June 6, 2012 by Evidence Based Birth

Our guest writer for today is Sarah, a friend of mine and client of Dr. Shannon’s. Sarah had her first baby this past fall in the hospital. Enjoy her story! ~Rebecca

When Rebecca asked me if I’d be interested in writing a guest post about my experience birthing in a hospital, I was very excited to share my experience! I often feel that as a non-medical professional I can’t have much of an impact on something I feel very passionate about (low intervention and natural birth) but hopefully my positive story can provide some encouragement!

Soon after I got that plus sign on my home pregnancy test I called Dr. Shannon to ask for recommendations for a good OB. I was surprised when she said, “You can come see me in Family Medicine!” It had never occurred to me that I could go to Family Medicine for prenatal care. So I made my first appointment and started seeing her around 8 weeks. During one of my first visits Dr. Shannon asked me if I thought I would have an epidural. I said, “Yes!” right away without thinking about it. Because that’s what you do when you have a baby, right? But then I started reading. The first book I read was Ina May Gaskin’s Birth Matters. The positive natural birth stories and the outline of risks involved in interventions had me second guessing my desire for an epidural. So I signed my husband and myself up for a natural birthing class in the area.

The class was at an independent childbirth education site (not affiliated with a hospital), and it was taught by a midwife. She went over all the possible interventions and instances where they would be needed or necessary—to emphasize that they really can be a good thing—when used for the right reasons! The most valuable thing that I came away with was that contractions were usually 45-90 seconds in length, that they had a peak about halfway through, and that if I took it one at a time I would get a chance to rest in between. Which was totally true. It wasn’t constant pain, like people think. She also talked about walking around or being on your side during labor and how being on your back was probably the most painful for most people. She gave us a hand out of different labor and birthing positions.

After taking the class, I wrote my birth plan. I will share it with you all in case you would like to see an example of a low-intervention hospital birth plan:

Birth Plan for Sarah

Doctor: Dr. Shannon

Due Date: November 5

I wish to have the following people at my birth:

  • Nicholas – Spouse
  • Courtney – Doula

I prefer the following general medical procedures:

  • Have saline lock
  • Have no IV fluids
  • Few vaginal exams or by my request
  • Intermittent external monitoring
  • Avoid Pitocin unless absolutely medically necessary

Pain Management:

  • Offer pain medication only if I request it
  • After medical guidance for pain relief, I would appreciate some private time with my partner and doula to discuss which pain management technique or medication I would like to use.
  • I would like to be free to move around

During the pushing stage:

  • Push when and how I feel is right
  • In any position that I feel is right for the time
  • As long as we both are healthy, no time limitations on pushing time
  • I prefer to tear, no episiotomy

Once the baby is born I would like:

  • The baby immediately place on my abdomen
  • I would like skin to skin contact before baby is taken for routine care
  • Breastfeed as soon as possible
  • Delay all other routine baby care until after breastfed

Routine baby care:

  • You can administer all newborn immunizations
  • My baby is to be exclusively breastfed.

At 36 weeks  I woke up one morning feeling a bit crampier than normal. I felt like my period was coming all day long. Around 2:00pm I started getting Braxton Hicks contractions along with the cramping. They were about 10 minutes apart so I drank a bunch of water and lay down. This didn’t help and they got a little closer together, but didn’t get stronger. I had an opera audition that evening at 7:30 and I was just hoping that they would go away before then. I got ready for the audition and contractions were still coming, now about every 6 minutes. I got to my audition and sang great, despite the fact I was having contractions every 4 or so minutes. As soon as I got home I called Dr. Shannon.  She said she would feel more comfortable if I went into Labor and Delivery and she would meet me there mostly because I was only 36 weeks. So my husband and I headed up to the hospital at about 10 pm.

Once at the hospital I was checked and monitored. I came in at 2cm and 90% effaced.  Dr. Shannon decided she would come check me in an hour and a half to see if I’d made progress. An hour and a half later I was 4cm and still 90% effaced. Since 4-5cm is generally considered active labor I was admitted and everyone seemed to think I was going to have a baby soon.

I tried to sleep that night, but was too excited. I kept waiting for contractions to intensify, but they seemed to be getting farther apart. At 6am Shannon checked me and I was almost 5cm and still 90% effaced. She could feel baby’s head, but it was still at a -2 station. So I stayed and waited some more. At noon my contractions had all but stopped and I had no more change. I felt fine and told them I was not going to have a baby today— I could just feel it. (Trust your body! You know it better than anyone!) I felt completely normal. Since I was only 36 weeks and we were still waiting on the results of the Group B Strep (GBS) test, I was sent home (yay!) and everyone expected to see me back in the hospital by the weekend or early that next week. I told baby to stay in until that Sunday when I would be 37 weeks, my doula would be back in town and my GBS results would be back (which turned out to be negative, thank goodness!)

So the weekend came and went. And the next week. And the next weekend. I was feeling uncomfortable, but still pretty good. I did my normal activities- yoga, grocery shopping, we went to an opera, out on a date. That Monday  I had my 38 week appointment. Everything was routine and I told Dr. Shannon I would probably see her the next Monday at my 39 week appointment. I decided not to be checked. I would have known if something had been happening!

Tuesday morning I woke up at 5:30 with contractions that felt different. Instead of just tightening my belly, they were really low and radiated into my back. They weren’t horribly painful, but definitely more than what I had felt previously. At 7:30am I told Nick I’d been having contractions for 2 hours and asked him if he’d mind waiting to go into work for a little bit. Around 8:30 my husband called our doula and asked if she could come over. My contractions were very regular- not too close together but averaged about every 8-12 minutes over the past 3 hours. Our doula arrived around 9am. I ate a bowl of cheerios with banana and just kind of walked around the house a little. The contractions started hurting a little more to the point where I had to stop and breathe through them, but they were still only about 45 seconds in length. I spent a lot of time on my birth ball, leaned over the foot of the bed. I had my labor playlist going and continued to eat light snacks- almonds, granola bar and juice.

Around noon my contractions started getting longer and more intense. I had to really concentrate on breathing through them and my husband kept counter pressure on my lower back since that’s where most of the pain seemed to be concentrated. They started making me break out in a sweat. At 1:00pm I asked Nick to make sure all our bags were packed and ready to go because when I decided to go to the hospital I didn’t want to be waiting around for things to be gathered and packed up. So he put everything in the car. I had a few more very intense contractions. They were still only about 8 minutes apart, but I decided I wanted to get to the hospital and settled in a room before things got really intense. Courtney brought up not finding out my dilation progress at the hospital. I liked the idea because I didn’t want to be discouraged or disappointed if I hadn’t progressed much in the past several hours. Dr. Shannon checked me upon arrival and told the nurses to get a room ready, so I knew I had progressed!

The next few hours I had no sense of time whatsoever. I tried hands and knees, but it was not comfortable for me. Even though most women say that lying down is the most painful, for me, side lying with two big pillows between my knees was the best position because in between contractions I could completely relax all my muscles. Through all my contractions at the hospital my husband applied counter pressure to my back. I’m not sure I could have made it through without that! The contractions for me felt like a radiating, almost burning pain through my low belly, hips and back. As they progressed they started taking my breath away and I had to regain control through each one and really focus on deep breathing and just concentrate on one contraction at a time.

At this point the only deviation from my birth plan happened. I had requested intermittent fetal monitoring and had to be on the monitor for 10 minutes once per hour. During one of those monitoring sessions the baby’s heart rate was not picking up (She was descending pretty far into my pelvis at so I’m not surprised!) but the OB on call rushed in in a panic (Dr. Shannon was not readily available) and checked me rather aggressively. She then informed me that I would have to be monitored for the rest of my labor. I was disappointed, but I was so focused on my contractions that I didn’t fight it too much. Once Dr. Shannon returned she was not alarmed in the least about the baby’s heart rate and said the baby was probably getting lower in the pelvis so it would be harder to pick up the heart beat, but the rate had been steady and healthy for hour so far, so there was really no cause for concern.

The next thing I remember was yelling out, “I’m pushing!” I could not stop myself.  Dr. Shannon checked me and I was 9cm with a little bit of a lip left before I was complete. My doula helped me do some quick exhalations to counter against the urge to push, but still helped me bear down. After the next contraction I was complete and was given the ok to push. I was still on my side and my husband and doula supported my leg so I could open my pelvis.  Once I pushed her head out, the rest of her slid out easily. My doula and Dr. Shannon said she came flying out! Her fast exit caused a long, but shallow 2nd degree tear (which I did not feel). I found out later that I only pushed for 20 minutes!

Our daughter, Maria Lorraine, scored a 9 out of 10 on her APGAR and was very alert. She latched on to the breast right away, which I think helped establish an easy time breastfeeding for both of us. She and I were not bloated or swollen at all, since I did not have any Pitocin. We enjoyed skin to skin contact for almost 2 hours before the doctors did their evaluation on her. Overall, I was more than pleased with how my natural childbirth went in a hospital setting. And remember that audition I sang while having Braxton Hicks contractions? I found out that night that I had gotten the role. :)

 

Maria shortly after birth

Maria shortly after birth

But afterwards it got me thinking. Since I was 36 weeks when I went in the first time and progressed to 4 cm rather quickly, but didn’t start active labor until 38 weeks, it really took 2 weeks to get from 4cm to 6cm! It made me wonder how many women in the hospital get Pitocin augmentation when their labor seems to be too slow for their doctors? Had I been 40 or 41 weeks the first time I went in and had a different doctor, I could have very easily been pressured into Pitocin when my labor “stalled.” I wonder how common it is to have a “long” labor, but no one ever knows because they are stuck to the clock and committed to making it happen on their own time table? It then took another 12 hours from the time my first real contractions started to the time I had my baby, even though I was starting at 4cm. It made me happy with my choices to not know my dilation, to labor at home for as long as I felt comfortable, and to have a family medicine physician who was supportive of natural childbirth! I was only in the hospital for 3 hours before I had Maria.

With such a positive experience, my confidence in my body’s ability to have a baby was boosted and I am actually looking forward to the next time I get to do it!

What do you think about Sarah’s story? What things did she do that boosted her chances of getting the birth she wanted? (I already think I know the answers, but I’m curious what you all think). Do you have any questions for Sarah?