A letter to Camilla. Your birth story…
On Tuesday July 14th your papa and I went in for our last prenatal visit with Dr. Weiss at Kaiser in San Francisco. It was to be a routine appointment before our planned induction on Friday July 17th. They had been monitoring me for high blood pressure, and this time it was elevated enough that they were concerned. I was quickly sent over to labor and delivery where after several hours of monitoring they recommended I be induced for labor immediately. Throughout my pregnancy I was being monitored for pre-eclampsia and potential Intrauterine Growth Restriction. High blood pressure can be a sign of the onset of pre-eclampsia, so they were concerned. After some discussion with our midwife Michelle we decided to leave the hospital to pack and return that evening to be induced. We had to sign an “against medical advice” form in order to leave the hospital. I was pretty upset about having to induce a couple days earlier than we had planned mostly because I wanted to give you as much time as possible in the womb, but I also felt that it was time to stop fighting the system and accept there might be something wrong. I didn’t want to push our luck any further. Anything that might be gained by a few extra days wasn’t worth the risk of your livelihood.
We went back to Mill Valley, ate a crab sandwich at Fish in Sausalito, and then went to the Mill Valley library to rent some movies (we only ended up watching Louis CK and Friday Night Lights but were armed with 10 movies). I slowly finished packing my bags at home and took one last walk with Papa down to Stolte Grove, my favorite, most grounding walk through the redwoods and magical garden of 3 groves. On the way back on the Pixie trail, a family of 5-6 deer crossed our path. I must have done this walk over a hundred times and have never seen this many deer at once. We watched as each deer tentatively crossed the trail until all had made through. This felt like a good omen for your safe arrival. I showered and Ginny came by and dropped off two nourishing soups for our hospital stay. We called Kaiser to let them know we were coming and to request that we be assigned nurses who were comfortable with women having unmedicated births. Maria suggested doing this, and this turned out to be a great suggestion. We headed into Kaiser SF around 10 pm with the intention of getting to sleep through the first round of interventions so that I could get a good night’s sleep before more active steps like Pitocin might be taken.
I was admitted to the hospital through the ER. A nurse came down and I was immediately instructed to take a seat in a wheelchair and was wheeled upstairs which I found very amusing since I was certainly able to walk. We got settled into our room on the labor and delivery (L&D) floor, put up our Christmas lights, and started setting up the altar and my parent’s Navajo sand paintings depicting spirits giving birth...all of which made the room feel more like ours and less of a hospital room. In fact, throughout our three days in the L&D unit people often walked in and commented how lovely the room felt. After a few days the charge nurse came in and told us we had to take the lights down, but even then we were asked in the nicest of manners (and told that they had ignored the violation for a while “since people liked us so much”); this felt like such an accomplishment since throughout my prenatal care I felt like I was at odds with all the Kaiser providers—a thorn in their sides.
The first thing to happen was a woman who turned out to be one of my favorite nurses, Lynda, inserted an IV saline lock in my left forearm. I later would find this to be one of the unexpected, uncomfortable parts of labor. That evening we met Dr. Mirsky who would be with us for the next few nights, and Lynda, the sweet, gentle Labor and Delivery nurse. She was extremely supportive of our plan of having a low intervention birth. This started off the tone of care very well and would actually be quite indicative of my experience with most of the nurses. Lynda encouraged me to try the Foley bulb telling me that it was especially effective as a way to start the process of labor for women interested in low intervention births. Lynda slyly gathered pillows from a bunch of rooms to make things as comfortable as possible and was extremely encouraging that I would be able to give birth my way.
The second step was to insert a Foley bulb catheter. When Dr. Mirsky tried, she found I wasn’t dilated enough to insert the bulb in my cervix. As part of this process Dr. Mirsky did a membrane sweep--the entire procedure was fairly painful. I knew labor would be a challenge, and that this was just one small part of it, so I worked on breathing through it. Since I was not dilated enough to insert the bulb, they offered me Misoprostol instead. I requested the lowest possible dose, and they agreed. Around midnight I was given my first dose of Misoprostol which was the tiniest pill I’ve ever taken (about ¼ of a tiny pill).
We slept in the hospital as I waited for the Misoprostol to kick in. Your papa slept in a pull out chair (and would continue to for the next few nights)…always by my side despite the terrible bed. In the morning around 6am Dr. Mirsky checked me again and my cervix was dilated enough to insert the foley bulb. It was uncomfortable but much less painful than the first attempt the previous night. I was so happy it worked, what a huge relief. Dr. Mirsky was about to step off as she would each morning, and told me that the next doctor would be the same woman I met at labor and delivery the day before when I was told I needed to stay at the hospital. For whatever reason, this I found myself extremely turned off by this woman’s voice and way of communicating and had a sense of dread that she would be my doctor for this important process. I took a deep breathe and gently requested another doctor be assigned to me instead. This was one of many requests I would make during my stay that I think really impacted my experience in a positive way.. Dr. Mirsky said this was no problem; I felt such a huge relief to know I wouldn’t be working with that particular doctor throughout my labor.
Wednesday July 15 went by with the foley bulb in place working on dilating my cervix. The foley bulb remained in place for about 24 hours; it was taped against my leg and made walking and using the bathroom pretty tough. Stacy visited bringing flowers, dried sage (for clearing the room’s energy), a feather for my altar (which would in fact be used when I was in transition and being coached on shallow breathing), incense to burn (while making a wish for the labor and delivery to go smoothly). Stacy also brought fabric and 2 dolls: a Pachamama and a Pachapapa from the Andes mountains to help with a quick ceremony to wish for a smooth birth and your safe arrival.
Thursday morning they extracted the bulb easily and at that point I was 3cm dilated; it was such a relief to have the bulb removed. They gave me another dose of Misoprostol to continue to dilate and efface my cervix. At this point I started feeling more regular contractions. Stacy visited again bringing flowers and her amazingly, supportive powerful energy. They wanted to give me Pitocin at this point, but I was able to successfully hold them off until the next morning, since I wanted to get a good night’s sleep before starting active labor. This whole experience was teaching me so much about how to gently advocate for myself while maintaining positive relationships with the people around me who I needed to have on my side.
Your father spent each night in the hospital with me, which ended up being 5 nights in total, sleeping in a terrible looking pull out chair/bed. Throughout the process he was a champ...my biggest supporter.
Friday morning arrived and my contractions had picked up from the Misoprostol enough that I felt like I was in active labor. Dr. G (or Bhakti--my daytime doctor) came in and said she “didn’t want me smiling” in between contractions as a measure for how progressed I was. That was frustrating to hear since I felt like I was in labor already and was having regular contractions. I knew I couldn’t push off the Pitocin any further, so I agreed to have a dose. I took my time…showering...eating…the shower felt amazing and I felt ready to be pushed further along with the dreaded Pitocin.
Michelle Welborn my midwife and Eliana Piper my doula had arrived and we toasted to the start of Pitocin. I was so scared of Pitocin and set the intention that somehow Pitocin would be my friend in this labor despite all my misgivings. At this point we had cycled through many (mostly) amazing RNs and landed on the woman who would help deliver you, her name was Kate. There were a couple uncomfortable moments when Kate first came onto her shift and I wondered if I would be OK having her as my nurse since it seemed like she and Michelle might butt heads, but after an initial off comment she chilled out and ended up being an amazing member of the birth team. Michelle thinks that Erin, our previous RN pulled her aside to let her know things were OK, or something along those lines because after that she came back into the room with quite a different energy (at this point my contractions were picking up and things get a little foggy).
The Pitocin kicked in around 12:15…Dr. G wanted to start me at 2 units and the nurse (Erin) said I could start lower if I wanted and I requested to start at 1. At this point I really felt like Kaiser was working with me every step of the way to allow me to go slowly as possible. I remember Erin stepping off shift and saying to me “I really think you can do this without pain meds”. That felt like such a win, since when she first heard I wanted to avoid an epidural she had skeptically asked me “why???”
From 12:15-6ish the contractions kicked in at 1 contraction every 2 min and didn’t let up. They felt really frequent to me, but it wasn’t until after the labor that I learned it is somewhat unusual for someone to have contractions that close together for that extended a time period. This is apparently an intense way to experience labor. Most women only get contractions 2 mins apart for a couple of hours during their most active time of labor. Luckily I didn’t know any different.
My way of coping with contractions was really going inward and using my breath –repeating what I read Ina May had written: “the same energy that was used to bring it in is the same needed to get it out”. I spent a lot of time with my head buried in my pillow on my hands and knees on the bed. Will, Eliana and Michelle were all doing such an incredible job supporting me, with foot massages, words of encouragement and back rubs.
Moving too much was challenging since I was hooked up to an IV pole for the Pitocin and the telemetry monitor for the fetal monitoring.
After several hours of intense contractions Michelle suggested we try the birthing pool. It’s pretty incredible we had the option at all since just days before it was a storage room that hadn’t been used as a birthing room for many years. With some prodding and the help of some amazing nurses they cleaned out the tub and enabled me to use it (we had to explain the situation to every new nurse who would inevitably reply when we inquired about it “we don’t have a birthing tub”, to which we would start out by saying “what about the room across the hall labelled “tub room”).
Will had decorated the tub room with little battery operated tea lights and getting into that tub was like heaven. It was my first big break. Will poured water on me and we were alone for a sweet spell in the dark and relaxing room. Being in water was such a relief. Michelle said if I started feeling pressure on my bottom that I should let them know… I wasn’t sure if that’s what I was feeling but it seemed like that so I got out of the tub and they checked my progress.
Dr. G checked my dilation and I declined to learn the results (I later learned to be 4 cm). They didn’t tell me this, thank god—I felt like I was close—close to needing to push. Nothing in labor is subtle though…when you need to push you know…I wasn’t there yet which I can only say I understand in retrospect.
The strong contractions continued. Will supported me the entire time. At this point I also had a “tens” unit placed on my back which was delivering electrical currents to ease labor during contractions. I think it subtly helped. At one point I was on my hands and knees on the hospital bed and I felt a strong wave of water flow out of me… it was such a relief. My water had broken. This was the second sense of relief I would feel after the bath. I also vomited several times which was also accompanied by a sense of purging and release.
Around 10pm the sensation of needing to push took over. After starting to push they checked my dilation and told me I wasn’t quite ready. This was so frustrating because my whole body was telling me to push and almost involuntarily pushing whether I wanted it to or not. It started to feel like this labor might last forever, and this was when I started to struggle a bit. Throughout this time Michelle, Eliana and Will were all supporting me in different ways. I remember Michelle telling me that this process was safe, that everything was ok. I remember a strong part of me feeling perhaps it wasn’t safe, it was so intense that it seemed possible that it wasn’t ok so that statement was reassuring to me.
Michelle and Kate instructed me to bring my breathing into a shallow space using quick breathing. Will laid down with me and they handed him the feather from my altar that Stacy had brought for me to breathe onto. Will’s arms were wrapped around me and he was breathing with me through the contractions. I was in so much pain that I felt like a wild animal. I was thrashing around during the tough parts of the contractions trying to escape the pain. At one point I remember biting Will somewhat involuntarily. I remember tasting his beard and thinking “this is not good”. This was the only part of my labor where I had trouble tapping into my mindfulness-based practice. Nothing it seemed could help me through these sensations.
At this point I didn’t know it but I was only 5 cm dilated; I was in transition and for 35 min trying not to push. For me this stage stands out as being the most challenging. I remember thinking “I am not sure I can do this”. The hardest part was not knowing how long it would last, and I wasn't sure I could ride out the pain. Resisting the urge to push felt practically impossible. At some point during the contraction my body would take over and I would shudder and involuntarily push like crazy. Between contractions I said: “I might need to revisit the plan of no epidural”. Michelle suggested we wait one more hour and see where we are. I held out for about 30 minutes and then couldn’t any longer. I knew instinctively you were coming down the birth canal. I said “I feel her head coming down” and reached inside myself and touched your head! With that they said it was finally ok for me to push. What a relief. It was 10:35pm. I later learned this had been especially challenging because of your size, and the size of my pelvis. You were pushing down on my rectum which made it even harder for me not to push.
I pushed for a remarkably short amount of time for a first time mom—only 39 min. With each push I could feel you moving down my birth canal. It felt like a water balloon coming out, one body part at a time. I could feel your head crowning and remember feeling the “ring of fire” (I believe I even said ‘I feel the ring of fire!’)…not super intense but I was aware of not wanting to tear so I worked hard to follow the instructions of the doctor in how to guide you out with my pushing. The Dr (Dr Freeman) stepped in only a few minutes before you were born. Up until that time it was really Michelle and Kate guiding me. Once your head was out everything else felt pretty easy. You arrived at 11:04pm on Friday July 17th. They pulled you up and your grey squirmy body was handed to me; you looked like a sweet alien covered in goo!
You came out head first and before they could see anything else your foot appeared under your chin. Your legs were in lotus position against your belly. Michelle said she’d never seen a baby deliver in that position. At this point I got to snuggle with you. I didn’t know it but the next big challenge was right around the corner. The cord broke as the doctor tried to pull out the placenta. Dr Freeman put her hand into my uterus to try and extract the rest of the placenta to get it out. This was excruciatingly painful, however, I felt a great sense of relief and accomplishment having delivered you which made the placenta struggle feel doable. They still were not able to get the placenta out so the attending doctor was invited in to assist. They recommended one more manual attempt (the next option would have been the operating room and general anesthesia which I really didn’t want especially after resisting intervention throughout the labor). They gave me the pain medication of Fentanyl and a round of antibiotics and quickly went in for a second attempt to manually remove the placenta. This was again quite painful as the Fentanyl hadn’t kicked in yet and wouldn’t until after they were done. After the second attempt they decided they had gotten enough out and could leave it at that which was such a relief to me; that had been so challenging after going through labor.
We learned later what had happened. The placenta was what they call a Velamentous Placenta where the umbilical cord doesn’t plant directly into the placenta but rather into a bunch of membranes that then attach to the placenta. This makes for a much weaker and potentially compromised placenta and likely explains many of the issues that were coming up during my pregnancy including your somewhat small size. However, it’s worth noting that throughout labor your heart rate was monitored and you never experienced a dip or spike (unusual no matter what the circumstances--even the healthiest babies don’t usually stay so steady) so the birth team and doctors were not all worried about you. Apparently, the very fact that there was no team of pediatricians waiting to examine you when you arrived (and that they allowed the labor team to be just Michelle and Kate for the vast majority of the time) shows the confidence Kaiser had in your health. As I have said time and again, you were small but mighty my little one.
Michelle tells me that “I was amazing” and that your labor by any account was a tough one, from the emotional element of having to be induced at the hospital when I had wanted a home birth, to the contractions coming 2 mins apart for 11 hours, to your head bearing down on my bottom making me want to push. Overall I felt incredible lucky to have delivered a healthy baby girl in as close to a non-intervention birth as I could. I feel fortunate to have felt you come down my birth canal and to have been able to deliver vaginally with no tearing, and to have a relatively easy recovery.
The next challenges were indeed around the corner, you weighed in at a slight 5lbs 4.5 oz and would have to quickly figure out how to feed, but for now we had a healthy baby girl and that was all that mattered.