In preparation for a different labor, I changed my nutrition for this pregnancy. It was far from perfect but included much higher amounts of vitamin C, sea salt, and pregnancy tea containing alfalfa - all of which are supposed to help strengthen the amniotic sac. I also learned a lot about diet and iron deficiency. At 28 weeks I had a hemoglobin almost below 10 which would have risked me out of home birth. I began pounding the steak with spinach, paired with vitamin C after (to help with iron absorption), and at least an hour before or after any source of calcium which negates the iron absorption. I also took twice daily doses of floradix and cholorphyll (more effective and easier to digest than ferrous sulfate tablets). Within a couple of weeks my Hgb went up to 11.2 and I began feeling a little bit more energetic, too!
Everything during the pregnancy progressed pretty normally and predictably, with the token discomforts and tired-of-being-pregnant feelings that many women experience. Despite it being my second baby, I felt as if I was a first-time mom all over again because I was learning so much from my midwife. I had the same doubts as to my ability to do it; do it meaning go into labor on my own and make it through with natural coping skills. And although I work "in the field", I still needed just as much (maybe even more?) reassurance and personalized support from my provider. When you are a nurse, many providers assume that you know all there is to know and do not need as much teaching but this is simply not true. One of the (many, many) reasons I chose my home birth midwife was that she was not someone who was ever a coworker/colleague/provider I worked with in the hospital. I only met her during this pregnancy and would never be in a position to take orders from her as an RN or to have any tension that was work-related. Appointments were totally focused on my pregnancy and health, of course with some side conversations about mutual interests. I transferred at about 16 weeks and once we made the decision and the first payment it felt super good on a gut level. For a few weeks I was wavering or considering dual care with her and the hospital providers "just in case", but part of the process for me included accepting and embracing the decision fully. I stayed on with the hospital providers up until 20 weeks for the anatomy scan and then began to see the home birth provider exclusively. Appointments were around an hour or so long each time. She was amazing with hands-on skills like Leopold maneuvers. I remember being blown away at a 17 week appointment that she could tell the exact position of the baby and feel his little legs. She was also able to tell from quite early on that his hand was persistently up by his face, which did play into my birth a little bit.
I continued working on the floor and teaching childbirth classes until just after 40 weeks and finished my grad school work around 40 weeks as well. There were many times that I was totally guilty of magical thinking. "Maybe once I finish this last paper....I can relax and go into labor" or "Maybe I just need to teach this last childbirth class and then I'll go". Or worse, "What if I submit my paper and I STILL don't go into labor?!" I discussed these fears with my midwife and we talked through what all the potential plans of care would be in the case of going over 42 weeks. She never expressed any doubt and always had faith in my ability to do it, but it felt good for me to have it all laid out. Also...all these fears and this magical thinking are proof that just because you know something intellectually doesn't mean you can embrace and embody it! I always tell the couples in my classes that it is totally normal and okay and expected to go past your due date ("Guess date"), but this didn't make it any easier for me to live it.
In the last few weeks of pregnancy I began to have some Braxton Hicks contractions, which were new and very exciting. None of them were exactly painful but they were a reassuring sign that things were progressing in the right direction. Then at 40 weeks and 5 days (my last day scheduled to work), I was SURE that my water broke in the morning and that labor would be starting soon. I had some moments of total anxiety over repeating the Abe situation (water breaking, not going into labor, requiring pitocin). My midwife had me act as if it had just in case, which means taking your temperature frequently, avoiding public bathrooms, and taking echinacea. In order to avoid total freak-out-ness I indulged in an 80 minute massage at Knead Relief. I really lucked out with the LMT Kelsey and had the best massage ever in the world. I requested that she stimulate some labor trigger points and she did. Later on in the day after that, it became obvious that this was not a rupture of membranes but bloody show. I was happy on both counts! My midwife said, "isn't it nice to see the process unfolding?" Yes, it was! I was getting all of these little signs that labor was around the corner.
The next day I woke up crampy, and asked Matt if he could work from home. During his lunch break we went to Wegmans and stocked up on some good labor food and other supplies so we could nest at home for a few days if need be. Turns out this was the right choice! Friday morning (at 41 weeks) I woke up at 3 AM with cramping. Thinking it was too good to be true and not wanting to jump the gun, I stayed in bed for 2 or so hours being woken up every 10 minutes. At around 5:30 they got to be too much to lie down through so I woke up and enjoyed the quiet house, sitting on the birth ball, making coffee, and eating breakfast. I started to time some to see if there was a pattern forming. When Abe woke up I did have a 20 minute lull, which is not at all unusual. Oxytocin, the hormone that drives labor, requires relaxation and a sweet but needy 3 year old doesn't always increase this hormone! Eventually, Matt brought him out for a sweet and happy breakfast together at our favorite greasy spoon and best doughnut place in the world, and then dropped him at preschool. I was happy they got to spend some one-on-one time together and was also grateful for the peace and quiet at home. I put on some Arrested Development to lighten the mood and distract me and began to eat tons of watermelon and popsicles. It just felt right. I was listening to the college radio station and right in a row they played Neutral Milk Hotel, Sufjan Stevens and Rilo Kiley. These 3 bands/artists were really important to me around age 18-20 and this was a nice connection back to the music at my Blessingway! This made me feel like the day was right and emphasized comfort and familiarity.
Being 41 weeks, I had an ultrasound scheduled at noon with a biophysical profile. I talked to my midwife about if I should go or not. She suspected that things might slow down with it being daytime and with the excitement of going in to the hospital, and felt confident that the baby was moving really well, had a reactive non-stress test and had adequate fluid but ultimately left the decision up to me to go or not. I knew I would feel reassured with a good BPP, especially if labor stopped and I continued being pregnant for a few more days. This is just another example of how care was with her. Everything was a discussion including risks and benefits: true informed consent. At no point in the pregnancy did I ever feel like I was being pressured into one decision or another.
On the way to the hospital for the BPP, Matt and I had an emotional but really nice and important conversation about our concepts of pain. I can't emphasize enough how important it is to have a supportive labor partner, whether it's your romantic/life partner, a doula, a friend or someone else! This is also the time when I began to shift moods and need him to be totally quiet during contractions - a sign of transitioning from early into active first stage labor. Ina May Gaskin has called contractions "an interesting sensation requiring requiring all of your attention", and I think this is where I was at that moment. I am not sure I would call it painful quite yet but it certainly required a lot of concentration! During the ultrasound the tech asked if I was having contractions and I said confidently, "Yes, I'm in labor". She seemed skeptical as my cervix was closed as far as she could tell with ultrasound. My midwife was concerned that hearing news like this might be discouraging to me, since the hospital culture is so cervix-centered for measuring labor progress. She reassured me that especially with a multip, the cervix can change very fast. We came back home after the ultrasound, made arrangements for Abe to be picked up from preschool & be at his grandma's for the weekend, and Matt had some work to finish up. I texted my midwife, "so when do I have you come here? When Matt stops being funny even in between contractions?" She thought that was probably a good time to head over and advised us that we could fill up the birth tub but not get in until she gets there, because it can cause so much relaxation that labor progresses super fast.
She got to our house around 3 or so, and I experienced the typical lull in intensity that happens as laboring women adjust to new people in their surroundings. Something else that is super important to a laboring woman in addition to a good support partner is the LACK of unsupportive people, as well as a feeling of privacy and protection. I have seen labor progress when the "wrong" people leave the room, and seen labor stall when someone comes in that makes the mother uncomfortable or fearful. Even with all the trust that I had in my midwife I still needed a little period of adjustment while she set up her equipment (basically everything you could possibly need for an emergency with mom or baby short of anesthesia, intubation and operation; though apparently some people believe that home birth midwives just "wing it" and have no safety equipment), and checked my vitals and baby's heart rate. This gave me a crazy appreciation for the trust that people trust in me/us as hospital care providers when they are at their most vulnerable.
She hung back in the living room for much of this phase of labor, checking the heart rate with a doppler intermittently according to AWHONN standards, but giving me and Matt tons of privacy. This really helped me feel comfortable and able to release and surrender to the process. I will miss having the beautiful photos that we had from Abe's birth, but I really felt privacy was the right thing this time. With Abe I felt as if I had an audience. This is not the fault of any of my providers, who were all wonderful, but a problem with my ability to relax and let go. I didn't vocalize with him at all until after I had a dose of fentanyl. This time, moaning and vocalization were essential. For most of labor, it was this vocalization in combination with counterpressure or shaking the apple tree from Matt that made it pretty tolerable. I remember feeling that if I could be louder than the contractions I could stay ahead of them. We listened to Nick Drake and Bon Iver during this part of labor. The first Bon Iver song to come on was one that I first heard during a point in my pregnancy when I was feeling discouraged and it was just right.
I totally lost track of time. I remember being shocked that it was getting into the evening. This was a wonderful surprise - it actually felt like time was moving fast up until around 7 PM. The midwife came in to check me (the first cervical exam for all of labor) because she said I was sounding pinchy and thought I might have an anterior lip. She was right! What an interesting and totally different way to gauge labor progress - by the sounds women are making! I had been showing other signs of transition before that. She asked permission to do the exam and I expressed my fear that I would still not be dilated at all. Again she had total confidence in me and said it'd be a very strange cervix that wasn't dilated right now. She was right about the anterior lip (which was probably due to his hand presentation) and offered to see if it would reduce manually if I could push during the exam. This was incredibly painful and I had to stop after one contraction. We tried this reduction a few times over the next couple hours but I really felt like I had to do it myself without the exam, even though it probably would have sped things up considerably. I started getting tearful and told her I was scared of pushing and tearing. Saying it out loud made it easier to get past. Once I expressed it I could let it go and began to push a little bit at a time. At this point the music needed to be turned off and I was a little less "in the zone" than before.
Pushing felt so much better than just tolerating the contractions. It was getting hard to relax between contractions, even in the tub, because of the way I was holding myself. I was in and out of the tub 3 times I believe through labor, and ultimately got out of the tub so I could relax my weight in between contractions fully on pillows and blankets. This proved difficult even on land because he was moving so much, doing his part of labor, between contractions. I was in classic, textbook transition at this point. Matt asked if I would feel better on hands and knees and I said pitifully, "I don't knooowww!" I felt like I couldn't move. Matt and the MW helped me get into a slightly more productive position, but ironically enough I ended up delivering in semi-fowler's which is a typical hospital bed position. I wasn't totally attached to delivering in the water which was helpful. I had tried hard not to be attached to one vision or idea of how I would deliver. Even the room we were in (the guest room versus ours) was kind of a last minute idea change that ended up being the right thing.
It was only 20 minutes before delivery that my water ended up breaking. What a triumph that felt like! Afterwards she said that it was indeed a really strong sac of waters, so that diet had really helped. It was quite a dramatic rupture since it happened during pushing. Matt did a WOAH HOLY S*** IT'S ON THE WALLS and the MW kept her total cool composure and poker face which really impressed Matt. Right before it broke I felt it as I was pushing and thought it was caput, so I was relieved that it was the bulging bag instead. Things really started to move forward fast from there. I didn't really believe it when she said I was crowning and that she could see ears. I was pushing with a very conscious effort and never really had a strong urge to push, unfortunately. However, at the end of these final contractions I noticed that my body was starting to do it on its own, even after I felt like I was done pushing. Again - how cool are our bodies that they know how to do this!?
Crowning was an interesting feeling. I'm not saying it felt good, or that I want to do it again tomorrow, but it just felt...big and warm and different than expected. I think that's part of why I didn't believe it was happening. She really tried to help hold his hand back so it wouldn't come out with his head, but he was damn insistent that it did. We're both confident that if not for the hand, I would not have torn but it was really not a bad one at all considering a hand presentation. He still keeps that hand up by his face for comfort!
After his head was delivered, I had a little lull in contractions so she had Matt do some nipple stimulation to get the oxytocin going which was effective. The next contraction came right away and I delivered his shoulders. She had me reach down when he was out to his abdomen and pull him up onto my chest. How awesome! I was anticipating wanting some time with him not on my chest (this is how I felt the first time after 4 hours pushing with an epidural), but I felt so ready and connected right away. It took us a couple minutes to remember to check if see had a boy or a girl! It really was true for us that we did not have a preference and I was just so happy either way. We had had a few backup names but I knew that this was Harvey when I looked at him. He felt so warm and just right.
I stayed in that bed snuggling with Harvey and feeding him for at least two hours. Matt made me a sandwich and the MW and her assistant made sure I was eating more watermelon, and peanut butter and crackers and drinking plenty, which they had been doing throughout labor as well. They set to work starting laundry and cleaning up, and preparing the placenta for encapsulation. All the while she was checking on both of us as needed, assisting with the latch and making sure Harvey was staying warm. After a while I was ready to get up for the first time. The MW helped me to the bathroom while Matt had his Harvey snuggle time and got him dressed in his first outfit. The assistant prepared a postpartum herbal bath to either put in a peri bottle or put onto pads and to freeze and make padsicles with. I got settled into my bed and the MW's assistant brought me a protein smoothie she had thawed out from the freezer and my cholorophyll/floradix/vitamin c drink. Matt put Harvey in the bassinet and gave me a mini massage with magnesium cream for my sore legs. One more belly check and the MW and her assistant were gone for the night and we got a nice long stretch of sleep.
Support after a home birth is amazing; at least with this MW. She came back by 24 hours postpartum, and has her clients text her or call every day for at least a week with updates on baby, mood, bleeding, feeding, etc. She came back for a home visit at 4-5 days after my milk came in, and again a week later, will return once more in two weeks, and then it's one more week until the 6 week checkup at her office. She emphasizes tons of rest for at least the first 3 days, and really listening to your body for healing. A fun guideline she also has is to wear pajamas for a while to make it clear to visitors that you are healing and to take the pressure to get up and do things off of you. This was basically my uniform for a week or so. She says if you are doing the right amount of rest your bleeding will be gone by around 2 weeks. Today is 2 weeks and she is right! So even with a three year old I am healing faster than I did with the first baby! Matt had two full weeks off and that was incredibly helpful. I cannot imagine doing it with either no partner or one who had to go back right away.
At our two week well child check, our pediatrician asked me if I was ever scared to be at home. The answer is overwhelmingly no, not at all, at any point. I had the normal fears and self-doubt in transition but I never feared for my safety or baby's safety. Studies on home birth are hard to interpret since in the US they sometimes include unlicensed MWs or unplanned home births, so I went with comparing this individual MW's safety measures and statistics to the individual hospital where I would likely deliver due to insurance issues. I felt that she was a very safe provider for a low-risk person. A less stressed out mom means a healthier labor and increased safety for baby. For me it also meant less risk of postpartum depression which is also healthier for baby. It meant more support and help with breastfeeding which is healthier for baby. So any of the typical concerns about home birth being selfish or just about my "experience" are just not valid. I am so glad I made this choice and would do it again in a heartbeat!
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