Day three...well, technically, day four

I wanted to check in before now, but I have been at three births, one clinic, and actually got to sleep for about 6 hours. Not bad for almost 72 hours.

I wish I could say the homebirth was easy and beautiful and idyllic. If this was fiction, I would have laidthe foundation of the perfect situation, the wonderful couple, the right support system, and then the birth happens the way we all wanted, and I made my point about natural birth. Don't get me wrong, the labor was probably the most fun I have ever had at a labor, and that is saying a lot for being up for a day and a half. However, the birth was hard, and it shook me pretty deeply.

The most important of the physiological changes in labor to allow for a vaginal birth is the a dilation of the cervix. "10 centimeters. Complete." Those are the magic words that every woman who has suffered through labor is longing to hear. Homebirth Mom was having great contractions, which is one mechanism that encourages the cervix to dilate. However, Homebirth Baby was coming down with her little head a little cockeyed. The pressure of the baby's head against the cervix also encourages the cervix to dilate, but a crooked head does not descend or dilate well.

The labor was long. None of us, least of all the mom and I, got much sleep. Her spirits remained astonishingly high. She danced, she laughed, she played between contractions, and she focused and breathed through them. However, her dilation stalled and stalled. Finally, her cervix was almost complete. However, one portion of it stubbornly remained thicker than the rest. This is known as a "lip". It is rare, it holds up the transition from labor to pushing, and I had one during my first labor with S seven years earlier.

I watched as the midwife rubbed out the cervix with her gloved fingers as the woman screeched and moaned. Homebirth Mom never pulled away, she never sobbed "NO! No, please stop, it hurts SO MUCH!" as I remember doing. I had a day long labor too, but I was in a cold hospital room, strapped to monitors and with an IV full of pitocin to make my contractions harder. No epidural, no best friend, no doula with lavender aromatherapy spritzer, no team of midwifery students. One midwife with the bedside manner of Dr. Frankenstein, one labor nurse who was wonderful, but who I had never met before, and my shell shocked husband and mother who were not that into the natural birth thing.

Homebirth Mom endured the midwife manipulating her lip for a good two hours. It took my midwife about three and a half hours to get rid of mine as I pushed and screamed. My mom kept waiting for the nonexistent doctor to come in, put me under and take out the baby.

When I graduated from high school, I initially became an education major because I was so disgruntled with my high school administrators. I switched to being a fashion design major because I hated the way the mainstream clothing industry seemed to not be able to make cool yet comfortable clothing. I was suddenly afraid I was training to be a midwife because I hated the way my first birth went, and I thought I could (eventually) do better than my midwife. But apparently, midwifes rub out cervical lips. Some of them, including the one at my center and the one who attended my first birth, did so with no anesthetic or ice or anything. And it hurts the mom. Would I be able to do that for a mom while she screamed and I flashed back to the intense, excrutiating pain I felt?

I sobbed as I drove a car full of homebirth supplies and the placenta back to the car. Oh wait, you wanted to hear about the birth. The baby finally came out, and was perfectly fine. The mom and dad were ecstatic, and I am sure they do not regret their choice of having a natural birth. She may even have another baby and may choose to do it naturally again, as I did. But I was shaken to the bone. I was thinking how an epidural would have probably been pure mercy for her, and for me. However, about 5 % of moms have persistent lips like that. I have probably only seen a midwife have to rub out the cervix on a screaming woman twice in the roughly 50 births I have been to.

So, without my crystal ball, I will not be able to predict who will have a lip, or any other complication. I got to see two more births today, after a solid six hours of sleep and a lot of thinking. I love talking with moms and doing prenatals. I love the post partum checks with the brand new babies and cheery but sleepy new parents. Believe it or not, I love the labors, even the long ones. And I love the easy births. And the medium births. It's the hard ones that really shake you. Especially if they remind you of your own. But, that's OK. It's not really the easy births that women really need midwives for anyway. As Shari says, most of those babies would eventually fall out on their own anyway.

I wouldn't go back in time and choose an epidural for my first birth, and I really doubt Homebirth Mom would either. And women who are willing to take the hard road need midwives who are willing to walk with them. I hope to be that one day.

Day two...a surprise at lunch

We were all sitting around a delicious lunch of falafel, hummus, tabouleh, and pita, including Homebirth mom. She was definitely feeling the contractions more now, and was moaning softly through them. In between, she joked with her dog and friends, and ate a sandwich. She was so hungry and grateful she was not in a hospital, where they would hook her up to an IV and starve her feed her only ice chips for her marathon labor.

One of the only unwelcome surprises of the labor was the appearance of Mom of Homebirth Dad. She apparently did not know Homebirth Mom was in labor, or that they were planning a homebirth! Luckily, Homebirth Dad did some MAJOR diversionary tactics. Homebirth Mom stayed comfortable on her birth ball at the table, and Homebirth Dad discreetly shuffled his mother out the front door with a hurried explanation. After a few minutes outside explaining to her why she could not join in the festivities, he returned to sit at the feet of his wife. I am so impressed he didn't bow to his mother's pressure and let her in to where they had decided she would not be helpful.

I am all for having relatives at a birth if they are a positive presence. Homebirth Mom's mom has been a remarkable calm and loving support throughout the entire labor so far. Moms of women in labor tend to be the most supportive or the most fearful and emotional. I am glad Homebirth Mom and Dad seemed to pick the right mom to be at the homebirth!

Day two...no sleep, but at least I'm not the one in labor

Homebirth mom called us back at 2:45 am. (Wouldn't you know the phone started ringing JUST as I turned off my computer and decided I would take a stab at sleeping on one of the couches at the birth center? I am definitely going to have to get over my problem sleeping anywhere other than a bed in a dark room with perfect quiet.) Her contractions had picked up to one every five minutes. Maribel and I got into our cars and headed back over to her house, this time possibly to stay.

We were pleasantly surprised when we arrived that Homebirth Mom, Homebirth Dad and Mom of Homebirth Mom had honestly tried to get some sleep after we left the last time. That can be incredibly hard when you are having contractions every 10 minutes and are extremely excited about having your first child. It is even harder to look back after hours and hours of contractions coming much closer together than ten minutes apart and to wish you could have just taken that two hour nap.

Maribel checked Homebirth Mom, and announced she noticed significant progression since our last visit, with effacement (thinning of the cervix) and dilation (opening of the cervix.) We were there to stay, and she went to call Shari to report the results of the exam, and to call Carol, the midwife who would be attending the homebirth.

It is now just after noon, and I have to say this is one of the most wonderful labors I have ever been blessed to witness. Homebirth Mom, Homebirth Dad, Mom of Homebirth Mom, the doula and her best friend are an incredibly positive and cheerful bunch of people. It is so refreshing to see a woman who has a long labor maintain a consistently positive and relaxed attitude.

No, she didn't have the four hour labor her mother had years ago in Rome. But, she didn't find out she had only dilated one centimeter and a half after four hours of natural labor and burst into tears and insist on being sent to the hospital for an epidural either. It breaks my heart when mom with all intentions of going natural gets a "bad grade" on a vaginal exam and all of a sudden "can't handle" the contractions that she was breathing through with no problem five minutes before the exam. I fully understand the disappointment, having a 24 hour and 36 hour labor (yes, the second one was LONGER...) under my belt. But, Homebirth Mom smiled, stood up, and went to dance to Bob Marley and Barry White with her best friend, mom, doula and Chihuahua .

Unfortunately, we are on a ticking clock since her waters are broken, which leads to increased risk of infection and a mandatory transfer after a certain amount of time in Florida. I will check back in with an update on how the remarkably accepting and upbeat Homebirth Mom does. So far she has had two hours of sleep, more than 12 hours of labor, no drugs except for the antibiotics we gave her, two peanut butter and jelly sandwiches, several cups of Gatorade and raspberry leaf tea, and an endless supply of joy and support from her remarkable labor posse.

Day one...water water everywhere

Well, the first day of "Hell Week" seemed to be relatively unhell- acious. I worked my regular clinic shift, which would usually be my one and only for the week. This week it will be my first out of 5 days of prenatal clinic.

It was a very rainy day. I got to see a lot of babies here for post partum visits. Many practitioners only do one post partum visit with their clients at six weeks, but we do five visits. We do a 24 hour home visit, and at the center, we see the mom and baby at 3 days, 10 days, 3 weeks, and 6 weeks after the birth of the baby. The director of the center, Shari, has found and other research has shown that moms and babies do a lot better with excessive attention than none for a month and a half. We have excellent results with breastfeeding. Well over 95% of our moms are breastfeeding exclusively at 6 weeks postpartum. We also catch other issues quickly and provide lots of support.

We had one baby which looked a little jaundiced today. Even though he had gained weight well, and was passing plenty of poopy diapers, his yellow eyes and skin were enough of a concern that we ordered a bilirubin test. Most babies who have jaundice badly enough to require treatment also have feeding, weight and / or defecation problems. Well, it is a good thing we decided to test the levels of the pigment, because the results did come back high. The mom and dad are worried, but we need to take another reading in the morning. Hopefully with lots and lots of nursing, the baby will pass enough of the pigment in through his stool. We will be doing another blood draw first thing in the morning to see if the numbers are dropping.

Just when we were done mopping and filing, we got a call from a mom who is planning a homebirth. (Let's call her Homebirth Mom) Her waters apparently had broken. Maribel is a midwife assistant and was on duty with me. We went to go check the mom.

Her house is beautiful. Her husband is a designer and had cool art everywhere. Other than the Chihuahua who seemed to be very angry at us for being there, the rest of the family, her mom and husband, were happy to see us and extremely sweet. This is Homebirth Mom's first birth. Most of our births are at the birth center, but we do about one homebirth a month.

Her cervix had thinned out a good amount, but she was only dilated 1 1/2 centimeters. First time moms tend to focus on that dilation number, but they generally need to thin out first. Her contractions had started, but were only coming every 10 minutes or so, and she was talking through them easily. After calling in a quick report to Shari, we told her to get some rest if possible.

Having broken waters puts her on a time clock where infection risk starts to climb. Luckily, most women don't have their waters break before regular contractions start, but Homebirth Mom is not as lucky. Her mom was wonderful and sweet, but was unfortunately filling her head with stories of her own four hour labor that may be hard for her daughter to live up to. That is a very short labor for a first time mom! We are hoping she will be calling us back soon, and I should get some rest.

I feel guilty because I was so excited about the visit to Homebirth Mom, I forgot to call to say goodnight to my husband Coach Stu and baby Z. S is staying with his real dad for the week. I did call 5 times from the car on the way here and once after dinner, so I think they know I miss them....