By Merrill Durham
My first birth with Genevieve was incredible, challenging, life-changing, and in many ways, traumatic. I had spent months preparing for the physical aspect of birth. I read every book, watched all the documentaries, attended a thorough childbirth education class, breastfeeding class, baby-wearing workshop, and talked to every mom I could about their labor experiences. I had attended a few births as a pseudo-doula (not yet trained) and I felt very prepared for my homebirth. (Here’s my blog post about why we chose a homebirth)Four days of labor and learning to release control and relax my pelvis, I finally jumped into active labor. Only 6 hours later and 30 minutes of pushing (75 hours total!), Genevieve was born. I had my natural homebirth, surrounded by my amazing birth team, my husband, mom, sister, and mother-in-law. I was utterly exhausted and very much in shock. Michael and I were on a high from it all and we connected in such a deep way through the process. But it was way harder than I imagined and I had some trauma I needed to process before having another baby. Transformation never comes easy. And I knew there would be things I would want to do differently the second time around. (Here are the detailed story of Genevieve’s birth and her birth video)
“Today I am reminded that nothing in nature is rushed. I’m learning how to ground myself and stay present by quieting my mind. When fear creeps in, I will choose to trust this process. I will allow the mystery to unfold perfectly, receiving the abundant peace available to me, despite the tension in waiting and my desire to control. I refuse to let my impatience rob me of the joy and deep connection I can experience with my baby, my body, and the Creator. I will surrender to every sensation and open myself to whatever the long days and achy nights hold, even if it means curling up in a ball and having a good cry. In this season, Adelaide and I are one in body and soul and I will not hurry that separation. I will hold my daughter soon and that anticipation will be my strength. I am ready.”
After a week of chiropractor adjustments, massage, acupuncture, lunges, walking, and smooth move tea, I started feeling some contractions. Sunday, January 17th we walked in the park and I was having lots of PMS symptoms – irritable, hot flashes, nauseated, tired, and very mild contractions at 15 – 20 minutes apart. Early Monday morning at 12:00am, I felt a weird sensation and some wetness while I was sleeping. I wasn’t sure if my water broke so I grabbed a towel and made my way to the bathroom. As I was walking I felt something come out. When I got to the bathroom I saw that I passed a blood clot the size of a golf ball. My adrenaline went through the roof. I had never heard of bleeding and clots in early labor and my heart was racing. I texted my midwife with a picture and watched to see if I had any more bleeding. Luckily, I was able to monitor the baby’s heart rate with my Doppler and the bleeding had stopped so I decided to go to bed and see what the morning brought.
Monday was uneventful, contractions were coming regularly at 10 minutes apart but I still viewed this as pre-labor. I didn’t want to get my hopes up after I had such a long early labor with Genevieve. And I was still able to walk and talk through these. They were very mild. Adelaide was moving around the same amount as before, I had no more active bleeding or clots, and her heart rate was great. Jennifer, my midwife, came by to see how I was doing. She did a cervical check just to see if it was possible that I was further along than we expected, but I was still 1cm and 50% effaced. Labor may not kick into gear for days, so we just continued about our day. I am so glad it was MLK Day because Michael had off work. So I ate pancakes, sat on the birth ball, listened to birth affirmations, and cuddled my family. Genevieve was not feeling so great so we slept most of the day.
Tuesday, January 19th (39 weeks and 4 days), I woke up with the same sensation I had the night before. It was 3am and I passed another blood clot. This time it was more like a softball size. Contractions were coming 6-8 minutes apart and after talking with Jennifer, we decided to go into Vanderbilt to confirm if this was cervical or placental bleeding. Although unlikely, if it was just cervical bleeding, then we could just go home and continue to let labor pick up. If the bleeding was from the placenta, the risk could be placental abruption, in which the placenta starts to detach from the uterine wall before delivery. This would cut off oxygen to the baby and I would bleed out. It’s a life threatening condition. The second I saw the bleeding, I knew I was no longer having a homebirth.
Michael scrambled some eggs for me because I knew food would be near impossible to get while at the hospital and I quickly threw together a hospital bag. I really only packed some clothes for postpartum, chap stick, phone charger, tooth brush, and receiving blankets and baby hats from our house to use at delivery. We called my mother-in-law to come to our house for when Genevieve woke up and we took a final belly picture.
At 6:00am Jennifer, Carissa (midwife assistant), and Becky (mother-in-law) arrived at our house. It was a freezing morning and I was not looking forward to getting in the car. I was still having contractions every 6-8 minutes and I was starting to have to actively work through them. The ride to the hospital wasn’t too bad but I remember thinking how awful this ride would be if I was in transition. Every bump in the road was miserable. I was glad I was only experiencing mild contractions at that point. We got to the hospital and the triage desk immediately sent us over to Labor and Delivery. My midwife gave them a heads up that we would be coming in for monitoring because of the bleeding so they had a room ready for us.
Let me tell you, it is so surreal to be a doula and have worked in that very room many times. I know the procedures, I know what is behind every cabinet door, and what doctor/staff to expect to walk in the room next. It felt a little out of body to be going through those motions. Had it been my first birth, I would have been so traumatized. I had a horrible hospital experience as a child and I wanted nothing to do with hospitals. But now that I’ve attended so many births in that setting, I was not bothered with the hospital at all. In fact, it was very comfortable for me. Because Vanderbilt is a teaching hospital and I didn’t have primary care established there, I was seen by the residents and medical students, which means I met 10+ people during my labor. As a doula with my clients, we normally request that no students come in and we try and limit the staff in the room. But for whatever reason, everyone’s presence did not annoy me at all. I was also so grateful to have an awesome nurse with whom I’ve worked before. She was one of my saving graces during this process. She calls all her patients “my sweet” and has an infectious positive presence.
At 7:00am a group of residents came in and introduced themselves. They wanted to perform a speculum exam to determine if the bleeding was cervical and they also wanted to do an ultrasound to confirm that baby was head down and that the placenta was not covering my cervix. For those who have read my previous birth story, you may remember that I had experienced abuse as a child that made any type of pelvic exam near impossible. Since Genevieve’s birth, I have healed in so many ways. The checks that Jennifer had to perform were no big deal at all and I’ve had no issues with relaxing my pelvic floor since my first birth. So despite having multiple strangers performing checks during labor, I had no trauma whatsoever!
After the speculum exam, they did a quick abdominal ultrasound to confirm that baby was head down, and then a different resident performed a cervical check to see where my progress was at that point. I was 3cm, 70% effaced, and station -2. Still very much early labor as I expected. Honestly, I don’t even know if I would have called it labor at that point. A third resident walked in, one whom we all love because of his British accent 😉 He started a long monologue about the risks of placental abruption, risks of a c-section, and how they would go about monitoring me during labor. I suppose that was when I was officially admitted.
The next hour and half (7:30 – 9:00am) were full of admission steps. I had two IV’s placed. One was a heplock in case I needed a blood transfusion and the other was to give me fluid and Pitocin if that became necessary. I also had a blood pressure cuff put on and a pulse oximeter to measure my heart rate. The nurse placed the baby on the monitor and I got a monitor to measure my contractions. I just started laughing. I mean what else could I do? This was exactly why I chose a homebirth in the first place, to avoid all of this. I was hooked up to six wires! But I knew at this point I was considered high risk and if I didn’t make the best of it, I would be so miserable. So I laughed and I let the craziness of it all become comical. And I decided to roll with it. Next the financial adviser came in to talk because I have unconventional insurance and he needed to know how I was going to pay for it all, I talked with the charge nurse about my experience so far, I talked to anesthesia, giving them consent to use general anesthesia if that became necessary, and I answered 100 questions for my chart. All of this I expected from experience with clients and once again, I chose to not be annoyed by the constant visitors (although my husband was perturbed). I really was happy through the whole process. The peace and joy I felt was so unexpected.
Finally by 9:00am we were done with admissions and we got a little bit of quiet. I chatted with Jennifer, Carissa, and Sandee (midwife assistant/doula) for a little bit and tried to process the whirlwind that just happened. My mom and Lauren (twin sister) then came to see me for a few minutes and give me final hugs. By 10:00am I was ready to be left alone. Had this been a homebirth, I would not have my birth team with me yet. It was still so early and I didn’t want to feel like ‘a watched pot’. I did that in my previous labor and I didn’t want to do that again. I sent all the final texts, Facebook messages, emails, and even confirmed a couple of Airbnb bookings 😉 before I shut off my phone. I was ready to get into birth world and get things going. And I knew it was not going to happen if my left brain was turned on. You can’t really think through labor, you have to shut off your brain and just be present. So by 10:30am the room was emptied besides me and Michael.
I was staying so calm and very intentional during the entire process. I was choosing joy despite everything being the opposite of what I had imagined. This was certainly not the birth experience I was expecting but I knew I wanted to make the best of it. With everyone gone and my birth playlist playing in the background, I finally let my emotions flow. I cried for a little over an hour. I cried because today was the day I was going to meet my daughter. I cried because I was not going to have the homebirth I had expected. I cried because I felt so much peace and I was so grateful for that. I was overwhelmed with how happy I was. I really don’t know how that was possible. I mean really, nothing was going according to plan and yet I found myself surrounded by peace. I know a lot of prayers were said on my behalf at that time.Now that this was the journey I was on and I had a good cry, I was ready to fully embrace it. I laughed as I tried to get to the bathroom. My goodness, IV pole, monitors, a mesh “diaper”, all while waddling to the bathroom, I could really relate to my clients now. I could have been upset but I just laughed. Every task was very challenging in this setting. I remember loving standing by the side of the bed swaying my hips and moving my body. Around 11:00am a med student walked in to introduce himself and he looked so confused. I will always remember his face while I was blasting music, swaying my hips, and smiling. He didn’t understand why I was out of the bed. He asked if my joints hurt and I laughed and said, ‘Um no… I am in labor. It feels good to move”. Maybe I taught him something that day about letting women do their thing in labor.
At 12:00pm my primary resident (whom I really loved) came in to check my progress. I had made minimal progress – I was 3cm, 80%, and station -1. He said they would come back in about 2.5-3 hours to see if anything had changed. Thankfully, he did let me take the IV out and the pulse ox and blood pressure cuff off. I felt so free! At one point I even sent Michael out of the room to get coffee so I could just be myself and really allow myself to enter birth world. My nurse was amazing and got me all my favorite drinks and even a little coffee because of my ‘lack of caffeine’ headache. Around 1:15pm Michael and I were in a good routine with contractions. He was massaging acupressure points that help with getting contractions going and I would sit on the birth ball and open my hips. But I knew that my contractions were still not in a great pattern. They were 3 minutes, then 6 minutes, then 4 minutes, then 10 minutes apart. No real rhythm. So I wasn’t expecting much progress when they checked me again.
Lauren showed up again at 1:45pm with a diffuser and some moral support. She was so great at rubbing my back and telling me how amazing I was doing. But I really was handling it fine on my own at that point, I even told her to give Michael a massage instead because I was totally fine and didn’t really want the touch at this point. But her presence meant so much to me.
At 2:30pm, my doctor came back in to see where my cervix was at. Unfortunately, but not surprisingly, I had made no progress since my last check 2.5 hours ago. I was recalling my previous birth and I remembered that I stayed around 4cm for DAYS. It took nipple stimulation, black/blue cohosh, and learning how to relax to kick my body into active labor. So I told my medical team that I sort of expected needing some augmentation to get labor really going. I also reminded them that I will probably go fast once my body kicked into gear. We decided at this point it would be best to break my water. I asked so many questions (my doula brain was running through all the pros and cons). My doctor reassured me that baby was well engaged and he was not concerned with cord prolapse and he didn’t think I would be in labor long enough to worry about infection. I also had to keep reminding myself that I am a second-time mom and so my pattern will likely move a little quicker than a first time mom.
So at 2:42pm, my doctor broke my water.
Even though I was only 3cm, my nurse started setting up the room for delivery. Thankfully, the water was clear so there was no need to have the NICU team at delivery. I remember the water being so warm. And then my next thought was a little bit of panic as I looked Michael in the eye and said, “This next contraction is going to be a lot harder”. I think I said something else along the lines of ‘shit’s about to get real’. And sure enough…. Holy moly….. My contractions went from mild to incredibly intense. It was insane! Lauren had texted Carissa to head this way as they were breaking my water because I knew it would be harder, so she arrived at 3:10pm. I was so happy to see her walk in. At that point I was off the bed and back on the birth ball and I turned to her and said, “Carissa… this is no joke…” She jumped into action with Lauren and Michael. Around this point I was starting to really vocalize. I mean it was like a loud, deep growl. I was able to keep my sounds super low but it was so intense. I am sure it would have frightened anyone in the hallway. I told the 3 of them that I need everyone to press on my back. It felt like my hips were coming apart. I didn’t remember this with my first baby. I remember contractions being more of an incredibly tight squeeze. This felt more like a ripping apart. It was as if their pressing was keeping my body in one piece. At one point someone eased up on the pressure and I started shouting, “Keep pushing on me”. My doctor and his team walked in at some point during all of this and Carissa said their faces were hilarious. I was not holding back, it was a pretty raw, intense scene and I am sure they were not used to that. Once again, teaching these new doctors what some laboring women look like 😉
I did this from 3:00 to 4:30pm and I just could not imagine doing it any longer. My coping techniques were not keeping up with the intensity. I had a quick thought that maybe it was so hard because my placenta was abrupting and something was wrong with my body. Nothing was wrong – baby looked great and I wasn’t bleeding but I did have a short moment of fear. I believe it was Carissa that told me everything was OK and I could do it and that snapped me out of that worry. I then started throwing up the coffee I drank and I was shaking all over. My contractions were coming right on top of each other. I believe I had about 1 minute in between to ‘rest’, although I never really felt relief. I was certain this had to be transition. My thoughts were just to survive and breathe. Michael kept reminding me to breathe but honestly, I was finding it hard to catch my breath. There were about 15 seconds during each contraction that I felt like there’s no way I can do this and then it would start to ease up and I was able to breathe again.
Here’s the thing, had I been at home or had I not been high risk, I would be getting in the shower or birth tub. I would not be hooked to 6 wires, confined to the perimeter of the bed, with nurses and doctors coming in and out. I was starting to feel like I was drowning during the contraction. I needed an anchor. I needed direction. I needed something about this whole situation to change. My body was going through such intensity that I could not do this for an indefinite amount of time. I was past the point of simply surrendering to the contractions. I needed something concrete to focus on. So I told my team that I wanted to be checked. If I was not 8 or 9cm then I wanted an epidural. Because the idea of doing this for hours and hours was not going to happen: a common feeling during transition.
At 4:30pm my doctor checked me and I was 5cm, 100% effaced and station 0. I had made great progress. However, as a laboring woman, all I heard was that I am JUST ENTERING active labor. I was certain I was in transition, but only 5cm!?! I could be doing this for 6+ more hours for all I knew. Of course, had I really listened to my body and thought about what was going on, I should have known that this baby was coming fast. But I needed something to help me cope and my only option was pain relief. In retrospect, nitrous oxide would have been totally sufficient but again I heard 5cm and from being a doula, I knew that nitrous was really most effective right before pushing. Oh had I just known that I would be pushing in a matter of minutes and had I been at home, that birth tub would have been perfect! I think natural birth is the way to go. There are so many benefits. And birthing at home makes having a natural birth way easier because you don’t have the option otherwise. But I knew that suffering for a natural birth was not what I wanted.
I had so many thoughts running through my head at that moment:
1. I remember thinking that this was way harder than I remember with Genevieve. The great thing about having a four-day labor is that you progress slowly and your body has time to adjust to the intensity. It wasn’t like I am not a strong person, but I really thought my body was about to come apart because the contractions got so strong so fast. The epidural wasn’t because I was exhausted, it was because my body was spreading, literally, faster than my coping skills could keep up with. I skipped active labor altogether. Although I wanted the relief, more than anything I needed to know that there was an end in sight. 2. I also remember thinking that I had nothing to prove. I had had a homebirth. I know natural labor. This environment was not what I planned, this environment was not conducive to my peaceful natural, home-like setting. I needed something to change and I could only use the resources available to me now that I was considered high risk and on constant monitoring. 3. It might seem weird, but I was sort of excited about getting an epidural. Or maybe the right word is intrigued. I wanted to know what the process was like since I already had so many other interventions happening to me. At that point my ideal birth was out the window and I was a lot more fine embracing my alternatives. 4. Choosing an epidural did not feel like defeat to me. I honestly felt empowered to ask for one because nothing about my labor was anything I could control, I wanted to choose something for myself. And it was the first thing that day that I GOT TO CHOOSE. I felt powerful to make that choice. And I felt good about it.
So when he said, “5cm”, I immediately said, “Nope. I want an epidural”. And they QUICKLY made that happen for me.
Lauren and Carissa went out in the hall and at 4:40pm they started the epidural process. Because my contractions were so incredibly strong at this point, I didn’t feel anything with the epidural. I don’t remember any of what they were doing except that I wanted them to go a little faster and it was borderline excruciating to sit on the side of the bed curled over trying to hold still during those contractions. But really, being forced to do something was exactly what I needed. I needed direction, I needed a task, I needed something to do. I had to sit still and follow directions and that process was perfect for where my mind was at that moment. Well by 5:00pm they had the epidural in but I was getting NO relief. They kept using ice to see if my body was numbing at all and it was not. They couldn’t figure out why the epidural wasn’t working at all. A few minutes later Adelaide’s heart rate was dropping a little during contractions and my immediate thought was, “Of course, head compression, I am about to push…” And then the nurse said the exact same thing. My doctor and the resident entourage entered the room. They checked me at 5:10pm and I just had a teeny cervical lip left! I went from 5cm to just about fully dilated in 40 minutes…..And not only that but Adelaide was super, super low, so she was moving through my pelvis at a rapid rate. They wanted me to labor just a little bit longer before pushing and during those 15 minutes I clung to Michael as my life support. I buried my face in his shirt and with all my strength, worked through one contraction at a time.
At 5:25pm my doctor said let’s go ahead and start pushing. The anesthesia team was still in the room because my epidural was doing absolutely nothing and they were trying to get me some relief. Ha. I was going to get a natural birth either way…Oh well…I didn’t even care about or need the epidural at that point. I knew I was pushing any minute and just the fact that the epidural placement process gave me distraction to get through transition was all I needed. So I gave it ONE PUSH and my doctor said, “Ok, let’s break down the bed for delivery.” I was over the moon. I love pushing. I loved pushing with Genevieve and I loved pushing with Adelaide. I felt like a complete badass when with just one push I was ready for delivery. It was incredible. Everyone in the room was impressed by my pushing. I remember feeling so so happy and strong.
The baby was starting to have some major decelerations but because I was such an effective pusher they weren’t concerned. They did put me on oxygen and my doctor just said turn the monitor off! He didn’t want to hear the heartbeat that low. I believe her heart rate was down to 60 at one point but I was never worried, I knew it was going to happen soon. And because the epidural could not keep up with how fast I was progressing I could still feel everything and I loved feeling her move down through my body. With Genevieve, I was so exhausted that I wasn’t fully present during pushing but this time around I was totally there and loved it! They asked if I wanted to touch her head and I said, “Absolutely!” It was amazing. And then I had a moment where I asked, “Wait, she’s already under the bone?” And they laughed and said, “Yes, you are about to crown”. I was shocked! I am so used to first time moms who take hours to push and I couldn’t believe the hardest part of getting the baby under the pelvic bone was over.
At 5:41pm she started crowning. She had a nuchal cord, that’s where the umbilical cord was wrapped tight around her neck, and that’s what was causing the major decels in her heart rate. They tried to move the cord over her head but it was too tight. So they told me that I was going to deliver through the cord. So I gave it 2 more pushes and at 5:42pm my daughter was born!
What a holy experience. I was totally lost in that moment, just engrossed in my daughter on my belly. I was rubbing her back and telling her how much I loved her and then she let out a beautiful cry. I don’t care how you have a baby or where you have a baby, that moment is just exhilarating. I was completely in love with her. I could hear Michael sobbing next me, even before she was born, just like with Genevieve. And we were so present in that moment. Just the three of us. Nothing, nothing will ever compare to that moment. It was very surreal and the relief I had was unlike anything. I kept saying over and over, “I am so happy, I am so happy, I am so happy!” I am telling you, this birth will always be marked with joy.
My final thoughts about the experience:
- Although my hospital birth experience was not a bad one, I would always choose a homebirth. Nothing can compare to the intimacy and sacredness of birthing in your own home, surrounded by friends instead of strangers, and with no interruptions or distractions. I will always advocate for homebirths and if we were to get pregnant again, I would choose to birth at home. There is just no way to compare the two experiences and as long as I am low risk, home is where I will be.
- This birth brought healing from my first birth in ways that I never would have expected. I was free from the fears about this birth that I released at my Blessingway. All the cervical checks I had during Adelaide’s birth (by strangers nonetheless) left me with NO trauma. I couldn’t believe it. I was totally fine. I also bonded immediately with Adelaide and was able to connect with her in ways I wasn’t able to with Genevieve. Both my trauma and ability to attach to my new baby were fears that I had beforehand and I experienced none of them. This birth was truly healing for me.
- Oh epidurals. I am still processing a whole range of emotions with that decision. Ultimately, I am fine with choosing to get one. It was my birth, my choice. But it’s amazing how I’ve already had people make comments like, “I am so surprised you chose an epidural” and “Aren’t you all about natural birth, I am curious as to why you wanted an epidural?” I do love natural birth and it is something that is important to me. But birthing in a hospital is far from serene and hands-off like a homebirth. I feel weird that I have to justify or defend my actions. I get moments where I feel shame for that decision and I can only imagine how so many moms feel when they don’t have the ‘ideal’ birth experience. Or maybe for some moms an epidural is an ideal birth, and that is OK! For me personally, I would have rather not had one, but let’s be honest, it didn’t actually work anyway. However, in just one hour I went from 5cm to delivery, baby moving down from station 0 to crowning, and an OP baby rotating to OA. I still can’t believe it! I’ve been to so many births and I have never witnessed one quite this fast. Not to mention she was about 9 pounds. It was unbelievably intense. And I used the only resource I knew to use at that point. I never judge a woman for choosing an epidural. Suffering through birth is never OK. If the coping skills you are using are not working, it’s OK to use what is available. So a mom in labor gets to call the shots for what her body needs in that moment. You will certainly never hear judgement from me!
- My emotional preparation made me so at ease and peaceful about everything. I chose to be intentional about enjoying this experience. I think this is one of the most important things I would tell people. We do not get to choose the details of our child’s arrival. Birth is full of unknowns and the journey is one of letting go of control and being present through the process. We certainly did not anticipate having a high risk hospital birth. What we do get to choose is how we receive the birth. When things shift from our ideal or our plans, you get to decide how to respond. Of course it’s OK to be disappointed, it’s OK to have a good cry, it’s OK to need lots of time to process after the birth. You may even feel shame or sadness or frustration, and that is OK. I’ve had many moments where I think I am going to get a redo with this birth in a few weeks, where I would get the chance to change certain aspects of the birth, but that’s not the case. I have felt every range of emotions since delivery and I’ve needed to process the experience with multiple people. I will still be processing this birth for a long time. But I do want to end by saying that I have never experienced so much peace and joy during such a challenging experience. I was proactive prenatally to emotionally prepare myself for birth. Daily I released my expectations and prepared myself to embrace whatever this birth would bring. I knew it would come with challenges but I also knew that it was through those challenges that we grow and experience life on a deep, raw level. Choose to birth life in joy. And choose to embrace your child’s unique story.