Thursday, June 14, 2007

Thomas is born!

Thomas Edward Kearns Lowry - born 9th July 2006

Rita's contractions began on a Saturday, exactly one week after her due date. She wondered if they were triggered by an American Ginseng tea that she had taken the previous night to enhance her "chi". The tea was prescribed by an acupuncturist, Anju, that Rita had consulted because she wanted to be prepared with an alternative means to induce, in case she ran so far past her due date that the hospital forced her into a medical induction.

At first the contractions were mild and irregular. She went to the farmers market with her husband, John, and together they cooked lunch for the contractors that were working on their house. It was fortunate that Rita's labor began on Saturday because Sunday was the only day that the contractors weren't working that week. Later, on Saturday afternoon, Rita and John took their two dogs for a long walk on the beach. At first Rita wasn't sure if she was getting real contractions. But by 6pm the contractions were 6-12 minutes apart and strong enough that Rita couldn't walk during them. She had to urinate frequently and saw some blood in the urine. John started taking notes and timing her "sensations". By 8pm the contractions were coming every 5-7 minutes. By 9pm, the contractions were so strong that Rita had to lean on a dresser and move her hips in order to endure them. John called their midwife, Maria, to let her know that Rita was in labor. John was so stressed that he stopped taking notes from that point onwards. She asked him to go to bed because she wanted him to keep up his energy for later. She tried to get some rest by putting cushions on the floor of the bedroom.

At midnight Rita vomited and lost her mucous plug. The contractions were two minutes apart and so strong that Rita could only moan during them. John called Maria and was relieved that she said she would come over. Meanwhile John was dealing with a snafu with the tub in the bedroom. He hadn't practiced filling the tub and he found there was a backflow problem with the faucet that caused the bathroom floor to fill with water faster than the tub. Somehow he moved the tub to the dining room around a tight corner and down two flights of stairs to fill it from the kitchen tap which was successful but extremely slow. By 1am, Rita was on her hands and knees in the bathroom, permanently moaning. She got no breaks in the pain between contractions. She took a long shower which gave some relief but she got out because she was afraid that it might slow down labor. Rita turned her attention inward and became uncomfortable if John came in to stand beside her. She told him "please don't stare" and preferred to be alone.

Maria arrived some time around 1am and moved the cushions into the small bathroom to make Rita more comfortable. She put a blanket on her to keep her warm because she was naked apart from a bikini top. Maria told John: "You can never predict where women are going to labor."

Rita's back was extremely painful and she didn't know when one contraction had ended because the pain never let up. She wondered to Maria if she could do it and Maria curtly told her: "You can do it.". Maria checked Rita's dilation at about 2am. Rita said to John: "Pick a number between 1 and 10." John guessed it right: Rita was at 3cm. Maria advised Rita to try to be more “soft and pliable”. Rita took this as her mantra.

Maria's apprentice, Kate, arrived. Finally, the tub was full enough that Rita could get in. The tub gave her some relief between contractions. Once Rita was in the tub, she stopped saying "soft and pliable" and changed to more of a groaning sound during the contractions. John sat on a chair beside the tub and dozed off. Maria timed the contractions and dozed on a chair at the dining table. Kate dozed on the couch. John asked Maria if this was normal and she said yes: It can go on like this for hours with laboring women. The contractions were becoming so intense that Rita wondered aloud how much longer she could take. Rita suggested that John join her in the tub. He started to cry when he got close to Rita and could see how much pain she was in. She vomited occasionally. She also frequently urinated after a contraction so the container we were using did double duty. John was later told that citrus-flavored drinks, like the one that he had been giving Rita, can cause vomiting.

Eventually, Rita asked Maria to do another internal exam. She had to run to the couch between contractions and told Maria to make it quick because it was so hard to handle a contraction outside the tub. She leaked some fluid onto the floor on the way to the couch. Kate tested this fluid and found that Rita's waters had broken. Rita had earlier told Maria that she didn't want any internal exams beyond the initial one, and a final one to check that she was fully dilated. So John knew that she was becoming desperate enough to change her plans for minimal interventions. She was 5cm at 4.35am which sounded to John like slow progress but Maria said that everything was going well. She suggested that Rita should try to relax her vagina which felt tight.

Rita knew from the time that she first met her midwife, that Maria had scheduled a vacation starting Sunday, and would not be able to deliver her baby if she was more than one week past due. But she still picked Maria as her midwife because several friends had previously had babies delivered by her. An added bonus was that Maria's hands were small and always warm. When Rita and John decided to leave their obstetrician, they at least wanted the reassurance of having a midwife who had been trusted by their friends. They were sure that Maria would leave them in good hands if she couldn't be there for the birth.

Maria handed over to Abigail who arrived about 5am. Shortly afterwards, Rita noticed that her contractions changed. She vomited again and told Abigail that she had an urge to push at 5.51am. Abigail waited a while to confirm Rita's feelings. She checked at 6.20am and found Rita was fully dilated and the baby was at +1. John assumed that the hardest part was now over but he found that the pushing stage was even more challenging for Rita. During this stage, Kate took more frequent measurements of the baby's heart rate and Rita's blood pressure. Rita found this unbearable, particularly during contractions and asked Kate to be as quick as possible. Despite her pain, Rita was still able to be assertive and tell the midwives exactly what she wanted. Sue, who was the backup midwife, arrived at around this time and sat on the couch watching. The midwives felt like family to John and Rita, and even to the dogs who were not as rambunctious as they normally are with strangers. It was an unexpected surprise to John that the midwives complimented the dogs on their good behavior.

As Rita's urge to push got stronger she waddled upstairs to the bathroom. During this time seated upstairs, Katie was kneeling beside Rita, telling her what a good job she was doing when Rita said “I don’t do well with cheerleading” Katie very graciously and quietly left.

The contractions were progressing, and Rita had remained seated upstairs for some time, so Abigail asked her if this is where she wanted to have the baby. Rita then remembered that she wanted to have a water birth and in between contractions ran downstairs in an effort to get back into the tub before the next one hit. Surprised, everyone trailed after her.

Downstairs in the tub, Rita got on her hands and knees to push. Rita chose this position because Zann, one of our birth class teachers, had said this was less likely to cause tearing. John could see all the muscles in Rita's back tensing when she pushed. She cried out so loudly with the effort during pushing that John was sure the neighbors would wake. Mostly it was grunts but sometimes she let out an expletive.

Rita kept telling Abigail that she thought that the baby was stuck. Perhaps she had memories of the experience of one of the women in our other birth class, taught by Jane, in which the baby really did get stuck during pushing and required hospital extraction. She kept asking how long it would take and the midwives always replied by saying something like: "It will take as long as it takes." Eventually, Sue said that it can sometimes take as long as 3 hours for the pushing and Rita replied that it gave her a pain just to hear her say 3 hours. Abigail checked and found the baby was at +2/+3 at 7.01am. She reassured Rita that the baby was moving during contractions and that there was plenty of room in her pelvis. Abigail's calm, straightforward manner and choice of words was great encouragement to Rita even though she was getting more desperate for the baby to come out. She tended to arch her body backwards during contractions and the midwives encouraged her to bend forwards. Rita asked if John wanted to catch the baby.

Rita said that she was getting very intense, burning sensations but still the baby showed no signs of coming so John suggested that Rita change to a squatting position because Zann had told us this gave a larger pelvic opening. John sat behind Rita to support her in a squat so he wasn't able to catch the baby. It initially appeared that the baby wasn't moving and despite her pain, Rita was able to joke: "This kid's in trouble already". Abigail told Rita to push through the pain and suddenly she said that the baby's head was out. The rest of the baby's body came out on the next push at 8.52 am. Abigail immediately put the baby on Rita's chest. Rita had earlier asked for no bulb syringe or other interventions after the birth and her wishes were respected by the midwives. Rita rubbed the vernix into the baby's body. The baby began bawling almost immediately. This concerned the parents but the midwives said it just showed that the baby's lungs were working well.

After a few minutes, John asked what sex the baby was. The midwives held up the baby so that its parents could see that it was a boy. John announced that he was called Thomas. The midwives joked that the baby's nose was so large that it had gotten bruised on the way out. They looked at the parents and decided that this was a characteristic inherited from the father and that it was a good way to prove paternity. Rita was extremely kind to tell the midwives that men with large noses have strong personalities.

Rita got out of the tub to birth the placenta which came out at 9.14am. Abigail asked Rita if she wanted a full Lotus birth, but she had decided a few days earlier that she wanted simply a delayed cord clamping. The midwives wrapped the placenta in chux. They made up a bed downstairs so that Rita wouldn't have to walk upstairs to the bedroom immediately after the birth.

Sue cooked everyone a delicious breakfast and started to drain the "birth soup" from the tub. Abigail and Kate weighed the baby and took its vital signs. Its weight was 8lbs 5oz and length was 21 inches. Rita had a small tear and Abigail said that she could stitch it, but Rita said to leave it. The baby had a lopsided head, which is known as being acynclitic. This may be why labor had been so painful. The midwives invited John to cut the cord at 9.54am. John put the placenta in freezer bags so that Kate could take it to be dried and powdered by a woman called Shanti in Sonoma. The midwives moved Rita and John up to their bedroom shortly afterwards and suggested that everyone go to sleep. Rita, John and Thomas needed little prompting to take this excellent advice.


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