Wednesday, May 1, 2013
The Medical Advocacy role of the Doula...in a birth story!
Elina Helen Freidenfelt- Born February 12th, 2013
I woke up at 1AM on Monday, February 11th with contractions. They weren’t painful, but they were enough to keep me from going back to sleep. I went downstairs, curled up on the couch, and started timing them. They seemed to be pretty regular, so I woke Alex up around 3AM. They continued through the morning, so I decided it was best not to go into school that day. I wasn’t sure if labor had actually started, but these contractions were different than the intermittent ones I had been experiencing, so I thought I should stay home. Around 7AM, I called our midwife, Chris, and she said it sounded like the real thing and to keep her posted. At this point, Alex was timing my contractions using an app on the iPad. I was still pretty comfortable, and our goal was to rest as much as possible. Little did we know how long it would be from this point.
Throughout the day, I labored well. We moved all around the house, staying active, and changing positions (like we had learned in our childbirth classes). I made sure to eat and drink regularly to keep my energy up. We went for a nice walk on the trails near our house. At this point, contractions were strong enough to make me stop when I was having one. Alex supported me through each one. We continued for a few more hours, and then Alex called our doula to come over. Kristin arrived around 3:00 Monday afternoon.
Having Kristin arrive was reassuring. It was nice to know that everything was normally progressing as contractions picked up in strength and duration. I still wouldn’t describe them as painful. I could still breathe through them, and I was feeling really good about what my body was doing. Kristin and Alex were amazing coaches. They were there through every contraction, offering massage on my hips and lower back, which was a great help. I found it comforting to have my arms around Alex during contractions. Towards the late hours of the evening, Kristin was in communication with Chris, our midwife. Chris listened to a few of my contractions over the phone. They started getting stronger and longer, and Chris asked us to come into the Birth Center shortly after midnight. At this point, I had been in labor for about 24 hours.
The drive to the Birth Center felt ceremonial. I remember driving down Sahalee Way with Alex, tearing up realizing how close we were to meeting our baby girl. I had about 5 contractions on the drive. Alex held my hand and helped me breathe through each one. I remember repeating the words, “Open, open, open” to remind myself what I was feeling in my body. We made it to the birth center around 12:30. Chris checked me upon arrival, and we were ecstatic when she said we were already 8-9 centimeters. Knowing I was already in transition made me feel on top of the world, like I was totally able to handle everything naturally.
I happily got into the tub after being checked. It felt like such a relief; I understand why they call it “nature’s epidural.” My mom and my sister arrived shortly thereafter. Megan put on some nice music and helped light candles around the tub. The atmosphere was very serene and peaceful- exactly what I had imagined. Contractions were continuing to get stronger. I remember needed silence from everyone during contractions. I later found out that I was really cute about always using “please and thank you” with each request. In our classes, we learned that formalities often go out the window at this stage of labor. I must’ve been trying to break that pattern.
Chris checked me in the tub, and she discovered a swollen cervical lip. She tried to push it out of the way while I pushed, but that didn’t work. At this point, she had me get out of the tub because the heat would make it worse. Our birth experience drastically transformed from this moment on.
The next few hours were spent trying to push back my cervical lip using a combination of different techniques. I labored in several different positions: hands and knees, side lying, leaning over a birthing ball, trying the birthing stool, etc. They gave me Arnica to help with the swelling. As time went on, the contractions reached a level of being excruciatingly painful. The urge to push kicked in, but I wasn’t at 10 cm. yet, so my body wasn’t technically ready to push. Around 3:30, I was checked again, and the swelling had really increased. The urge to push was uncontrollable, and I pushed through the next contraction. We all heard a loud “POP,” and with that my membranes ruptured in what felt like a tidal wave. We tried more different positions, lots of Arnica, and nothing seemed to get the rest of that lip out of the way. My body wanted to push through each contraction, which felt like pushing against the worst bruise of my life. I couldn’t help but scream through contractions at this point. Nothing helped, the pain was intolerable, and I wasn’t progressing. It was decided it was time to transfer to the hospital.
Chris knew this was a likely outcome, so she had already set everything up behind the scenes without my knowing. When the decision was made to go, she was ready to make it as smooth as possible. I knew I needed pain relief, so she started an IV of fluids, so there would be no delay in administering the epidural once we arrived at UW Medical Center. Alex and I rode in Chris’ car with my IV bag hanging from the dry cleaning hook in her back seat. Just before we left, I looked out the window, and noticed my mom and my sister watching, looking very upset. I was in my own world at this point, but it must have looked pretty scary from the outside. I later found out that my mom had asked Chris what would’ve happened back in the day. She bluntly told my mom that the baby or the mom would often die if medical intervention wasn’t available. Chris encouraged me to pant through the contractions in the car, but it felt almost impossible with the persistent urge to push. The pushing led to screaming, which was my exorcist-like coping mechanism.
Around 6AM, we got to UW. Mara, Chris’ student assistant, knew exactly where she was going, and there was zero delay in getting me to my room. They were expecting me, and the anesthesiologist was ready to administer the epidural on arrival. This certainly wasn’t part of our birth plan, but it felt like the only option. UW is a teaching hospital. There were students and residents everywhere. Apparently, I freaked out the resident who was supposed to give me my epidural, so his supervisor gave it instead. I was happy for this because the epidural was administered quickly, painlessly, and the relief was immediate. I could still move my legs, which made me thankful. When the rest of the birthing team came back in the room, I had been transformed.
After a few hours, the doctor(s) checked me, and I had progressed a little bit. In a few more hours, there was no change, so they recommended Pitocin. We knew we wanted to avoid Pitocin, so we delayed this for a few hours. Chris thought Pitocin was appropriate given the situation, so we decided to give it a try after waiting with no change. The purpose was to increase the strength of my contractions to get me to 10 centimeters. I had been at 9 centimeters for over 17 hours at this point. They started the Pitocin slowly, gradually increasing it. For the next 6 hours, I slept, got my pain meds adjusted, and hoped that my body would progress to the point of pushing. The doctors didn’t seem too optimistic, but since I was okay and the baby was okay, they let us continue laboring. In the late afternoon, they started making rumblings about a C-section. I wanted to avoid this at all cost, mostly because of the difficult recovery. Around 5:15PM, the doctors came in to check me. We were expecting the big C-section talk, but after nearly 12 hours in the hospital (and 28 hours of labor before that), I was finally at 10 centimeters! I could tell by the tone of their voices that the doctors and nurses were surprised at that outcome. Later our midwife told us that she was surprised they let us continue to labor because most doctors would’ve performed a C-section by this point. Chris said that we didn’t follow the outcome that would’ve been written in textbooks. The doctors said I was ready to start pushing, and I so relieved and ecstatic to hear the news. You couldn’t wipe the smile off my face. Finally, the end was in sight!
Around 5:30PM, I started pushing. The nurses and Kristin helped me to make my pushes as efficient as possible. This was the first time that I felt back in control after we made the decision to leave the birth center. I was determined to push this baby out. I pushed on my side with a leg propped up, and my pushes were doing the job. After about 30 minutes of “practice pushing,” they could tell the baby was getting closer, so everyone started to get ready for the birth. Although they weren’t very painful, I could feel the contractions, so they took out the monitor that measured the strength of my contractions.
I pushed for about 1 1/2 hours, but it felt like 5 minutes. I got to rest for several minutes between each contraction. As the room filled up with medical professionals, I found myself concentrating on the familiarity of Kristin’s voice. She encouraged my pushing, and she let me know when my pushes were really effective. I remember looking up at one point, and I saw an overwhelming number of people in the room. When I saw several people lingering in the doorway, I got upset and said something about there being way too many people in the room. Alex said that a lot of people looked around, but nothing changed when I said this. I was quickly distracted by my next contraction. At a later appointment, our midwife said that we had taught the young doctors a very valuable lesson about waiting for a woman’s body to do her job. From the teacher’s perspective, it was a good thing that so many people were involved in her birth. When we got close, everyone got into position. My sister caught the moment on video, my mom held up a leg, Kristin coached my pushing, and Alex got ready to guide her out of me into the world.
At 6:54PM, our beautiful baby Elina was born. Alex caught her and put her on my stomach with the help of the doctors. She was slippery and bright pink with a strong set of lungs. We wanted to wait for her cord to stop pulsing before he cut it. After about 15 minutes, Alex cut the cord, and she was brought closer to my chest. What a beauty! She weighed in at 8lbs, 14oz. We delayed newborn exams (there were no immediate health concerns), so we could bond as a new family for over a half an hour. I had a second degree tear, so unfortunately, this time was also shared with me being stitched up. Elina was a lovely distraction.
Very shortly after her birth, the massive team of medical professionals left the room. My mom and sister left after things had settled down. Alex’s mom came to meet her first granddaughter, and my dad and Megan were next. We all moved down to my recovery room later that evening. We left the hospital around 5:30PM the following day. We tried to leave earlier, but they wanted to keep us for 24 hours, and there were lots of “delays” which kept us there on their timeline.
Although Elina’s arrival didn’t go according to our birth plan, we still felt like were in charge of the decision making process. Being educated and having our doula there were essential to advocating for the birth we wanted for our daughter and our family. The contrast of the hospital experience and the birth center experience was night and day. The cervical lip issue doesn’t usually happen with future children, so we look forward to (hopefully) a different experience with our next child. We are thankful for a very healthy baby and all the caring people that helped bring her into the world.