As the light came up on Sunday morning I was about 26 hours into labor (counting from 4 am on Saturday, which is when the contractions had first begun), and I was getting incredibly exhausted. Our midwife finally checked me around 6 am to see where I was at, and it turned out I was only 4 cm dilated!! And not a loose and stretchy 4 cm, a tight and unstretchy 4 cm, and only about 80% effaced! I can’t even begin to describe my disappointment at this point. I had thought I had been going through strong active labor, and here I was still in early labor, more or less, after all of that hard work! Our midwife gave us a pep talk: the longest part of labor is the latent phase, I was now 4 cm which is pretty much the end of latent phase and a great place to start from, the baby’s heart had always sounded perfect every time we had listened to him, so he was holding up well, and everything was still looking good. We decided to re-set and take a rest. I was truly exhausted, and knowing where I was in the labor was helpful, at least, because it gave me perspective. Our midwife went home to get a nap, our doula and friend fell asleep on our couch, and my husband and I went to bed. Every time I had a contraction I just kept telling myself it was nothing, no big deal, and to relax, thinking that if I was only 4 cm dilated, these contractions weren’t the real deal, and shouldn’t take up so much of my attention. With this mindset I was able to sleep for about 2 hours, and the contractions mercifully spaced out quite a bit.
I woke up around 9:30 am on Sunday morning and headed upstairs again. Our doula woke up and cooked some breakfast for us (mmm, pancakes–although I was only able to eat a few bites), and we began our second day of labor. It was a strange mix of hope and fear. I was hopeful because I had made it to 4 cm, which meant that something was happening, and that every contraction after that was hopefully dilating me further. But I was also doubtful and full of fear, unsure if things were actually progressing or not. My midwife brain was still very active, thinking about possible scenarios and what-if situations: what if I didn’t dilate any further? What if I was too exhausted to go on? What if I was the same at the next exam? Then what? I read aloud a long list of birth affirmations which I had written during the pregnancy, and we listened to some powerful Goddess chants while I labored on the ball, and eventually we took a walk around the block, just to get some fresh air. Our midwife had left the birth set-up at our house, and since our doula was also a Labour & Delivery RN, we periodically checked the fetal heart beat throughout the day with the doppler, and his heart continued to chug along nice and steady, 120s-130s, which was very reassuring. At least he was doing well, even if his mama was languishing! The contractions continued pretty regularly every 4-5 minutes throughout most of the day, but by late afternoon they had begun to peter out again, and I was beyond exhausted at this point. I had more or less decided in my mind that the next step was going to be heading in to the hospital for an epidural and pitocin, because I was truly beginning to feel like I couldn’t take it any more.
The first on-call midwife came back over late Sunday afternoon around 4 pm and at that point I was very business-like. I wanted an exam, and I wanted to know what the next step was. She checked me and, much to my despair, I was only 4-5 cm dilated, although now it was a very stretchy and loose 4-5 cm, and She was able to manually stretch and dilate my cervix to 6 cm (which was EXCRUCIATING), and I’m not even sure if it stayed that way because his head wasn’t well-applied to the cervix at that point. We talked through our options once again. I mentioned the epidural and pitocin idea, but everyone else felt this was premature. It was a moment where my birth team had more faith in my power to birth than I did, and I am so grateful to them for their strength and perseverance, because I was losing faith in myself! Our midwife suggested trying some nipple stimulation instead of pitocin. So once again we re-set, and tried to change the energy in the room. We put on a mix of some of my favorite hip-hop and rap songs with a strong and powerful beat, and I began to move more vigorously, doing squats and lunges during the contractions. In between contractions we stimulated my nipples with a breast pump while I rocked my hips back and forth in time to the music.
After another few hours of this, I was once again exhausted and losing faith and the contractions, despite the nipple stimulation, were petering out once more. At this point the second midwife came over and we had a very long heart-to-heart conversation about all of our options. I was about ready to throw in the towel; I was practically convinced that going to the hospital was the only way out of this situation. Instead, the second midwife went through all of the positives with me: the baby’s heart was strong and he was doing well, so there was no concern about fetal distress, my membranes were still intact so there was no risk of infection, and slow labors are still normal labors. We also talked about my fears at this point. My biggest fear was simply that I couldn’t do it; that giving birth vaginally, at home, no less, was beyond me. I was scared that I had watched it happen for so many other women, but that somehow now that it was my turn it wasn’t going to work for me. After all, I hadn’t given birth yet—how did I know if I could actually do it or not? She told me that what I needed was sleep more than anything, and that my body would probably naturally pick up where it had left off when it was better rested and ready to continue. This midwife had over 25 years of experience, and had been attending homebirths for over 12 years, and when she spoke it was with the wise voice of experience, which I found incredibly reassuring. She told me a few stories about other homebirths she had attended which had also lasted for days and days, and reminded me that there was no Freidman Curve in a homebirth (i.e there was no ticking clock hanging over us)! Even though she hadn’t been attending most of the labor so far, speaking with her was just what we needed at a very crucial point in the labor.
So we took a second nap break (around 8 pm on May 15th) with the assistance of lots of hydration and a glass of wine, which went straight to my head given that I had hardly eaten during the labor, and I hadn’t been drinking alcohol for the preceding nine months. The contractions spaced out a bit and I was able to get some rest. Everyone took a break, actually; our doula and good friend both headed home, and the midwives gathered up all of the birth equipment and left as well. I was hoping I would be able to sleep for 4-5 hours, and half expected to wake up around 2 am, which was the time our midwife had randomly suggested the labor might restart. Instead, while only an hour and half into my nap, I was awakened by shockingly strong contractions, much stronger than anything that had come before. I moaned my way through a couple of them, and then around 10:30 pm I had three MONSTER contractions in a row which needed more than mere moaning to get through them. I had also begun to shake uncontrollably, and my teeth were chattering. I couldn’t stop the shaking and shivering in between the contractions, and I was feeling very panicked because the contractions were suddenly so strong, and so close together. I couldn’t even get out of bed before the next one hit me, and I couldn’t stop shivering and chattering. I was also hot at the same time, and sweating profusely. It was a very strange combination. I woke my husband up out of a dead sleep and told him to call our doula and the midwife ASAP, because I was frightened and I didn’t know what was going on. He went upstairs and wisely called our doula first (but not the midwife), who hopped in a cab and came back over even though she had only been home for 3 hours. While we were waiting for her to get to our house, he helped me out of bed and got me upstairs, where I spent my time clinging to the railing by the stairs while moaning and shivering through contraction after contraction. They were every three minutes at this point, and I was finally (finally!!) in booming, active labor.
Our doula arrived and I stopped feeling so panicky, although the shivering and sweating and teeth chattering continued. The contractions felt out of control, so much stronger than anything that had come before! I also vomited for real this time, but I was too deep into the labor to even comment on it, although the thought that this was a good sign did flash through my mind briefly. My husband and our doula re-filled the birth tub, and I got into it for the second time, which took about an hour. During that time I stayed on the ball for the most part. I also got up to go to the bathroom, too, and ended up having a few contractions on the toilet, which felt like water torture! There was so much more pressure while on the toilet, and I remember clutching the side of the sink with both hands and feeling like I was about to pass out from the pain. Everything was so stark and bright in the bathroom, the white of the porcelain sink was so white, the pain was so sharp! Thankfully, the birth tub was full soon after that, and I was able to get into the merciful, soothing warm water. In the tub I was on my hands and knees during contractions, clinging to the grips on the side of the tub (or my husband) for dear life and moaning my head off, while in between I was able to more or less float on my back and sleep for 3-4 minutes. The tub didn’t really make the contractions easier to bear, but it allowed me to completely relax in between contractions to the point that I could sleep, which was so important because I was so exhausted.
I had also become completely non-verbal, barely able to respond to folks and sleeping in between contractions. The most I could do was say “gatorade” every now and then when I was thirsty, and wave my hand in front of my face, which either meant “fan me” or “stop!” if someone was touching or doing something which was painful or annoying. My husband proved invaluable in interpreting what these different signals meant. In retrospect there was such a clear difference between the labor at this point and the labor which had preceded it. During the whole of Saturday night and Sunday day, even though the contractions had been strong and regular and intense, I was still alert and communicative in between contractions, talking to folks, even cracking jokes now and then. During the active phase, Sunday night into Monday morning, there was no communication in between contractions. I was dead asleep, and responding to the contractions instinctively, 100% in my monkey brain, as Ina May would say. My birth team was also pretty much dead asleep. I remember opening my eyes briefly in between a contraction to see both my doula and husband resting on the edge of the tub with their heads on their arms. Time had no meaning. We would sleep in between contractions, mobilize for the contraction itself, and then fall asleep again as soon as the contraction was over. I remember thinking that the contractions were terrible—just TERRIBLE—but that all I had to do was get through the contraction and then I could return to the delicious sleep state which was thankfully much longer than the contraction itself. There was still a lot of residual pain after the contractions, though, and my birth team did a great job of reminding me to relax my shoulders, my face, my jaw in between, and return to a restful state. My best friend arrived again at some point during this time, but honestly, I can’t even remember when. I remember looking up and seeing her there, watching me, and I said “hi” briefly, then I was back in it again.
The first on-call midwife arrived on the scene around 2 am again Monday morning, lugging all of her birth equipment with her. I was anxious to be checked, because I felt that surely (surely!) I must be progressing, and I was hoping that I was close to fully dilated. We also listened to the baby’s heart again, and there he was, chugging along like usual, strong and steady with a fetal heart rate of 120s-130s. Unfortunately, I was not quite fully, but I was thankfully 8 cm dilated (woo-hoo!!!), and at this point I was too deep into labor to think much about it. It was all I could do to stay on top of the contractions, which were still every 3-4 minutes, and beyond huge and intense. At some point after this, the nature of the pain began to change, and I found myself wanting to bear down with it every now and then. Instead of moaning or blowing with the contraction, I would find myself involuntarily holding my breath and grunting.
After another hour of this, I was beginning to feel like I would be in labor forever. I had forgotten why I was in labor. I could only think about the contractions, which felt like they had been happening since the dawn of time, and would continue indefinitely. I think I had even asked for an epidural a few times, or asked to just be put out of my misery, which my birth team wisely ignored (although afterwards they admitted to giving each other “high-five” looks with their eyes during these comments). I was thinking that even a cesarean didn’t sound like such a bad idea, if it would only take the pain away, although I didn’t say this aloud. Finally, completely exasperated and feeling like I would never be fully dilated, I reached down and checked myself to see what was going on, and to my immense relief, I could actually feel his head low in my pelvis, just sitting there, on the verge of being born, with only a thin lip of cervix in the way. It was such an incredible feeling! During my self exam I said aloud, to the midwife: “anterior lip, +1, bulging bag” which made perfect sense to me and her, but which absolutely mystified my husband. Afterwards, he said he couldn’t believe that in the middle of labor—in the middle of a contraction—I was able to say something like “anterior lip”. But that’s what I was feeling, and I was so thankful to be almost finished with the first stage of labor! I also can’t describe how amazing it was to feel something which I had felt so often in other women during labor actually occurring inside of me—my own body and baby on the verge of delivery! It was such an amazing feeling that I reached down to feel it again after a few more contractions, and this time there was an internal pop feeling, and my own bag of waters broke. Suddenly I was sitting in a pool of vernix, but the fluid was clear, which was a very good sign. The midwife asked if I had popped it on purpose, but I hadn’t! It had happened on its own, spontaneous rupture of membranes at 3:55 am on May 16th.
Once the water broke, I began to feel a lot of rectal pressure (the “grapefruit in anus” feeling which we had joked about during our childbirth class), and my body began to bear down with the contractions, but it was so painful!! I kept shying away from actually pushing with the contractions, even though my body was trying to, because the pushing felt absolutely excruciating! After a few more attempts at pushing in the tub, someone suggested I get out of the tub and try pushing on dry land (I’m not sure who suggested this…or even if I was the one who suggested it?) It felt like the tub was too relaxing, though, and it was too easy to run from the pain of pushing, instead of facing it and beginning this very different kind of very hard work. So with assistance I got out of the tub and lumbered over to the futon we had set up in the living room, complete with plastic sheet and two layers of cheap polyester sheets on top, perfect for getting mucky and bloody. Our midwife re-checked me one more time at this point, and I still had the small lip of cervix in front of the baby’s head, so with her assistance I pushed through two contractions while she held the lip out of the way, and after two unbearably painful contractions I was finally (finally!) fully dilated.
I was half expecting that pushing would go pretty quickly, because I had it somewhere in the back of my head that I would be a good pusher. Instead, my birth once again humbled me and taught me a different lesson. Pushing ended up taking 4 hours, although I wasn’t really aware of the passage of time because it was so intense, and because I felt that he was on the verge of being born with every push, and then the next push, and then the push after that. I finally couldn’t run away from the pushing, but had to embrace it—the only way out was through. My body was pushing so powerfully with every contraction, doing this completely on its own. It was as if I were constipated with the largest poop of my life, and my body was bound and determined to push it out against my will. So when the contraction started, I curled up on my side while my midwife or doula held one leg, and then I would squeeze my stomach muscles and strain with the contraction, trying to move the grapefruit down little by little. At first I felt like I was making no progress at all, but everyone began to say very encouraging things, and I could tell from their tone of voice that they felt I was doing a good job, even though I felt like he was stuck and going nowhere. And we pushed. And pushed. And pushed. When the contraction came, I grabbed whatever was closest to me in a fearsome grip and squeezed for dear life—usually this was my husband’s hand, or shoulder, or shirt, or leg, or hip. He was curled up on the futon at my head, and I kept flopping back into his lap in between the contractions, still dead asleep in between the pushing. It’s hard to actually remember this part, because my eyes were closed almost the entire time, and I was so internally focused on my body. I do remember opening my eyes at some point and marveling that it had gotten light out—I couldn’t believe so much time had passed! To me it felt like it was still only 2 or 3 in the morning, in the deep dark of the night.
I do remember reaching down at one point and feeling his head beginning to present—he felt so huge and bulging in my rectum, but all I could feel was a tiny quarter-sized bit of head between my legs, and I remember shrieking: “that’s it???” Compared to how everyone had been encouraging me, and compared to how low and full he felt, I thought he was nearly out of me. But everyone continued to encourage me, and my body kept giving me no choice, so I kept pushing. And pushing. And pushing. Our second midwife had come back over again at some point (probably once I was fully and pushing, although I don’t remember when she came), and she kept fanning me and making sure I had sips of Gatorade in between pushes. She really wanted to be there for the delivery, but there was another woman in labor at the same time, and her labor was going very quickly, so unfortunately, even though our second midwife kept trying to put it off, she had to leave to attend the other birth, and I ended up delivering with the first on-call midwife, which actually felt very appropriate since she had been there through the bulk of the labor with us.
I tried pushing in a few other positions (hands and knees, kneeling), but the side-lying position seemed to be working the best, so we stuck with that for the majority of the time. Honestly, I’m not sure where I found the strength to do it—it was more like I was on a runaway train and there was no way to get off, so I had to just keep going, and pushing with every contraction because I had no choice. Finally, he began to crown, and everyone kept reassuring me that he was finally under the pubic bone and wasn’t slipping back into my pelvis in between pushes, and that they could see more and more of his head. They offered me a mirror so that I could actually see him coming out with each push, but I didn’t want to look. It was easier just to feel, and amazingly, when I reached down I could feel his little head just sitting there between my legs—with so much downy soft hair on his head! Great, I thought, it will be soon! And I let myself begin to believe, truly believe, that I was going to give birth vaginally in my home, soon. But he continued to crown, and crown, and crown, and even though I was pushing incredibly strong with every contraction, I couldn’t seem to actually get him out.
My midwife tried to apply some warm compresses to my perineum, which felt okay, although sometimes too hot. She also tried to do some perineal massage, but this was way too painful to tolerate, so I eventually snapped at her to keep her hands off. I could also, incredibly, feel him squirming his little head around inside of me, trying to find the perfect fit through my pelvis. I thought it was the midwife touching me again, and I told her again not to touch me, but she assured me it was the baby, she was keeping her hands off. It got to the point that I couldn’t even tell when I was contracting anymore, because everything had become so painful. The midwives were listening to the baby’s heart every other push at this point, and even having the Doppler pressing against my skin right about the pubic bone was excruciating. As soon as I heard his heart, I kept trying to get them to take the Doppler away as quickly as possible, although they wanted to listen for longer than just a second. But I could feel the baby moving inside of me, and I knew that everything was fine with him—there was no way I could communicate this to the birth team, so generally it amounted to them listening to his heart while I moaned and waved my hand and tried to get them to take the Doppler away. I began to feel the “ring of fire”, which truly was a ring of fire, so painful that every time I got to that point, it was very hard to push past it. And since I could hardly tell when I was contracting anymore, my husband began to count down for me, and I would push with him when he told me to push. It felt as if I were turning my insides out. Our midwife finally suggested that I get into a kneeling position for the last few pushes, and with some effort I was able to turn myself over with a baby half sticking out of me, and I knelt on my knees and leaned on against my husband’s chest for the last few pushes.
Suddenly the midwife told to my husband to come look, quick, and I could finally (finally!) feel the baby slipping out of me, through the ring of fire. It happened so quickly, after such a long push, that it was hard to believe it was finally over. The midwife passed the baby up between my legs towards me, and there he was: pink and wet and screaming, waving his little arms and legs, looking completely outraged! I had thought I would cry with joy when I first saw him, but honestly, my first thought was: oh thank the gods he’s out!!!!!
They put the baby on my chest and I eased myself back into a sitting position, and we all just marveled over how amazing and beautiful our son was. Slowly, slowly it began to sink in that the labor was over, and there was a baby in my arms!
Within a few minutes (seemed that way at least, since time had stopped), the midwife said the placenta was just sitting there, and that I needed to give a few pushes. I was so exhausted, and pushing felt so painful that I’m not even sure I was any help at all, but I did hold my breath and grunt a few times, and the placenta slipped out between my legs, and it was finally over! I couldn’t care less about the placenta, though—I was too busy marveling over our baby. But suddenly the midwife, who had been inspecting the placenta, gasped and told me to take a look at it. Instead of a normal cord insertion, where the three blood vessels of the cord insert into the body of the placenta directly, our baby had something called a velamentous cord insertion, which occurs when the blood vessels insert into the membranes instead of the placenta directly, and aren’t protected by the wharton’s jelly. It happens in about 1% of all pregnancies, so it’s pretty rare, and also very fragile and delicate, and isn’t seen on sonogram (usually). If anything had happened to one of those tiny vessels during the delivery, it could have been catastrophic. I had actually encountered a similar cord insertion several years ago when I was working as a L&D nurse, and we actually lost that baby—during the pushing phase the baby had descended very rapidly, and had torn one of the vessels on the way down, and we even though we had rushed the mother and baby back to the OR when the fetal heart rate dropped and didn’t recover, we hadn’t been fast enough.
So in the end, I feel like I had the perfect birth—the exact birth that my baby and I had needed. Suddenly, in light of my placenta, my slow, protracted labor made a lot more sense, as did the four hours of pushing, where he descended at a snail’s pace, slow and steady. Every time we had listened to his heart, he had sounded strong and healthy, without a single deceleration or indication that anything was wrong. I also think that my labor had to wear me down to the point that I was so exhausted I couldn’t think any more. During the whole of Saturday and most of Sunday, I had still been in my brain far too much, still been thinking about everything too much, still too much of a midwife and not enough of a laboring woman. It wasn’t until I was utterly exhausted, 41 hours into labor, that my mind finally turned off, and my body could take over. Once that happened, once my mind was finally out of the way and my monkey brain was running the show, then suddenly the labor progressed pretty quickly. 41 hours of latent phase, 11 hours of active phase, 4 hours of pushing, and one beautiful, perfect son (and an intact perineum!!). And I’m so grateful that I was allowed to labor at home, with a birth team that totally, 100% believed in me and the power of my body! I am fairly certain that if I had been in a hospital, the clock would have started ticking at some point, and steps would have been taken to move things along–an epidural and pitocin, or maybe even a cesarean for “failure to progress.” Probably at the point on Sunday when I was still only 4-5 cm dilated after over 36 hours of labor. In general, I feel like most hospitals, and most providers aren’t as patient as mine had been, or so certain in their belief that labor is a normal, healthy process, and that long, marathon labors can still be normal too. And then who knows what would have happened to our baby if we had been forcing things to move more quickly–if the pitocin had brought him down too quickly, or distressed him in some other way, especially given his fragile cord insertion. It’s all in the realm of what might have been, thankfully. What actually happened was just what needed to happen, and my beautiful son was born at home into the loving arms of his family.
Because of its rarity, and because this is a midwife’s blog, I am posting a picture of the placenta here, behind the “More” link. WARNING: placenta alert! Not for the squeamish! But check out the velamentous cord insertion: pretty fascinating (from an academic point of view):
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