or Facebook page at https://m.facebook.com/alabamabirthcoalition/.  

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