Finally, a Birth Story

As most of you know, the plan we had for Fausto's arrival was a midwife-assisted homebirth. Some thought that meant a hippie rejection of western medicine (you know who you are), but in truth it was a result of carefully considering the statistics and best expert medical advice on how to minimize complications.

For women with no risk factors, homebirths are statistically safer for mom and baby alike, and there are many benefits to having the experience in an intimate setting where mom feels emotionally safe and baby can be welcomed into the world with a minimum of medical fuss.

But that homebirth experience, at least in our case, entailed prenatal care that was extremely thorough and quite clinical, particularly as I edged past the 42-week mark. As those of you who’ve been following the saga know, we underwent non-stress tests every-other day, biophysical profiling to check placental health and amniotic fluid levels, and a host of lab tests to be certain the swelling I experienced primarily in my feet and lower legs was not becoming toxemia.

All tests showed that baby Fausto and I were both in fine health with nothing to worry about. Nothing except the calendar that kept creeping inexorably past my due date.

Now, the reality of “due dates” is that they are approximations based on the likely date of conception and the typical length of a menstrual cycle. While we were roughly sure of the first, the second was more of a mystery, since the method of birthcontrol had been an IUD, a device that tends to alter the character of periods just enough to make knowing exactly when they stop and start hard to pinpoint, even if you’re paying attention. Which I wasn’t. And even if you were to know the conception date and cycle length, many OBs put the normative gestational time of a first pregnancy at 41.5 weeks.

So as the days drifted by, and the tests kept coming back fine, our thinking was that as long as there were no problems, why force the issue? And as we spoke to more women in Memphis, we heard story after story about 10-month pregnancies that had gone just fine. So why worry?

But of course we did. We knew that modern OBs insist on inducing by 42 weeks. Their attitude is, as one said to us, “nothing good happens after 39 weeks.” But we also knew that once you start a “medical” induction, i.e. pitocin, there is a high likelihood of a cascading series of problems: the contractions the drug induces are far harsher than natural ones, peaking faster and more painfully. As challenging as natural childbirth can be, a pitocin-driven one can be excruciating, leading most moms to opt for the epidural. But the epidural can interfere with helping the contractions along, and the intensity of the efforts are more prone to cause fetal distress. So, weighing out the pluses and minuses, there was no compelling reason to go in after him.

And besides, it’s not like he wasn’t going to come any second. Every single day for the last five weeks of my pregnancy, we would convince ourselves that “today is the day.” Because in the last several weeks, any kind of walking would immediately trigger contractions. Lots of them.

The standard for when you should go to the hospital – for those who want to have their babies there – is either 5-1-1 or 4-1-1: contractions coming either 5 or 4 minutes a part, lasting for a minute each, and continuing for an hour. In the last three weeks of my pregnancy, each walk was marked by 5-1-1, 4-1-1 or even 3-1-1 or better, meaning baby should arrive any minute.

But you can’t walk forever, particularly not with a 43-week belly, so after an hour or two of walking, we’d end up back at the house, I’d put my now very swollen feet up, and the contractions would start slowing down and then stop.

Finally, with more of the same but no labor impending on the eve of week 44, our midwife Andrea said we needed to consult directly with the obstetrician. Of course, as soon as he heard what the ostensible dates were, he said we needed to come in immediately.

Dr. Carruthers was a bit bemused by our situation but unfailingly respectful. He told us that, as a surgeon, he was trained to be aggressive about treatment, while Andrea and Amy, as midwives, were going to be cautious. Between him and them, we were getting the full range of medical opinion to act on. But from his perspective, there was a lot that could be going wrong this late in the game and no good reason not to move things along.

We agreed to start a pitocin induction, which got underway at 10pm that night. The pitocin-induced contractions lived up to their billing. After a few hours of working my best through guided meditations to manage the pain, I opted for an epidural to help get through the insane contractions, which at that point were intense enough to make me nauseated with each one.

Over the next several hours, I got to 4 cm dilation and nearly 90% effaced, but then the baby's heart rate had a couple of decelerations and then became elevated, so they stopped the pitocin. His heartrate stabilized over the next 15 minutes, the contractions continued without the drugs, and within the next hour I went from 4cm to 7, but he was still staying high up. It was now 7:00am.

During the night, we discovered that the baby, active until the very end, managed to turn backwards into a posterior position, which can make it harder to drop down. So even with all the IV lines and monitoring straps – not to mention the epidural – I tried lots of last-minute baby-spinning techniques, including getting on hands and knees on the floor, much to my nurse’s shock. But he wasn't budging.

At roughly noon, Dr. Carruthers came in to discuss the situation. He checked our progress and found that I’d dilated to 9 cm, but I was still at 90% effaced, and the baby was at a “station” of –1, meaning he just wasn’t descending into the birth canal. Dr. Carruthers said he thought it was time for a C-section, that if he were managing the case he’d have gone in after the baby at 6am when Fausto showed the heartrate decelerations. He also told us he felt a cranial “cap” developing, which is basically a cone-shaped protrusion of the skull from the pressure around baby’s head, but he was clearly more concerned about that than Andrea was.

Since Dr. Carruthers was there for a scheduled C-section anyway, he said this would be a good time to do it, as the surgical team was already assembled. We asked for more time to think, and he agreed to check back in after the other procedure.

William and I talked things over with Andrea and concluded that, while there might be things that could be done in a home setting to help move the baby into a better position and get him to start moving down, the constraints of the hospital made that considerably more difficult.

I was having a hard time giving up on the process, but by this point William was getting pretty worried. He made it clear he needed some sort of milestones for the decisionmaking process, so we agreed that if there was progress since the last check, we’d continue. But if there was no change, we’d opt for the C-section. At 2:45 pm, the nurse’s put us as still at 9cm and –1. So we called Dr. Carruthers.

By 4:00pm I was prepped and in the OR with a gowned and masked William by my side. To do the procedure they had increased the epidural, which had effectively worn off at that point anyway, so that I would be conscious but feel less. Those of you who know me well will not be surprised to learn that I was taking little catnaps on the table waiting for things to start. At 4:06 pm the pediatrician had arrived and Andrea, our midwife, was also gowned-up to observe. From time of incision to baby Fausto being handed to the pediatrician was just shy of two minutes. The time to remove the placenta, inspect and stitch the uterus, stitch back the fascia of the abdominal muscles, and close the incision was only another nine minutes. Total time of procedure: roughly 11 minutes.

Midway through the delivery, Dr. Carruthers asked William if he wanted to see his baby. I think he was a little concerned about looking, having been warned by friends that he wouldn’t want to see what happened in a C-section, but he gamely stood up and looked over the surgical curtain to see baby Fausto’s head being brought out of my abdomen, eyes open and looking at him. And as Dr. Carruthers pulled him out, William also got to see one of the reasons the little man may have been resisting descending. The umbilical cord was wrapped not once but twice around his neck and shoulders.

“Here’s the reason for those de-cels,” Dr. Carruthers said as he un-looped the cord from Fausto’s head. But the excitement didn’t end there. I couldn’t see anything from my flat-on-my-back position behind the curtain, and the anesthetist hit me with fentanyl immediately after the delivery, but William had a good view of the pediatrician and his nurses, who were busily suctioning little Fausto’s mouth and throat and pounding on his back.

Anytime you’ve got a baby who has gone past 40 weeks you expect to see some meconium, which is basically just fetal poo that ends up in the amniotic fluid with the baby. But sometimes the baby will aspirate some of it on the way out and end up with yucky stuff in the lungs that can be an infection risk.

In the case of baby Fausto, the pediatrician suctioned enough meconium out to be both impressed and concerned. What that meant for us was that instead of the immediate skin-to-skin contact and breastfeeding we had requested, Fausto was whisked off to the nursery for constant observation until they could do a chest x-ray. Fortunately, William got to go with him to keep an eye on things, but it took two more hours before either of us got to hold him. Nonetheless, I was delighted to finally meet a beautiful, alert, and hungry baby boy that evening.

We were worried that the separation might interfere with his latching on to eat, but when we finally got him to the room with me, I put him on my stomach, and he crawled right up to my breast and got right to nursing. And all was good with the world.

This was a far cry from the gently homebirth we had planned, but as our midwife Andrea said to us throughout the process, Fausto had some things to teach us. Of course, little did we realize how much he yet had to show us about patience and hope and the beautiful unpredictability of the best things in life. . . .