We often approach the experience of giving birth with hope and expectations, sometimes even fear and anxiety. When we face our fears, work through our anxiety, let go of expectations, and keep up hope, we can create such a positive birth. Here is one woman's story...
I had the pleasure of working with B during the end of her pregnancy. We met together a few times and talked about the pregnancy, the upcoming birth, about past births, and about how to help this birth be the best experience possible. I also gave B some relaxing prenatal massage.
It happened that I went on a trip to the Kotel (Western Wall) in Jerusalem two weeks before the birth. I had just arrived at the Wall and my phone rang. B was calling from the hospital where she was getting some postdates monitoring. They had told her the baby was big and then sent her for a second opinion. The second Dr. said yes baby IS big but not as big as the first doctor had said. She politely declined their offers to schedule a repeat c section. I wrote her name and a prayer for a safe and successful birth and placed it into the cracks of the Kotel, which was quite full of notes that afternoon…..
B knew her body made big babies. She knew her body could birth them too. This was her 7th baby. Her 6th baby was born by c-section. The doctors had recommended it due to gestational diabetes –they suspected the baby would be large- he wasn’t. Her 5th baby, however, was born naturally, weighing 4.7kg, without any complications. She did not have gestational diabetes with that pregnancy.
She finally began contractions at night, two days shy of 41 weeks. Being a busy mom of 6 young children, I could see that it was a challenge for her to “find the time to give birth” and that her many roles and responsibilities were making it hard for her to just let go and allow the process to happen. Late at night, with her family tucked into their beds, she was finally free to labor and her contractions started to really pick up. She called me about 1:30 am to let me know, and we decided that we’d head to the hospital in a bit.
Sometimes, the process of checking into the hospital for a birth goes quite quickly. This wasn’t one of those times, but that was okay. The space that she had to just labor without her kids around was what she needed and so the 2 hours of getting checked in were used well.
Jumping through the birth hoops; Pee on a stick, monitor the baby, midwife asks questions, doctor asks questions, ultrasound to check size, blood tests, antibiotics for gbs, heplock, more contractions, internal exam- 3 cms…. Then a nap. We were told around 6 that a labor and delivery room was finally ready for her. Great news! They gave her a very large room, joking that because the baby was so big, she needed a big room to give birth in. The midwives were kind, patient, and supportive. The doctors: understanding that mom wanted a VBAC, didn’t mention cesarean, even when the baby measured over 4kg on the ultrasound.
We made our way to the room and sighed with relief to have the intake process behind us, now to get on with the business of birthing’. I went to scout out one of the most important resources for a good birth: FUEL. I found enough to make a picnic breakfast of bread, veggies, and gourmet cheese. We fortified ourselves for the work ahead.
B’s contractions were still coming, but the midwife thought an enema may help shift the labor into a better pattern. She got into a hot shower afterwards and really enjoyed herself. Afterwards she sat on the freshly inflated birth ball the midwife had brought her. The contractions continued to come and I massaged her back and hips, helping her to relax a bit. We were confident that these contractions were bringing baby down and helping her labor to progress. A few hours later, the midwife wanted to check her again and see what was happening. She checked and found the baby’s head was quite high and the cervix was still only 3 or maybe a tiny bit more. Another doctor came and checked and remarked that due to her history and the head being high, they wanted her to get an ultrasound downstairs in the hospital to check the baby’s weight.
Stav, our sweet midwife, wheeled B downstairs in the hospital to the women’s clinic where the doctor did a very long and detailed ultrasound for her. I think she may have been on the ultrasound exam table for close to 40 minutes. The doctor was talking to himself the whole time. He seemed quite perplexed by the baby’s position. The original reason for her coming down there, to measure the baby’s size, suddenly became second to the issue of position. The doctor seemed to think the baby was over 4 kg, with the head down towards B’s right hip and the bottom higher up towards her left hip, in a position sometimes referred to as oblique. B’s water broke during the ultrasound and came pouring out all over everything…
When B heard what the doctor was saying about the baby’s strange and unusual position, she felt very concerned. It sounded like the doctor was saying that there was no way baby could be born vaginally and she would need a c section. I wheeled her back up to the chedar leida and the midwife asked me what had happened in the U/S. I quickly told her what they had seen and she replied that we should just wait and hear what the doctors had to say, that it wasn’t necessarily a surgery that she would need.
The doctors did appear, and they told her that they’d give her a couple hours to see if the baby shifted her position and was able to progress. B was becoming very tired at this point, and we talked about how to help her…knowing the labor could still take a while, and that she had been awake for nearly 30 hours at this point. We (B, midwife, myself, the father) discussed an epidural. We thought that if she could get some pain relief and rest a bit, then the baby may come down into the pelvis. If it turned out that she needed a c-section, then she would already have an epidural for the birth.
She had had a scary and painful experience during her last birth, the c-section. The epidural wasn’t working properly and so she felt the surgery. She was immediately put under general anesthesia and woke up after the birth. She didn’t want to miss the birth again so by getting an epidural prior to any plans for a c section, she felt good knowing that it was in the right place and functioning properly. She decided to go ahead with it and so the epidural was placed without complications and worked well.
The shaking after receiving the epidural was surprisingly uncomfortable for B. She couldn’t relax due to the shivering her body was doing. I coached her into a deep relaxation using her breath and visualization, and the shakes got a bit better. Each time the doctors would swoop in to check on her situation, the shakes would start up again and we’d go thru the relaxation techniques again…
B was beginning to become very hungry and thirsty. The doctors had forbidden her to eat or drink anything since the ultrasound because the position of the baby made them assume a c-section was a good possibility. After an hour with the epidural, the big crowd of doctors paraded into her room again and one of them proceeded to examine her. He pronounced that the baby’s head was so high that he couldn’t even feel it and it certainly wasn’t in the pelvis yet. The doctors all agreed that the recommended course of action would be a c section. The said that due to the facts that B had had a c section previously, had a big baby, a low lying placenta, waters broken with some meconium, and baby in an oblique position, it looked like that was the way things would go. We asked it that was the only option- I asked if they’d be open to giving her a bit of Pitocin to see if slightly stronger contractions would bring the baby down. They said they were open to it, but the risk of uterine rupture was higher, though they’d be willing if B wanted to try. They stood over her, really intimidating her, though they didn’t mean to. They were actually open to all of our questions and showed respect for her wishes.
In the end, she opted for the c-section. She said she just didn’t have the koach to go on. I knew how much B wanted to avoid another surgery, and I knew how hard that decision was for her to make. It was during the doctor's visit that Nechama, an amazing midwife and friend of mine, came on shift as B’s midwife. She heard what B said about not having any strength. She told B that she has never heard a women comment on how much koach she has while giving birth. She said, “No woman feels she has koach to give birth, yet they go on and do it anyway!”
The operating room was being prepared, waivers were signed, belongings were collected and the bed that was sent to take her to the OR was being wheeled in the door of her room. At that moment, B casually mentioned that she thought her epidural was wearing off. It struck me because women only say that, in my experience, when they are progressing…or of course, if the epidural really is wearing off. I mentioned this to one midwife in passing and she shrugged and said yes the epidural probably was wearing off. A minute later Nechama entered the room. I immediately related what B had said and asked if the epidural was wearing off. Nechama looked and said she didn’t see how it could be; it was set on a continuous pump, and wouldn’t wear off until it was disconnected. I asked Nechama to check B one more time just to be sure. Nechama checked her and exclaimed with a big smile that the baby was right there against the cervix and that she measured about 4 cm open. She looked B directly in the eye and said, “You are progressing, go for it!” We all cheered and suddenly everything shifted. All at once there was so much hope in the room. B was immediately inspired to keep going. She told me, “Chavah, go tell my husband!” I ran out into the hall and said to him, “B changed her mind, she going to go for it!” He just lit up with a huge smile.
I went back into the room and the doctor who had pronounced the baby “head too high to even feel” was there to get to the “bottom” of things. Why was this yoledet getting these crazy ideas? He hastily checked her and impatiently barked at Nechama that the head was in the same place as when he checked…He made some exasperated gesture as if to say, whatever, and walked out. I turned to Nechama and said, “If B was a lady who just arrived in the chedar leida and you examined her, would you think there was anything abnormal?” She said firmly, “NO! Everything feels totally normal”
We saw B was still having strong contractions now, even without any Pitocin. She never did get offered any…which was fine, because she didn’t need any. She progressed beautifully over the next number of hours. She felt her contractions and was able to work with them. She was able to describe the sensations of pressure and intensity which was the baby descending into her pelvis. The progress was not swift, but she kept it up and thank G-D the baby looked great on the monitor the whole time.
I was massaging her hips and legs and Nechama helped her to get into a very good position for opening the pelvis. Lying on her side, allowing her knees to get close together while keeping a good distance between her feet. Kind of knock-kneed. It really helps a lot! Nechama and I worked as a team, which I love. After a number of hours, B began to make different noises then the ones she’d been making. Midwives know the sound well. Pushing noises.
The midwives were next door at this point, helping a woman give birth. There were enthusiastic sounds coming from adjacent room, thrilled sounds in excited Arabic and gentler coaching in Hebrew. Soon there were cheers and the cries of a baby, and a very nice woman doctor appeared in B’s room to check what was happening. Nechama was finishing up the birth next door so the Dr. checked to see if she was ready to give birth. She had finally dilated almost completely and soon Nechama was back with us.
One of the nicest things this night was that everyone there: doctor, midwife, a doula who works in the hospital, were so positive and supportive. We all felt like one team working for one goal. Nechama began to coach B to push. We got her the squatting bar and helped get her up a bit. She was pushing on her side for a while and using the squat bar to brace her feet, then to pull against it using a piece of fabric. It wasn’t too long before she found her rhythm and brought the baby’s head right down. She was tired, so incredibly tired, but she managed to find some reservoir of strength somewhere, and she didn’t stop until the hard work was done!
The baby WAS indeed big! As the head crowned, slowly slowly, it turned dark purple. The ears squeaked out, blanching white from the intense pressure. Nechama deftly maneuvered the shoulders out and unwound the cord from the neck. A girl!!! So lovely! She was quite limp for a minute, we talked to her and encouraged B to talk to her too. She took a tentative breath and made some noises, another half minute passed and she was crying and breathing, turning a lovely shade of pink.
Eyes open, looking around, experiencing her birth, meeting her Ima. She was hungry!!! She showed interest immediately when offered the breast! B and her husband were overjoyed, elated! Nechama and I were impressed with how strong B was and what a miracle the birth was.
Soon B delivered her placenta and we worked together to clean her up and get her comfortable. NO TEARING! B was bleeding a bit more than we thought was normal, and that made sense because her uterus was likely quite tired from birthing such a large baby over such a long birth. Nechama started a Pitocin drip and the bleeding resolved.
B looked so beautiful holding her perfect baby, all 4.5 kg of her! Glowing and strong, she had given birth to her big, healthy, daughter with grace(chen), dignity, and with faith (Emunah). She trusted herself, her midwives, and HaShem!
Tags: midwifery care, prenatal care, pregnancy, midwife, pregnant, womens health