I’m going to begin to write about Felix’s birth today. Please know that his Mama and Papa gave me full consent to write about his birth and share his birth story from my perspective. Everyone remembers things a little differently in births. I’m sure that there are things I recall that she has forgotten and things she would highlight that I have omitted. This story is only a part of Felix’s birth story. Hopefully he will enjoy reading it someday.
So Felix came into my care after his Mama began planning an unassisted birth at home when after learning that he was in a breech position and she started to change her plans. First she went to the Legacy Emmanuel midwives and obstetricians to attempt an external cephalic version. After attempts to turn Felix were unsuccessful (and quite painful, and according to his Mama, totally not worth it) his Mom came into my care. OHSU was willing to allow Mama to have a trial of labor, and so plans were made for a vaginal birth in the breech program on the hill.
The docs at OHSU wanted to induce my client, but she was adamant that her baby (and herself) not be exposed to unnatural interventions. She did, however, agree to a Foley bulb induction and labored in the hospital overnight to 4 cm (the diameter of the Foley bulb). She was
discharged left the hospital AMA after she refused Pitocin to augment her labor and went home to labor peacefully.
Several days passed, along with her due date. I am sure she was increasingly concerned that OHSU would not allow her to labor if she went too far postdates, so the pressure began to build for Felix to arrive. She went in to have her membranes stripped on Thursday and again on Friday morning. On Friday (July 1) after her membranes were stripped by her OB, her water broke and she began to have contractions that increased in duration and intensity. I was called to the hospital Friday afternoon.
Amanda and Jason were at OHSU working through contractions when I arrived on Friday evening. I felt familiar with Amanda in labor, since we had been to the hospital before with the Foley bulb and worked through contractions together, but she had a much different vibe. She couldn’t seem to find that space within where you can manage the pain, instead every contraction was like a wave of fear and pain that washed over her. She tried position changes, back pressure, hip squeezes, and light touch, but nothing was taking off the edge enough for her to get on top of the contractions. She was tearful and sobbing, crying out in pain.
At 11:30 that night she decided that she wanted an epidural. I didn’t question her much. The fact is, she is a grown woman who has educated herself about the risks of epidurals – ask her about the ‘Cascade of Intervention’ that is associated with epidurals – she can tell you all about it herself. Knowing that she had probably been weighing the benefits and risks in her head for quite some time, I merely double checked that she was positive that it needed to happen and it couldn’t wait even one more contraction.
I think that the waiting period between requesting an epidural and actually receiving an epidural might be one of the worst times women experience in their lives. You know that pain relief is on the way, but yet… it’s so far away. Why aren’t they just here yet? What is taking them so long? Where is the damned anesthesiologist?! I think the only time I made a pest of myself as a doula at this birth was pestering them to get the anesthesiologist in the room faster than he was coming. Once a woman has made that decision, and it’s her ‘final answer’, then people should move expeditiously.
While she was waiting for her epidural, it stands out in my memory that Amanda felt intuitively that something was ‘wrong’ with her labor. She was prepared for a painful birth, she was in the Navy; this is not a woman who expected a baby to just pop out of her vagina without some work! But, after nearly 2 weeks of prodromal labor and a rocky start, she was in for a rough birth. I think that the epidural was an excellent choice for her.
The anesthesiologist placing her epidural took quite some time. It’s ::really:: difficult to hold still while you are having contractions that are so intense that they require an epidural. First they use Lidocaine to numb up the area, which hurts from the injections and burns from the liquid. Then, as you can see in this picture, they insert a needle very carefully and attempt to inject fluid from the syringe through the needle into the dural space. In Amanda’s case, the anesthesiologist had to ‘dig around’ to try to find the right space and it took quite some time. He had to actually completely withdraw the needle and repuncture her skin in a different space.
Once the needle is in the right space, a catheter is threaded in and medicine begins to be delivered. They tape down the catheter to your back so that it won’t be pulled out of the space and it remains there for the duration.
By 3:00am on Saturday (7/2), she was sitting upright in bed, resting and chatting comfortably. It took a bit to get the epidural just right. She was more heavily affected on the left side than on the right, but her pain seemed to be under control. The epidural meant, though, that she was now confined to bed with a catheter, a BP cuff, and continuous electronic fetal monitoring.
Amanda was able to rest with the epidural. She sat herself straight up in bed to try to keep the baby’s bottom against her cervix and rested upright for a few hours.
In the morning the doctor checked her cervix and she was 6 cm. I could tell that she was disappointed to hear that she was ‘only’ six centimeters. Doctors started talking about keeping her to Friedman’s Curve, and conceded by giving her 2 hours to make a change instead of 1 hour. The next time they checked her, she was 7 cm.
It felt really positive. The baby was tolerating the contractions well, without decelerations and with good variability. Amanda was clearly more comfortable, despite the hinderances of the cables and cords and the numb left leg that she couldn’t move. She was aware of the contractions, but not in pain. She could feel the pressure the doctors were beginning to put on her to take some Pitocin and asked for a breast pump to do some nipple stimulation. For 20 minutes every hour she pumped, relaxing and envisioning her baby, intentionally trying to increase the levels of oxytocin in her body. Her contractions did seem to intensify while pumping and immediately after, but after several hours of pumping cycles, her cervix was rechecked by the doctors had not changed, nor did it feel as though the baby was well-placed on her cervix.
At this point, the doctors began to really talk about a Cesarean. Their concern was that she was ‘stuck’ for several hours at 7 cm., despite the pumping and several position changes intended to keep her vertical and keep the baby on her cervix. The doctors suggested earlier that she try some Pitocin and cautioned that if she went on too much longer, Pitocin wouldn’t be an option (implying that a Cesarean would be her only option). She continued to labor and work her baby down, asking for a little more time.
The last time she was checked, she was still dilated 7 cm. The doctors came in and began discussing Cesarean. Her pulse started racing. The baby’s pulse began to race, reaching into the 170′s and everybody began to worry about signs of an early infection in the baby – a risk when vaginal exams are done, in this case no fewer than five times, after a woman’s waters have broken. She asked if she could just be alone and rest for a minute. She attributed the tachycardia to anxiety. Jason and I went down to the cafeteria to grab a bite to eat while she napped. We were called back into the room very quickly.
When we arrived back to the room, the nurses and doctors were getting consent from her for the Cesarean. I gave her time alone with Jason and waited outside their room while they spoke privately. The baby’s heart rate had skyrocketed and meconium was pouring out of the baby. It was clear that he needed to be born quickly. She was prioritized and prepped for a Cesarean immediately. She tearfully begged the anesthesiologist to allow me into the room with her. How could he deny her? He let me in with Jason with the caveat that I remain seated and behave professionally.
I sat with Jason while she was prepped, rubbing his back and reassuring him. He was terrified that he would lose his baby and his partner all in one, but determined to be a strong support for Amanda in the operating suite. He was amazing! He sat with his lips to her ear, whispering loving affirmations about their baby the entire time. I sat behind him, rubbing his back and listening, watching the surgery in the lights above. Very soon after we were seated, the incision was made. Within minutes the baby was born. His cord was immediately clamped and cut and he was transferred to the baby warmer where I watched from around the drape and listened for his first cry.
The four minutes and some odd seconds that I watched and waited for him to cry felt like four hours and some odd minutes. I heard his first Apgar announced as zero. They had to help Felix get started. He needed some PPV and they did some pretty deep suctioning. Then I heard his cry… and made sure his Mama heard it, too. His Apgars improved. At 5 minutes they were 6 and at 10 minutes his Apgar score was a 9. He was pinking up and coming into himself.
Soon he was all swaddled and brought to his Mama, who was still being sutured. His Daddy held him next to her face so she could love on him and talk to him. His Papa is such a rock star that he even tried to put Felix next to his Mama’s nipple so that he could smell it and bond with her. I’m really, really proud of him for his support!
Daddy went to the NICU with the baby for a 4-hour observation period while I stayed with Mama in the recovery room. Soon, after she was stable and resting in recovery, I went down to the NICU to take some pictures, get some video, and get a report for her. This is Felix’s first picture:
Felix still had some purple toes and fingers, but he was otherwise doing great! As you can see, he looks a little bewildered by the whole thing and has quite a story to tell himself! I stayed with Felix and Jason for a few minutes in the NICU and then he came back with me to get the colostrum that Amanda had expressed for him while she was in the recovery room. Jason went back to the NICU to give Felix some kangaroo care and finger-feed him the droplets of colostrum that his Mama had so carefully collected for him. On the right is a picture of Jason holding his son in the NICU.
I said goodbye to Amanda in the recovery room and left with her baby’s placenta after a couple of hours. She was ready to sleep and Jason was with the baby down in the NICU. I left them with instructions to call 24/7 if they needed me back for any reason. On my way home, I dropped off her placenta to be encapsulated.
I was happy to sleep and wake up to hear that Mama and Baby were both doing excellent the next day. I went to visit that evening, admiring the baby and bringing Amanda some flowers and a little gift for Felix. Here is a picture of Felix, 24 hours old. You can tell that he was a frank breech – just look at his foot up next to his head! That’s how he likes to be swaddled.
Amanda and Jason both felt really positive about the birth, knowing that they had done everything they could to bring Felix into the world naturally and also knowing that they did the best thing for Felix by consenting to the Cesarean when they did. He was clearly in distress and this was not at all an unnecesarean. Felix is a champ nurser, and focusing on a positive breastfeeding relationship felt very healing to Amanda. I left with warm fuzzies, knowing that things were going so well for my Mamababy pair.
Welcome to the world, Felix Bahir Hashim Heath! Weighing in at 6 lb. 7 oz. after a very long labor and a surgical birth. You are the best thing that ever happened to your Mama and Papa. I saw their lives change while you worked your way out. You are loved <3.
[Update 3/27/12: I am still close with Amanda and Jason and baby Felix via Facebook and I have enjoyed watching him grow up into a very smart and very engaging baby! It's fun to see infants become babies and babies toddlers and soon they're in kindergarten and off to college... it happens fast! The days are so long sometimes, but the years are always short when you have children or you are a birth worker!]