Wednesday, September 3, 2014

Lincoln's Birth - Our Doula's Perspective

Welcoming Lincoln

Kris and Becca hired me as their doula about halfway through their pregnancy with Lincoln. Becca had a cesarean with their son Harrison and VBAC’s are really something I enjoy working with. There is a lot of myths and severe lack of education that surround having a vaginal birth after a cesarean section. I have attended several successful hospital and homebirth VBAC’s so Kris and Becca felt I was a good candidate for their preferences.
Becca had a great pregnancy, despite some very traumatic events within their familyKris’ younger brother was tragically killed shortly before Kris and Becca were going to announce their wonderful news. Aside sadness and grief, there was hope. Precious hope that they hung onto. There was a new little life growing. Becca focused on that and her faith that God plans all things and He was in control. He knew the reason and the season in which this had all taken place. Having lost my brother in law at a young age to a senseless tragedy, I understood her pain. They prayed constantly for this pregnancy. Lincoln grew. And kept growing. And then he grew a few more weeks. ACOG classifies post-date as anything after 42 weeks and 1 day. Becca had to be a major show off and carried till 43 weeks and 2 days. JThroughout her pregnancy, Becca was an amazing example of peace and grace. She had the faith that she was to deliver her baby in the way she was meant to and that he would be born on the day he needed to be. Despite the extra weeks and wondering when she would have her baby, they held onto their faith and remained positive that Lincoln would choose his birthday when he was ready. We talked numerous times a week leading up to his estimated date about everything and I would wait for Becca to have the normal “I am so ready to have this baby and am done” talk. She never failed to inspire me with how at peace she was, thanks to her faith. As her estimated due date came and went, we discussed all the normal things and next steps, etc. Lincoln was measuring perfectly and Becca was in great health!
Finally..the day arrived. Becca texted me late at night to let me know how she was feeling and that she was thankful and praising God. She let me know the next morning when it was time for me to come. I arrived shortly after the midwife and began setting things up! Becca was so calm and working with her body in what it needed to do. Kris was such an amazing support for her. He never failed to sense what she needed at the moment and was always close by her. They have such a wonderful bond and it was very touching to see. I wish all men were as intuitive. ;) After everything was set up, I thought Becca would want me to coach her or what not. She and Kris were in such a beautiful rhythm that I simply observed and was ready if she decided she needed anything. I am not much of a ‘all women are so gorgeous when in the midst of labor and are goddesses’” type of doula.Women are strong and amazing, but birth is not all butterflies and fairies. Sweat and tears might be what gets a baby here. ;) Becca’s radiance shone through and I would catch myself taking photos and thinking “Dang, thatlooks good!” Haha! Becca had her birth playlist going which consisted mostly of worship songs. If you know Becca, you know she is music. J She would occasionally be in the midst of a contraction and we would hear her beautiful voice fill the room. I recorded a few clips of this…maybe if everyone asks her, she may share. I was so relaxed and calm just watching and listening to her sing. Becca continued laboring throughout the day making progress. She found the birth pool relaxing and would rotate between that and walking around a bit. She labored into the evening. She asked the midwife Sue, to do a cervical check and see where she was. She was confident despite being very tired and praised God when Sueannounced, “You’re complete with a small cervical lip!” I looked at Becca and exclaimed, “You did it! Becca, you’re at 10 centimeters! You did it!!” I was SO excited and wanted to do some fist pumping or cartwheels!! She labored for a few more hours but never quite got “the urge” to fully push. She decided it was time to go to the hospital. Kris was supportive of her choice though he later admitted he was nervous. VBAC homebirths are often frowned upon in our area, mostly due to lack of knowledge and specific education. We prepared to leave and Becca noticed the baby making very strong movements that were painful. Little did we know, this baby was making his way down like a corkscrew. He was determined to come out in his own way! We arrived at the hospital and made our way up to L&D. We had a welcoming committee! There were at least 8-10 staff members waiting in the room for the lady who was 10 centimeters. ;) Being in the medical field myself, its always a little funny to see medical personnel shocked that a woman giving birth naturally isn’t writhing around on the ground and yelling for help. Between contractions Becca answered the typical admitting questions and Kris filled in when she was focusing through a contraction.After being in the room for only a few minutes, one of the nurses told the doctor “I’ll go ahead and prep her for a C-section” to which the doctorreplied, “She came here for a VBAC”. Inside fist pump from me. The OB was very supportive and encouraging, despite the hospitals in this area not being very VBAC friendly. One of the nurses did a cervical check to confirm dilation and check to see what position Lincoln was in. Becca still had asmall cervical lip and the baby was now OP or “sunnyside up”. They administered an epidural to give Becca some time for that cervical lip to dissolve and move out of the way.  Oftentimes if a woman starts pushing with a cervical lip, it can cause the cervix to swell and can cause damage or prevent the baby from descending. After about an hour or so, the lip was gone!! Time to have this baby! The staff rushed to get everything in place. Typically only one person is allowed to stay for the delivery due to all the staff but I asked the doctor if I could please stay in the delivery room as I was taking photos. She agreed and we got ready to begin. Kris was on one side of Becca with me on the other. She did a few test pushes and we could see the top of his little head! She was making wonderful progress. Soon, Lincoln Cameron Redus was born vaginally, in his own way. He had his arms crossed in front of him with his hands in front of his face. That explained a lot! The doctor did a bit of delayed cord clamping and handed a yelling baby boy to his overjoyed mama. Becca looked at us both while saying in awe “I did it. I had a VBAC. I did it. I did it”. After snapping a few photos of the baby with Kris and Becca, I moved down to the foot of the bed. Most moms want to know how things go and ask me to pay attention so I can tell them later. If you know me, you know I have a fascination with placentas. I mean, come on people. These things are amazing! Two residents were attending with the OB and the doctor had handed over the task of delivering the placenta to one of the residents. Most of my clients prefer to let the placenta deliver naturally, as studies show that’s the best for the body. Most hospitals do what is called controlled cord traction, where the physician gently and firmly helps “guide” the placenta out. I noticed the intern was struggling pretty hard with it and that the cord was showing some bubbling in areas. I drew the doctor’s attention to it but she stated it was normal and the intern continued. I considered saying something else, but as adoula, my job is to quietly learn and support my clients. The placenta came out and the resident said, “That’s the biggest placenta I’ve ever seen!” My mouth dropped open as I realized that Becca’s uterus had inverted and was still attached to the placenta. I loudly said, “That’s not the placenta, that’s the uterus! The OB pushed the intern out of the way and quickly attended to the problem. I left soon after as I knew Becca would be being attended to and now was not the time for me to be in the room. Becca told me several hours later that she had to be taken into an emergency procedure to save her uterus. Thankfully, the procedure worked. Oftentimes with inverted prolapse, a hysterectomy is the only way to stop the hemorrhage. One of the most common causes of prolapsed is premature delivery of the placenta.
Becca remained in ICU for a few days and I was able to be at the hospitalwhen she was moved to a postpartum room. Oh, the emotions when they brought her baby in. Babies cannot be in ICU so she had been separated from him the entire time, except for ten minutes. The nurse, Becca and I were all crying. I was able to capture some of the sweetest moments. A mama breastfeeding her baby for the first time. A mama examining every inch of her newborn and basking in his perfection. A new baby enjoying snuggling skin to skin with the person who carried him for 43 weeks. Precious firsts. Lincoln has been a light and joy to all of those around him and he proudly carries a very special name.

You will do great things little Lincoln.

Monday, September 1, 2014

Lincoln's Birth Story

Have you ever met someone who went to 43 weeks with their pregnancy? No?

Well now you have. I expected to go past my due date but never, ever did I think I would give birth at 43 weeks and 2 days. Before I even begin the full story let me tell you what I've learned: God has designed the human body to do amazing, miraculous things when we give Him control. And you know what? He does it on His schedule, not mine.

So let's begin. Nearing the end of my pregnancy I was still physically comfortable, though a little tired, and emotionally equipped to keep going. I was trusting that God would get things going in His timing. Then on Tuesday, July 8 I hit the 43 week mark. I went to my appointment with my midwife and was finally feeling a little discouraged. I reached the point, like most women waiting on a baby do, where I started to think "This baby is going to be inside of me" I decided that if my contractions hadn't picked up by that night that I would try taking castor oil. I keep it in the house for washing my face so it was accessible. My emotions continued to get the best of me so after dinner I took the plunge. Disgusting. Revolting. I do NOT recommend it. A few hours later all I had was a nasty taste lingering in my mouth and a slightly sour stomach. I decided to take a warm bath and spend some time in prayer and finally told Kris that I just felt done. I was ready to hold my baby and emotionally exhausted with pregnancy. I think, looking back, that I would have gone into labor that night without drinking the castor oil but of course I'll never know. I finally reached that point where my body and heart were ready. I went to bed and, like so many nights previously, prayed that God would start my labor that night. 

Sure enough, I woke up at 2:30am to a contraction and thanked God. I was so relieved! I laid in bed and rested/slept between contractions for about an hour before I got up to go to the bathroom and text my doula and midwife. I let them know I was in labor and how my contractions were going but didn't need them to come yet. Contractions were 2.5-3 minutes apart for that hour and were manageable. When I got up I found that I had a bloody show and I was elated. It's funny the things you start to get excited about when you've been waiting that long to have a baby! I was so excited because that meant I really was in labor and not just having random contractions. Right after I got resettled in bed Harrison woke up in his room and wanted to snuggle...bad timing, man. I got him settled in our bed with Kris and tried to go rest in our guest room but it took a while. I continued to rest and sleep between contractions in the guest room until around 5:30am. I was uncomfortable laying down at that point so I started packing Harrison's day bag and picking up around the house. It felt good to have something productive to do in between contractions. Around 7am Kris woke up and came out to check on me. It was so nice to have some quiet time that morning before Harrison woke up for the day. I remember feeling very peaceful and comforted about everything...this was what we had been waiting for! I was feeling Lincoln move around a lot and was encouraged knowing he was doing well. We lined up friends to watch Harrison and around 9 I took a shower while Kris dropped him off for the day. I was relieved to know that he would have a fun day but sad to see him go. After showering I was so enjoying the effect of the water as amazing pain relief that I took a bath. I labored there until Kris came home and a little while later got dressed and started pacing the house.

During my labor with Harrison I enjoyed having Kris play his guitar and I would sing off and on. I expected this to be similar but, instead, I had my birth playlist going and wanted contact during contractions. Every time I would feel a contraction begin I wanted Kris right next to me. I would put my arms at his neck while bending and swaying, or lean against the table while he had his hands on my back. That tangible support was incredible and he rose to the occasion perfectly. My husband was a perfect picture of support and Godly leadership throughout the labor! At 10:45 my contractions were getting stronger but farther apart. I started resting on the couch in between them to preserve my energy. At 11:30 I felt like things were picking up quite a bit and thought that it was time to call my doula, Shanna, and midwife, Sue. It was around this time that I started to realize how much the castor oil was affecting my ability to feel well during labor. I expected to feel sick but the trouble was that I found it very difficult to eat or drink. I had no appetite and even water was very unsettling. I drank as often as I could but it took a lot of effort.

At 1:30pm Sue arrived at my house! I was so relieved to see her. I wanted her to go ahead and do a cervical check to see how much I had progressed so far. I thought that surely after 11 hours of labor I would be around 5 centimeters. Ha! Wrong. I was at 3cm. I'll admit, I was initially disappointed that it wasn't more but then Sue said, "Praise God for the increase!" and it hit me. Progress is never something to be disappointed in, even if it's just a little. My body was doing exactly what it needed to and I needed to be thankful. My phrase throughout labor, from the time it started until the end, was "Thank you God!" after every contraction. Then, as they got harder I started saying, "Thank you God. I'll have another." Hey, it made me smile and remember that every contraction was something to be thankful for and I wanted them to continue, not stop! It made me refocus and laugh a little inside each time. I'm not one to undervalue a little healthy smiling. Shanna arrived about 15 minutes after Sue. I was so excited for her to be there! She and Kris started setting up the birth pool in our living room. Poor Kris, he was helping Shanna in between me calling him over to stand with me through contractions. Once I was able to be in the tub I had found my happy place. Being in the water gave me the ability to move more freely and comfortably during contractions. It was also a nice, restful change from walking around. 

I labored in the tub while worshiping and singing some for a couple hours before getting out around 4pm. I checked out at 5-6 cm! I was very encouraged by more progress. My mom had arrived around this time as well. We had thought initially that she might go get Harrison when she arrived but it was clear that I still had a ways to go so she came straight to the house and got to be there for the rest of the labor! Between 4 and 5:30 I was walking, sitting and laboring out of the pool. My contractions had increased in intensity and were 2-3 minutes apart. 

At 5:30 I got back in the pool and had a nice time with a bit of an endorphin rush. I spent a lot of time nodding off between contractions and the next couple of hours really run together for me. It was similar to my peaceful time with Kris earlier that morning. Throughout the day Shanna kept the pool heated, had cool washcloths on my head and face, and was an amazing encourager! Kris hardly ever left my side and was so calm and collected. My mom and Sue kept me smiling, calm, and confident. It was an amazing time. 

At 7:30 we did another cervical check and I was thrilled! I was nearly complete, 9cm with a small cervical lip. I wasn't feeling any urges to push and was hoping the cervical lip would resolve with a little more time. We decided to go ahead and break my waters with the hope that his head would put more pressure and help with getting my cervix to open just a bit more. I got back in the tub and started praying hard for the labor to end soon so I could hold my baby. I continued there for a while longer before we decided to try walking around the house again to get him moving down. During this time I was beginning to feel small urges to push but also feeling very tired. I hadn't had nearly as much water throughout the day as I should have because I just couldn't stomach it. 

Around 9:30, after walking for a while and not feeling pushing urges as strongly, I tried laboring and pushing on our bed. It was during this time that I started to have this incredibly intense feeling that I almost can't describe. It was like I was being kicked, very hard. It startled me because, up to this point, I felt each contraction come on like a dimmer light: slowly up and slowly down. This didn't feel like a contraction, in fact it didn't feel like it was happening to my uterus at all. It was just intense vaginal pressure and it shook me up because it was so different from everything else I had felt. I had a hard time pushing during those pressure moments because it caught me so off guard. This was the moment when, more than anything, my exhaustion and lack of hydration caught up with me.

At 10:10 I suggested that I might be ready to go to the hospital. I didn't feel like a failure and no one treated me like that. But after 3 hours of fighting the lip without success I knew I only had so much more time before my body wouldn't be able to push any longer.  Over that last hour at home my contractions had gotten farther and farther apart and, other than the moments of pressure, were feeling much less intense. We talked it out for a little bit before I finally made the call. I went back to our room to change clothes and grab a few things. I sat there in our bathroom and labored for a little while and was very conflicted. I had worked so hard and was warring within myself on whether or not I had made the right decision. I found myself praying but my heart was so torn. It felt like I sat there forever but I'm sure it wasn't very long at all. Kris came in and sat with me and then we loaded up to head to the hospital.

We knew from the beginning that if we needed to transfer that we had a great option literally right down the road from our house. As soon as I got in the car to head there I began to pray that God would prepare a good environment at the hospital and that He would give me a gracious and thankful heart. Shanna called to let them know we were on our way and they were ready for us as soon as we got there. I was expecting to be treated at the very least like the village idiot and at the worst like a terrible mother who must be immediately wheeled to the operating room for a cesarean after endangering herself and her baby by laboring at home. I was beyond thankful that they were incredibly kind and accommodating. I did my best to answer their questions in between contractions while Kris filled in the rest. The doctor on call had a team of residents and interns with her in addition to the nurse so it was a full house. We talked with Dr. P about an assisted delivery but she wanted to make sure the cervical lip had gone away. I appreciated that she respected my decision to have a VBAC and she supported me in that. At this particular hospital that is quite rare so God most certainly answered my prayers. I accepted the epidural with the hope that it would help my cervix relax but requested no pitocin. Once again, they respected my decision. I must have said, "Thank you for being so understanding" at least a hundred times. I was so glad that I wasn't being forced into interventions that I didn't want. At one point during all this the nurse looked at Dr. P and asked "Do you want me to just go ahead and prep her for a csection?" to which she responded, "No. She came here for a VBAC." Seriously. God answers prayers.

After I got the epidural Dr. P suggested we give it an hour to see if the lip would go away. Most everyone left the room for that hour so Kris and I took that opportunity to talk about the day and how we felt about the transfer. We both knew that another c-section was a possibility but we prayed that God would continue to work in my body. I assured him that I was doing well despite the disappointment of the transfer. This was a very quiet hour and I was very thankful for that. The hour passed and Dr. P and her team came back in. My mom, Shanna, Sue, and Kris were all still with me at this point. Dr. P checked me and found that the cervical lip was gone. This was the best news we could have hoped for! Praise God, once again, for answered prayers. At this point I could begin pushing so they asked everyone to clear the room. Kris was allowed to stay and I requested that Shanna be able to stay and take photos as well. 

As I began pushing with contractions I was relieved and hopeful. My contractions were long but only 5-6 minutes apart. During each contraction Shanna and Kris were right there supporting me and Dr. P was encouraging me as well. As far as a hospital experience with an epidural goes I don't think it could have been a more positive environment. Over the next hour I pushed with all my might with each contraction. It was clear that he had a very unusual positioning and, as he descended, he kept turning like the hand on a clock. That explained the intense feeling I was experiencing before. Toward the end of the hour Dr. P suggested we try an episiotomy. He was crowning but it was clear that his position was making it take a little longer for him to come out. I was thankful that she suggested it to me as an option while I was between contractions and able to communicate. I told her that I didn't want it, we discussed it further and she respected my decision. His head was so close and I prayed that with the next contraction he would come. 

Sure enough in one good push he was born! His position was highly abnormal: he had both arms crossed at his chest and hands by his face! His head and his whole body came out at once and they immediately held him up for me to see before placing him on my stomach. I was able to reach down right then and touch him. What an incredible moment! I looked at Shanna and Kris and said over and over "I did it! Praise God!" There was a lot of "Oh my gosh" as well! Ha! This was absolutely one of the most blessed, God centered, triumphant moments in my life. I can't, even now, begin to wrap my mind around the rush of gratitude and love that came over me. I could never replace that moment. After months of preparing and praying we had done what we knew God had called us to do: have a beautiful vaginal birth after cesarean. God answered our prayer! He does mighty, wonderful things. 

I wish, so badly, that the story ended there. That it ended with that moment of triumph and rush of excitement. The next part of the story is the hardest to tell but that's life, right? Taking the good with the bad. As Dr. P began to show one of the interns how to clamp the cord I asked if they could please delay for a little while. She said that they couldn't and I didn't want to fight it. She walked the intern through the process and then asked Kris if he wanted to cut it, but he didn't so she let the intern do it. Next, Dr. P explained to the interns how to do something called controlled cord traction. This is a common procedure in some hospitals where the umbilical cord is clamped and then slowly turned to remove the placenta. I was able to hold Lincoln and admire him even though I was lying on my back. He was crying and I felt like he might soothe quicker if he was held upright so I handed him to Kris to be weighed and measured. During this time the interns were given control of the cord traction while Dr. P stepped aside to take care of something else. The nurses called out his weight, 9 pounds eight ounces and 22.5 inches long! I was so surprised that, even born 2 weeks farther along than Harrison, he still weighed so much less! I saw that Shanna began to look concerned and she explained to me later that she saw the umbilical cord started to look distorted and the intern working with it was straining as she pulled. Shanna tried to draw her attention to the cord but she was brushed off and just a little bit later they were finished. I was on my back and couldn't see what happened next but I heard the interns gathering together as one of them exclaimed, "Wow! That's the biggest placenta I've ever seen!" Kris was walking around the room with Lincoln and looked down absolutely shocked. Shanna told the interns "That is NOT a placenta. That's her uterus." Dr. P heard what Shanna said and rushed over. She told the interns, "That's her uterus! We have to put it back!" I was looking for where Kris was with Lincoln and, though he heard and saw all of this, I missed the exchange between them. I asked Kris to come stand with me and sensed that a change in atmosphere had come over the room. Dr. P was working feverishly on me and asking me if I had a history of fibroids in my uterus. She and I went back and forth about my medical history as she explained to me that I was losing a lot of blood and she didn't know why. Shanna had to leave the room right before this so it was just Kris and I with Lincoln and the medical staff. Dr. P requested that the other Dr. on call come and take a look at what was happening because she couldn't figure out why I was losing so much blood. After a few minutes Dr. M came in and assessed what was happening. She immediately knew and told everyone that I had a uterine inversion. I know now that what happened was that the interns pulling on the umbilical cord were pulling very hard and very prematurely. The placenta had not had a chance to detach from my uterus so as they pulled on the cord they actually pulled my uterus inside out onto the bed. It had to be pushed back into my body and now, because of the immense amount of trauma to the muscle, wouldn't stay in place. In the moment, all I knew was that Dr. M told me I had a uterine inversion and it was causing me to hemorrhage. She explained that I would need to be taken to the operating room while they tried to revert it because there was a chance that I would need a hysterectomy. What happened next is really very surreal for me to explain even though I’ve experienced God’s hand in giving me peace before. I had remained very calm throughout our entire time in the hospital, even when it became clear that all was not well. But in that moment I had this immense peace come over my entire spirit. I thanked her for explaining it to me, took a deep breath and said "Ok, do what you need to do." They rushed around to get everything ready to take me downstairs and I was able to say a quick goodbye to Kris as he and Lincoln had to leave. I told him that I loved him and I was ok with whatever happened. As he left Dr. M came over to check in with me and I told her that I was praying for her and all of the people helping that they would be able to fix this. She asked me if I was a Christian and I told her yes so right there in my room she prayed that God would heal me and that He would bring us all through this. As soon as she was finished praying they wheeled me out into the hall.

This was where I started to realize the effect of the blood loss. I was barely conscious as they pushed the bed through the halls as quickly as they could. In the operating room I was in and out of consciousness but in the moments I was awake I remember hearing Dr. M talk aloud as she was trying to complete the procedure. I'm so thankful that I was conscious to hear her shout out "It's reverted! Yes!" and know that they had succeeded. I didn't have to have a hysterectomy and they didn't have to do surgery at all. They placed a balloon called a Bakhri into my uterus that was successfully holding in into shape as it healed. 

Over the next day and a half I was in ICU. I lost three liters of blood and was incredibly weak, but I was safe and so was Lincoln. The most difficult part of that time was that I couldn't have him with me. I was able to see him for 10 minutes during my entire ICU stay due to a couple of really amazing nurses who we were so blessed to have. I made it my mission to be as positive as possible and to just thank God for each and every bit of healing. 

I wasn't aware of why this had happened until about halfway through my ICU stay and, even then, only because of what Kris and Shanna saw and heard. Our research confirmed that uterine inversion is caused by prematurely pulling on the placenta. This isn't something that "just happens" and it isn't due to the fact that I was a VBAC candidate or because I labored at home. So of course I wonder what would have happened if we had just stayed at home. I'm thankful that I've never struggled with living in the past so I really have handled the emotions involved in all of this very well. I am blessed to not be working through any anxiety or depression in relation to my birth. Overall it just saddens me to know that this kind of thing is often brushed to the side. How often do you hear people talk about the horrors of homebirth? But when was the last time you heard about a woman who nearly lost her uterus due to a mistake made in the hospital? It happens. It happened to me. Do I think that this makes the hospital an unsafe place to birth? Absolutely not. But does it confirm to me that there are risks no matter where you birth? Sure does. I believe now, more than ever, that a woman should be able to choose to birth at home or at the hospital. The more important factor is how well supported and well taken care of is she in either environment. I received amazing support and care from Dr. P and I'm beyond thankful for that. I also believe that students have to learn on somebody but they should always be supervised the first time they do something.

This is what matters the most: I prayed HARD throughout my pregnancy that I would be able to have a vaginal birth to a healthy baby and that I would bring glory to God in doing so. I believe that God answered my prayers. I never would have been able to have so much peace and positivity otherwise.

The last thing I want is for my experience to scare someone away from birth at home OR from birth at the hospital. If anything, I hope that it encourages people to open themselves up to the risks and benefits of both and diligently research the best option for them. If even one person can walk away from reading this and use it to improve their experience in birth (instead of just thinking "wow, what a nutcase) then I'll be so glad.

Lincoln is a blessing and his birth fulfilled so many of God's promises to us. He is worth every single day of my pregnancy, every moment of labor at home, and even every second of those scary moments after his birth. He is loved by his family and his village. We pray for him the same that we pray for Harrison: That he will grow to love Jesus, love his family, and make a difference in this crazy world.