The day before Maya was born, Mac and I went on a lovely walk around the Patuxent Wildlife Reserve in Laurel, MD. We had spent much of the weekend finishing getting ready for baby. I had cleaned the house from top to bottom for what I figured was the last time before the baby. Mac finished the co-sleeper attachment for our bed (henceforth referred to as "the sidecar"). On Sunday the 28th, we picked up the birthing tub from our birth assistant and stopped at the second-hand store for some spare sheets. Finally, we made our way to the nature reserve for some outdoor togetherness time.
We have a history of making major life decisions on long walks outdoors and have cherished hiking as an opportunity to really focus on each other -- no cell phones, no email, no other people -- and take stock of where we are and what makes us happy. On this particular walk, we inevitably found ourselves talking about how our life would change in the coming weeks and what excited or frightened us about the impending birth. We also decided that if the baby hadn't come yet, we'd find a way to fit in a walk during the following weekend as well.
Back home that evening, I found that I didn't have the energy to tackle the pie I'd been planning to make (we had a whole cooked pumpkin to deal with) and that brownies were more my speed. Mac joined me halfway through brownie making to read aloud in the kitchen and just after putting the brownies into the oven, I felt pressure, a pop, and a gush . . . my water had broken.
Hurry Up and Wait
A call to BirthCare's answering service was quickly responded to by Regina, the midwife on call. We met at the office at 9:15 pm for a quick exam, which confirmed that my water had broken, the baby was head down, and that my cervix was not at all dilated.
We called another midwife, Erin, who would be on call starting at 10 pm that evening, to plan for the next morning. Regina sent me home with two bottles of castor oil and instructions to get some sleep, take one bottle of oil in the wee hours of the morning if I wasn't having significant contractions by then, and to page one of them in the morning.
On the way home, we called Alex, my sister, my mother, and our birth assistant, Liz, whom Mac had called with a heads-up when the water first broke. Kathleen assured me that her labor with my nephew started exactly the same way (also early). We set my mother and Alex into a tizzy about preparations for each of their arrivals at the house (Alex was catering for the new parents and the midwives; Mom was planning to come stay and care for me and the new baby). When we got home, Mac and Tom set up the birth tub. (Apparently Tom and Paul tried to set it up when we were gone and couldn't figure it out; Mac knew where to find the instructions.) I sat down and wrote an email to my boss about how I wouldn't be at work in the morning and to my assistant about all the loose ends that she was going to have to take care of that week. I finally crawled into bed around 11 pm and tried to sleep.
Most obstetric professionals in Washington DC strictly limit -- driven by insurance and liability concerns? -- how long a woman can wait between her water breaking and delivering the baby. It's usually 24 hours. Because the membranes protecting the baby from foreign bacteria are broken, the risk of infection to the baby and the mother increases. Infection is still rare and can be safely managed without inducing labor but most OBs prefer not to wait for labor to begin on its own. BirthCare midwives must negotiate with their backup physicians for the protocol in these cases. Generally, the woman must be in active labor within 24 hours to avoid medical interventions. Because my backup hospital was Washington Hospital Center under the care of the midwives of the DC Birth Center, Erin felt we might have more wiggle room. Still, the clock was ticking for that intervention-free home birth we planned.
It was difficult to relax and sleep, but I did manage between 5 and 6 hours of good rest, most of it sleep. I had very light contractions through the night and woke around 5 am to take the caster oil. In a glass of orange juice, it wasn't nearly as bad going down as I expected. Back to bed after a bowl of oatmeal, contractions picked up a bit and were mild and about every 10 minutes for the next couple of hours. The castor oil also kicked in, with all the lovely effects you'd expect, which is supposed to stimulate sympathetic contractions of the uterus.
Erin returned my page just after 8 am and instructed that we try to generate stronger contractions by nipple stimulation. That resulted in still mild contractions a little closer together. We checked in with Erin again at around 9 am. I finally remembered to tell her that I had been having some bloody show since getting up at around 5 am, evidence of labor progress as it indicated that I was loosing the mucus plug in the cervix. That clearly made Erin happy. Though it meant my cervix had probably dilated some, we didn't discuss estimates. By now, I was restless and wanted to take a walk, which could help labor along as well. I figured the castor oil had run its course and I didn't have anything left in my digestive system. Since Mac hadn't eaten yet and I was hungry again, he first made omelets. I found myself doing hip circles in the kitchen through a quick succession of light contractions (30-45 seconds in duration and 2-4 minutes apart).
We finally started walking at around 10:15 am. It was a lovely morning. The air was cool and light and there were leaves falling all around. We walked to Lincoln Park and circled the park a couple times. While we were out, we called my parents to plan for my mother's arrival. We decided she should leave for DC the following morning and plan to arrive in the afternoon or evening because, surely, the baby would be born by then. We also called Mac's parents to alert them to the imminent birth of their first grandchild. Everyone marveled that we were out walking. I only had to slow down or stop for a few contractions at this point but as we circled the park for a second time, I mentioned to Mac that I thought I was wrong about the caster oil and that we should find a bathroom.
I had determined that I could make it back to Safeway (a planned stop anyway), when we happened to run into Mary Elizabeth, an old writing workshop student of Mac's, standing in her front yard on Kentucky Avenue. She graciously allowed me to use her bathroom (much to the surprise of her husband and kids when I walked into the house). She was mighty surprised herself when the question "when is the baby due" resulted in the answer "today."
By now it was 11 am so we called Erin again. She seemed concerned that the contractions were still very mild and said we should decide in an hour if I needed to take the second dose of caster oil. Mac commented that he thought things were moving faster than Erin realized and my continued good mood wasn't a good indicator since I grinned like crazy all the way through a couple of marathons. He felt he was seeing some strain. And, perhaps just at the suggestion of more castor oil, the contractions picked up, causing me to stop several times in the grocery store. By the time we had walked the final two blocks home, I was in rolling contractions (about 11:30 am).
Let the Show Begin
Mac called Liz again to report on progress. She felt that I should try to nap and conserve some energy since it would likely be a long night of either labor or baby care. It was clear that Erin and Liz thought we were in for a long haul so I went to bed when we got home. I wasn't in bed for fifteen minutes before I couldn't lie still through the contractions. I got up to go to the bathroom and had a contraction strong enough that I threw up (now evacuating my digestive system from both ends, what fun!). I called downstairs to Mac (who was going to try to grade a few papers while I napped) that we needed to call Erin again and went back and threw up again. That was suspicious enough to get Mac to come running and I filled him in.
By just after noon, Mac confirmed that Erin was coming to check on me. I moved downstairs to the living room and parked myself in front of the couch on my knees. I found out quickly that sitting during a contraction (on the toilet, exercise ball, or anywhere) was just awful and went right for hands and knees. In front of the couch, I could move through the contraction, rest my head and torso on the cushions between them (2-3 minutes apart), and hold a trashcan between my knees because I continued throwing up. At this point, Mac was frantically filling the tub and calling Liz and Erin, one more time, to urge them to come and come now. He then took up his station beside me, rubbing me ("don't touch the belly") and regularly swapping out trash cans.
Mac was fantastic. He talked me through contractions and reminded me to breathe, to release, and to let the energy flow. We established "no questions during contractions" protocol, but he still managed to get some answers out of me and swapped the music, putting in an Indigo Girls album, a good choice. He used great imagery about letting the energy wash over me and radiate through me. He kept using this puzzling analogy about a starfish, however, referring to its six limbs just like ours. Now, I know a starfish only has five limbs and I really thought that people had only four but I didn't manage to ask about that until weeks later (seems he meant arms, legs, head, and tail).
At some point, Alex arrived and went right for the kitchen. Erin arrived at 1:15, just as I was going upstairs to the bathroom again. She set herself up and I returned to my station in front of the couch. Erin sat down on the couch and took notes, occasionally checking the baby's heart rate and asking questions to assess my condition and the baby's position from how the contractions felt. I'd known for ages that the baby preferred the occiput-anterior position (ideal birth position). This, plus the fact that the contractions were even across the pelvis, confirmed to Erin that the baby wasn't in a posterior position. Erin also gave me something for the nausea. Through this, Mac had been alternately supporting me and fetching things and sending Paul to get parking permits for Erin, Liz (who arrived at 1:45), and the student midwife, Juno (who arrived at 1:50). I was only vaguely aware of anything outside of breathing and moving through contractions.
Later, I was asked to rate the pain on a scale of 1 to 10. My answer was that it couldn't be done. One of the questioners tried to clarify by explaining that part of such a rating was the pain and the other part was the anxiety that the pain caused. I tried to explain that If I had ever stopped to think about a rating or, worse, consider how long the pain might continue, I would have simply panicked. The only thing that was important was the moment. That was especially true at this point. I had no idea how long labor would last or how much I was dilated. Because of the ruptured membranes and the risk of infection, Erin wasn't going to do an internal exam unless she had to. Later, I would be in a groove that many describe as "labor land" a fuzzy mental state caused by natural hormones that prevent too much thinking and that provide some natural pain relief. At this point, I was focusing on the not thinking.
Just before 2pm, Erin asked if I wanted to use the tub. I said I did and got into the tub after one more bathroom break. Mac hopped in beside me moments later. This was one of the many details that we never discussed, but that flowed perfectly even so. The water was great! I had been chilled from the sweats caused by all the vomiting and appreciated the warm water. The water also supported me and allowed me to relax even further.
At 2:20 (according to Erin's log), I flipped over from hands and knees to reclining against the tub wall. At this point, I was feeling the baby move down in my pelvis rather dramatically and was vocalizing appropriately. Somewhere along the way breathing had turned to moaning that crescendoed with each contraction. I found that because I was in the water, I was able to completely relax the lower half of my body and let it float through the contractions. By 2:35, I had flipped back over again onto my knees as the baby moved down the birth canal.
Looking back, our house was pretty crowded. Mac was in the tub with me. Alex was in the kitchen and dining room, apparently making pie and listening for needs he could meet, such as more hot water for the tub or more sports drink for me. Paul had been upstairs working and decided to head to a friend's house at around a quarter to 3 pm. Tom had been at a doctor's appointment that day and dropped by to change and check status at around that time as well. Erin, Liz, and Juno were in and out of the living room checking the baby (usually Juno), occasionally making suggestions (Erin), taking pictures (Liz), doing whatever else needed doing, and stepping out into the dining room for snacks. When planning for the birth, I had been concerned about the number of people who would be around. In the moment, I didn't care at all. The postman could have come in and I wouldn't have cared -- so long as he didn't ask me any questions.
Meet Maya Rose
Around 3 pm, I announced that the baby was really low. I may have even said, "right there." Erin asked me what I felt and I answered, "a very pointy head." At this point, I was consciously not pushing. I hadn't been told to push -- aren’t they always shouting "don't push yet" in the movies? -- and no one had even confirmed that my cervix was fully dilated. I was consciously not pushing, but not fighting it either. I was letting my body do what it knew how to do. I was simply getting out of the way.
After a couple of minutes, Erin asked if I wanted to get out of the tub. I think responded, "If I have a choice, I think I'll stay right here." That started a bit of activity since Erin wanted the water warmed up above body temperature. Erin began talking Mac through what would happen next. Based on my position leaning forward, Erin thought she would catch the baby and pass her through my legs to Mac and to me. She made it very clear to Mac that once the baby surfaced it could not be put back under the water so we had to manage the birth position to ensure that there was enough umbilical cord for the baby to reach my chest. As birth got closer, I found myself in a more upright position and Erin suggested that I catch the baby and lift her up myself.
It wasn't until the baby crowned that I actively pushed. I remember thinking, "okay, lets be done with this." Three or four pushes and I was holding a tiny, tiny baby. It was 3:28 pm.
I heard Erin say "oh, that is a little baby," and the baby was quickly covered in blankets and a heating pad and I was guided out of the tub. Since it all happened pretty fast, we hadn't discussed where I should go next. I ended up on the floor covered in blankets with a baby on my chest while we checked the baby's vitals, confirmed the gender (hello Maya Rose), and examined me. Mac cut the cord at 3:39.
By 4:15, I had birthed the placenta and Juno had stitched a tiny tear. By 4:45, I was showered and back on the couch for milk (for both me and Maya) and Alex's homemade cookies (just me). Erin performed a newborn exam and pronounced Maya "perfect" right there on the couch and we celebrated with Alex's quiche and tapioca. (Erin, Liz, and Juno thought that Alex should cater all their births.)
Except for the caster oil and chasing labor bit, I couldn't have asked for a better birth experience. Erin, Liz, and Juno were great and recognized that I had all the labor support I needed in Mac and only stepped out of the background as necessary (apparently Mac ran out and hugged Alex for support a couple of times). Mac was fantastic. Alex, Paul, and Tom were appropriately helpful and scarce as needed. Maya Rose is perfect.