Dottie’s birth story
Warning: this is crazy long, because it covers a lot of territory. I will probably come back and update it as I remember things, for my own benefit mostly, so as of September 8 this is essentially just a complete draft. There’s a lot here for me to process. In case you don’t already know, this is the story of a successful home birth, followed by an emergency ambulance transport to the hospital because of a retained placenta. It contains graphic birth photos.
Pregnancy
Just to prepare me for what I’m sure will be endless list of differences in parenting a second child, this pregnancy was totally different than with my son Rusty back in 2009. The seasons were shifted (conception in November rather than March; due date in August rather than December), but I physically I felt different too. I had very little nausea in the first trimester, which was great, but I was also convinced that I wasn’t really pregnant for most of it because I felt mostly normal most of the time (to be honest, I had icky moments too, but they were the minority of my experience).
At 12 weeks I had an incident with a gush of fresh red blood that definitely had me convinced I was miscarrying. My husband Casey and I were very sad for a few hours, until we realized that it had slowed down. An ultrasound the next morning showed a healthy little baby and a complete placenta previa (placenta covering the cervix). I can’t imagine a better scenario for finding a placenta previa - we were so relieved to have a healthy baby that we didn’t really worry about the placenta even though I continued to spot off and on for a couple of weeks. We figured it would travel up as the uterus grew, and a later ultrasound showed that it did.
Overall, I felt really good during this pregnancy. I wasn’t working in the fields the way I did with Rusty, so my energy levels were higher (I was often exhausted at the end of the day with Rusty). However, I was still chasing after Rusty, and that caused a couple problems when I carried him around too much. I hurt my foot and my back at different times, both of which were pretty painful and inhibited my mobility for a period.
In the weeks leading up to my due date, I felt Pip (our in utero name for baby) moving pretty dramatically from side to side. Sure enough, baby was at times posterior or close to it. I wasn’t sure whether the big movements caused some of my back pain or vice versa, but they continued up until I went into labor even my back was better by then.
As with Rusty, we didn’t find out the sex ahead of time and planned a home birth.
Labor - Stages 1 & 2
At 41 weeks, I still hadn’t gone into labor. I’d been having Braxton Hicks throughout the pregnancy and was still having them, but nothing that felt like the real deal.
I was starting to feel antsy, so at 41 weeks and 1 day (September 3), I decided to take measures. I went on three walks throughout the day, including a lovely walk around the field by myself after Rusty went to bed. In the evening Casey suggested we try making love, which was something we hadn’t done it way too long. I had to think about his suggestion because I felt so big and awkward, but in the end I thought it sounded awesome and we had a very sweet (if physically awkward at moments) evening of reconnecting. It was so loving and nice that neither of us cared much whether it “worked,” but sure enough (much to my surprise) about half an hour after we finished, I started having real contractions (at 9:30 pm or so).
We got household business in order, just in case, and went to bed. I never slept that whole night, because the contractions were so regular and increased in strength steadily. At that point, I was also pretty excited, both about the labor and how quickly it seemed to be moving along (in comparison to Rusty’s labor, which was very slow to get moving).
Sometime around midnight, I gave up on sleeping and got up to prepare for the birth, deal with some last minute household/farm things and generally distract myself from the contractions a bit. They were getting strong enough that I had to pause and breathe through them as I puttered. I put away laundry, emailed chefs, wrote up a long list of reminders for our employees, and eventually called my midwife and my mom to let them know what was happening. At around 3:30 am, I went back to bed, with the idea that the contractions would either speed up or disappear with my fatigue and sleepiness. They totally increased in strength, and at 4:30 pm, I woke Casey up (he had continued sleeping all night on my request - we both wanted him to be rested!) and said it was time to call the midwife and my mom (I needed her to be available when Rusty woke).
I went downstairs and had an epic contraction. I swear that it lasted longer than ten minutes, but it was probably a series of contractions with no breaks. It was all I could do to get to the bathroom to clear out my bowels, and then I made it to the futon (which I had unfolded into a bed) to lie down and kept moaning and moaning. The contractions kept coming like that, hard, long and frequent until my midwife Margy showed up. When she arrived, I immediately started barfing, and I was sure I was in transition. It felt like things were progressing so quickly, and I was worried that Casey wouldn’t get back from milking the cows in time for the actual birth!
The time that Casey was gone milking was really hard. I felt like I had to wait for him to let myself “go,” and I told my midwife that it felt like once he was back I would walk across the floor, squat and push out the baby. If only. That is really what all signs pointed to - I was SO deep in labor land that I barely registered anyone coming and going (including the rest of the birth team, and Rusty and my mom who left to spend the day at my parents’ house).
Unfortunately, that is not what happened. When Casey got back, I did take off my underwear and drop to my knees. I’m sure everyone expected to see a head any minute, but I just labored through another series of epic contractions. And, then the tub was ready, and I got in there instead, which felt so good (you know, in a relative sense). The water gave me my first real break from the onslaught of long hard contractions. I think the sun was coming up around now, but I have no clue about the time anymore.
I stayed in the tub laboring for a while. The contractions still hurt, but the time between gave me some rests. This is a blurry period for me. I may have gotten in and out a bit and walked around, and I know I changed up my position some - but I can’t honestly remember the sequence or what happened exactly. There was a lot of pain, and I remember questioning why I had gotten pregnant again and telling myself that I was definitely never doing this again.
The contractions were so much more intense than what I remember with Rusty (except for maybe the ones I had in transition with him). I definitely had to focus on moaning low through them and keeping my jaw and mouth loose. I also found that I really had to keep my thoughts positive. In earlier labor, my inner mantra was “Open. Down.” but in the tub I had to think, “I can do this. I can do this. I can do this.” otherwise my thoughts went to really negative places. I nodded through each contraction as I thought that: “I can do this.”
I was also getting really exhausted from lack of sleep. I started falling asleep between every contraction, which was probably useful for keeping my energy up since I had no interest in food (I did sip a small cup of Emergen-C throughout).
Even in the tub, I was in so much pain that I didn’t want ANY stimulation - no touching, no talking, no soothing. I could barely tolerate the Doppler between contractions, and it was really hard to have it against me during them. Every now and then someone would offer a cold compress or to push on my back and I was like: “NO!” So, mostly my birth team sat around watching and waiting.
I keep saying it “hurt,” which is very vague. I’m not sure I can, or want to be, more specific. The nature of the pain is already fading in my memory, and I am happy for that. The day after the birth, it was still fresh and it was very unpleasant to reflect upon.
Honestly, the driving force that kept me going was the constant sense that the birth had to be imminent. If I had known how long I would labor, it would have been really hard to continue going. Also, the thought of transferring was worse than continuing to labor (because of the pain). But, if any person in my birth team had suggested I couldn’t finish the job and that we transfer, I would have consented immediately. As time wore on, I had a hard time believing that I COULD do it (especially during the pushing that came later).
Eventually, I moved to the futon bed to labor some more lying down on my side. I asked Margy if she thought she should check me, and she suggested I should listen to my body (or something like that). I started pushing, to see what it felt like, and it felt a lot more comfortable than just breathing through the contractions, so we all moved into pushing mode, assuming that I was ready. I pushed a while on the futon and some leaning against the tub. I passed the mucus plug finally, but at this point my water still hadn’t broken. My contractions were still coming hard and steady but the pushing didn’t seem to be getting us anywhere. Here is a photo from that phase of pushing:
Margy did finally check me and felt Pip’s head against my pubic bone. She also felt that the position wasn’t quite straight on, but she wasn’t sure exactly was the presentation was. We did some attempts at her holding Pip’s head while I pushed and that seemed at the time to adjust the presentation. Even though my contractions were hard, I wasn’t experiencing what I thought would be called “back labor,” so we didn’t really suspect a posterior presentation.
So, I pushed and pushed and pushed, in a ton of different positions, trying to get Pip’s head past that pubic bone. My water did break and it was clear (and Pip’s heart rate continued to be perfect throughout all of this), so we kept on.
Eventually though, I was clearly not getting anywhere, in spite of a lot of pushing (including a lot of pushing out of poop). So, Margy checked me again and felt some kind of band of muscle or cervix that seemed to be blocking the head from staying down - I’d push it down and then it’d get pushed back again. So, she suggested I take a break from pushing and breathe through the contractions again, in hopes of dilating fully.
The birth team left the house to give Casey and me some privacy and we lied down together for a few contractions. I tried to breathe through them, which hurt so badly again (well, it had all hurt, but not pushing felt worse). Pretty quickly, however, the urge to push just intensified and I experienced the involuntary pushing I’d read about but never experienced. My body started pushing the baby down, in spite of my efforts to prevent it. It felt almost like throwing up, but in the opposite direction, and it was clearly a lot more effective (I may have finished dilating too in those earlier contractions) because we actually started seeing progress at that point.
I can’t remember the details, but I pushed in a few different positions and kept making slow progress. Casey kept asking Margy to give me feedback, because I was clearly getting exhausted and needed to be told that things were in fact moving along now. But it was so slow feeling compared to Rusty’s birth - with him, the first stage of labor was long but the pushing was relatively fast.
But I did progress, and eventually I dropped down into my favorite position (squatting between Casey’s legs while he sat behind me on the futon) and pushed as hard as I could (with contractions and still having the involuntary aspect too). The head finally crowned, and I pushed Pip out in several more contractions than Rusty. Here’s a photo of the final pushes:
This time I actually felt it all happening: the stretching and the ring of fire. So intense! And, then, Pip was out (at just around 12:30 pm on September 4 - 15 hours after labor began and seven hours after I thought I was in transition and that birth was imminent).
YES! And, when the baby came out, we learned why it had all been so hard and slow - Pip presented brow first AND posterior. Individually, those presentations both add challenge to a labor, but together they created what was clearly an extremely challenging pushing scenario. You can see the sunny-side-up face in this photo:
Pip was also very slippery - lots of vernix on the back and goop all over - with a shortish cord, making it super awkward to hold this little baby. It took me a few seconds of maneuvering before we found out the sex - a GIRL! Dorothy Raven! Dottie! That was a very sweet moment, and the midwives gave us some space and time to meet our little girl. I love this photos of us:
Labor - Stage 3. Woah.
Then it was time to get the placenta out. With both births, I was very aware that this was a critical moment in the entire labor scenario. The adrenaline of pushing brought clarity of mind and I was hyper aware of wanting to get through the third stage quickly so I could relax with my baby. With Rusty’s, it passed with no drama. This time … well …
After our bonding time (and a little bite of yogurt), Margy started tugging very gently on the cord to see if the placenta had detached. I did have a gush of blood, which we thought meant it was ready, but our efforts to gently tug and/or have me push didn’t move the placenta. Margy was concerned, so the birth team gave me a shot of pitocin in my right leg. I’m not sure when exactly it happened, but at some point in this, I stood up to try pushing the placenta out and felt faint (with more blood gushing).
Nothing changed, so they gave me a shot of methergine in my other leg. Still no placenta, but my cervix was apparently starting to close and Margy reached in to assess even as my uterus was trying to clamp down (more blood throughout all of this). She tried to manually remove the placenta from my uterus (OUCH!), but it didn’t move. I wasn’t sure what the words meant, but she and the experienced assist midwife who was there got even more serious, talked about “scapula” or “scraping.” And, then very quickly, they decided to “call.” “Call who?” I asked. I figured the hospital, but they were calling 911.
Meanwhile, I was lying back on the futon, and Casey was holding Dottie. The assist midwife picked up Casey’s phone to call, which is hard to use because all the buttons are caked with dirt from his pocket. Between that and having difficulty finding Margy’s supplies, she was getting visibly agitated. Casey helped her push “send.” Margy was palpating my uterus while the other midwife explained the situation to the dispatcher (which of course took several repeats to get the whole story out).
Casey called my parents to tell them what was happening - a hard phone call, I’m sure. It went something like: “Good news, Dorothy Raven is here. Bad news, Katie is going to the hospital.”
Within just a few minutes, there was a knock at our front door. It was so fast that Casey was annoyed, thinking it was an employee or something. In walked one of our neighbors, who is the coordinator for the volunteer fire department and an ER doc in Portland. “Hi John,” I said, as I lay sprawled, naked and bloody with my legs spread.
Even though it was possibly awkward, having John there was actually really comforting. He gave us the update on the timing of the rest of the EMT crew and checked in with Margy and me. Within another few minutes, a volunteer EMT showed up and started an IV in my arm (the midwives had started one just a moment before, but it wasn’t working for some reason). Then the ambulance crew showed up, and they got another IV going in my other arm and transferred me to a gurney (with Margy still palpating the whole time). Casey hovered in the background and kept catching my eyes and pointing to Dottie, as if to say: “Hey, this was the point. Look what you have to live for.”
(On a random note, they used a throw blanket and chux pad to transfer me because I was lying on them already and they also grabbed a pillow for my head - the blanket and pillow followed me throughout my stay in the hospital and managed to stay blood free!)
They wheeled me out to the ambulance (with Margy still palpating) and we went on a ride to the hospital with sirens, lights and all. I didn’t find out what everyone else was doing until later, but at that point, Casey went out and found my mom and Rusty at the swing in my parents’ yard. I missed my children’s first meeting, but Casey said it was sweet. He told Rusty that this baby was Pip, and Rusty said “ooh!” and wanted to pet her.
Casey, Rusty, Dottie, and my mom headed to the hospital in our car. Dottie’s first car trip was when she was less than an hour old! She hadn’t been weighed or carefully examined (although her first APGAR 9 at birth and 10 at ten minutes, so that was a relief), and her cord was still pretty long (Margy cut it much earlier when we were still trying to get the placenta out but it hadn’t been banded). Casey also just barely managed to get a diaper and blanket on her, so she traveled naked. He also grabbed the hospital bag I had packed “just in case.”
My dad (who is an anesthesiologist at the hospital) had called the hospital after hearing the news and got assurances that everything was being lined up for my arrival. He plays it cool, but I know he was really freaked out about all of this. He drove separately.
Anyhow, on the drive to the hospital I was weirdly chatty. I get this way when I am a patient - I have a strong desire to make my care providers calm, happy and comfortable. I make jokes; I smile. I think it is comforting to me to do this and it certainly helped keep me from freaking out about the fact that I WAS RIDING IN AN AMBULANCE ON THE WAY TO THE HOSPITAL BECAUSE PEOPLE THOUGHT I WAS ABOUT TO DIE FROM BLOOD LOSS. Among other things, I chatted about how it was a Dragon Year (in the Chinese zodiac) and how the last Dragon Year was 2000 and, man, wasn’t that a weird election year. Go figure.
So, we arrived, and I was wheeled in to an ER intake room (with Margy still palpating). Margy gave the update to the ER folks. My dad came in and checked in with me. Casey came in with Dottie, and I nursed her for the first time on the gurney while all of the logistics were being worked through. Miraculously, she latched and we had a sweet little nursing session, which really helped me relax about going away from her. Things were moving oddly slow, and then I had another big gush of blood that ran off the gurney onto the floor, and then everyone picked up the pace. The OB came in and introduced himself and we talked through the anesthesia options with the nurse anesthetist. We all decided on a spinal block, in part because I wouldn’t have to wait to nurse at all (as opposed to a sedative or something simpler). Also, I had eaten that TINY bowl of yogurt immediately after the birth, and they were worried about the risk of aspiration under a different kind of anesthesia.
Eventually, I was being wheeled down the hall by a super nice nurse with a vaguely comforting British accent. I was wheeled into the OR, where they started prepping me for the spinal and the procedure. I had hoped my dad would come be with me, but apparently he was uncomfortable with that, so instead he paced outside the whole time. Everyone was really nice, and I managed to stay eerily calm and chipper. The spinal went in without a hitch, and the OB manually removed the placenta after several minutes of hard work. Apparently it was still very attached on one part - there was nothing unusual about the placenta that came out, so why this happened is still a mystery.
All in all, everyone estimated my blood loss at about 1500 cc, or just shy or half a gallon (which is a unit that I understand better). I only ever felt faint once (except again once in recovery), but obviously the big danger all along was that I would have a big bleed. Everyone was prepared for a blood transfusion at every step, but I did well - even in the moment of the transfer, I was very grateful for my unusually high iron counts (I am not even remotely anemic) and general good health because I needed all my reserves for the birth and everything that happened after.
Immediate post partum
After removing the placenta, the OB also stitched me up because I had second degree tears from the delivery. All in all, it sounds like the tearing and stitching were no more significant than with Rusty, which is probably in part because I was forced to push Dottie out slower and consequently stretched better.
Then, they wheeled me to recovery. I had some idea I’d be in recovery for two hours, so this was a harder wait for me. The recovery room nurse came and went, and it was dim and boring, and I finally had a calm moment to realize what was happening. I can’t say that I really processed anything in that moment, but it really was the first time everything hit me. My dad did visit me then, which was nice. Because I was fine, I left recovery much sooner than I expected, and the hospital sent me to a room in the birthing unit - in part because the plan was to have me stay overnight and I wanted Dottie with me, but also because I HAD just had a baby and was still very much in immediate post partum mode.
Casey and Rusty met me in the hall, and I guess I looked awful, because the sight of me really disturbed Rusty. I tried to be chipper and calm and reached out to him. Casey put him in the bed next to me, and he got really upset. He did not like what he saw. My face was pale, bloated and covered in broken capillaries and I had a bunch of tubes everywhere. Yeah, pretty disturbing.
As soon as they got me in the room, we took out the oxygen, which helped calm Rusty somewhat. So I held Rusty on my left side and then finally I got to hold Dottie again on my right side - my first time holding both my babies at once, in a hospital room:
I wanted to nurse Dottie again, and Margy helped me get her latched since I was pretty reclined and awkwardly hooked up to bunches of tubes and things. Once again, she latched well - so wonderful to have some important things go well amidst the chaos!
My parents were there, along with my midwife. All of us went into two modes: baby worship and debriefing the incident. It was a happy mood, because I was in the clear, but obviously we were all keenly aware that the transfer was a rare and scary event - one that none of us desired or expected ahead of time, obviously. Margy’s assistant Rosemary showed up soon after with some supplies from our house (blankets, food, my purse, etc.) and joined in the talking (before that, she and the other midwife cleaned up the bloody “crime scene” that was our house).
(All along, I felt bad at everything Rosemary witnessed - a hard labor and then a dramatic transfer - because she is pregnant with her first and due in October. When Margy was still trying to get the placenta out, Rosemary was holding my legs up as in stirrups and had a front row view of the gore of my blood. I’m sure she’ll have her own processing to do before her birth. I told her later that I “took one for the team” with the combination of rare challenges I had, and so obviously her birth would be quick and uneventful.)
At 6:45, we finally had a moment to do the newborn exam and cord finishing. Dottie weighed 9 lbs 1 oz -- almost a pound more than Rusty at birth! Woah!
The hospital initially wanted to keep me overnight for observation, but the OB agreed to let us go before midnight if I was doing well. Eventually, everyone had cleared out (Rusty went to stay overnight with my parents for the first time), and Casey and I settled in to get me well quickly. My dad brought back some chili that I had thawing at home, and Casey spoon-fed me bits of beef. I also ate some hospital chicken soup that was ridiculously delicious, given how unlike our normal food it was (I think I was hungry!).
Eventually, I got up to pee for the first time, and that was my first test. They took me into the bathroom in a wheelchair and then had me walk back out to see how I did (with two nurses spotting me). I did have ringing in my ears just as I got back to the bed, but when I did it again an hour or so later, I made it to and from the bathroom without any obvious signs of faintness. I did feel very weak, but not faint. Around 9 pm, they took some blood to check my blood cell count. It was low, but the OB discharged me anyway. Casey, Dottie and I hung out a while longer, because we were sure that every hour would add to my strength. We finally left to go home at 11:30 pm.
It was lovely to return to a clean house. Casey made up the futon bed again with the clean sheets, which is where Dottie and I tried to sleep (I got some sleep, but it was late and Dottie was past her initial just-born sleepiness and wanted to suckle all night). Casey slept on the floor. But, finally - FINALLY - we were home.
Here’s a photo of me with my babies, at home, from the next day:
And, Dottie on her own:
More observations on the birth & Dottie
* So, the biggest two QUESTIONS begged by this birth are: will we have another child? And, if so, will we birth at home again? At the hospital, I assured everyone that we would NOT be having more children, but of course the next day as I gazed at Dottie’s tiny soft shoulders, I reconsidered that idea - or, at least, put the decision off for a while. But, either way, there’s no question that my feelings about home birth have been sobered. It isn’t that I’ve “lost the faith” - not by any means. When I think about what the same birth scenario would have been like in the hospital, it sounds just as hard and there would have been much of the same drama (minus the transport of course), or possibly more. My situation was really an example of a home birth that went RIGHT - as in, I chose competent midwives who were able to take quick and appropriate measures, and we had planned well for transport ahead of time (and I had even weighed the risks of our rural location, and felt ok with it because of things like the proximity of our ER doc neighbor). But, of course, to many people, it will not be a good example of a good home birth - people like to hear about home births where everything is textbook, beautiful and magical. This birth was not any of those things. Regardless of my own opinion or judgment, I also don’t feel like I will be able to talk about home birth in the future without telling people the full story (i.e. the transfer). Again, even without me adding anything to the facts, my story is sobering. And, if we DO have another child, choosing where to have the birth will necessarily be a really big, complicated decision. My parents’ willingness to be respectful of our desires may have been stretched to this limit (and this matters, because we live next door and are very close). And, I may have a lot more anxiety about birth next time too. Clearly these are things to address if/when that situation comes up, but I know I’ll be chewing on them a lot in the near future too (and anytime birth comes up).
* Having had an unexpectedly hard, complicated birth has given me a lot more understanding of birth in general. I have this very deep sense of how PROFOUND it is to give birth, regardless of how or where. I know that we natural birthers do all sorts of birth art and hypnosis to convince ourselves otherwise, but birth is scary. It’s a really big deal. I am reminded of that now in these days right after, when it is all fresh. I have so much respect for all women who have given birth. We are amazing. We are so strong. Where does this strength come from? Is it from our love for our children? Some cosmic spirit? It’s awesome (in the original sense of the word). I am in awe of birth and its force.
* While I am sad about how things went down (who would choose that presentation or the placenta retention?), I still do feel very empowered by the first part of the birth - getting Dottie out! I think there is a tremendous different in the emotional fallout of transferring after the birth rather than before. As it is, I feel very accomplished. Also, I was grateful all along that we were transferring because of ME rather than DOTTIE. It was easy for me to stay calm, because I knew how my body felt, and I did not feel about to die.
* In retrospect, two other factors made the birth and transfer a lot less traumatic feeling for me. The first is a simple thing: I had already taken my contacts out for the night and didn’t bother to put on glasses until after I was out of recovery, so I had blurred vision for the entire birth, transfer and time in the OR. I really think it helped keep things just a bit surreal and less overwhelming. It also helped that I never could see the expressions on people’s faces and wasn’t able to pick up as easily on their stress. On a more profound note, it was amazing to be transferred living in such a small community. And, of course, my dad works at the hospital where we went. At every step of the way, I was cared for by who I actually knew, or who knew of me, or who I knew of before. There were connections already in place, and I really felt like I was being cared for as a person. As an example, in the ER intake room, Casey told the folks that we wanted to take home my placenta. Since this is an unusual request, people wanted to make sure it was followed, and so it kept coming up. I would remind someone, or someone else would note it to a new person who’d come into the OR, etc. It was somewhat humorous actually how many times it came up, but it helped me feel like I was being honored throughout the process.
* Being the mother of a daughter already feels like a different kind of responsibility than being the mother of a son. The world seems harder and scarier for little girls - there’s so much I already want to protect her from (especially some crazy cultural and material girly stuff). But I’m also so excited about (hopefully) having a mother-daughter bond that will last my lifetime. I know that these relationships can often be strained or drama-filled at times, but it seems like daughters tend to stick closer and lean on their moms more. I don’t know, that sounds nice.
* Life does go on. I’m four days out and feeling so much more human. The first two days were really hard. I felt like I’d been hit by a truck, but I’ve been taking it easy (or trying - life on the farm has been crazy stressful this week) and even got some fresh air. My milk came in just fine. I do still have some mysterious butt weirdness, but overall I feel like I am recovering well and in due time. We've had amazing support from friends and family, which helps a lot, especially because parenting two is challenging (especially when in recovery). I look like me again too:
* Once again, I am so grateful for my birth team. This is a vast understatement.
* Casey is my rock. In every way. An amazing father. An amazing man. So strong. I love him so much. Another vast understatement.
* It was hard. So hard. Unbelievably hard. And, now that she’s here, it was totally worth it. <3
Pregnancy
Just to prepare me for what I’m sure will be endless list of differences in parenting a second child, this pregnancy was totally different than with my son Rusty back in 2009. The seasons were shifted (conception in November rather than March; due date in August rather than December), but I physically I felt different too. I had very little nausea in the first trimester, which was great, but I was also convinced that I wasn’t really pregnant for most of it because I felt mostly normal most of the time (to be honest, I had icky moments too, but they were the minority of my experience).
At 12 weeks I had an incident with a gush of fresh red blood that definitely had me convinced I was miscarrying. My husband Casey and I were very sad for a few hours, until we realized that it had slowed down. An ultrasound the next morning showed a healthy little baby and a complete placenta previa (placenta covering the cervix). I can’t imagine a better scenario for finding a placenta previa - we were so relieved to have a healthy baby that we didn’t really worry about the placenta even though I continued to spot off and on for a couple of weeks. We figured it would travel up as the uterus grew, and a later ultrasound showed that it did.
Overall, I felt really good during this pregnancy. I wasn’t working in the fields the way I did with Rusty, so my energy levels were higher (I was often exhausted at the end of the day with Rusty). However, I was still chasing after Rusty, and that caused a couple problems when I carried him around too much. I hurt my foot and my back at different times, both of which were pretty painful and inhibited my mobility for a period.
In the weeks leading up to my due date, I felt Pip (our in utero name for baby) moving pretty dramatically from side to side. Sure enough, baby was at times posterior or close to it. I wasn’t sure whether the big movements caused some of my back pain or vice versa, but they continued up until I went into labor even my back was better by then.
As with Rusty, we didn’t find out the sex ahead of time and planned a home birth.
Labor - Stages 1 & 2
At 41 weeks, I still hadn’t gone into labor. I’d been having Braxton Hicks throughout the pregnancy and was still having them, but nothing that felt like the real deal.
I was starting to feel antsy, so at 41 weeks and 1 day (September 3), I decided to take measures. I went on three walks throughout the day, including a lovely walk around the field by myself after Rusty went to bed. In the evening Casey suggested we try making love, which was something we hadn’t done it way too long. I had to think about his suggestion because I felt so big and awkward, but in the end I thought it sounded awesome and we had a very sweet (if physically awkward at moments) evening of reconnecting. It was so loving and nice that neither of us cared much whether it “worked,” but sure enough (much to my surprise) about half an hour after we finished, I started having real contractions (at 9:30 pm or so).
We got household business in order, just in case, and went to bed. I never slept that whole night, because the contractions were so regular and increased in strength steadily. At that point, I was also pretty excited, both about the labor and how quickly it seemed to be moving along (in comparison to Rusty’s labor, which was very slow to get moving).
Sometime around midnight, I gave up on sleeping and got up to prepare for the birth, deal with some last minute household/farm things and generally distract myself from the contractions a bit. They were getting strong enough that I had to pause and breathe through them as I puttered. I put away laundry, emailed chefs, wrote up a long list of reminders for our employees, and eventually called my midwife and my mom to let them know what was happening. At around 3:30 am, I went back to bed, with the idea that the contractions would either speed up or disappear with my fatigue and sleepiness. They totally increased in strength, and at 4:30 pm, I woke Casey up (he had continued sleeping all night on my request - we both wanted him to be rested!) and said it was time to call the midwife and my mom (I needed her to be available when Rusty woke).
I went downstairs and had an epic contraction. I swear that it lasted longer than ten minutes, but it was probably a series of contractions with no breaks. It was all I could do to get to the bathroom to clear out my bowels, and then I made it to the futon (which I had unfolded into a bed) to lie down and kept moaning and moaning. The contractions kept coming like that, hard, long and frequent until my midwife Margy showed up. When she arrived, I immediately started barfing, and I was sure I was in transition. It felt like things were progressing so quickly, and I was worried that Casey wouldn’t get back from milking the cows in time for the actual birth!
The time that Casey was gone milking was really hard. I felt like I had to wait for him to let myself “go,” and I told my midwife that it felt like once he was back I would walk across the floor, squat and push out the baby. If only. That is really what all signs pointed to - I was SO deep in labor land that I barely registered anyone coming and going (including the rest of the birth team, and Rusty and my mom who left to spend the day at my parents’ house).
Unfortunately, that is not what happened. When Casey got back, I did take off my underwear and drop to my knees. I’m sure everyone expected to see a head any minute, but I just labored through another series of epic contractions. And, then the tub was ready, and I got in there instead, which felt so good (you know, in a relative sense). The water gave me my first real break from the onslaught of long hard contractions. I think the sun was coming up around now, but I have no clue about the time anymore.
I stayed in the tub laboring for a while. The contractions still hurt, but the time between gave me some rests. This is a blurry period for me. I may have gotten in and out a bit and walked around, and I know I changed up my position some - but I can’t honestly remember the sequence or what happened exactly. There was a lot of pain, and I remember questioning why I had gotten pregnant again and telling myself that I was definitely never doing this again.
The contractions were so much more intense than what I remember with Rusty (except for maybe the ones I had in transition with him). I definitely had to focus on moaning low through them and keeping my jaw and mouth loose. I also found that I really had to keep my thoughts positive. In earlier labor, my inner mantra was “Open. Down.” but in the tub I had to think, “I can do this. I can do this. I can do this.” otherwise my thoughts went to really negative places. I nodded through each contraction as I thought that: “I can do this.”
I was also getting really exhausted from lack of sleep. I started falling asleep between every contraction, which was probably useful for keeping my energy up since I had no interest in food (I did sip a small cup of Emergen-C throughout).
Even in the tub, I was in so much pain that I didn’t want ANY stimulation - no touching, no talking, no soothing. I could barely tolerate the Doppler between contractions, and it was really hard to have it against me during them. Every now and then someone would offer a cold compress or to push on my back and I was like: “NO!” So, mostly my birth team sat around watching and waiting.
I keep saying it “hurt,” which is very vague. I’m not sure I can, or want to be, more specific. The nature of the pain is already fading in my memory, and I am happy for that. The day after the birth, it was still fresh and it was very unpleasant to reflect upon.
Honestly, the driving force that kept me going was the constant sense that the birth had to be imminent. If I had known how long I would labor, it would have been really hard to continue going. Also, the thought of transferring was worse than continuing to labor (because of the pain). But, if any person in my birth team had suggested I couldn’t finish the job and that we transfer, I would have consented immediately. As time wore on, I had a hard time believing that I COULD do it (especially during the pushing that came later).
Eventually, I moved to the futon bed to labor some more lying down on my side. I asked Margy if she thought she should check me, and she suggested I should listen to my body (or something like that). I started pushing, to see what it felt like, and it felt a lot more comfortable than just breathing through the contractions, so we all moved into pushing mode, assuming that I was ready. I pushed a while on the futon and some leaning against the tub. I passed the mucus plug finally, but at this point my water still hadn’t broken. My contractions were still coming hard and steady but the pushing didn’t seem to be getting us anywhere. Here is a photo from that phase of pushing:
Margy did finally check me and felt Pip’s head against my pubic bone. She also felt that the position wasn’t quite straight on, but she wasn’t sure exactly was the presentation was. We did some attempts at her holding Pip’s head while I pushed and that seemed at the time to adjust the presentation. Even though my contractions were hard, I wasn’t experiencing what I thought would be called “back labor,” so we didn’t really suspect a posterior presentation.
So, I pushed and pushed and pushed, in a ton of different positions, trying to get Pip’s head past that pubic bone. My water did break and it was clear (and Pip’s heart rate continued to be perfect throughout all of this), so we kept on.
Eventually though, I was clearly not getting anywhere, in spite of a lot of pushing (including a lot of pushing out of poop). So, Margy checked me again and felt some kind of band of muscle or cervix that seemed to be blocking the head from staying down - I’d push it down and then it’d get pushed back again. So, she suggested I take a break from pushing and breathe through the contractions again, in hopes of dilating fully.
The birth team left the house to give Casey and me some privacy and we lied down together for a few contractions. I tried to breathe through them, which hurt so badly again (well, it had all hurt, but not pushing felt worse). Pretty quickly, however, the urge to push just intensified and I experienced the involuntary pushing I’d read about but never experienced. My body started pushing the baby down, in spite of my efforts to prevent it. It felt almost like throwing up, but in the opposite direction, and it was clearly a lot more effective (I may have finished dilating too in those earlier contractions) because we actually started seeing progress at that point.
I can’t remember the details, but I pushed in a few different positions and kept making slow progress. Casey kept asking Margy to give me feedback, because I was clearly getting exhausted and needed to be told that things were in fact moving along now. But it was so slow feeling compared to Rusty’s birth - with him, the first stage of labor was long but the pushing was relatively fast.
But I did progress, and eventually I dropped down into my favorite position (squatting between Casey’s legs while he sat behind me on the futon) and pushed as hard as I could (with contractions and still having the involuntary aspect too). The head finally crowned, and I pushed Pip out in several more contractions than Rusty. Here’s a photo of the final pushes:
This time I actually felt it all happening: the stretching and the ring of fire. So intense! And, then, Pip was out (at just around 12:30 pm on September 4 - 15 hours after labor began and seven hours after I thought I was in transition and that birth was imminent).
YES! And, when the baby came out, we learned why it had all been so hard and slow - Pip presented brow first AND posterior. Individually, those presentations both add challenge to a labor, but together they created what was clearly an extremely challenging pushing scenario. You can see the sunny-side-up face in this photo:
Pip was also very slippery - lots of vernix on the back and goop all over - with a shortish cord, making it super awkward to hold this little baby. It took me a few seconds of maneuvering before we found out the sex - a GIRL! Dorothy Raven! Dottie! That was a very sweet moment, and the midwives gave us some space and time to meet our little girl. I love this photos of us:
Labor - Stage 3. Woah.
Then it was time to get the placenta out. With both births, I was very aware that this was a critical moment in the entire labor scenario. The adrenaline of pushing brought clarity of mind and I was hyper aware of wanting to get through the third stage quickly so I could relax with my baby. With Rusty’s, it passed with no drama. This time … well …
After our bonding time (and a little bite of yogurt), Margy started tugging very gently on the cord to see if the placenta had detached. I did have a gush of blood, which we thought meant it was ready, but our efforts to gently tug and/or have me push didn’t move the placenta. Margy was concerned, so the birth team gave me a shot of pitocin in my right leg. I’m not sure when exactly it happened, but at some point in this, I stood up to try pushing the placenta out and felt faint (with more blood gushing).
Nothing changed, so they gave me a shot of methergine in my other leg. Still no placenta, but my cervix was apparently starting to close and Margy reached in to assess even as my uterus was trying to clamp down (more blood throughout all of this). She tried to manually remove the placenta from my uterus (OUCH!), but it didn’t move. I wasn’t sure what the words meant, but she and the experienced assist midwife who was there got even more serious, talked about “scapula” or “scraping.” And, then very quickly, they decided to “call.” “Call who?” I asked. I figured the hospital, but they were calling 911.
Meanwhile, I was lying back on the futon, and Casey was holding Dottie. The assist midwife picked up Casey’s phone to call, which is hard to use because all the buttons are caked with dirt from his pocket. Between that and having difficulty finding Margy’s supplies, she was getting visibly agitated. Casey helped her push “send.” Margy was palpating my uterus while the other midwife explained the situation to the dispatcher (which of course took several repeats to get the whole story out).
Casey called my parents to tell them what was happening - a hard phone call, I’m sure. It went something like: “Good news, Dorothy Raven is here. Bad news, Katie is going to the hospital.”
Within just a few minutes, there was a knock at our front door. It was so fast that Casey was annoyed, thinking it was an employee or something. In walked one of our neighbors, who is the coordinator for the volunteer fire department and an ER doc in Portland. “Hi John,” I said, as I lay sprawled, naked and bloody with my legs spread.
Even though it was possibly awkward, having John there was actually really comforting. He gave us the update on the timing of the rest of the EMT crew and checked in with Margy and me. Within another few minutes, a volunteer EMT showed up and started an IV in my arm (the midwives had started one just a moment before, but it wasn’t working for some reason). Then the ambulance crew showed up, and they got another IV going in my other arm and transferred me to a gurney (with Margy still palpating the whole time). Casey hovered in the background and kept catching my eyes and pointing to Dottie, as if to say: “Hey, this was the point. Look what you have to live for.”
(On a random note, they used a throw blanket and chux pad to transfer me because I was lying on them already and they also grabbed a pillow for my head - the blanket and pillow followed me throughout my stay in the hospital and managed to stay blood free!)
They wheeled me out to the ambulance (with Margy still palpating) and we went on a ride to the hospital with sirens, lights and all. I didn’t find out what everyone else was doing until later, but at that point, Casey went out and found my mom and Rusty at the swing in my parents’ yard. I missed my children’s first meeting, but Casey said it was sweet. He told Rusty that this baby was Pip, and Rusty said “ooh!” and wanted to pet her.
Casey, Rusty, Dottie, and my mom headed to the hospital in our car. Dottie’s first car trip was when she was less than an hour old! She hadn’t been weighed or carefully examined (although her first APGAR 9 at birth and 10 at ten minutes, so that was a relief), and her cord was still pretty long (Margy cut it much earlier when we were still trying to get the placenta out but it hadn’t been banded). Casey also just barely managed to get a diaper and blanket on her, so she traveled naked. He also grabbed the hospital bag I had packed “just in case.”
My dad (who is an anesthesiologist at the hospital) had called the hospital after hearing the news and got assurances that everything was being lined up for my arrival. He plays it cool, but I know he was really freaked out about all of this. He drove separately.
Anyhow, on the drive to the hospital I was weirdly chatty. I get this way when I am a patient - I have a strong desire to make my care providers calm, happy and comfortable. I make jokes; I smile. I think it is comforting to me to do this and it certainly helped keep me from freaking out about the fact that I WAS RIDING IN AN AMBULANCE ON THE WAY TO THE HOSPITAL BECAUSE PEOPLE THOUGHT I WAS ABOUT TO DIE FROM BLOOD LOSS. Among other things, I chatted about how it was a Dragon Year (in the Chinese zodiac) and how the last Dragon Year was 2000 and, man, wasn’t that a weird election year. Go figure.
So, we arrived, and I was wheeled in to an ER intake room (with Margy still palpating). Margy gave the update to the ER folks. My dad came in and checked in with me. Casey came in with Dottie, and I nursed her for the first time on the gurney while all of the logistics were being worked through. Miraculously, she latched and we had a sweet little nursing session, which really helped me relax about going away from her. Things were moving oddly slow, and then I had another big gush of blood that ran off the gurney onto the floor, and then everyone picked up the pace. The OB came in and introduced himself and we talked through the anesthesia options with the nurse anesthetist. We all decided on a spinal block, in part because I wouldn’t have to wait to nurse at all (as opposed to a sedative or something simpler). Also, I had eaten that TINY bowl of yogurt immediately after the birth, and they were worried about the risk of aspiration under a different kind of anesthesia.
Eventually, I was being wheeled down the hall by a super nice nurse with a vaguely comforting British accent. I was wheeled into the OR, where they started prepping me for the spinal and the procedure. I had hoped my dad would come be with me, but apparently he was uncomfortable with that, so instead he paced outside the whole time. Everyone was really nice, and I managed to stay eerily calm and chipper. The spinal went in without a hitch, and the OB manually removed the placenta after several minutes of hard work. Apparently it was still very attached on one part - there was nothing unusual about the placenta that came out, so why this happened is still a mystery.
All in all, everyone estimated my blood loss at about 1500 cc, or just shy or half a gallon (which is a unit that I understand better). I only ever felt faint once (except again once in recovery), but obviously the big danger all along was that I would have a big bleed. Everyone was prepared for a blood transfusion at every step, but I did well - even in the moment of the transfer, I was very grateful for my unusually high iron counts (I am not even remotely anemic) and general good health because I needed all my reserves for the birth and everything that happened after.
Immediate post partum
After removing the placenta, the OB also stitched me up because I had second degree tears from the delivery. All in all, it sounds like the tearing and stitching were no more significant than with Rusty, which is probably in part because I was forced to push Dottie out slower and consequently stretched better.
Then, they wheeled me to recovery. I had some idea I’d be in recovery for two hours, so this was a harder wait for me. The recovery room nurse came and went, and it was dim and boring, and I finally had a calm moment to realize what was happening. I can’t say that I really processed anything in that moment, but it really was the first time everything hit me. My dad did visit me then, which was nice. Because I was fine, I left recovery much sooner than I expected, and the hospital sent me to a room in the birthing unit - in part because the plan was to have me stay overnight and I wanted Dottie with me, but also because I HAD just had a baby and was still very much in immediate post partum mode.
Casey and Rusty met me in the hall, and I guess I looked awful, because the sight of me really disturbed Rusty. I tried to be chipper and calm and reached out to him. Casey put him in the bed next to me, and he got really upset. He did not like what he saw. My face was pale, bloated and covered in broken capillaries and I had a bunch of tubes everywhere. Yeah, pretty disturbing.
As soon as they got me in the room, we took out the oxygen, which helped calm Rusty somewhat. So I held Rusty on my left side and then finally I got to hold Dottie again on my right side - my first time holding both my babies at once, in a hospital room:
I wanted to nurse Dottie again, and Margy helped me get her latched since I was pretty reclined and awkwardly hooked up to bunches of tubes and things. Once again, she latched well - so wonderful to have some important things go well amidst the chaos!
My parents were there, along with my midwife. All of us went into two modes: baby worship and debriefing the incident. It was a happy mood, because I was in the clear, but obviously we were all keenly aware that the transfer was a rare and scary event - one that none of us desired or expected ahead of time, obviously. Margy’s assistant Rosemary showed up soon after with some supplies from our house (blankets, food, my purse, etc.) and joined in the talking (before that, she and the other midwife cleaned up the bloody “crime scene” that was our house).
(All along, I felt bad at everything Rosemary witnessed - a hard labor and then a dramatic transfer - because she is pregnant with her first and due in October. When Margy was still trying to get the placenta out, Rosemary was holding my legs up as in stirrups and had a front row view of the gore of my blood. I’m sure she’ll have her own processing to do before her birth. I told her later that I “took one for the team” with the combination of rare challenges I had, and so obviously her birth would be quick and uneventful.)
At 6:45, we finally had a moment to do the newborn exam and cord finishing. Dottie weighed 9 lbs 1 oz -- almost a pound more than Rusty at birth! Woah!
The hospital initially wanted to keep me overnight for observation, but the OB agreed to let us go before midnight if I was doing well. Eventually, everyone had cleared out (Rusty went to stay overnight with my parents for the first time), and Casey and I settled in to get me well quickly. My dad brought back some chili that I had thawing at home, and Casey spoon-fed me bits of beef. I also ate some hospital chicken soup that was ridiculously delicious, given how unlike our normal food it was (I think I was hungry!).
Eventually, I got up to pee for the first time, and that was my first test. They took me into the bathroom in a wheelchair and then had me walk back out to see how I did (with two nurses spotting me). I did have ringing in my ears just as I got back to the bed, but when I did it again an hour or so later, I made it to and from the bathroom without any obvious signs of faintness. I did feel very weak, but not faint. Around 9 pm, they took some blood to check my blood cell count. It was low, but the OB discharged me anyway. Casey, Dottie and I hung out a while longer, because we were sure that every hour would add to my strength. We finally left to go home at 11:30 pm.
It was lovely to return to a clean house. Casey made up the futon bed again with the clean sheets, which is where Dottie and I tried to sleep (I got some sleep, but it was late and Dottie was past her initial just-born sleepiness and wanted to suckle all night). Casey slept on the floor. But, finally - FINALLY - we were home.
Here’s a photo of me with my babies, at home, from the next day:
And, Dottie on her own:
More observations on the birth & Dottie
* So, the biggest two QUESTIONS begged by this birth are: will we have another child? And, if so, will we birth at home again? At the hospital, I assured everyone that we would NOT be having more children, but of course the next day as I gazed at Dottie’s tiny soft shoulders, I reconsidered that idea - or, at least, put the decision off for a while. But, either way, there’s no question that my feelings about home birth have been sobered. It isn’t that I’ve “lost the faith” - not by any means. When I think about what the same birth scenario would have been like in the hospital, it sounds just as hard and there would have been much of the same drama (minus the transport of course), or possibly more. My situation was really an example of a home birth that went RIGHT - as in, I chose competent midwives who were able to take quick and appropriate measures, and we had planned well for transport ahead of time (and I had even weighed the risks of our rural location, and felt ok with it because of things like the proximity of our ER doc neighbor). But, of course, to many people, it will not be a good example of a good home birth - people like to hear about home births where everything is textbook, beautiful and magical. This birth was not any of those things. Regardless of my own opinion or judgment, I also don’t feel like I will be able to talk about home birth in the future without telling people the full story (i.e. the transfer). Again, even without me adding anything to the facts, my story is sobering. And, if we DO have another child, choosing where to have the birth will necessarily be a really big, complicated decision. My parents’ willingness to be respectful of our desires may have been stretched to this limit (and this matters, because we live next door and are very close). And, I may have a lot more anxiety about birth next time too. Clearly these are things to address if/when that situation comes up, but I know I’ll be chewing on them a lot in the near future too (and anytime birth comes up).
* Having had an unexpectedly hard, complicated birth has given me a lot more understanding of birth in general. I have this very deep sense of how PROFOUND it is to give birth, regardless of how or where. I know that we natural birthers do all sorts of birth art and hypnosis to convince ourselves otherwise, but birth is scary. It’s a really big deal. I am reminded of that now in these days right after, when it is all fresh. I have so much respect for all women who have given birth. We are amazing. We are so strong. Where does this strength come from? Is it from our love for our children? Some cosmic spirit? It’s awesome (in the original sense of the word). I am in awe of birth and its force.
* While I am sad about how things went down (who would choose that presentation or the placenta retention?), I still do feel very empowered by the first part of the birth - getting Dottie out! I think there is a tremendous different in the emotional fallout of transferring after the birth rather than before. As it is, I feel very accomplished. Also, I was grateful all along that we were transferring because of ME rather than DOTTIE. It was easy for me to stay calm, because I knew how my body felt, and I did not feel about to die.
* In retrospect, two other factors made the birth and transfer a lot less traumatic feeling for me. The first is a simple thing: I had already taken my contacts out for the night and didn’t bother to put on glasses until after I was out of recovery, so I had blurred vision for the entire birth, transfer and time in the OR. I really think it helped keep things just a bit surreal and less overwhelming. It also helped that I never could see the expressions on people’s faces and wasn’t able to pick up as easily on their stress. On a more profound note, it was amazing to be transferred living in such a small community. And, of course, my dad works at the hospital where we went. At every step of the way, I was cared for by who I actually knew, or who knew of me, or who I knew of before. There were connections already in place, and I really felt like I was being cared for as a person. As an example, in the ER intake room, Casey told the folks that we wanted to take home my placenta. Since this is an unusual request, people wanted to make sure it was followed, and so it kept coming up. I would remind someone, or someone else would note it to a new person who’d come into the OR, etc. It was somewhat humorous actually how many times it came up, but it helped me feel like I was being honored throughout the process.
* Being the mother of a daughter already feels like a different kind of responsibility than being the mother of a son. The world seems harder and scarier for little girls - there’s so much I already want to protect her from (especially some crazy cultural and material girly stuff). But I’m also so excited about (hopefully) having a mother-daughter bond that will last my lifetime. I know that these relationships can often be strained or drama-filled at times, but it seems like daughters tend to stick closer and lean on their moms more. I don’t know, that sounds nice.
* Life does go on. I’m four days out and feeling so much more human. The first two days were really hard. I felt like I’d been hit by a truck, but I’ve been taking it easy (or trying - life on the farm has been crazy stressful this week) and even got some fresh air. My milk came in just fine. I do still have some mysterious butt weirdness, but overall I feel like I am recovering well and in due time. We've had amazing support from friends and family, which helps a lot, especially because parenting two is challenging (especially when in recovery). I look like me again too:
* Once again, I am so grateful for my birth team. This is a vast understatement.
* Casey is my rock. In every way. An amazing father. An amazing man. So strong. I love him so much. Another vast understatement.
* It was hard. So hard. Unbelievably hard. And, now that she’s here, it was totally worth it. <3