Birth photography

With Littles
Between my husband, our doula, and me, and our little point and shoot camera, we managed to capture some lovely images, like this one (after getting out of the shower on the morning of Littles' birth -- the big purple glove was to keep my hep lock dry):

Or my infamous "birds nest hair" picture, taken shortly after she came out:

Or this shot of my husband's first moments alone with our new baby, which I had to capture as best as possible from my bed across the room (no way was I getting up to take pictures):

Of course, I treasure these pictures because they take me back to that amazing day. But still, there were a lot of moments that were missed, simply because my husband and doula were (understandably!) more focused on caring for me than on capturing those moments.

With Noob
I believe I first learned about the concept of birth photography early in my pregnancy with Noob. It sounded like a great idea, but I dragged my feet on actually booking a photographer. At my 37-week checkup, I saw a flyer from a local birth photographer. It reminded me that if I wanted to do it, I really needed to get on it :)

I talked to my husband about it first. He was dead-set against it. It was a lot of money, and I don't think he really liked the idea of having someone there snapping away with her camera during that very intimate time.

But I really, really wanted it, and eventually managed to convince him to not throw the photographer out when she showed up during labor :) My next hurdle was finding a photographer with availability. Really, any professional photographer can take great pictures, but there are a couple of photographers in my area who specialize in birth photography. Like I said, it is a very intimate and special time. I really wanted someone who understood and respected that.

I really lucked out when I contacted Elizabeth at Earth Mama Photography. She has tons of experience in birth photography and is usually booked up months in advance -- in fact, when I contacted her in January, she was already fully booked for July! But she had a couple of late January and early February moms who went early, so she happened to have a hole in her calendar for me.

On Noob's birth day, Elizabeth arrived and left with my midwife. In between, she captured some absolutely amazing pictures. She also blended right in with the rest of my support team. She has kids of her own and used to be a doula as well, so she's been at a lot of births, and she just knows what needs to be done. It is hard to put into words. I imagine it could be awkward, having someone shove a camera in your face during a contraction, or in your vagina when you're trying to push a baby out :) With Elizabeth, it wasn't awkward at all.

She certainly won my husband over. Not only did he not throw her out, but in the weeks following the birth, he kept asking when the final set of pictures would be ready :)

These are some of my favorites.

With Q
It wasn't even a question. Early in my pregnancy, I announced to my husband that I was hiring Elizabeth again. He poked me a bit about having "expensive tastes." I reminded him of how much money he's spent on his woodworking tools. That was that :)

Elizabeth ended up missing the birth itself (no fault of her own, totally mine for not giving her enough of a heads' up), but she showed up literally seconds afterwards and captured some incredible images. Well worth it.

Induction, part 3: Luck

I am a great believer in luck, and I find the harder I work, the more I have of it.
     -- Thomas Jefferson

I started to write this post about two months ago. I had collated a ton of information on questions to ask when you're headed into an induction. Then my computer crashed, and I lost all of it, and I haven't had the motivation to write it again.

Until a few weeks ago, when I got a text from my good friend "N." After months of preparing for a med-free childbirth, she was facing a medically-necessary induction, and was wondering if I had any tips? Gee, it would've been nice to be able to point her to that blog post...

As it turns out, N didn't need it: She made it through her induction epidural-free and birthed her baby girl vaginally. But with induction rates soaring, there are still a lot of women out there who do need this information.

I see a lot of commonalities between N's labor/birth and mine with Littles. We both got lucky, for sure. One of the things that really struck me about Littles' birth was how little control I had over the process. It was up to my body to do its thing, or not do its thing. Thankfully -- luckily -- it did.

But I don't think my successful induction, or N's, was due to pure luck. We both worked hard to be that lucky. There is nothing a woman can do to guarantee a successful induction, but there are certainly some things she can do to up her chances of it.

Namely, ensuring that she has answers to a couple of key questions.

Do I have the support that I'll need?
A successful induction starts long before the induction. In retrospect, three keys to my induction were in place many weeks before I found out I would be induced:

1. I educated myself -- and perhaps more importantly, my husband -- on birth and birth options via childbirth preparation classes.
2. I talked over my birth plan with my OB, and ensured that she was on the same page.
3. I hired a doula.

Many people say that these things aren't important, and for some labors, that's true: I probably could have gotten through my two-hour labor with Q without any of that in place. But inductions can be challenging -- Littles' certainly was! And so having that support in place can make a huge difference in the outcome.

In fact, if you have that kind of support lined up already, you could probably skip the rest of this post. You won't have to ask a whole lot of questions before/during your induction, because the people around you will automatically shepherd you in the right direction. Indeed, my friend N had great support as well: She birthed at the awesome hospital where I originally planned to have Noob, she took Bradley classes with her fabulous husband, she hired M (who attended my last two births) as her doula. So when she texted me to ask for advice heading into her induction, I gave her a few quick pointers, but trusted that I didn't need to say a whole lot. She already knew most of what I'm about to write, and I was confident that her husband or OB or doula or L&D nurse would help with the rest.

What are the risks of an induction?
Even the most necessary of inductions carries some risk. This goes back to my key #1 above: If you've taken a good childbirth prep class, you're probably well aware of these risks. If you haven't, ask your OB. If your OB tells you that there are no risks... do some research on your own. M (my doula) has a great blog post that will get you started.

Why am I being induced?
Hopefully, you don't even need to ask this question, because you and your provider are communicating well and you fully understand the reasons behind his/her recommending induction. But if you're unsure, well, you'll want to clarify whether you're being induced for urgent medical reasons or just because your provider is going on vacation.

Can we wait to induce for another day? Two days? Three days? Longer?
Every day your baby stays inside is another day for him/her to develop, and another day for your body to prepare for labor. (Or even go into labor on its own!) Even so, sometimes, babies reach the point where they are safer out than in and really need to be induced ASAP. But it's worth clarifying whether this is the case with your baby or if you could wait another couple of days (or weeks?) to induce.

What is my Bishop score?
Your Bishop score takes into account the dilation, effacement, consistency, and position of your cervix, along with your fetal station.

The higher your Bishop score, the higher your chance of a successful induction. Bishop scores of 9 or higher are associated with the greatest chance of induction succeeding.

Your Bishop score should be weighed against the answers to the previous two questions. If you have a low Bishop score but you're being induced for solid and urgent medical reasons, you should start with cervical ripening and hope for the best. But if you have a low Bishop score and you're considering an elective induction... well, you might want to give some serious thought as to whether that is the right course of action.

If I need cervical ripening, will you use Cytotec?
If you need to be induced despite a low Bishop score (5 or lower), your provider should recommend cervical ripening first, before starting Pitocin. There are a variety of methods for achieving cervical ripening, including a foley catheter, Cervidil (prostaglandin E2 gel), and Cytotec (misoprostol).

Cytotec is a favorite villain of the natural birth community, primarily for these three reasons:

1. Cytotec is not FDA-approved for labor induction. Induction is an "off-label" usage.
2. There have been reports of uterine rupture after using Cytotec to induce labor.
3. As a result of #1 and #2, Searle (the former manufacturer of Cytotec) sent a letter to doctors warning them not to use Cytotec to induce labor.

While all of these criticisms are true, they do not give the full story:

• Regarding Cytotec's "off-label" usage, doctors prescribe drugs off-label all the time. It is not necessarily dangerous or sinister. Case in point: I've mentioned previously that I took progesterone supplements (specifically Prometrium) during the first trimester with both Noob and Q. Prometrium is FDA-approved for hormone replacement therapy in menopausal women; pregnancy is listed as a contraindication. Yet it's commonly prescribed "off-label" for pregnant women with low progesterone, and I credit it with saving both Noob's and Q's lives.
• Regarding the reports of uterine rupture, they occurred primarily in women attempting VBAC (vaginal birth after cesarean). Certainly, Cytotec should never be used in women with a history of uterine surgery. But for women without such a history, the risk of uterine rupture with Cytotec is similar to what it is during a spontaneous labor.
• Regarding Searle's letter, it was primarily a "cover your ass" move, to absolve the company of any responsibility for adverse outcomes resulting from off-label use of the drug. Again, it does not mean that this off-label use is dangerous or sinister.
• Cytotec has been shown to be more effective than other methods of cervical ripening. Women induced with Cytotec are less likely to need other interventions, such as Pitocin or a c-section. See, for example, this study and this study.

All that said, when I was facing induction, I specifically talked to Dr. S and Dr. K about avoiding Cytotec. There are two things that I don't like about Cytotec:

1. It is a pill that you take either orally or vaginally. If it does cause uterine hyperstimulation, which is a known risk, you cannot remove it (like you can with Cervidil) or turn it off (like you can with Pitocin). You just have to wait for the dose to dissipate and hope your uterus doesn't rupture in the meantime.
2. A Cytotec pill contains 100 micrograms of misoprostol. The recommended dose is 25 micrograms. This means that the pill must be cut into quarters before administration to the patient. Since the medication may not be dispersed evenly across the pill, a quarter of a pill could contain 25 micrograms of misoprostol... or 0 micrograms... or 100 micrograms. You just don't know.

Bottom line, there are benefits and risks to Cytotec. Informed consent is key. Ask your provider if s/he plans to use Cytotec, and if s/he does, have a conversation about those benefits and risks so you can decide if Cytotec is right for you.

How do you see my induction unfolding, as far as which induction mechanisms at what time?
Most providers will have women who need cervical ripening (Cervidil, Cytotec, foley catheter, etc.) come in the night before the actual induction to get started with that. For example, my Monday induction started with Cervidil on Sunday night.

If your cervix is already ripe, your provider will likely have you come in on the morning of your induction to get started with Pitocin, amniotomy (breaking your bag of waters), etc.

You should talk over the "schedule" with your provider, as well as discuss which induction mechanisms s/he plans to use and why. For example, if your provider plans to induce you via amniotomy, you might want to talk about whether that will put you "on the clock" (many providers want women to deliver within a certain time frame after their bag of waters is broken, usually about 24 hours), when and why s/he might decide that you need Pitocin to move things along, the risk of infection, etc.

Will I be able to eat/drink freely during my induction?
I already wrote a whole post on eating and drinking during labor, but it is even more relevant to an induced labor because inductions can take a long time. And unlike a spontaneous labor, where you can labor at home (and therefore eat and drink freely) for much of your labor, an induced labor typically takes place entirely in the hospital. I've had friends who have had 2- and 3-day inductions where they were allowed nothing but ice chips. That seems borderline cruel to me!

As I pointed out in the other post, there is really no good reason for hospitals to restrict food during any labor, induced labors included. With Littles, my hospital brought me breakfast on the morning of my induction, after the Cervidil was removed but before starting Pitocin. If your hospital isn't as progressive, consider sneaking some snacks to keep your energy levels up.

What sort of fetal monitoring will I need?
Most hospitals require continuous electronic fetal monitoring (EFM) for women being induced. This is for good reason: One of the big risks of induction is that it can be too effective, causing uterine hyperstimulation, potentially leading to fetal distress, uterine rupture, etc. EFM can help detect this situation before it becomes an emergency.

Normally, EFM requires two large belts to be strapped to your abdomen (one to monitor the baby's heart rate, another to monitor your contractions) and hooked up to a machine:

Obviously, this greatly limits your freedom of movement... but you can still move around while on EFM. I certainly wasn't walking the hospital halls during my induction, but I was able to sit on the edge of the bed, sit on a birthing ball, sit in a chair, stand up, squat, etc. Good thing, because lying in bed was absolutely excruciating for me. If I hadn't been allowed to move into other positions, I don't think I would have lasted more than an hour or two without an epidural. And if I had gotten an epidural, then I wouldn't have been able to move into other positions. My body was already at a disadvantage, trying to birth a nine and a half pound baby who was not necessarily ready to come out, without the benefit of all the spontaneous-labor hormones that would have prepared my body to help her come out. Being stuck in bed would have put my body at even more of a disadvantage.

Despite all this, many doctors require women to stay in bed while on EFM. As far as I can tell, there is no good reason for this. The only problem that moving around caused me was that the belts would slip and lose Littles' heartbeat. This meant that a nurse had to come in every few minutes to readjust the belt and pick up her heartbeat again -- inconvenient for her, I'm sure, but, well, it was her job. My job was to get my baby out. We both did our jobs, and I absolutely believe that contributed to the positive end result.

So, if you'll be on EFM during your induction, don't let them stick you in bed! Talk to your OB about moving around within the limits of the EFM machine. Also, ask if your hospital has wireless telemetry units. These allow for fetal monitoring while giving you complete freedom of movement. You can even go in the tub with one on! But not all hospitals have them, and those that do sometimes don't have enough for every laboring woman -- so it's good to know ahead of time whether it's an option for you, and to express your interest in using one if possible.

I wanted to birth without pain medication. Now that I'm being induced, is this still possible?
This isn't a question for your provider, but for yourself. And the answer is an unequivocal YES. You have to believe that you can do it... because you can.

Back when I was pregnant with Littles, I heard very few stories of pain-med-free inductions. Even my doula admitted (after the fact) that I was her first client to make it through an induction without an epidural. Now I hear those types of stories all the time. Women are doing it. You can do it.

I've done everything "right." Does that mean I'm going to have a wonderful, easy vaginal birth?
Unfortunately, no :( It might not be any of those things. That's labor for ya. Jefferson said that the harder he worked, the luckier he was -- not that he was lucky all the time.

But for me, this goes back to my birth mindset. I had a sense of peace when I showed up at the hospital for my induction. Induction wasn't what I had hoped for, but I knew that it was the safest, most informed decision under the circumstances. I knew that I had asked all the right questions. I knew I had a great support team surrounding me. And so that sense of peace came from knowing that I was headed for the best possible outcome. Again, not necessarily the outcome I had hoped for (that is pure luck)... but the best possible outcome regardless.

It's my hope that every woman headed into an induction -- or into spontaneous labor, or into a scheduled c-section, for that matter -- has that sense of peace, and achieves her best possible outcome as well.

Induction, part 2: A change in mindset

I headed in to my 41-week appointment with Littles prepared to set an induction date. I wasn't prepared for how upset that would make me.

The appointment was with Dr. S. He and I had never really "clicked," and our relationship certainly didn't improve as my pregnancy progressed. By this point, I had the on-call schedule memorized and was actively hoping not to go into labor on the days he was on-call.

He did all the usual appointment stuff, as well as a cervix check to assess my "progress," and a non-stress test (NST) and biophysical profile (BPP) -- two common forms of monitoring for overdue women. Then, at the end, he announced that the baby needed to be born by 42 weeks, so I needed to get an induction date set. He also said that I had an "unfavorable cervix," so I would need to come in the night before (i.e. no later than 41 weeks 6 days) for cervical ripening prior to Pitocin.

I left the appointment in tears. Dr. S had not seemed real open to questions. For example, when I asked him whether I'd get Cervidil or Cytotec for cervical ripening, he stared at me in surprise for a moment before answering -- like he wasn't used to answering questions like that.

But I had lots more questions running through my head: Would I need continuous fetal monitoring? Would that mean I'd be stuck in bed? Since I had to come in the night before, would I get breakfast in the morning, or would I be expected to labor the entire time with no food at all? And perhaps the most important questions: Could I do this without an epidural, as I had planned all along? Did I have a decent chance of delivering vaginally, or would I likely end up with a c-section?

I pretty much cried for three days straight. My husband was upset at seeing me so upset. He encouraged me to call and schedule another appointment, with Dr. K, who would be the OB on call during my induction. (That was one benefit to being induced: I was able to choose to deliver with Dr. K, rather than Dr. S, or one of the other four doctors in the practice, none of whom I'd met before.)

They squeezed me into Dr. K's schedule on Friday morning, 41 weeks 3 days. Dr. K ran me through the same tests that Dr. S had done earlier in the week, but she seemed much more relaxed, and it made me more relaxed. Rather than rushing through the ultrasound for the BPP, as Dr. S had done, Dr. K took her time to explain what she was looking at and why it was important. Later, I asked her the Cervidil vs. Cytotec question again, and she took it completely in stride, spending a few minutes explaining what she planned to do and why. I was able to open up and get all my other questions answered to my satisfaction.

My induction date didn't change as a result of that appointment. My mindset, however, changed drastically: I felt 100% comfortable with what was happening. I still wasn't thrilled about it, but I had come to terms with it, and became determined to make the best of it.

I hope every woman facing induction can have a similarly productive conversation with her provider -- especially if she wants a pain med free birth. If you're one of those women, and you're wondering how to kick off that conversation, stay tuned for my next post...

Induction

Littles was born via induction, due to being two weeks late.

Labor induction is the subject of much debate, for a variety of reasons. For one, it's on the rise: Approximately 1 in 4 labors in the USA now start via induction, and it appears that much of the increase is due to elective (rather than medically-indicated) inductions. "Early term" elective inductions (at 37 or 38 weeks gestation) are associated with a significantly higher rate of NICU stays and other complications, compared to inductions at 39 weeks or later. Pitocin, a drug used in many of those inductions, has the reputation of stimulating contractions that are far stronger than contractions experienced during a spontaneous labor, dramatically increasing the likelihood that the mother will need an epidural. And since by definition, induction is designed to make a body give birth before it's ready, it has the reputation of greatly increasing the risk of ending up with a c-section.

These reputations are so pervasive that I've heard women say things like, "I knew the Pitocin-induced contractions would be awful, so I refused to let them start Pitocin until I had my epidural." Or, "My OB is talking induction, but I'm thinking it would be better to just accept the inevitable, and have a scheduled c-section. Better than an emergency one after a failed induction."

Simply put, this wasn't my experience. I labored on Pitocin for nearly 12 hours with no epidural or other pain medications. I ended up delivering vaginally with no complications. Even now, having experienced two spontaneous labors, I still consider Littles' birth to be a wonderful experience -- very different from my other two births, to be sure, but amazing in its own way. I also didn't find Pitocin-induced contractions to be any different from the spontaneous contractions of Noob's and Q's births. The main challenge in Littles' birth was just that it took much longer -- roughly 11 hours of truly "active" labor, compared to about 4 hours with Noob and maybe 2 hours with Q. The individual contractions weren't any harder to deal with; there were just a lot more of them to deal with :)

Numerous studies back up my experience. For example, this study, this study, and this systemic review all found that inducing labor does not raise the risk of a c-section, and may actually result in lower c-section rates in certain populations, e.g. women at or beyond 41 weeks gestation. And in the seminal Dublin study on active management of labor, 25% of labors were induced (via amniotomy followed by oxytocin [Pitocin] if contractions didn't start on their own) and 55% of labors were augmented with oxytocin at some point, yet the c-section rate was only 5.2% and nearly half the women in the study did not receive any pain medication.

(As for the issues associated with "early term" elective inductions? Those are definitely real, and are the reason for a March of Dimes campaign against such inductions.)

Okay. Studies are great and all, but it really seems like most of the moms I know who went in for an induction walked out with a c-section. Especially the first-time moms. And when I hear their birth stories, I often find myself shaking my head at some of the unnecessary hoops they were forced to jump through. Like the women who were forced to stay in bed for the duration of their induction. Or who were only allowed ice chips for sustenance.

The natural-birth community loves to vilify Pitocin, but this gap between the studies and my reality makes me wonder whether the problem is not Pitocin per se, but how it's used, or abused, as the case may be. For example, in the aforementioned Dublin study, each laboring woman was assigned a personal nurse for support -- essentially a doula. The mere presence of a doula has been shown to lower epidural rates and c-section rates. Perhaps that helps account for some of the study's results despite the relatively high reliance on Pitocin.

If that's the case, it is good news, because it means that women can do something to improve their chances of a successful induction. In my next few posts, I'll talk about some of the things that I believe helped with making my own induction successful.

Littles' birth story

A couple of notes about the birth stories:

1. Grab a cup of coffee and settle in. They are long.
2. They contain stuff that some people may consider TMI. Mucus plugs, bloody show, tearing "down there," etc. You have been warned.
3. They were all written within days of the respective births. That means that they are a good indication of my perspective and mindset at the time of the birth. In some cases (especially regarding Littles' birth), my perspective/mindset has changed with time.
4. Hypnobabies users: You may want to use your BOP. All birth stories contain standard terminology (no "birthing time" or "pressure waves" here...) Littles' mentions p**n a few times; Noob's and Q's do not.

Still want to read? OK. Here goes...

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Background: I had an easy, healthy, normal pregnancy, aside from testing positive for Group B strep at 36 weeks. We planned a natural birth and took Bradley method classes. Unfortunately, the baby wouldn't cooperate, and at 41 weeks, I got scheduled for an induction starting at 41 weeks 5 days (June 17). I was rather upset, as this put a major kink in my natural birth plans and there didn't seem to be any reason to rush the baby out, but I decided to make the best of it and try to make it through with as few interventions as possible.

Afternoon of 6/17/2007 - I stood up and noticed a tiny gush of fluid. I thought it was probably my imagination, or if not, most likely urine -- but that itself was odd, as I had no problems with urine leakage at all during pregnancy.

6/17 7:30 pm - We were getting ready to leave for the hospital when I noticed a more noticeable gush of fluid. Still nothing huge. I had a gut feeling that it was amniotic fluid.

8:15 pm - We arrived at the hospital and got checked in. I mentioned the fluid leakage to the nurse. She said if my water really did break, it would keep on leaking, and to let her know if that was the case. I got hooked up to the external fetal monitor, which showed I was contracting about every 5 mins, but I couldn't feel them at all.

10:30 pm - The on-call OB examined me. I was 1cm dilated, very soft cervix -- basically no change from my appointment the previous Friday 6/15, so my contractions weren't really doing anything. I had had no more fluid leakage, so she went ahead and inserted the Cervidil and kept me on the fetal monitor. Pretty soon, I started feeling more contractions. They either felt like a painless tightening of my stomach or like mild menstrual cramps. I turned down an Ambien (I didn't want the baby or me to be sedated, in case things got moving before the drug wore off) and tried to get some sleep.

6/18 12:00 am - I had just drifted off to sleep when I felt something leaking. We called the nurse, who confirmed that my water had broken. She consulted with the on-call OB and decided to leave the Cervidil in, but put in a hep lock and start IV penicillin due to my GBS status.

(In retrospect, I'm pretty sure that my water would've broken on its own on Monday or Tuesday had I not been induced. Getting induced when I did was something of a blessing, as it allowed me to labor some on Cervidil rather than going straight to Pitocin.)

6 am - The contractions had gotten strong enough that I could no longer sleep through them, so I was waking up about every 5 minutes. I tried to relax through them and hoped they were doing something.

6:30 am - Round 2 of penicillin.

7:30 am - My OB, Dr. K, came in to examine me. Good news, I had dilated to 4cm and 90% effaced on the Cervidil alone! She decided to let me labor for a bit on my own to see if we could avoid Pitocin. We called our doula E, and I took a shower and ate breakfast. I did some walking to try and get things moving -- it just felt good to be off the monitors and the IV. (I still had a hep lock for antibiotics and for Pitocin if needed.)

10 am - Yep, I needed the Pitocin :( Back on the fetal monitors and the IV. No more walking.

11 am - I posted a labor update to my blog. By this point, the contractions were strong enough that I could not type during them, but I still had a good break in between them. They quickly got so intense that I couldn't do anything but focus on them.

1:30 pm - I'd been laboring hard for 2.5 hours. My bloody show had turned from pink to bright red, and I was feeling some pressure in my bottom. So the nurse came in to check on me. I had moved to 100% effaced, but I was still 4cm dilated, just as I had been six hours earlier :( Thank goodness for Bradley classes, where we talked about the NAP (natural alignment plateau) -- my husband, E, and I all knew I could be minutes away from transition even at 4cm. Transition turned out to be a little longer in coming :), but I didn't get too discouraged. I told E, "I don't care that I'm still 4cm. I know I'm making progress. This hurts too much to NOT be making progress."

Around 2:30 pm - Dr. K came back (she'd been at the office) and asked if I'd had a shower. Of course I hadn't; I was still hooked up to the IV and fetal monitors. Bless her, she told the nurses to take me off all that and let me get in the shower. I don't know if it was the shower that helped or just being off the Pitocin, but my pain got better. It was a very welcome break for maybe 20-30 mins, giving me a bit of a second wind.

4:30 pm - Dr. K checked me again. "Floppy" 6cm dilated. OK, better than 4cm. At least I was making progress. I was still nervous that my progress might just stall at some point.
By this time, the contractions were incredibly intense. I was chanting "Open" through them and trying to visualize my cervix opening up. I was switching positions as much as I could, from sitting on the edge of the bed to sitting in a chair to sitting on E's birth ball. I was also able to stand up, but I felt very tense in that position, so I figured it was counter-productive. Lying on my back or side (which I had to do momentarily when they checked me) was absolutely miserable.

The wonderful thing about having E there through all this, besides the obvious support that she gave me, was that she was able to give my husband a break. He actually took a hard 20 minute nap during this period, and he was also able to get lunch and dinner throughout the day. Without E there, I think he would have been too exhausted by the end of the day to really support me when I needed it desperately. Doulas are worth their weight in gold!

6:00 pm - Another check. 8cm, stretch to 9cm. Still making progress. Referring to my Ironman experience, I made a crack about how I'd finished the swim and the bike, and now just had a marathon to run :)

6:30 pm - Round 3 of antibiotics.

Around this time, things got really bad. I had been able to relax through my contractions for most of the day, but now it was all I could do to hang on and stay on top of them. I couldn't even chant "Open" or hum anymore; I just tried to breath. I was incredibly tired and just wanted to get off the Pitocin, fall asleep, and continue laboring later. I actually did sleep in between quite a few contractions.

In addition to the three positions we'd been using all day, E also had me try all-fours and squatting. All-fours felt pretty good. Squatting was REALLY intense. I tried it two or three times and I just couldn't handle it.

My memories of the next few hours are a little fuzzy as far as time goes...

Contractions started to get all over the place. Some were so intense and painful that I couldn't do anything but cry out "Ow! Ow! Ow!," and I even kicked my husband once. Others were quite manageable and gave me a nice break. I also started feeling more contractions in my back. I must've hit transition somewhere in here, but it wasn't very different from what I'd been feeling all along. I did get some shakes, maybe around 7:30 or 8 pm?

Everyone kept asking me if I was feeling pressure, as this would indicate whether it was time to push. Well, I'd been feeling pressure all day, so how was I supposed to know when it was "real?"

The L&D nurse (Melissa) and Dr. K checked me a couple of times. I was fully dilated but still had an anterior lip of cervix that neither of them could push back. I was incredibly discouraged and convinced that the lip would never go away.

Finally, Dr. K said to go ahead and push as she held the lip back. This worked out fine -- the lip moved, and I was finally able to push freely!

Pushing was hard work, but an incredible relief. I was on top of the contractions again. I was DOING something! And it was fun 'cause everyone was cheering me on. I have no idea how long I pushed. My husband says 20 minutes. I think it was closer to 30-45 minutes. I pushed mostly on all fours, then switched to my left side for the last few contractions.

And then, at 9:26 pm, out came Littles! 13 days past her due date, 23 hours after labor got started, 11.5 hours after the evil Pitocin went in -- and totally worth the wait.

She came right on my belly, and not knowing any better, I thought she looked like any other newborn. It was Dr. K, Melissa, and E (who have been around a lot more newborns) who immediately said, "Wow, that is a BIG baby!" Sure enough, she weighed in at 9 lbs 7 oz. We had NO idea she was that big, as my OBs don't typically do late ultrasounds for weight estimates. I am glad they don't, because if I had suspected she was big, I might have doubted my ability to push her out. Ignorance is bliss :)

I am really glad we let her have those extra days in the womb. She has been doing so well -- very active right from the start, picked up breastfeeding right away, no jaundice issues, fantastic hearing (the hearing test lady was very excited, as she scored over a 300, which is apparently fairly uncommon) -- and I think part of the reason why is that she got those extra days for her brain to build some extra connections to help her out.

Anyway, whatever the reason, she is just wonderful and we love her so much already :)

How I embarked on this journey: The long version

(The short version is here.)

My birth -- June 19something (Yeah right. Like I'd tell you the actual year :) When I asked my mom about my birth when I was growing up, she described it like this: She went into labor early in the morning, precisely two weeks after my due date. She labored by herself for a few hours and then woke up my dad to go to the hospital. She did not receive an epidural or other pain medication. I was born about twelve hours later, weighing in at 9 lbs 6 oz.

What I wrote above is pretty much how she said it. No long drawn-out horror stories of the aaaaaaaaaaaaaaaaaaaaagony of waiting two looooooooooooooooooooong weeks to go into labor, or of laboring without an epidural for the better part of a day, or of delivering a nine and a half pound baby.

So I grew up thinking that delivering 9+ pound babies two weeks late with no epidural was just "normal."

Littles' birth -- June 2007

Throughout my pregnancy with Littles, I saw an OB and planned to deliver out of a hospital, with minimal interventions, including no pain medication.

Again, I believed that delivering babies two weeks late was "normal," and so I was not at all surprised when I went overdue. As week 40 turned into week 41 and started approaching week 42, everyone seemed to assume that I must be miserable and just done being pregnant. I really wasn't. I was eager to meet Littles, but I also loved being pregnant.

Finally, my OB said that she needed to be out by 42 weeks. I went in to the hospital on Sunday night to get Cervidil, and then started Pitocin on Monday morning. Littles was born that night, weighing in at 9 lbs 7 oz. Aside from the Cervidil, Pitocin, and antibiotics due to being GBS positive, I had no other medications.

I wouldn't say it was an easy birth. Mostly, it was just long. I was so tired by the end that I was falling asleep between contractions. But it was an absolutely amazing experience and I loved it. The next day, my nurse asked me if I'd do it without pain medications again, and I didn't even hesitate with my reply: "Absolutely."

I consider Littles' birth to be a very positive hospital birth experience. I'm not at all anti-hospital. I've learned over the years that having an experience like that, or like my mom's, may not be as automatic as it really should be, when you're birthing in a hospital -- but that doesn't mean it's impossible.

Noob's birth -- January 2010

We moved out of state when Littles was about a year old, so delivering future babies with my same OB was not an option. In a way, I was relieved, because although I had had a really positive experience, there were also some things I wanted to change, and our move gave me the opportunity to do that.

In particular, I felt that most midwifes would be more in line with my views on birth than most OBs. I considered out-of-hospital birth early in my pregnancy, but my husband wasn't comfortable with it. Instead, I found two midwives who delivered out of a hospital considered to be one of the most natural-birth friendly ones in my area.

I loved my midwives, but as the birth approached, I found myself turning back to the idea of out-of-hospital birth. My hospital was great, but it's still a hospital, and there were some things I really wanted that simply didn't work well with birthing in a hospital, such as allowing Littles (then age 2) to be an integral part of the birth.

I finally decided that my husband and I needed to meet with a homebirth midwife, "C." We did that just before New Years. I was 35 weeks pregnant. I fully expected my husband to walk away from that meeting saying, "I'm sorry, I'm still not comfortable with this idea." And then, I was fine sticking with our original plan of the hospital-based midwives.

To my complete and utter surprise, C was able to address most of his concerns. We decided to make the switch. Noob was born almost exactly four weeks later, two days before his due date, at home, weighing in at 8 lbs 11 oz. His birth was quick, easy, comfortable, peaceful. Incredible.

Hospital vs. home
When I switched to homebirth, obviously I knew that it would be very different from hospital birth. Still, I was surprised by some of the more subtle differences that came out, even in just the four weeks that I was under C's care. I quickly learned that homebirth is not just like hospital birth except you stay at home at the end. It is a completely different approach to pregnancy, birth, and the immediate postpartum period.

Take Group B Strep (GBS), for example. GBS is a bacteria that colonizes the vaginal tract in approximately 25% of women at any given point in time. It's harmless to the woman, but if she gives birth while colonized by GBS, her baby is at a higher risk of becoming infected with GBS. GBS infection in a newborn can be very serious, even fatal.

When I was pregnant with Littles, my OB followed standard American protocol for minimizing the risk of GBS-infected newborns: I was tested for GBS at 36 weeks. When I tested positive, I received IV antibiotics during labor, cutting Littles' risk of GBS infection. Of course, antibiotics carry risks as well, such as possible allergic reactions and an increased risk of acquiring other bacterial infections (since antibiotics kill off not only "bad" bacteria like GBS but also the "good" bacteria that naturally keep "bad" bacteria at bay).

With Noob, I switched away from my hospital-based midwives right at 36 weeks, but it appeared that they follow the same protocol: Test at 36 weeks, IV antibiotics during labor for women who test positive.

My homebirth midwife takes a different approach. She is not licensed to give IV antibiotics to GBS+ moms during labor. Some might point to that as an example of how homebirth is less safe than hospital birth... but that's not the full story.

Rather than simply treating GBS colonization when it's detected, my midwife tries to prevent it in the first place. She recommends taking probiotics and certain vitamins that have an antibacterial effect, starting a few weeks before the test. (With Noob, I was lucky that my doula had proactively passed along a similar GBS-fighting regimen to me when I was still under the care of the hospital-based midwives. So I had been following it even prior to my switch to homebirth.)

I ended up testing negative. So the lack of IV antibiotics was a non-issue, and I didn't have to worry about any negative side-effects of the antibiotics, either.

The difference between preventing and treating GBS is not something that I can quickly explain to the average person who looks at me in horror saying, "Giving birth at home? Are you insane? That's so unsafe!" But they're the kinds of things I want to document in this blog.