Why You Might Want a Natural Birth.

It's been so long since I've blogged.  I miss it.  And I haven't.  I've been quite present online, whether on diaperswappers or Facebook's newsfeed or various forums or discussion boards, or Instagram or craigslist... to the point of having to seriously limit myself.  But blogging, not so much.  I've been seldom opening the computer between one thing & another (smart phone, hello!), and when I do it's usually for a specific task, like DOULA CERTIFICATION COURSEWORK!!!!  (might be slightly looming over my head)  All that to say, I do have a few posts rolling around in my head-- mostly ones that will be helpful to my expectant mama clients.  It's on the brain, what can I say?  If you choose to read this, please know that I am NOT in any way suggesting that those who go a different route-- whether by choice, happenstance or emergency-- are failing, stupid or "wrong."  I'm simply trying to explore the rationale behind the choice, since you know we get asked it! :)

Childbirth-- it's a big deal for most women.  It's something they either look forward to, fear, find inspiring, find intriguing, or find disgusting.  Or, more likely, all of the above in varying degrees.  Movies portray it as a scream-fest involving a scared husband watching his wife being wheeled away as the doors slam in his face, her threatening divorce until she gets an epidural, then sneezing and popping out a pink clean chubby baby (and all the moms say "no way is that a newborn").  Why would anyone want to endure THAT unmedicated??  Isn't it so dangerous, so painful?  I mean, didn't women DIE all the time from childbirth a hundred years ago?  Well... not exactly.

There actually are several reasons why mothers might chose a natural birth, despite having access to medication & technology.  Here are a few I thought of, in no particular order:

1.  God is smart.  He designed birth, and it's a complex, intricate, miraculous process that even the best doctors don't fully understand.  From what begins it to the hormones that regulate it to the way various organs in both baby & mom change radically throughout the process, it's just really really cool.  For thousands of years, women have given birth.  What about the Curse, you ask?  Didn't it mess up childbirth?  Well, yes, women's main role-- as relational care-givers-- is now hard.  But the pain in child-bearing extends far beyond conception, labor & delivery.  It's just as seen in rebellious toddlers, in horrific accidents taking teenagers, and in sending your dearly beloveds off to take their place in their own families.  We mothers will always suffer in so many ways.  But pain & death doesn't summarize motherhood any more than sweat & frustration summarizes work (the arena where men were cursed)-- and neither does it summarize childbirth.  Yes, things can go wrong there, and yes, there is much that we humans can do with the intelligence God has given us to intervene skillfully when those things do go wrong (placenta previa, shoulder dystocia, maternal hemorrhage, etc), but, just as in the rest of life, stuff usually goes the way it's supposed to go.  Great sermon from John Piper on the suffering of motherhood.

2.  Women's bodies were made to birth.  Not only do we have all the right organs, we have all the right hormones & instincts.  This is the fundamental difference between [most] OB/GYN perspectives and a midwife's:  the former views pregnancy/labor/birth as one of many pathologies of the female reproductive system that must be "treated."  Midwifery views it as a natural process, and trains practitioners to watch for warning signs of problems & otherwise just empower women to labor on their own.*  I'll briefly touch on a few aspects of the intricacies of birth:
- the hormone cascade, in which oxytocin (mood-altering bonding hormone & pain killer), prolactin (milk-making hormone), adrenaline (strengthening hormone) and beta-endorphin (opiate & analgesic) all are precisely released.  There is no way to artificially mimic these-- synthetic versions can't cross the blood-brain barrier so can't act as pain-killers, and once the cascade is interrupted  it's difficult to get the train back on the rails, so to speak.
- the beginning of labor itself, which I've blogged about before.  Pregnancy generally lasts longer than the 40 weeks we've come to expect (especially in Caucasian first-time mamas).
- position & its effect on pushing, which is far more instinctive than we Westerners tend to think it can be.  Laying flat on your back is probably the absolute worst way to push, yet if you are medicated & monitored, catheterized and hooked to an IV, it's about the only way you can push.  Women who are unmedicated and thus in tune with their body's instinctive positioning will usually choose to push in a crouched, standing, hands-and-knees or squatting position.
- baby's rotation as it descends, which can be affected by Mom's position while in labor.  Again, an unmedicated mom will be in tune with what she needs.  Here again laying still on a bed is not helpful.  The "wrong" position will be agony, the most helpful will provide relief.
Recommended reading: Ina May's Guide to Childbirth, by Ina May Gaskin

3.  Birth is empowering.  Just like people voluntarily climb mountains, bike across the US, and run marathons, so there is joy in physically, mentally & emotionally "pushing yourself" and seeing just how far you can go.  The bear went over the mountain, why?  To see what he could see!  And probably, to see what he could do.  When women are properly supported in labor, they are admired, affirmed, and encouraged, perhaps like never before in their lives.  They are doing something unique that no one else can ever do:  bring forth that child into this air. The incredible endorphin rush after birth had me saying, seconds after my daughter emerged after 45 hours of labor "let's do that again!"  I have never forgotten the incredible sense of accomplishment and thrill I got from birthing each of my children!  Anything worth doing is hard, and we know that deep in our bones.  After my first natural birth, I felt inducted into the kinship of all the mothers before me, including my own mother, grandmother, and even that teenaged girl laboring in a barn in 1st century Palestine, bringing forth my Savior.

4.  Human imitation is always, at best, just a mimicry-- with plenty of [often unforeseen] pitfalls & side effects not present in the Original.  Think margarine instead of butter, aspartame instead of honey, 'ostomy bags instead of colons... The more we know about birth, the more we realize we don't know about it... and the more amazing it is that so many babies/mamas emerge relatively unscathed in all the impositions various centuries have tried to force on it (Victorian diets of crackers & water & indoor confinements, restrained "twilight sleep," among others).  There are pitfalls & risks at every stage of intervention, from induction (lots of aspects of risk here, from autism to use of pitocin to accidental prematurity), to restriction of food/water intake due to IV use, to use of artificial hormones (pitocin, cervadil), to use of drug-analgesics (such as epidurals), to guided pushing, to use of forceps, to use of surgery.  We simply don't know the long-term effect medications have on infants who receive them (many studies suggest that it's not good), and it's well-documented that epidurals are hard on babies during delivery, and that's just the tip of the iceberg.  Recovery & long-term health for mom, future pregnancies, health of baby, mom & baby's early relationship, all can be affected by interventions. Recommended reading:  Henci Goer's Thinking Woman's Guide to Better Birth. Recommended watching: The Business of Being Born

5. The skills found in natural labor are very beneficial in other areas of life.  Learning to manage pain, to work through physical exertion, to relax & focus despite circumstance, to keep outcome in mind despite process-- these are all very useful!  Labor can be a tremendously powerful unifying agent to husband & wife, sister & sister, mother & daughter, too.  There is something sacred about any birth, and natural birth is particularly beautiful to be a part of.  Spiritually, I learned to trust God for strength in the moment in a way I'd never had to do before.

6.   Pain is not the problem; suffering is.  There are other ways of managing pain besides drugs-- to either minimize, remove, manage, or remove it from the foreground of experience.  This is a crucial point to make.  While I accept that pain may be a part of most women's labor, just as it is in pretty much any other intense physical feat (distance running, team sports tournaments, weight lifting...), suffering can be avoided.  Those of us who birth without pain meds don't like pain.  We just know that some pain can be managed, gotten through, used-- and true suffering can be avoided.  Some methods include:  hydrotherapy (laboring in a deep tub of warm water is called "the midwife's epidural" for good reason!), aromatherapy, massage, position, use of a rebozo (shawl/sling), emotional support, internal focus, self-hypnosis, sterile water injections, movement (slow dancing, belly dancing, walking, swaying, rocking), and controlled vocalizations.

Mamas who've done this, what would you add?

*Note:  notice how OBs usually talk about "delivering a baby," or even "delivering her of a baby" while midwives usually speak of mothers "delivering their babies."

Joy in Our Hearts-- Lots of It

I listened to music while laboring with both my babies. With Eowyn, the song I most remember (the one playing as she was born, actually) is Sandra McCracken's "Close of the Day"-- fittingly a song about all the simple blessings of life -- "close of the day/ fireworks and rain, feels like a holiday/ unburdens my frame"-- as well as the deep blessings of the Gospel-- " the marks of my name/ torn into Your Hands" --with the refrain "and this is not what I deserve." Really perfect to remember as I contemplated the joy of bringing forth a child contrasted with the Hell I'd have earned myself with all my sin, as well as the far greater pain He went through for me!

Anyway... the song that will always remind me of Liam's birth is Sara Groves' "Joy is in Our Hearts." It's got a great tempo, great contemplative, calm, intense vibe that is perfect for the work of labor. And the words... wow, the words are great for the discomfort, pain and trial of waiting that is the last stage of pregnancy and all of labor. It's also been perfect for me as a new mom full of fears: once you've been given such a precious gift, it's easy to fall prey to the temptation that it will be taken from you. This song helps me remember that even if I lost my little son or worse, I would have Christ, and Him for all eternity!- and that would be reason enough to sing for joy. This song was written, I think, with the persecuted church in mind.

 I pray this little montage encourages you! I get teary just watching it. :) Pregnancy and labor are good for my spiritual condition. Which means we'll probably be having more kids.

"Joy Is in Our Hearts"

"We were pressed on every side,
Full of fear and troubled thoughts;
For good reason we carried heavy hearts

"It is good to come together
In our friendship to remember
All the reasons hope is in our hearts:

Hallelujah! Hallelujah!
Christ our joy and strength!

"Now with patience in our suffering,

Perseverance in our prayers,

With good reason this hope is in our hearts:
Hallelujah! Hallelujah!

Christ our joy and strength!

"Oh, we saw the face of angels--

Many good things well-secured

For good reason this joy is in our hearts:

Hallelujah! Hallelujah!

Christ our joy and strength!

For good reason joy is in our hearts."

The Birth of our Firstborn Son

Ponderously-Cheeked Pondering

  For all of you wanting the short-and-sweet version, here you go:

William Christopher barreled his 10 1/2 lbs into the air at 11:07 Sunday night, June 24th, 2012.  This fulfilled his daddy's wish for a birthday full of multiples of 6, and his mommy's prayer for a birth far quicker that his sister's.  Speaking of Ryan, you can read his account of the story here.

For those of you wanting DETAILS, ta-da!:

William's birth story begins with my 41-week prenatal visit the previous Thursday.  Measurements showed that I was measuring 42 cm (consistent with a 41-week gestational age estimate), and I continued to display all the signs of imminent labor, from strong frequent contractions to the passing of my mucus plug to loose bowels and an unsettled stomach to a totally dropped baby.  But for whatever reason, I had yet to experience the regular, strengthening contractions of "active labor."  My midwife encouraged me to think and pray about using some herbal means of induction if nothing got started on its own, using her decades of experience.  Her theory was that because I was carrying Liam so far "out there" that gravity was actually working against the contractions-- which were trying to bring him in vertical alignment with my very-posterior cervix.  This would explain why I had so many of my strongest contractions at night or in the car, but why they tended to stop when I stood or walked for long periods of time.  She counseled me to wear my belly band at all times.

Ryan requested a weekend induction attempt, and we had a wedding for a family friend that I wanted to attend on Saturday, so we decided that-- if we attempted to kick-start things-- it would be Sunday.  I was still quite unsure about meddling with the natural order of things, so I was researching and praying and re-calculating my due date, and looking at Eowyn's birth records.  What I found was that the herbs my midwife was recommending-- blue & black cohosh-- would not force a labor on an unready cervix or baby, but would rather help coordinate the efforts my body was already naturally making.  When Saturday brought several hard contractions that petered out true to form, and Saturday night proved particularly un-restful and frustrating, I decided that my body had had enough of this pre-labor (it'd been going on in full force for over 2 weeks... 2 weeks of frequent contractions, many nights of nearly no sleep, stomach upset, etc.).

Black cohosh ("snake root") stimulates uterine contractions.  Blue cohosh ("papoose root"-- Native Americans used it in labor extensively) actually calms the uterus, so is useful in stopping preterm or Braxton-Hicks contractions (wish I'd known this about a month ago!).  Taken together the two work to augment and streamline labor.  They are most effective when contractions are already present.  Check!  Normally my midwife recommends a castor-oil cocktail to start contractions, and then uses the herbs, but since I was already contracting, we agreed to start with just the herbs.  (I've heard too many negative things about castor oil...)  So at 10 o'clock Sunday morning, I put the first 2 1/2-droppers of the cohosh tinctures under my tongue.  OOOOOHH talk about burning!!  The tinctures are dissolved in alcohol... so I was popping the gum to make sure I didn't smell like a distillery at church, hehehe.  Every subsequent hour, on the hour, I took a full dropper of each.  Ideally, tinctures are taken under the tongue for fast absorption, but... you try holding whisky under your tongue some time.  By 4 pm I was putting the tinctures into a few ounces of pineapple juice (also good for labor induction).  Contractions were certainly coming but were all too true to form:  irregular.  I tried not to be discouraged as we settled in to our family nap.

I awoke at 4 to a strong contraction.  I tried to rest after that, but noticed that every 20 minutes another contraction came.  They were consistently strong, too.  I tried timing a few and they were about 90 seconds long.  By 5, it was time for my next tincture dose, so I called my midwife & asked if I should keep taking them or wait and see what my body would do on its own.  As contractions were still coming, Mereinda recommended I stop the herbs.  As time progressed, I began to have to "work" to get through the contractions, blowing or saying "oooh" in a deep tone.  Eowyn woke up and needed watching and I had a hard time focusing on her as contractions took more and more concentration.  Ryan woke up and took over Eowyn-duty, explaining that "Mommy's belly is getting really tight, so she makes noise to help it hurt less."  Eowyn accepted this.  I was still reluctant to call my aunt Olga- who would be watching Eowyn- or my Mom- who would accompany us to the birthing center, fearing that this was yet another false alarm.  It wasn't until Ryan pointed out that I hadn't had to vocalize through any of my other contractions that I realized something was different.

At 6 we called in the troops.  I ate some yogurt & started a bowl of cereal, and stayed glued to my birthing ball.  Unlike with most labors, an upright position slowed my contractions (gravity pulling Liam forward instead of down), so sitting on the ball or bed helped keep them intense and regular.  They were 6 minutes apart, then 5, then 4, still lasting 60-90 seconds.  It was a while before my aunt could make it to our house, but thankfully my mom arrived and was able to take care of Eowyn (and wash our dishes =D), since I now needed Ryan to support me through contractions.  He rose to the occasion beautifully, doing his reading in Ina May's Guide to Childbirth justice. I texted some close friends, asking them to pray that this was the real thing, and for a safe (and short!) delivery... while confessing that a part of me wanted to stop the whole thing, because it was starting to hurt!  As Eowyn came to kiss me goodbye, she asked "You not feeling good, Mommy?"  "It's ok, baby girl." Then, with utmost sincerity, "Jesus will help you!"  That comforted my heart.  :) Then she was off, thrilled to be spending the night with some of her favorite people.

We headed to the birth center around 8:30.  I'd tried to hold out a bit because I knew my midwife's son's 18th birthday party was going on, but the labor tub started to sound too appealing to miss.  She tried to check me when we got there, but laying on my back was agony, bringing a seemingly unending contration, and my cervix was still posterior.  By my demeanor and the sounds I was making, she estimated me to be at about 5 cm dilated.

I cannot tell you what a difference that labor tub made.  I will never- NEVER- labor without one again.  I'll stand on my head to stop contractions if I have to. :)  Slipping into the warm water was so comforting.  I told Ryan, "It's actually quite delightful between contractions!"  Mereinda advised me to labor as much as I could leaning back, to try and bring Liam's head over my cervix instead of its current place of low but in front of it.  I could not have complied were it not for the tub.  In the tub, the water's buyoncy provided counter-pressure, supported my legs so I could let them float, and kept the baby's head from jarring against my tailbone as he descended.  Contractions were never pleasant, but they were bearable.  Labor really began moving along.  I entered the slightly-out-of-mind-state of moaning, praying, etc., through a contraction, and then nearly falling asleep.  Ryan kept reminding me to relax my hands, to have loose lips, and my doula-training kept me keeping my tone low and to relax as much as I could (hah- NOT natural for me!).  I told Ryan that these contractions felt more intense than the ones I'd had with Eowyn, and he was surprised, since he thought I was handling them much better.  I count the tub & my doula experience for that.

I began to get unbearably sleepy around 10, telling Ryan pitifully after a contraction "I just wish they'd stop so I can go to sleep...I'm so so tired."  Mereinda immediately began trying to get me to eat, but the most I wanted was a few bites of very soggy cereal, so she pushed the gatorade, saying she was concerned about my energy level.  This did perk me up a bit.  I tried a few different positions, but mostly labored on my back.  When I had to get out of the water to use the bathroom, contractions would become far worse.  Even in the water, a few times it felt like someone was taking a hacksaw to my back.  Ryan would provide counter-pressure, rub my head, encourage me, and keep me drinking water.  A few times I was overwhelmed by contractions, having to work very hard to keep any semblance of control, crying out loud to Jesus for strength, and talking to William "move down, baby!"  I remember also repeating "the baby-- I want to see the baby."  A few times I told Ryan I didn't want to do this anymore, or just cried that it hurt.  My first successful cervical check came at 10:45, when I was declared to be 7 cm dilated, with a fully anterior cervix, & a baby ready at +1 station.  I just want to take a second here to praise my midwife's compassion and skill-- she was constantly assessing my progress based on how I sounded, how I described my pain, and how I looked, NOT using monitors and numbers (though she regularly checked William's heart rate with a doppler.). Her voice was reassuring and kind, even as she gave me instructions or recommendations.

By now I knew I was in "transition."  Contrations became closer together, longer, with a more intense peak.  At least I knew I wouldn't have to deal with them long. With Eowyn, I'd had my water broken at 7 cm, and only labored 4 more hours.  I decided to hold off on breaking my water since I hadn't been laboring all that long. Not 15 minutes later I told Merienda that I was feeling "pushy."  She checked me again (can I say how much better being checked is in the water??) and announced that I was nearly complete, with only a tiny little bit of the cervix left in front.  The very next contraction I shouted "I'm pushing and I can't stop!"  Pop!  With a feeling like a water balloon untying, and a burst of fluid, I broke my own bag of waters for the first time. That was a good feeling. :)  Merienda took one look at the water and said "there's a bit of meconium in the fluid, so in case we have to suction him, I'm going to need you to deliver on the bed.  I know it's going to be hard to get out and move, so just give it every bit of strength that you've got!"

Moving wasn't too bad.  I made it to the 4-poster bed, collapsed onto my left side, and immediately started having pushing contractions.  It was absolutely surreal, like a typhoon was sweeping through my body.  I began to roar like a mama dinosaur as the only way to stay somewhat in control.  "Slow it down! Pant a little bit!  I don't want you to tear."  "I'll try!"  The midwife's assistant, Carrie, showed up just in time.  I was on my left side with Ryan holding my right leg bent and at a 90 degree angle.  Mom was at my head, stroking my hair and holding my hand.  I buried my face in the covers and gave unbelievably strong pushes as the contractions swept through my body.  The pushing contractions were nearly continuous, and I found strength and energy in abundance to push along with them.  I only really remember stopping and breathing between 2 of them (there were about 5 total).  Suddenly, there was pressure and a burning and the words "he's crowning!"  Ryan told me "I can see our boy!"  Then they told me to wait a minute as they checked for a chord around his neck because his head was out!  No cord, but he did have a little fist tucked right under his chin.  It felt like a vat of snakes writhing in me as the midwife's assistant swept her fingers around and pulled his little hand free.  Another huge long push, and my son's body slipped into the air.  Seven minutes after I'd started pushing-- 25 after I'd entered "transition"-- and what struck me as a purple giant squid was plopped on my chest. "Thank you, Jesus!  Oh, thank you!" Not having seen him emerge at all, having had no time to process his arrival, it was totally surreal.  In a daze I marveled at his huge hands. "He's so big!" and "I can't believe he's actually here!" were two phrases I kept repeating.  I think we were all a bit in shock.

Mom & Ryan immediately began rubbing him down as I called to him and the midwives tapped his feet, trying to get him to take his first breath.  He never really cried but instead gave a little gasp and protested our efforts a few times.  He started pinking up right away.  We waited a good 10 minutes to cut the cord, and I was relieved when it was finally cut because I was so swollen and tender that even the light pressure of the cord on me was abrasive.  I was overjoyed to learn that I needed NO stiches, only having a tiny tear from where his hand had had to be pulled out.  The little munchkin had been sucking his fist throughout all of labor, which accounted for the spots of awful back pressure I'd felt:  his hand pressed against my tailbone.  He is very attached to his hands. :)

He came out pooping and pooped on me another two times before his first half-hour of life.  He started to nurse fairly quickly, too.  When it came time to weigh him, Merienda laughed that she knew she wouldn't be able to hold the spring-scale high enough to get a reading, since she's short and she knew he was a chunker.  This meant that the proud Daddy got to weigh him, and I was shocked as the scale pulled down past 10 lbs...4, 5, 6 ounces!  Yet another benefit of the tub:  the water softens your perineum so much that tearing is far less likely, as my large baby with a neuchal hand demonstrated.  He was 22 1/4" long, with a 14" head (quite molded though).  "There is no question that that is a 41-week-old baby!" my midwife affirmed, and I knew I'd done fine to use the herbs.

I got everything I prayed for:  a face-down baby, a non-marathon, unmedicated labor, minimal tearing, trustworthy & knowledgeable birth attendants, a supportive husband who was with me the entire time in every sense of the words, and a healthy baby boy with every sign of looking like his Daddy-- from the dark hair to the Szrama dimpled chin and perfect bow lips.

Two hours after the birth, with my mom's home cooking in my tummy and the clearance from my midwife, we were headed home to sleep in our own bed.  In our bags were several goodies, like goldenseal capsules to dry up Liam's umbilical stump, and an herbal sitz bath formula to use as a peri-wash.  I really respect everything our midwife recommends, as so far every bit of her advice or recommendation has proven absolutely right on!  Guess it comes with that whole decades-long-practice thing... :)  We could not have had a better experience, nor more highly recommend Merienda and her birthing practice, Upstate Birth Center.  There is something so empowering about feeling total freedom in your own birth-- the freedom to eat, say, cry out, position yourself, do, or not do whatever your body tells you or your best research recommends.  Psychologically it's amazing.  Even Ryan kept commenting at how refreshingly different this experience was from our hospital birth experience with our daughter-- and we had a totally positive experience there, too!


"Do I bring to the moment of birth and not give delivery?" says the LORD. "Do I close up the womb when I bring to delivery?" says your God."  (Isaiah 66:9)

"Every good and perfect gift is from above, coming down from the Father of the heavenly lights, who does not change like shifting shadows."  (James 1:17)

Group B Strep- What's Up with That?

Around 35 weeks of pregnancy, most women begin hearing the initials "GBS."  Standard protocol in the West is to have a pelvic exam that includes a swab which is tested for the presence of "Group B Strep," a bacteria that many of us carry around in our bodies in various concentrations at different times.  If a woman is "GBS+," meaning that she has Group B Strep bacteria colonizing her birth canal, she'll be told she will have to have IV antibiotics (usually one in the penicillin family, most often ampicillin) every four hours during labor and delivery, to keep her baby from getting a Group B Strep infection.  (Moms allergic to penicillins will likely receive vancomycin, cefazolin or clindamycin, depending on their care provider & situation.  These aren't as effective as penicillin & have their own risks.)  If a mom comes into the hospital too late or progresses too quickly to get the antibiotics, the babies are usually given antibiotics and have several blood samples drawn to ensure they aren't infected. Signs of early-onset Group B Strep infections in newborns include: fever or abnormally low body temperature, jaundice (yellowing of the skin and whites of the eyes), poor feeding, vomiting, seizures, difficulty in breathing, swelling of the abdomen, and bloody stools.

With Eowyn, I was tested and was GBS- (I didn't have any Group B Strep bacteria colonizing me at the time), so it wasn't an issue.  This time around, I had the option to not have a GBS test done, as well as having an interest as a doula in the issue.  So... I set off researching.  First off, I wanted to know the risks of having GBS and not being treated.  Second, I wanted to know the risks of standard practice (IV antibiotics to all GBS moms).  Thirdly, I wondered if there were more selective, less invasive means of treating GBS (if it needed to be treated), both before birth, and after birth.  Lastly, I wondered what steps could be taken to help babies and moms treated in the standard way.  Here's what I've found out!

First off, I wanted to know the risks of having GBS and not being treated.  
About 10-30% of all women have GBS colonizations (and generally have no symptoms). I'll use 25% as a steady figure:  1 in 4 moms are GBS+. According to CDC estimates, without treatment only 1-2% born to moms with GBS will become infected (2% of 25% is 0.5%, or 1 out of 200 babies), and of those, 6% will die.  So death is a risk of about 3 in 10,000 babies born to GBS+ moms with no treatment.  Infections in newborns are never good things-- GBS infections affect the brain, spinal cord, or lungs.  The risk of a baby getting a GBS infection goes up if the mom has a long labor (18+ hours with water broken), a fever above 100.4 in labor, or goes into labor before 37 weeks.  For perspective, about 1 in 150 of all delivering moms in the US will have some form of placental abruption, and 1 in 300 will have a prolapsed umbilical cord.

Second, I wanted to know the risks of standard practice (IV antibiotics to all GBS moms).

my belly at 35 weeks

IV antibiotics are a pretty big gun to pull out, as they kill bacteria that we need.  Not only are there thousands of beneficial bacteria in our bodies, they are all over our bodies!  They help us digest our food all along the digestive tract, they act as our immune system's main line of defense, they are our main source of Vitamin K, they keep harmful yeast and bacteria in check on our skin, in our guts, in our ears & sinuses, in our urinary tracts, and in the female reproductive tract.  Wiping them ALL out is pretty drastic-- we've heard a lot about the dangers of overusing antibiotics lately.  From yeast infections to weight gain to chronic gastrointestinal problems to super bugs, killing off all the little guys in our bodies opens us up to a whole new can of, umm... bacterial worms. :)  New babies especially need to receive a healthy dose of bacterial flora as they journey into the world, so that they are able to digest food properly and begin to form their own defense mechanisms against pathogens.  They get this through their eyes, nose, mouth, and skin as they are born, and later through breast milk. If they are born to a mom whose bacterial eco-system has just been severely thrown off-balance by antibiotics, they aren't going to be able to get that colonization, and it will take weeks for her breast-milk to return to normal --provided she doesn't get a yeast infection in the meantime.  What about the baby who is born during IV antibiotics who is also formula-fed?  Has anyone ever tried to nurse with thrush (a yeast infection)?  NOT FUN.  Obviously, the risk of dying from an infection is more severe than the risk of starting off life with bacterial imbalances, but if the risk of dying of infection is so low in the first place, yet a fourth of all moms and their babies are being put on IV antibiotics, it bears considering.

Another, more dramatic risk of the antibiotics, is the risk of anaphylactic (allergic) reaction-- this can happen even if a mom's never reacted to a drug allergically before, at about a 1 in 10,000 rate.  These cases put both mom and baby at a very real risk of dying.  I'll quote again from an overview of the topic in Mothering magazine:

"We can compare this to CDC estimates that 0.5 percent of babies born to GBS-positive mothers with no treatment will develop a GBS infection, and that 6 percent of those who develop a GBS infection will die. Six percent of 0.5 percent means that three out of every 10,000 babies born to GBS-positive mothers given no antibiotics during labor will die from GBS infection. If the mother develops anaphylaxis during labor (one in 10,000 will), and it is untreated, it is likely that the infant, too, will die. So, by CDC estimates, we save the lives of two in 10,000 babies-0.02 percent-by administering antibiotics during labor to one third of all laboring women. We should also keep in mind that this figure does not take into account the infants that will die as a result of bacteria made antibiotic-resistant by the use of antibiotics during labor-infants who would not otherwise have become ill. When you take that into account, there may not be any lives saved by using antibiotics during labor."  (emphasis mine)

** The linked-to article is very helpful, and is a GREAT starting point to thinking through this issue!  Every GBS+ mom should read it and use it as a jumping-off point-- there are plenty of citations to journal articles and scientific studies that bear reading!**

A final risk of the routine IV treatment is non-GBS infections (often anti-biotic resistant), especially E. coli infections.  
A study published in 1998 on the effects of the use of ampicillin before delivery concluded that:

"The increased administration of antenatal ampicillin to pregnant women may be responsible for the increased incidence of early-onset neonatal sepsis with non–group B streptococcal organisms that are resistant to ampicillin. At this time penicillin G, rather than ampicillin, is therefore recommended for prophylaxis against group B streptococci. In addition, future studies are needed to determine whether alternate approaches, such as immunotherapy or vaginal washing, could be of benefit. "

E seems unimpressed with the idea of IV antibiotics for GBS

In English (:D), they found that there is an increase in infections from bacteria besides Group B strep (especially E. coli) which don't respond to normal antibiotic treatment.  Especially scary is that this risk is even more pronounced in preemies, and labor before 37 weeks is one of the #1 signs of GBS infection, and therefore moms of preemies are the women most likely to get IV antibiotics.  The researchers recommended the use of penicillin G instead, and research into another approach, such as localized use of antibiotics.  (Mind, this was 14 years ago... WHY are IV drugs STILL the treatment of choice for GBS??) Two more quotes from Mothering magazine highlight the risk of antibiotic-resistant infections:

"We should not take lightly the use of antibiotics for 200 women and their babies to prevent only a single blood infection-however serious that infection might be-especially in this age of increasing resistance to antibiotics. [Edit:  remember the figure that 1 out of 200 babies get a GBS infection if their moms are untreated.] Concerns have arisen in several areas regarding the use of antibiotics for so many laboring women. One dilemma is that colonization of the vaginal area by GBS is, at best, a poor method of predicting whether a newborn will develop a GBS infection. As mentioned, even without any intervention during labor, fewer than 1 percent of infants born to carriers of GBS develop infections."

"A study of 43 newborns with blood infections caused by GBS and other bacteria found that, when the mothers of the ill newborns had been given antibiotics during labor, 88 to 91 percent of the infants' infections were resistant to antibiotics. It is unlikely to be a coincidence that the drugs to which the bacteria showed resistance were the same antibiotics that had been administered during labor. For the newborns who had developed blood infections without exposure to antibiotics during labor and delivery, only 18 to 20 percent of their infections were resistant to antibiotics."

So, are there more selective, less invasive means of treating GBS (if it needed to be treated), either before birth, during labor and after birth?
YES!!  The more I've read about IV-antibiotics, the more they seem like using an AK-47 to shoot a fly:  waayyyyy overkill.

First line of defense:  help the body regulate its own bacteria before birth.  If a mom is re-tested before she goes into labor and is GBS-, this whole issue is removed from the table.  This occurs without any intervention in some moms, and it can be helped along by non-invasive natural means, the biggest of which are:  probiotics (in capsules and in fermented foods like saurkraut and yogurt), garlic, and echinacea.  My own midwife puts any GBS+ moms on doses of garlic & echinacea, and retests in 3 weeks.  Read here about using garlic & goldenseal.  A fuller listing of suggestions is here.  As far as probiotics go, L. rhamnosus GR-1 and L. reuteri RC-14 are really helpful in regulating vaginal flora, and S. cerevisiae boulardii, Lactobacillus rhamnosus GG, and Bacillus coagulans GBI-30 are good for regulating digestive flora, so probiotics containing those strains would probably be most helpful.  (See a great article on using probiotics to fight various ailments here.)

Second line of defense, during labor: avoid cervical exams (and stripping of membranes), dilute the bacteria by giving birth in the water, or use a chlorhexadine vaginal wash (once every 6 hours) during labor once water has broken.  Not only are these methods less invasive, they target the only area where the GBS is located, as opposed to flooding the entire body.  To use the wash, a mom is handed a periwash squirt bottle and irrigates herself... no needles, no invasion of privacy, it's simple and done.  This has the added benefit of reducing other, non GBS infections, such as E. coli, as well-- remember, IV antibiotics INCREASED the risk of those!

"In this carefully screened target population, intrapartum vaginal flushings with chlorhexidine in colonized mothers display the same efficacy as ampicillin in preventing vertical transmission of group B streptococcus. Moreover, the rate of neonatal E. coli colonization was reduced by chlorhexidine." (from “Chlorhexidine vaginal flushings versus systemic ampicillin in the prevention of vertical transmission of neonatal group B streptococcus, at term.” J Matern Fetal Med 2002 Feb;11(2):84-8.-- Read its abstract and other related articles here.)

Third line of defense, after birth: as has been stated before, if a mom goes into labor without knowing her GBS status, or as an untreated GBS carrier, her baby can be tested for GBS infection and treated immediately if infected.

Lastly, I wondered what steps could be taken to help babies and moms treated in the standard way.
Probiotics!!  Both mom & baby will desperately need to rebuild their bacterial ecology.  One study found huge reduction in "colic" in infants who received the probiotic L. reuteri.  It would make sense to proactively give antibiotic-exposed infants such probiotics (the specific brand in the study was BioGaia, and it's readily available online at Amazon or at drugstores such as Walgreens), and to have moms taking therapeutic doses of the above mentioned probiotics.

One final note I'll make is that there is no real need for an expectant mom to have to have a full pelvic exam to be tested for GBS.  Many midwives simply hand their patients a swab and send them to the restroom to privately culture themselves.  I must say I greatly prefer this method. :)  As a dear friend put it yesterday, "they're called PRIVATE parts for a reason-- I'd like to keep it that way!"

[Personally, I feel the proactive measures of taking probiotics-- both in fermented foods and capsules (I'm taking first Renew Life Ultimate Flora Extra Care Probiotic- containing 10 probiotic strains including L. rhamnosus, L. acidophilus and several Bifidobacteria strains, then Nature's Way Primadophilus Reuteri, which contains L. reuteri, L. acidophilus & L. rhamnosus)-- as well as planning a water birth are the way to go.  If I'd had the option, I would have cultured myself and been tested that way... next time!  If I were GBS+ I'd first try the preventative measures of probiotics & garlic, etc, and if those weren't enough, I'd do the chlorhexadine wash.  :)]

Thoughts from Eowyn's Birth

Writing everything up again with the perspective of hindsight and the additional knowledge & experience I now have as a doula-in-training, leaves me with a few thoughts I'm filing away for next time (i.e. gulp!- 11 weeks from now):

Lookin at her perfect face, 3 days old

-- I'm excited about having a home birth midwife (Lord-willing) attend me next time, because she'll be with me most of the time.  I would like to hire a doula for the same reason.  While my hospital midwife was great, she just wasn't there for the first two days of my labor-- while I'm sure her partner told her about finding Eowyn's head descending in front of the cervix rather than directly over it, since she wasn't there, there wasn't much she could do about it.  Had a midwife (or even a doula) been with me, we probably would have been doing various things to encourage Eowyn to rotate, from the rebozo technique to fetal stroking to side-lying to sitting in warm water to doing strategic back massage (to relax the back & pelvis so it was more comfy for Eowyn).  I also doubt that pitocin would have been recommended, since the problem wasn't "inefficient" contractions (the monitors were showing them nice & strong, and I sure was feeling them loud & clear!) but rather a baby in a position keeping the cervix from dilating.  Pitocin would probably have only made things worse, tiring me even more, tensing me up, possibly requiring me to stay in positions that did NOT encourage fetal rotation & descent, and stressing Eowyn.  Had she not shifted who knows where we would have ended up.  I'm so thankful that the Lord had her move!

-- I'm so thankful I wasn't induced.  While my labor was long, my body knew when to take breaks, both for my sake and for Eowyn's.  My contractions eased so I was able to sleep for 4 hoursish, and then were spaced enough at various points throughout the next 12 hours that I was able to rest and refuel.  Once you are on a pitocin drip, your uterus is essentially being forced to contract without any regard to the signals the rest of the body (and baby's body) is sending-- such as "we need to rest!"  While some doctors are willing to turn the pitocin down and let a mom sleep, most do the opposite and keep turning it up until a baby is out (especially if your water has already been broken).

Very tired, but happy 1 day after birth (with Ryan & his mama)

-- It's not a bad thing to go home from the hospital and try again later. :)  For one thing, you can eat as much as you want!  If you're hungry, it's because you need the calories... your body knows when to stockpile.

-- Hydrotherapy, counter-pressure, emotional support, and moving around are the best ways to avoid thinking about pain meds for most moms.  Also having an environment where they aren't even mentioned-- like I said, I never even thought about them.  Now if I'd been alone, in a bed, told to lay on my back, told I'd probably need meds soon... that would have been different.

-- While much of my family was in town, since they drove there wasn't the pressure of being on a timetable lest they miss meeting the baby.  This is huge.  As a doula, one of my first recommendations to my clients is:  unless you want your family member helping you IN labor, tell them to schedule their trip 2 weeks after your due date.  That way, they're sure to meet the baby, and you won't be pressured or anxious to have the baby in a certain time frame!

-- I will remember to keep my pitch "low" next time.  Now I know that it's instinct for most first-time moms to tense up with each contraction and let out these higher-pitched moans & screams, but these just serve to keep mom's whole body tense.  Far better to keep a lower pitch (my tagline is usually "try to sound like a cow...a very feminine, sexy cow") which leads to relaxation.  Had someone been coaching me to do that-- to keep my mouth loose and my pitch low-- I may not have torn so badly.

-- In future I will try to push to the "ring of fire" and then stop and pant/blow.  With Eowyn I was so tired of being in labor, and just so tired in general, that we were all just concerned with being done! and I didn't really care at all about how much pressure or burning I felt in the process.  Having gone through the recovery now, I'll (maybe) care a little more. :)

Was she really this small??

-- We got a surprise when Eowyn's physical exam came back saying her estimated gestational age was not 41 weeks 1 day, but 39 weeks!  I'm skeptical that she actually was early (look at the size of her, come on... and the fact that my body was preparing for her to come by dilating 4 cm), but it's quite within the realm of possibility that she was just a "crock-pot baby."  Babies develop at different rates OUT of the womb (sitting, rolling over, grasping, etc. at different ages)... why not IN the womb, too?  This is yet another reason I'm glad that I was never pressured to induce labor.  Had I been induced on my "due date" I would have been pushing out a baby as mature as the average 38 week-er.  With brain and lungs being what develops most those last few weeks, I'm glad she got to have the time she needed.  As long as fetal heart tones are strong and fluid levels are fine, there doesn't seem to be any reason to do anything but wait and let Baby say when he's ready to come (it's also not uncommon for due dates to be miscalculated by 2 weeks or even more).  I'll be preaching this to myself once it's June, I am sure.

Eowyn's Birth Story, Part 2: Settling in for the Long Haul

Finally, Ryan gets to hold his daughter!

Day 2:  Settling in for the Long Haul
(read Part 1 here)
Once home, contractions slowed enough for me to think I might be able to sleep through them.  Mom fed me a little food, heated up the water bottle one more time for me, and propped it against my back with pillows.  Ryan slid into bed beside me and within 20 minutes the house was still and quiet.  I awoke 4 1/2 hours later and updated the blog & FB, and curled up in my blue recliner to try and pray.

I was quite frustrated, and told the Lord so.  :) Hadn't I felt like she'd never be born?  Why tease me like this?  I just want to see my baby... what is going on?  In His kindness, He met with me in my fear and unbelief and comforted me with His Word:  "Tremble, O earth, at the presence of the Lord, at the presence of the God of Jacob, who turns the rock into a pool of water, the flint into a spring of water." (Ps. 114: 7-8)  Ok, Lord-- if Your presence can make hard rocks refreshing, You can make times of waiting sweet.  Your nearness is enough.  I'll be content to sit with You.

By this time, Ryan's mom, step-dad, sister, and grandparents were all en route from Georgia & Virginia, as they'd been told we were headed to the hospital the previous evening.  Our small house got very full, but everyone was very respectful and quiet.  Ryan's step-dad hung the new curtains Ryan's mom had made for us, the two grandmas-to-be made a roast (my request) with plenty of potatoes.  People asked me questions, and I found myself unable to answer.  I'd hit my wall with decision-making.

Meanwhile, I tried to follow my midwife's advice and rest as much as possible.  "In my experience, walking doesn't really help much with getting labor going-- it just tires you out.  When you're ready, your body will start back up again, and you're going to wish you had more rest!"  With my abs already feeling like I'd done 100 too many crunches, I believed her.  Contractions continued throughout the day, many of them strong and semi-regular, but we resisted the urge to time them.  I worked through them with breathing, swaying, rocking, and spent most of the day lying on the couch or on the birthing ball.  Reading back over my journal I'm reminded at just how many people were praying for me, and how the Lord kept me trusting Him, at peace in His plan, His will, His timetable.  Ryan & I went to lay down for a nap for about 2 hours in the afternoon.  I couldn't actually sleep, but being just the two of us in the dim quiet was good for my nerves.  By dinner time I devoured two plates of roast & veggies (my mother in law later admitted she was shocked at just how much I ate!)-- my body knew I'd need the strength.  I was SO glad I wasn't in a hospital with someone telling me I wasn't allowed to eat!!

By day's end (9 pm) I had a head-ache and sciatic nerve pain during contractions-- still plenty of contractions, many of them strong, but no change in frequency. .  I couldn't resist running up and down the stairs a few times around dinner, but gave that up fairly quickly as a stupid idea. :)   I called Beth again, at my family's insistence, and she assured me that neither headache nor nerve pain were cause for alarm. "The headache probably has something to do with the fact that you didn't get any sleep last night!" she chuckled.  She recommended hands-and-knees to try and shift Eowyn off whatever she was pinching.  And then she encouraged me to go to bed.


Intense Labor, Round Two
Of course, as soon as I lay down, Little Miss Drama Queen decided it was a good time to be born after all.  I couldn't take it lying down, either, so Ryan & I back to our old standby of walking through contractions.  As soon as I'd feel one starting I'd lean on him, we'd slowly walk with him keeping my breathing deep and even, until I told him it was over. Between contractions I usually rested on all fours or leaned on the birth ball or against the bed.  We kept the lights low and paced slowly, around, and up and down.  I remember the calm, yellow-golden light, the gentle burnished glow of the hardwood floor, the feel of the beige blanket on my cheek, and the pattern of blue plaid on the bedspread.  I was most happy moving through contractions.  Hardest for me was remembering to breathe deeply and to relax instead of tensing up during a contraction-- so counter-intuitive for me.  Ryan helped so much at this point, helping me relax, reminding me to breathe slowly, and pressing against my back & hips as I requested. 

Mom worked quietly keeping the hot water bottle filled & applied, and timing contractions.  I lost all track of time, life becoming a routine of contractions and strength-gathering.  I vaguely remember Ryan calling Beth a few times-- I asked him not to tell me how close or far my contractions were. It was all I could do to just work through the contractions one at a time, without worrying about "progress" or how much longer it would be. 

By 3 am we re-packed up the car (forgetting much more than the first time), tiptoed through the house to avoid waking sleeping family, and drove to Clark Memorial again.  Again we went to triage.  Again I got hooked up to the cuff, the monitors.  This time I spent very little time in the bed, though, and  spent the next 2 hours walking the halls.  All night, I sang to myself "When through the deep waters I call you to go/ the rivers of sorry shall not overflow/ for I will be with you, your troubles to bless/ and sanctify to you your deepest distress." and praying "Lord, I want to meet my baby.  Please help me meet my baby."  I cried at times, but nothing uncontrollable.  The hospital felt so bright and white.  Ryan, who had been up with me two nights in a row now, bearing much of my weight, was so tired he laid down in my bed, asking us to wake him in a half-hour.  We let him sleep. :)


Day 3:  Begging for Mercy

I think it was around 5 am that the nurse on duty checked me.  All that labor and still only 4-5 cm.  Again the check was very painful;  Eowyn was still descending in front of the cervix, meaning all these contractions weren't dilating me much at all.  They were strong & regular, but not getting harder or closer together.  They were also on the long side-- about 1 1/2 minutes long.  (all signs of an unevenly or malpositioned baby)  Beth advised me to be admitted and start a pitocin drip, concerned that without getting the contractions closer together, I would labor another 24 hours and be too tired to push.  Ryan & I asked everyone to leave so we could decide what to do.  I totally fell apart.  So much was at stake, and I was too exhausted to make this choice... but no one else could.  I knew I could manage these contractions, but wasn't sure about the pitocin-augmented ones.  Worse, the nurses informed us that their portable fetal monitors were malfunctioning, meaning I'd be tied to the bed, since continuous fetal monitoring is a must once drugs get involved.  No way did I think I could handle pit contractions in a bed, without the option of hot water to ease the pain.  I saw a clear slide from pitocin drip to some form of pain killer to ...C-section?  I cried & cried and begged Ryan to pray for us.  We asked for wisdom, for peace, and for God's mercy to move Eowyn so that my body could work on its own.

It took about an hour for the room to be readied, for me to get a Hep-lock for the IV, for the paperwork to be finished.  The Lord's peace fell on me; I knew I could trust Him, and that He is Good.  By 6 am we were in our new home.  I met my L & D nurse, Judy, who turned out to be an amazing help-- totally no-nonsense, capable, yet motherly and reassuring.  I trusted her right away.

Our first "miracle" came in the form of a nurse bustling in, saying "let's see if we can't get this telemetry (portable fetal monitor) unit to work!" My heart leapt-- if they could get that working, suddenly I had the option of laboring in a tub again, not to mention unlimited movement.  My miracle-worker fiddled a bit, then, presto!  It worked!  I couldn't stop thanking her, or God.  Then, Judy told me it was time to start the pitocin drip.  Something told me to wait.  "Please, just wait until my midwife gets here-- she's on her way-- just let me check her one more time, ok?"  They agreed.

Within 10 minutes, Beth arrived and I felt myself relax even more. It's amazing what feeling like you are safe and in good hands does for a body!  She checked me, and for the first time I screamed-- "please!"  Beth "emerged" with a huge grin:  "You're not going to need that pitocin!  You're at 8 cm, and I just stretched you another 1/2!  I can break your water right now if you want!  That'll probably speed everything right up!"  Breathless with disbelief, I asked "you can reach the cervix?"  "Yes! No trouble at all!"  God had answered our prayers.  Eowyn had moved, and in one & 1/2 hours, my body had dilated 3 1/2 cm, when 36 hrs of labor had progressed me less than 1.  I was so thankful I was almost giddy, and I said "yes, yes! do it!"  I'll spare you the details of having your water broken, but I didn't much like it. :)


On to Transition

Now, the real fun began.  Steadily, the contractions grew harder.  I got louder, actually yelling, to tell the truth.  Judy helped me get control of myself, making sure I was one top, riding the contractions instead of being pulled, dragged, behind them.  I found a huge difference between vocalizing (yelling) as a way to keep focus and as a sign of losing control.  I often stared into Ryan's deep brown eyes, and he'd breathe with me.  I remember doing what my mom had told me she did in her labors, and crying out Jesus' name-- and having Him help me.  He kept giving me the endurance for one more contraction, never failed.  We kept the lights low, my "labor mix" playing, and I hung little E's white eyelet dress as a visual focal point.  Out the window was a pro-life billboard featuring one of my preK students as an infant in his father's hand, and that was another encouraging focus point.

By 9 am I tried getting into the labor tub.  The warm water felt great, but I got frustrated at how slippery I found the tub-- no hand-holds or places to push against.  I tried a few different things, but felt so insecure, like I'd just slip all the way under the water.  I remember begging Ryan "help me, please!" and drawing on his calm unflappable strength.  Looking back, I'm pretty sure this is when I hit transition.  I made my way back to the bed, and I remember asking Ryan "how many more do I have to do?"  "Just a few more, Baby, you're almost done."  "You don't know that!  You're just saying that to make me feel better!" "No, I really mean it- I promise."  (Internally, he was praying, "Lord, don't make me a liar!")  I remember thinking "women who do this more than once are clinically INSANE... yeah, I'm sure I'll be one of those insane women eventually..."  Once I think I shouted that I was going to DIE... but not once did the thought of pain meds cross my mind.  I was way too busy getting through each contraction as each came.

Beth & Judy suggested various labor positions.  Some helped, but being on my side was unbearable.  We tried it twice, since this often helps malpositioned babies rotate and descend, but I completely fell apart each time.  Something about childbirth is so intimate and precious-- the utter vulnerability you have in your nakedness and pain, yet the amazing power and confidence you feel as you alone must- and can- bring forth this mingling of you and your husband.

Final Phase:  Pushing!
11 am found me dilated to 9 1/2 cm, and Beth had me push a little bit as she stretched me the last 1/2 cm.  A few pushes later, and my body began giving me that unmistakable, undeniable urge to push.  It took me a little while to figure out how to coordinate pushing, breathing, resting, and the urges-- I actually did find it helpful for Judy to count once I started pushing with the urge, with me not stopping pushing for 10 counts.  Some women dread pushing, but I loved it.  It was like the pain of lifting weights vs. long-distance running.  With running, there's a persistent pain, but all you can do is keep going, confident that the pain will get you where you want to go.  With lifting, there's a specific pain of muscles giving all they have, with the sweet release of rest in between and the knowledge that that specific pain just accomplished some thing.  Also encouraging was watching the "baby team" assemble around me-- that meant she was close, right?  Between contractions, I collapsed against the pillows, with Ryan spooning ice chips into my mouth and my mom putting cool cloths on my forehead.  When another contraction started, I sat up, Mom snatched away the cloths, and I grabbed the squat bar and pushed with all my might.  Hah!  I just remembered Ryan's live-Tweeting of the event.  He would grab his phone and type a few words, then as soon as I sat up, rush back to my side.

By noon, Eowyn was crowning.   I gave a last huge push and her head was out.  I watched her be born, finding it fascinating that the grey mass suddenly became a face-- one looking straight at me (hah! THAT's why she took so long to come out-- she was "posterior" or "sunny side up").  Beth kept her hands ready to catch and coached Ryan on where to grab as I gave another push and she was out!  "How do I grip her? She's so slippery!" he laughed, and she was slippery!  I've never seen such a vernixy baby-- she looked like she was a wedge of white-rined cheese!  I reached down and caught her too, and pulled her straight up to look me in the eye.  My mom somehow snapped a picture of us staring at each other-- her mouth open in a cry of her first breath, mine in amazement that she was here, in the air!  12:09, and my family waiting outside the door heard a healthy lusty cry, and my amazed "Daddy!  We have a baby girl!"

It was another miracle to see the pink spread throughout her body, starting with her face & chest, and moving down to her grey-purple perfect fingers and toes.  The cord was long enough for me to cradle her and kiss on her easily, and she quieted down in my arms very soon.  I was totally blissful.  One of my favorite parts of natural labor is how amazing Mom feels once Baby is out, and how awake Baby is!  (This is how "high" I was:  soon as she was out, in my arms, and nursing, I turned to Ryan-- this is as they are still delivering my placenta, mind!-- and grinned "Let's do that again!" Apparently I'd already forgotten that an hour before I classified such "repeat offenders" as "clinically insane."  Yeah... endorphins, my friend.  They really do a body good.)  Delivering the placenta, being stitched up (2nd degree tear, 11 stitches), whatever!  I had my daughter in my arms!  She latched on and began to nurse very quickly, and as soon as she did my uterus started contracting again, stopping my bleeding and allowing me to forgo even a shot of pitocin.  Ryan cut the cord once it stopped pulsing.  We got a shock when the scale told us she was 8 lbs 10 1/2 oz!  "Where were you hiding her!?" Beth asked me. I remember Ryan saying that the family wanted to see the baby, and I freaked out "no! don't let anyone in!"  My modesty was returning, heh.  He assured me that no one would come in, but he did hold her up at the door so they could catch a look at the first grand child.

I remember crashing (energy-wise) as I was on the phone with a friend, telling her the good news.  All of a sudden I just wanted to sleep for days.  I was wheeled to recovery holding my baby, and was so proud to get all the compliments in the elevator-- could she be any more perfect?  Once we got to our room, Ryan took sleeping 2-hour-old Eowyn to the nursery for her observation & hearing tests, etc., and I pretty much passed out on the bed.  Sleep felt like ice cream... yummmmmm. :)  (Note:  we opted out of all newborn interventions except the Vitamin K shot, blood screen, and hearing test)


I'll just add that the one thing that I found surprising was how painful recovery was.  I'd expected a painful labor, but no one had told me how bad the renewed contractions would hurt every time I nursed Eowyn.  Nor did I anticipate a very bruised pelvis, combined with overall exhausted-muscle pain, and swollen "everything else."  It made moving very difficult and sitting impossible.  Thankfully I'd brought my own pillow and we had plenty of others to work with. :)  Oh yes, and good thing my reward was so precious!! :)

Eowyn's Birth Story, Part 1: Just Getting Warmed Up

This has been so long in coming (Eowyn is 2 1/2) that many might be wondering why I'm even bothering at this point.  I have always wanted to write it-- I have written it down in my personal journal-- and since it was a labor on the longer, more difficult side, I have recently been thinking that it might be encouraging to others... thence this post.  I'm also heading into the homestretch with pregnancy #2, and Lord-willing I'll be going through the childbirth miracle again in the next 3 monthsish to meet little William face to face.  Thinking back over Eowyn's birth has come naturally to me as Liam's approaches.  Oh yes, and I finally have some time. :)  Moving 4 states away from your friends & responsibilities helps clear your social calendar!

I'll warn you:  this will be long.  My labor itself was long-- 43 hours long, so a write-up isn't gonna be any paragraph affair. :)  I'll warn you also:  this isn't going to be graphic, but it IS about childbirth.  If you don't want to read it, don't. :)


Day One:  Just Getting Warmed Up

One of my "nesting projects" was this pillowcase

A very hot September was coming to a close-- I was gaining and losing up to 5 lbs of water a week, starting to swell and feeling generally uncomfortable in the sweltering heat.  I feel sorry for cows in the summer now.  My mom flew up from South Carolina to be with me right before my "due date" (Sept 17th), and we had a blast cleaning, doing projects and enjoying Louisville.  I remember having that "nesting urge" to tie off all loose ends; I finished 3 t-shirt quilts, made a pillowcase for my body pillow, and made a dozen "reading pillows" out of donated towels for my preschool classes.  We also cooked and froze meals and tended the last of my garden.

I finally allowed my midwife, Beth, to "check" me the day before my due date-- 2-3 cm dilated, 80% effaced, baby at a -1 station.  While this was certainly not discouraging news, I didn't really put much stock in it. First babies come an average of 8 days past their due dates, and I myself (a firstborn) had been no exception!  I had frequent practice ("Braxton-Hicks") contractions so I knew my body was preparing for labor and was committed to waiting until Eowyn let us know she was ready to meet us.  (Evidence points to hormones indicating a baby's brain is fully developed being the trigger for labor-- so I didn't want to try and rush her before she was ready!)  A week later (6 days "overdue") Sept 23rd, Beth found me to be 4 cm, 90% effaced and E had dropped further to a 0 station (that means she was really low in my pelvis).  A fetal non-stress test revealed that she was doing great, and amniotic fluid levels were normal.  My midwife commented that she didn't expect me to make my next appointment (a week later), and that with my body type & level of physical fitness I'd probably have a short & uncomplicated labor any day now.  If only... :)

Trying to stay cool at 41 weeks pregnant

I remember finding the "not knowing" to be the hardest part of waiting.  When will the baby come?  What will labor be like?  For someone who likes planning... my planning had stopped.  Now I was forced to wait on the Lord's timing.  I found comfort in reading Psalm 139, where David marvels that not only did God knit him together in his mother's womb and KNOW HIM THEN, but that God had also ordained every one of his days.  God knows Eowyn's birthday, I kept telling myself.  I remember asking my mom "how will I know when it's real labor?  I mean, I've been having tons of contractions for the past month."  (I know now that this is a real "novice" question, hehe)  She just smiled and said "oh, you'll know."  I was also getting advice on how to start labor from every corner of Facebook.  I've since learned not to EVER post on an expectant mom's page anything remotely resembling "still no baby?"  (To which the response is "No, duh.  And don't I know it.")  Instead, I appreciated the comments that encouraged me in the waiting, assuring me that no one stays pregnant for ever, and that God was in control.  When I asked for labor-starting tips and got them, I appreciated those, too.

Out to Indian food the night before labor started

Wednesday September 24th was a bright, hot sunny day.  I noticed I was having regular contractions (10 minutes apart) at around 5 pm.  We finished up dinner and decided to walk across the park to church for prayer meeting, thinking that maybe these would keep the contractions going and maybe jump-start active labor, if I wasn't already in it.  As we left the house, I told my mom to go ahead and pull the locked front door shut behind us at the exact same moment that Ryan realized his keys were inside.  So there we were, locked out of the house with a contracting, overdue woman toting a birthing ball.  HAH that's a recipe for labor, huh?  Ryan sent my mom & me to church (carrying the birthing ball, as I didn't want to sit on anything else), and he set off as fast as he could to our friend Ashlea's house, keeper of our spare key.  We got to church and set up shop against the wall, me swaying on my birthing ball with each contraction, which intensified with the walk and kept coming right at 10 min apart... and realized, for the first time in recent memory, Ashlea (who worked night shift) was AT CHURCH.  She set off to her house, intercepted Ryan on his way back, and tracked down our key... phew!

Big belly= personal table

Throughout the prayer service, contractions stayed regular and fairly intense.  I thought back to my mom saying "you'll know" when they're the real thing, and thought "you know, this DOES feel different.  These kind of hurt!"  I went to the bathroom and ran into two friends, one of whom (Athena) is a doula.  A contraction hit while we chatted, and I kind of zoned out for a minute, leading them to ask "are you in labor right now?" I smiled and said I just might be!  We took our time leaving church, and made it home around 9 pm, 4 hours after I'd realized my contractions were regular.

Once home, labor continued to pick up in intensity.  I wanted all the lights off but one dim one in the living room, and one dim one in the kitchen.  If you've been in our house, you know that the downstairs is one long rectangle with no halls but just rooms one behind the other.  We fell into a rhythm:  during a contraction, I'd walk from one end of the house to the other, breathing deeply, singing in my mind the song "Jesus, What a Friend for Sinners"; once the contraction stopped, I'd sit on my birthing ball in the small pool of light in the living room, with my mom holding a heating pad to my back and Ryan watching the clock.  My contractions were very soon about 3 minutes apart, so he would tell me when I hit the 3 minute mark, and I'd stand up to start walking again-- walking made the contractions more bearable, but trying to stand up DURING a contraction was absolute agony.  At some point in the night Ryan began walking with me during contractions, with me leaning on his back, my hands over his shoulders so he bore some of my weight.  During some contractions we'd stand still and just sway together, like a slow dance.  I wanted to be in the dark during contractions.  Mom kept the hot water bottle as close to boiling hot as she could as that provided good relief.  By 2 am I was unable to talk through contractions and was crying in between them.  I wanted Ryan to take me to the hospital. He, however, had been noting my contractions and didn't think they were regular enough, varying in duration and spacing.  Looking back, this was the first sign that Eowyn was not in an optimal birthing position (facing my back), but was either uneven (her head cocked) and/or facing my tummy. Since he didn't want us to get to the hospital too early and be put on their clock, he told me he'd take me in an hour if labor hadn't slowed down.

In triage- attractive gown, huh?

An agonizing hour later, Ryan agreed that we should head to the hospital, with contractions at most 4 minutes apart, 1 minute or more long, for over an hour.  I had a few contractions in the car (no fun), but could tell they were slowing down a little as is usual when switching locations.  We got to the ER, and had a funny moment when the night staff asked "how far along?" and Ryan answered "a few hours."  Seeing their confusion, I answered "41 weeks" and they got hopping.  I will say I was unimpressed by the admission nurse.  She seemed to think it was fine to ask questions during contractions and take all the time in the world to fill out forms (though all my records had been sent over and I was already in the system).  Clearly, she'd never labored in a hard chair in a glass-enclosed room!

Half of my tired labor team (my Mom)

Finally, I made it to triage.  This was a surprise to me.  Somehow I'd never really understood that upon showing up at a hospital, you don't get immediately taken to a room.  Instead, you go to "triage," a holding area where you are monitored and if you are in enough labor, you are admitted.  I got hooked up to a monitor that registered how strong my contractions were, as well as my heart rate & BP, and Eowyn's heart rate.  I remember HATING having to contract while in the bed!  Talk about the most painful way to labor!  I ate a Popsicle at some point so they could watch E's heart rate rise and fall.  The contractions were showing up fairly strong.   As soon as I could I got off those monitors and began walking the halls.  Mom came with me, and I'd squat and breathe whenever a contraction hit.  The midwife on call (not Beth but her partner Allison) came and checked me... to my immense discouragement, I was only 4 cm dilated... i.e. the exact same as earlier that morning, before all the labor!  Why? Eowyn's head was actually descending in front of the cervix, making it almost impossible for Allison to even measure.  The check was so painful to me that my labor slowed and then completely stalled out.  By 6 am, my midwife told me they could admit me-- my contractions were strong enough to be considered "real labor," but that would mean no food, a Hep lock, etc.  I was already starting to feel hungry, and tired from the night of walking and contracting.  One look at my mom & Ryan, both of whom looked ready to fall over made my decision for me:  if we went home, we could all sleep.  So, as UN-fun as it is to leave a hospital with no baby, we headed home.  By this point I'd been in labor for 13 hours. 

Tune in next time to read Day 2:  Settling in for the Long Haul...