Apr. 6th, 2011

tehuti: (Default)
This entry is going to be long, folks. Consider yourself warned.

We finally made it into the room at 1:30pm. They put us in room 1823, one of the largest rooms on the floor, at the far end of the hall, closest to the operating room. I think they put us there for two reasons. They knew that Aimee had a sizable entourage, and that she intended to have a natural, intervention-free birth.

Whenever we talked about having a child, Aimee was always clear about two things. First, that she wanted to have her first child by age thirty. Second, she wanted to do it naturally. We came close on the first one. She turned thirty right around the time she became pregnant. The second desire was tougher. Women today just assume a lot of things about birth as a matter of course. Of course you'll give birth in a hospital. Of course you'll circumcise male babies. Of course you'll take pain medication, and pitocin, and an IV, and everything else the hospital nurses and doctors want to do to you. That's how it's done, right?

Not so for our Princess. She knew what she wanted, and dammit, she was going to have it. Her birth plan reflected that, which I share here with her permission:

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I will have a doula with me for my labor. I have 3 partners who I would like to be present for the birth. They are all very important to me, and I do not want to have to choose who can and cannot be present.

While I recognize that complications can arise, my goal is to have as unmedicated and as intervention-free birth as possible.

Please do not offer me any pain medication. I know that it is available and will ask for it if I choose.

I would like to be given an opportunity to try natural labor progression methods (nipple stimulation, intercourse, walking) before being offered any interventions (ie pitocin)

I would like to eat and drink freely during labor.

I would like the option of wearing my own clothing for labor and the duration of my hospital stay.

I would rather not have an IV unless it is necessary for my health or the health of my baby.

I would like to be able to move freely during labor and make use of any available positioning tools, ie birthing balls, squatting bars.

I would like the option of laboring in a tub if possible. If the tub is not available, I will plan on showering.

I would like to keep a calm environment and would prefer if the lights remained dim.

I would like to keep fetal monitoring and cervical exams to a minimum.

Unless there is an emergency, I would like my child to remain in the room with me at all times.

I would like immediate skin to skin contact with my child. Please perform any newborn exams with my child on my chest.

Please delay cutting my child’s cord until it has stopped pulsing. I would like my partners to be offered a chance to cut the cord if they choose.

I am planning on breastfeeding. Please do not give my child any bottles, whether they contain formula or water, or pacifiers.

If there is an emergency, I would like one partner to be allowed to remain with me, and one partner to remain with the baby at all times.

I would like to avoid being catheterized unless it is absolutely necessary.

I do not want an episiotomy unless it is necessary for the health of my child.

I am having a boy and I do not want my child circumcised.

I do not wish to have a routine pitocin injection to deliver the placenta. Please only offer the pitocin if it is necessary for my health.

I will be having my placenta encapsulated and will bring a cooler to bring it home with me.

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I know that some of you reading this are aware of Bay State's reputation. They have a fairly high rate of caesarian sections, about one in three. They are known to be intervention-heavy, and don't have a lot of experience with doulas, let alone alternative families. If the list above is the kind of birth that Aimee wanted, why weren't we at a more accommodating hospital, like Cooley-Dickinson in Northampton? First and foremost, we live in Springfield. Northampton is at least forty minutes on a good day by car. Bay State is about ten. And if you don't think there's a difference between two or three contraction on the way to the hospital and twelve to fifteen, try having one sometime and I bet your opinion will change. Second, if anything did go wrong, we'd already be at the best place to be. Bay State accounts for almost half of all births in Western Mass. every year, and is the only Level III NICU in our end of the state. These folks really know what they are doing, so we elected to go with their experience and expertise.

Our room was a strange hybrid of hotel and hospital. The lighting was pure institution, with bright overheads supplemented with softer site specific lights. The medical equipment was all mobile and/or concealable, so it was only around as long as we needed it. We didn't have enough chairs (there were five of us in the room, after all), so we got an extra. One of the chairs was a spring rocker, which basically is an oversized chair with a bouncy back. We had a TV (that never got used) and more outlets than we could use. And considering that we brought nearly all of our computers and electronic gadgets along, that's saying something. The bathroom was nothing special. The shower had a hot water governor on it that made using it somewhat unsatisfying. If that was our biggest complaint, we were doing ok, no?

So anyway, by the time we made it to our room, were all hungry, since breakfast was four hours before and none of us had eaten much. Excitement does that to the appetite. I had just tweeted to the world that we were safely ensconced, and could update the folks at home more quickly and easily when I got sent off to the cafeteria to hunt us up lunch. I made it back to the room around 2:30 with lunch, but all Aimee could swallow down was a few bites of a protein bar. At this point, her contractions were coming every two to three minutes, lasting for a minute or more, so to her, it felt like she was getting no break at all.

Aimee labored like a champ, and here is where Barbara really demonstrated why every pregnant woman should have a doula. She gave expert advice on positioning, encouraging Aimee to shift positions frequently to prevent fatigue. She had, of all things, a piece of shelf liner (the kinda rubbery mesh kind that keeps things from sliding around), that she used to hold up Aimee's belly. Taking the weight off of her, for even a few minutes at a time, was an invaluable relief. And I cannot underestimate how important her presence was for Ian, Michy and I. She took the lead on helping Aimee through the beginning of her active labor, which kept the rest of us physically fresh for when Aimee needed us later. She also taught Aimee a technique to use sound to stay on top of her contractions. They harmonized together, at a low frequency (kinda like a modified "ohm"), to help her stay focused. It worked amazingly well, almost to the very end, when the pain and frequency finally began to overwhelm her.

But I'm a bit ahead of myself. The next few hours were a blur for all of us. Aimee's contractions were almost non-stop at this point. Barbara and Aimee would harmonize through her contractions, and eventually we all took it up, taking turns being her physical and emotional support. Around 3:00pm, she was hit with the strongest contraction yet, and her control faltered for the first time. As it passed, she told us that she peed "a little". It's an easy mistake to make for someone in her position. What actually happened is that her membranes ruptured. When a woman's water breaks in the movies or on television, it's usually portrayed as a gush of fluid. This is rarely the reality. Aimee was much more typical. She leaked a bit, fairly consistently, for the next two hours. If you stop to think, it makes logical and biological sense. The amniotic fluid helps lubricate the way for the baby to pass through the birth canal.

Ironically, right before that contraction, we were talking about getting Aimee out of the clothes she was wearing to the hospital (the outfit she had on in the deep squat picture). She settled that question for us!

At this point, Aimee again asked for the tub. She'd asked for it earlier, but it wasn't available. Bay State does not allow water births, but they do have a jacuzzi tub for women to use. It's the same principle as the strap Barbara was using; take the weight of the belly off of the mom. And warm water doesn't hurt, either. We changed Aimee into a skirt and sports bra, and prepared to walk her to the tub room. Before we left, the nurses checked her cervix again. She was at 7cm.

Knowing that the end was in sight, we headed off to the tub on foot. Unfortunately for the rest of the unit, it was on the complete opposite side of the ward from us. Aimee had two contractions in the hallway. We must have been a sight, four people helping to support one laboring mom, two nurses trailing behind, stopping every few minutes to moan in tandem in the halls! One nurse playfully shushed us, saying Aimee would scare the other moms.

The tub was instant relief. It was a free standing tub, with high sides and a hand sprayer. It was theoretically mobile, but in practice they kept it in the same room most of the time. The water was warm and waiting for us when we got there. I know Aimee would have stayed in there and given birth if they'd let her. She really liked the tub. After one contraction, she tiredly exclaimed, "You guys are awesome." We were trying to keep a light and humorous attitude throughout Aimee's labor, for her sake and ours.

It seemed longer at the time, but we were only in the tub room for about thirty minutes. The nurses kept checking in with Aimee while she was in the water, asking her how she felt. They kept asking if she felt pressure, like she had to go to the bathroom. Aimee was so far out of it at this point that she didn't understand why they were asking. Once a mom passes 5cm, the labor process accelerates. She could go from 7cm to baby in the blink of an eye. She reported that she felt pressure, so they moved us back to our room. Mercifully, we transported Aimee back in a wheelchair.

Once back in our own room (about 3:45pm), Aimee got back in the bed, on her hands and knees, and continued to labor. They were coming in a constant wave at this point. The nurses began monitoring them more regularly; blood pressure for mom, heart rate for the baby. Both passed every check with flying colors. About ten minutes after we got back in the room, our midwife said to Aimee, "You're ready to push!" Aimee, becoming more unaware of her surroundings with every passing minute, replied, "Really? I can do that?". The nurse chuckled, "That wasn't a question, it was a statement. Your body will know what to do."

She was right. Aimee started pushing at 3:58pm. Ian supported her upper body, Mich and I stood on both sides. The nurses faded into the background. Barbara helped with ice, but from here on out, our family was pretty much running the show. With each contraction, Aimee pushed, with very little coaching or encouragement. More fluid came out, more harmonizing happened. It was getting harder and harder for her to stay on top of the pain. Her voice was starting to break, the humming replaced with exclamations like "Come on baby!", "Get this kid out!", "I can't take anymore!", and "Jesus Christ!" and other more colorful expletives. At one point, I pointed out to her that her Catholic was showing, so the next contraction was met with, "Oh Gods!".

After about a half hour, Aimee's poor legs had finally had enough. She'd spent much of her labor on her knees, either over the bed, a yoga ball, or in the tub. We coaxed her into lying down on her side. Ian continued to hold her upper body, so with every contraction, he held firm, giving her something to bear down on. Mich held her left leg in place, while I held her right leg up. Once she was laying down, she again said that we were all awesome, and got down to the serious business of birth.

We first saw his head about fifteen minutes before Connor was born. Each push brought him tantalizingly closer. The nurses kept back, letting Aimee and us do the work. Every few minutes, they'd check the baby's heartbeat, but otherwise, we could have been at home alone. Twice, they encouraged Aimee to reach down and feel his head, to prove to her that her suffering meant something.

I don't want you to leave with the impression that the nurses didn't do much. They were constantly in motion around us, but in a way that faded into the background. They changed the chucks under Aimee a few times, to keep things fairly clean. When we got close to the end, they got all of the equipment we needed ready. They were just as awesome as Aimee thought we were.

Every time Aimee pushed, I glanced at the clock, wondering if this was the minute he would emerge. Ian joked that we should have gotten a pool going. Michy held up like a champion, being strong for Aimee when she needed it most. At about 4:55, our midwife asked if we (Michy and I, since we were in position), wanted to catch him. A few minutes later, Connor was fully crowned. Time slowed down. Even though the contractions kept coming at the same pace, each one felt like an eternity, the breaks between them somehow longer. At 5:04pm, Aimee gave a prodigious push, and Connor's head popped out. Liz (the midwife) guided Michy and I to catch him. Aimee screamed in pain and relief, and with one last bit of encouragement, pushed for the final time.

Connor Paul Bouchard entered into this world, caught safely in the hands of his father and his little mother together, while his Dad-E held his mother safe and strong.

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January 2012

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