Because Alisa and I have only experienced this twice, it's really easy to compare and contrast with the Maya/Max birth. The two experiences seem to only have one similarity...water breaking to really kick things off. With Maya and Max, it happened while Alisa was at a friend's baby shower, which I'm sure left a great memory for a bunch of baby-excited women. This time, the water release wasn't quite so dramatic, happening in the middle of the night at our home.
Early Sunday morning on 26th of June, Alisa woke up at about 1 AM. As she fell back asleep, she said she tried to visualize going into labor. She next woke after 3 AM to a warm gush, which she immediately recognized as water breaking (unlike last time when she thought she had peed her pants). She woke me right away, and we turned on the light to look at the water, which had a green tint and kept coming. With the evidence of meconium in the water, we texted our midwife, Sharon, who decided to come over for a check of the baby's heart rate.
By the time Sharon arrived around 3:45 AM, Alisa had begun to feel consistent contractions (maybe 2 every 10-15 minutes) but was not in "established labor". We discussed staying at our house for Alisa to labor at home until labor was established, but with 10 days past due date, meconium in the water, and the VBAC, we decided to prepare to head to the hospital. What was reassuring was that Sharon just discussed everything with us and was calm about the situation (she didn't even express much concern about the meconium). At that point, we called a friend (Christina) to come over and stay at the house while Maya and Max slept. Christina arrived very quickly, and we were off to the hospital, where Sharon had gone ahead to get things prepared for us.
We arrived at North Shore Hospital (10-15 minute drive from our house) sometime between 4:30 and 5 AM and were checked right into a labor and delivery room, which had a nice little view of Lake Pupuke and Rangitoto Island (not that Alisa spent much time looking out the window, but I appreciated it). At this point, contractions were more consistent and stronger, and Alisa was starting to feel bothered by the effects.
Before we get further into the story, I want to explain a bit about the hospital staff and procedures. Sharon was in the room with us through the entire labor. Of course, she would step out to get supplies, equipment, or assistance from others from time to time, but she was basically in the room a huge majority of the time. While Sharon was our midwife and who we discussed and developed the birth plan (which was only verbal this time, whereas with Maya and Max it was a detailed written plan), the hospital had a "midwife-in-charge". I don't know exactly the organizational structure, but it seemed like Sharon mostly received support and advice from the midwife-in-charge, who came into the room maybe once every 1-2 hours and then during key phases. Beyond the midwife-in-charge, any significant concerns would be raised to an obstetrician, who we only saw once early in the labor and once after it was all over.
Due to the VBAC, a few procedures were implemented that Alisa would have preferred to avoid. The first was that they set up an IV port on her hand in case it was needed at some point during labor. This was a pretty minor inconvenience and actually proved useful later, but it's important to note that we have been told it's not standard procedure to do this in NZ where it is standard at many hospitals in the US. The other procedure was that they required continuous fetal heart monitoring, which again is not required for a normal vaginal delivery in NZ but was required for Alisa due to the VBAC. The trouble with the fetal heart monitoring was that Alisa wanted to move around the room, especially during the first few hours. At first, she was connected to wired monitoring equipment, but then Sharon was able to sort out wireless equipment so Alisa could move around. Even with the wireless equipment, we had some difficulty keeping the monitors in place. When Alisa would have a contraction come on, the monitors would sometimes get moved around to where they weren't picking up signals. I wasn't really concerned about it because baby's heart rate never seemed to get off. Sometime within the first couple of hours at the hospital, an OB came into the room to check on the progress of labor and expressed concern that the monitoring signals were dropping out during the contractions. So Sharon gave me instructions to help keep the monitors in place during the contractions. Sharon explained that we needed the monitoring data to have proof that baby was fine so that the midwife-in-charge and/or OB wouldn't suggest interventions that we hoped to avoid. Eventually, the external fetal heart monitor just wasn't working well enough, and Sharon (I think at the prodding of the midwife-in-charge) decided to put an internal fetal heart monitor, which was an electrode stuck to baby's head.
Now back to Alisa and baby...between 5 and 7 AM, contractions continued to get stronger and closer. Alisa was still coping fine but also was wondering if she was ready. At some point, she had the feeling of needing to escape, and she whispered to me a few times that she "had to get out". By 7 AM, Sharon did the first check for cervical dilation, and Alisa was at a 4-5, which is only marginally more dilated than she had been a few days earlier. To some extent, Alisa may have been hoping to be further dilated at that point, considering the intensity of the contractions, but she didn't waiver from the plan. Sharon was happy with the progression of labor and said that she would plan another exam at 10 AM.
Over the next couple hours, Alisa got into a good zone. In preparation for the births of Maya and Max, she had read about hypnobirthing and practiced various relaxation techniques. With this pregnancy, she again practiced the meditation and relaxation methods, and it was during this part of labor that it paid off. Alisa made some movements around the room, but for a long period, she just sat with eyes closed in a "lazy boy" chair and focused through the contractions. We used one of her Mayan textiles from Guatemala to wrap around her lower back which I held onto creating counter-pressure for the contractions.
|Photo of Trent wrapped in the Mayan fabric we used for counter-pressure during labor|
By 9 AM, the contractions were getting very intense, and Sharon decided to do another exam at 9:30 AM. Sharon indicated that Alisa was nearly fully dilated but had a lip on one portion of the cervix. Sharon also said that Alisa was now going to want to push but that she needed to wait until the lip was gone. For the next 45-60 minutes, Alisa endured through intense contractions and tried to stave off any pushing, which she really wanted to do. I know hypnobirthing philosophy says that contractions are "surges" and labor pain is "discomfort", but this stage of labor was brutal. Toward the end, Alisa was intensely feeling the pain, and Sharon then gave her a hit of pethidine through the IV that had been set up. The pethidine seemed to calm Alisa down enough that she made it through the last bit, and by 10:30 AM, she was fully dilated and ready to push baby out.
At this point, I kind of felt like everything was going just right (of course, I wasn't doing any of the serious work), even after the intense period of the transition phase. When she first started pushing, I think Alisa was still recovering mentally/emotionally from the extreme pain of the previous hour and was showing some fear of pushing. Initially, Sharon and the midwife-in-charge were on each side of Alisa with Alisa's feet positioned on their hips, and they were both coaching her on how to push. Eventually, the midwife-in-charge dropped out (which actually helped because she was kind of high stress anyway and that wasn't helping), and I got closer to the action by taking Alisa's leg. This was Alisa's first time pushing, so Sharon did a great job of getting Alisa's focus back by coaching her through the pushing. Bit by bit, Alisa got more effective in her efforts, and baby's head came closer and closer with each contraction. Alisa was wondering if she was making any progress, but I could see it happening and was able to reassure her that she was working well. From my perspective, it was amazing and awesome to watch, especially in contrast to the surgery of the C-section on the last go.
Alisa had been pushing for over an hour when Sharon and the midwife-in-charge decided that Alisa needed an episiotomy to help get the big boy out. The episiotomy wasn't in the plan, but Sharon asked or suggested to Alisa that they do it. I was surprised when Alisa said yes so quickly, but of course she had been going through hell anyway so she would agree to anything. Sharon left the room to get supplies and the midwife-in-charge to assist, and I sat there debating how much resistance I should give. Alisa agreed to it, but to me it seemed unnecessary at that point. When the midwifes came into the room, I asked a question or two about why they were doing it, but I didn't push back too much. In retrospect, I wish I would have asked them to delay a bit. A couple weeks after the delivery, we talked with Sharon, who said that she wanted to wait a bit longer to calm Alisa down and explain how it was going to happen but that the midwife-in-charge was pushing for the episiotomy. Sharon still felt the episiotomy was needed, but she felt that she could have better prepared Alisa for it if the midwife-in-charge was more patient.
Back to the story, they prepared to administer local anesthesia to the perineum prior to doing the episiotomy, and I was surprised that they went to give the shot during a contraction. Initially, Sharon had the needle in her hand, but she hesitated for a moment and the midwife-in-charge took the needle and gave the shot. Alisa wasn't really ready for it, and it threw her for a loop. By the next contraction, they were ready to do the episiotomy. When the contraction hit, Sharon took the scissors and did the deed. This was an intense episode, as Alisa was really worked up. While I was generally feeling positive and calm throughout the labor, this was the point that I just couldn't watch. I saw the first bit and then turned away because I felt guilty that I hadn't suggested avoidance of the episiotomy because I felt terribly, horribly bad for Alisa. Fortunately, the intensity of the moment passed, and Alisa was relatively calm pretty quickly.
When the pushing started again, the moment soon came that I think is what I will remember most from the experience...baby's head coming out!! I can't really describe the feelings of seeing baby's chubby cheeks, closed eyes, and head that had gone through the twisty canal of wonder sitting almost peacefully on Alisa. He was on his way out, and the way he was coming out seemed so incredibly amazing and beautiful, even though parts of the process were extremely intense. To contrast with Maya and Max, my first thought in seeing them was how skinny and alien they looked, and with Trent, it was definitely how chubby his cheeks were.
It seemed like a long time that his head was out but the rest of his body were still inside, but I think it was only in between contractions that he sat there. On the contraction, Alisa gave a good push, and Sharon seemed to wrestle baby out. I was kind of amazed at how much force Sharon tugged on the little guy (later she said that she was worried about his big shoulders getting through). As baby floated out, I was taken by the emotion of it (which surprised me a bit), and I stepped away from the bed (from just prior to the transition phase through the rest of the birth, Alisa was on the bed, where she felt most comfortable). Honestly, the part after the birth is a bit of a blur to me because I was so joyful and amazed by the birth. Sharon and the midwife-in-charge put baby onto Alisa pretty quickly, and I cut the cord, which I was never really keen to do but I wasn't going to say "no" after having watched what Alisa did. Alisa was able to begin breastfeeding right away. Trent was born just after 12 PM.
After the birth, everything was pretty calm. Baby was good, and the midwifes were not at all concerned about him. Sharon went about checking on Alisa and saw that, besides the episiotomy, Alisa tore in another spot. Sharon realised that she needed an OB to come have a look at the tear, which ended up needing some extra care. Somewhere between 1:30 and 2:00 PM, they came to take Alisa off to theatre (which is what they call the operating room) to get stitched up. The irony of the episiotomy and tearing is that Alisa ended up getting an epidural to get stitched, while she went through the entire labor without it.
While I would have much preferred that Alisa not needed the follow up visit to theatre, I took advantage of the bonding time with Trent. I think Alisa was gone for almost 2 hours, and I was able to hold a peaceful little guy for most of that time. It was a major contrast to Maya and Max because they were whisked away from the operating room straight to the NICU. In fact, I probably held Trent for more time in his first 3 hours of life than I was able to hold Maya and Max for the first 3-4 days of their lives. I also was left alone for most of that time, with Sharon occasionally checking in. It was a sweet time for me, although I was concerned for Alisa and I was relieved when she made it out of theatre fine.
Looking back, the labor and birth experience quickly became uplifting and unifying for Alisa and me. I was very excited about the entire process (other than the episiotomy). I was thrilled that Alisa got to experience something that she so much desired and that she persevered through the intensity of it all. It pushed her beyond where she thought she could go, and she came out of it. I received a greater appreciation for Alisa's strength and sacrifice by witnessing and experiencing the labor process and progression.