A Natural Hospital Birth with an ObGyn and Doula

by Krystal Cleaver on January 9, 2014

My second son, Gabriel Lee, was born on February 12, 2013 at 6:58 pm. Before I get into the details of how he came into the world it is helpful for me to recap the birth of my first son, Anderson Matthew, and review a little of what my pregnancy was like with Gabriel. Anderson was born in December 2006 while we were living on North Carolina. I had planned a normal, natural birth and was under the care of midwives at a birth center. Midway through my pregnancy with Anderson I developed pregnancy induced hypertension which ultimately led to being put on bed rest and needing to be induced and birth at the hospital instead of the birth center. Although I still labored without an epidural the intensity of labor augmented with pitocin was so much more difficult than I had anticipated. When I started to have an uncontrollable urge to push at only 6 cm dilated I asked for and received a dose of stadol. My normal, natural birth was no more. My son was born – beautiful and perfect. He nursed right away and continued to do so for 20 months. He was happy and healthy. I am so grateful for all of that. But I was sad about some aspects of his birth, being induced and needing narcotics specifically, and I knew that I wanted my next pregnancy and birth to be different.

When I found out I was pregnant in June 2012 I immediately began looking for a home birth midwife. Our family had recently relocated to Northeast Iowa where I had been called as the pastor of a small, rural church and we had the joy of living in a 99 year old Iowa farmhouse that the church owns as its parsonage. It is the home of my dreams and I could envision welcoming our second child into the world in this peaceful space. I met with a midwife that I really liked and we scheduled my first prenatal appointment at 8 weeks. Imagine my dismay when we discovered that my blood pressure was elevated at this first visit. I had read about the Brewer’s diet before getting pregnant and was already following it so I was crushed with this new development. We monitored my BP for another week, but when we realize that it wasn’t coming down my midwife and I had a heart to heart about the fact that I likely wasn’t a good candidate for a home birth. There are three hospitals nearby and we discussed where I might like to be referred. The two larger hospitals have lower c-section rates than the smaller hospital closest to me and they also boast women’s clinics with multiple midwives on staff, but my homebirth midwife recommended an OB at the closer hospital – a personal friend of hers – who had given birth her own child at The Farm (with Ina May as a back-up midwife!) and whom, my midwife believed, would be my biggest advocate for having the natural birth I wanted in the hospital setting. The referral was made and my midwife was right, I loved the OB she recommended, Dr. L.

My pregnancy continued fairly uneventfully, my BP even came down to normal range as I continued to be faithful to the Brewer’s diet and walked two miles three or four days a week. The worst pregnancy symptom I had was a nearly constant cold – but otherwise I felt great and was confident that our newest child would come into the world just as he/she should. At our anatomical ultrasound we discovered we were having another boy (much to my surprise as all of my dreams and intuition had been screaming girl…). Perhaps the biggest crisis of my pregnancy came when, at 24 weeks I measured 6 weeks “big” during a routine prenatal appointment. This prenatal appointment was the first I’d had with the newest OB hired by the hospital and it was a disaster. Not only did this physician talk down to me, dismiss any conversation I tried to have regarding my goals of care and hopes for a natural birth and insult me (insisting I’m a “big girl” so maybe I’m just having a big baby) but the doctor also ordered unnecessary tests to check for super scary diseases that might be causing me to measure big and refused to discuss why these diseases were of concern and what it might mean if any of the tests came back positive. Needless to say the next two weeks waiting for those results were excruciating and I knew within my heart that I could not have that physician as part of my care team and have the peaceful birth I envisioned. I am so thankful that we had already hired and established a relationship with our doula, Larissa, by this point because her support was invaluable to me during this stressful time.

After all the tests came back negative, thanks be to God, I had a follow-up appointment with Dr. L (the OB to whom I was originally referred). I let her know how disappointed I was with the other physician and how I couldn’t, in good conscience, continue with this practice and deliver in that hospital if it was necessary for him to potentially be the physician who would be present at my birth. I was very careful to ensure that I wasn’t asking her to intervene or to play mediator between her colleague and I, but I let her know that I was trying to protect my birth plan and advocate for the patient centered care I had hoped to receive in order to birth naturally in the hospital.

She was very receptive to my concerns, offered me words of encouragement and let me know that it was not unusual for a patient to request the care of only one physician in the practice for personal reasons. She and her colleagues went out of their way to try to meet those needs when possible and as this was a small hospital that saw less than one birth a day they were often able to do so. Dr. L let me know that she would make every effort to be the physician who delivered our son and agreed to discuss a backup plan with the third OB in the practice (whom I liked also) to ensure that she would be present in the event that Dr. L could not be. Later that night Dr. L called me to tell me that everything was worked out and that I needn’t worry. She assured me that my birth plan would be honored and that she would do her very best to be the one on call when it was my birth time. I felt heard, respected and valued. It is amazing how much difference it makes when you know you can trust your health care provider.

After this my pregnancy continued without a hitch until 36 weeks when my BP started to sneak back up. It never got to a level of serious concern, but it was higher than all of us liked so I agreed to bi-weekly NSTs to keep an eye on the baby. Dr. L and I agreed that there was no need to induce with these moderately high BP readings and the NSTs would ensure that we had the necessary documentation to support letting things run their natural course. We did discuss how my birth plan might need to be modified if an induction became necessary if my BP suddenly spiked. We reviewed all of the “natural” induction methods to try first to avoid pitocin at all costs. I was grateful that we had this conversation when things weren’t urgent. It allowed me to prepare myself for whatever might happen. I felt like I had a say in deciding what an induction might look like if needed.

We both thought that I would go into labor before my due date. Dr. L wrote the schedule to ensure that she would be on-call in the weeks leading up to my edd of 2/13/13.  We repeatedly reviewed and amended my birth plan. Dr. L even called me after hours one night to discuss the possibility of sharing my birth plan at an upcoming conference and to let me know what she’d found when researching the most updated pros and cons of delayed cord clamping. (She was pro-delay by the way…) Again, I felt validated, respected and like an active participant in my care despite being in the hospital “system”.

 Weeks 37, 38 and 39 came and went. Baby was snug as a bug, my BP had leveled back out to totally normal levels, and the NSTs were all showing that he was doing just fine thus negating any medical “need” for induction – natural or otherwise. I asked for a vaginal exam at my 39 week appointment which showed my cervix was less than 1cm dilated and very high and firm. Dr. L was as surprised as I was since I had been having regular practice contractions. She had made plans to go out of town the weekend after my EDD (thinking that baby boy would come well before then…) and we both got a little panicky. I cried all the way home from that appointment; certain that baby would decide to come late when Dr. L would be out of town. I bought a bottle of castor oil just in case…

On Monday, February 11, 2013 at 39.5 weeks I went about my day as usual. I was “officially” on maternity leave at this point but had to handle a few sudden church related crises on my way to my final NST. I had plans to go to the bank and run some errands afterwards. My NST was fine, as usual, but this time I had the procedure done in a labor and delivery room as the outpatient room where they usually did the test was occupied. As I was leaving the room I picked up the tiny newborn diaper waiting in the basinet imagining that my son would soon be born and fit into that. I immediately chastised myself thinking, “Someone’s baby has to wear that diaper and I just contaminated it with my dirty hands…” Little did I know that “someone’s baby” would me mine!

I ran my errands and got a little cheeky with the check out lady at the grocery store who asked me to lift up the two boxes of cat litter I’d purchased by myself because she had a bad back. I guess she couldn’t tell I was nine months pregnant under my bulky winter coat. I responded, “Well, I am due to have a baby on Wednesday, maybe all this lifting will encourage the little guy to come out sooner…” She couldn’t apologize fast enough…ha! That night Anderson and I met my husband Matt, at McDonald’s for dinner and as we were getting up from the table I thought I had pulled a muscle in my side. I had to stop and catch my breath and recover for a few seconds before I could walk again. I’m thinking now that it was likely a contraction. Once Anderson and I got home from supper I started having regular practice contractions as was usual for me, but this time the pain was radiating down the insides of my thighs – almost like nerve pain.

Once Anderson fell asleep I took a shower to see if things might ease off which they did. I finally laid down but my coughing (from the incessant pregnancy induced cold) kept me awake. As I was lying in bed I felt and heard a distinct pop during one of my coughing fits. I wondered if my water broke, but as I went to the bathroom there was no sign of leaking fluid. I did, however, have a bit of blood when I wiped (the first all pregnancy) so I started to really get my hopes up. I texted Larissa to let her know of these interesting changes. I sat down in the glider in our bedroom and tried not to get excited. The next thing I knew I felt fluid leaking out that was not related to a coughing fit. The leaking continued for a while and I finally sent a text to Matt at baseball practice (he’s a college baseball assistant coach) that I thought my water broke and to come straight home after practice. I still wasn’t 100% sure it was my water, but the more fluid I leaked (in between coughing) the more convinced I became.

Matt got home around midnight and we debated what to do. Since I had tested GBS+ I knew that we couldn’t labor at home for too long. I needed to go get antibiotics started when my water broke (I had a niece who was hospitalized for multiple weeks after birth due to GBS so I wasn’t willing to take chances here) but I had also hoped that labor would be in full force by the time it was necessary. In this case my water was broken but even my practice contractions had slowed to a complete stop. We waited another hour or so – gathering our things, calling our parents (mine had to make a 10 hour trip from KY and Matt’s mom was coming from 2 hours away to be with Anderson) and calling Larissa (who I told to sleep until I got settled in at the hospital…).

At this point I called the Birthing Center at the hospital to let them know I was on my way. This is my favorite part of Gabriel’s whole birth story. The conversation went something like this:

Nurse: Hello, Birth Center, this is the nurse…

Me: Hi. My name is Jessica. I am a patient of Dr. L’s and my water just broke. I am GBS + so we are going to head that way soon. Can you tell me which doctor is on call?
Nurse: It is so funny you called! Dr. L called about 45 minutes ago and said, “I have a feeling one of my patients, Jessica, might be calling tonight. I am off today and tomorrow, but I have promised to be the doctor who is there for the birth of her baby so if she calls tonight, call me right away.” So I know who you are and I’ll let Dr. L know you are on your way.

Me: WOW! That is amazing! We must be on the same wavelength. Ok. Great. See you soon!

I took that as a good sign that my son had picked the perfect time to be born and felt even more confident that I had made the right choice sticking with Dr. L.

We arrived at the hospital at about 2am. After an initial exam to confirm that my water was indeed broken the nurse reported that my cervix was still only about 1cm dilated and not very soft or thin. I was too excited to be discouraged at this point. I got changed, the nurse started my first round of IV antibiotics and hooked me up to the monitor. My mother in law arrived to take Anderson back home for some much needed sleep. Larissa informed me that she would arrive at about 5am unless I needed her sooner. Dr. L called me at the hospital to touch base. We decided that I would try to get labor going on its own using my breast pump and clary sage oil. Knowing that I didn’t want to be hooked up to the monitors much or have many cervical checks Dr. L suggested that I be monitored for 20 minutes when I received my antibiotics every four hours and we’d do cervical checks then too only if I wanted. I felt comfortable with this plan.

Once my antibiotics were finished I began to stimulate contractions with pumping, regularly smelling clary sage oil during contractions to intensify them and started walking. A little while later Dr. L called back to discuss some options with me for augmenting things (cytotec if my cervix didn’t dilate, pitocin if contractions never became regular, etc)  in the event that my labor didn’t pick up on its own. She was very clear that she didn’t think we would need these measures nor did she want me to feel pressured to use them, but she wanted me to know my options so that I could make the best possible decision if necessary. I was grateful that she discussed these with me when it wasn’t “urgent” so that I could feel confident in the moment if we needed to do something differently. Thankfully none of these options were ever needed.

At 6:30 am it was time for my second round of antibiotics, monitoring and I consented to another cervical check. I was 2cm at this point and 70% effaced. While I was concerned that this wouldn’t be enough change to continue to allow things to continue naturally, Dr. L was very pleased with this progress and encouraged me to keep on doing what I was doing. I was reassured that there was no need for any augmentation as clearly my body was laboring effectively. Matt, Larissa and I had prepared for this labor and birth by taking Hypnobirthing courses and it was at this point that I started to rely on some of the techniques that I learned to manage the contractions. I plugged in my headphones to listen to my birth affirmations while I was on the monitors and receiving antibiotics. Matt and Larissa took much needed naps.

At about 9:30 a massage therapist arrived in the birth center and offered me a massage and Reiki. She used clary sage massage oil and did some energy work on my back and feet. She intensely massaged the uterine pressure points on my feet to help stimulate labor. My contractions slowed down during the massage, but I fell into an almost a trance-like state. I was so relaxed. It was such a helpful “break” from labor. After the massage therapist left Dr. L came by (wearing jeans and uggs!) and asked if I wanted her to check me again before my next round of antibiotics. I agreed and we discovered I was 3cm dilated and 80% effaced – more progress, slowly but surely! Dr. L felt confident that labor would continue just as it should and she encouraged me to trust my body.

I did more walking, pumping, clary sage sniffing and things continued to pick up. My family arrived from KY after driving all night and at my next antibiotics/cervical check I was still just 3cm dilated, but more effaced and baby had moved down to a -1 station. Labor was definitely kicking into a higher gear at this point. Larissa left to get something to eat and to nurse her own baby during this time, my family left to get food and Matt and I labored together using our hypnobirthing skills. I was really happy with how everything was progressing. I felt calm and in control. My contractions were regular enough at this point that I decided to get into the whirlpool tub to relax. It was helpful but I struggled to find a truly comfortable position.

While I was in the tub my contractions became significantly stronger. Larissa returned from getting some lunch and was able to snap some pictures of me in the tub. At this point, because I was in active labor, the nurses were checking baby’s heart rate with a Doppler every 15 minutes. I had officially entered that “timeless” phase of labor because those 15 minutes between heart rate checks seemed to fly by. At one point a nurse came in to check baby’s heart rate and it was very low. They tried repositioning me several times and even had several different nurses try to find it. There was some confusion as to whether they were getting my heart rate or the baby’s. Another nurse finally found the baby’s heart rate easily – but there had been so much confusion (which created concern) that they had me get out of the tub for more continual monitoring. At this point Dr. L came back in to check me (I was at a 5) and told me that while she was sure everything was fine she wanted me to be on the monitor’s continuously just to be safe, but I was still free to walk, to move around the room and to labor in whatever positions made me comfortable.

a reverend hypnobirthing

After the nurses were sure that baby’s heart rate was good they left us alone again. Matt, Larissa and I labored intensely for nearly an hour and a half. My contractions were no joke. I needed counter pressure on my back (which Matt provided perfectly with a couple of tennis balls) and Larissa spoke to me encouragingly using hypnobirthing phrases. It wasn’t long before I began to have the uncontrollable urge to push – so much for my hypnobirthing goal of gently and peacefully breathing my baby down. I became worried knowing that I had only been at a 5 an hour before. I remembered how early I had the pushing urge with my first son’s birth and how long it took until he was born (3+ hours). I started to doubt if I could complete this labor naturally. I remember asking Matt and Larissa, “Why does my body do this?” While all this was going on inside my head several nurses came in because baby’s heart rate was significantly decelerating after contractions. They had me get in the bed to get a more accurate reading. This added to my stress and panic. Matt and Larissa were doing their best to keep me calm and to reassure me – but I totally lost all the focus I had had for so much of my labor.

I asked to be checked again because the urge to push was overtaking all my thoughts and zapping all energy. The nurse checked me and I was at a 6 – much to my dismay – even though baby was now at a +2 station. It was like my first son’s birth all over again. I knew that if I had to fight against my body’s urge to push for several more hours I would never make it. At this point I had been in labor for nearly 18 hours and awake for 40 – I was exhausted. I caved and asked for a low dose of a narcotic. Matt and Larissa did everything in their power to convince me I didn’t need it. They tried to get me to wait through several more contractions; they encouraged me to be strong for 5 more minutes. Larissa gave me a comb to squeeze in my hand to distract me, she encouraged me to hold on to the bed rails and pull up every time I had the urge to bear down. The nurses were doing all they could to convince me not to push all while still trying to figure out why baby’s heart rate kept dropping. It isn’t helpful having folks frantically concerned for your baby’s well-being and telling you not to push for fear of ripping your cervix all while being completely unable to fight the urge to push. It was pure chaos and I felt like a crazy woman.

a reverend hypnobirthing

Matt went out of his way to reassure me that I could do this without drugs. In hindsight he told me how hard those moments were for him to see me struggling so much. He wrestled between encouraging my natural birth plan while still honoring my needs in the moment. I finally said, through tears, “I really appreciate what you both are trying to do. I know you are trying to help me get the natural birth that I wanted, but I am ok with this. I said in my birth plan that I might ask for a low dose narcotic. It is ok. I really want the medicine.” Matt stepped away from the bedside and re-read my birth plan, (God bless him). He came back and said, “You used the words “in the rare event that I ask for pain medicine…” are you sure this is that rare event? I really think you can do this without the medication.” I replied, “Yes, this is the rare event. I want it.” He then asked the nurse to ask Dr. L to order the medication. I felt some measure of relief knowing the medication was coming but the urge to push was still all-consuming and overbearing and I was so discouraged that I couldn’t make it without the medication. The baby’s heart rate was also still fluctuating significantly and I was worried.

A few minutes later a nurse walked in with the medication but Larissa encouraged Matt to ask me, “Are you sure you don’t want to be checked one more time before you get the medication – just to see…” I think she could tell I was in transition and knew that the end was near. I consented to one more check (so much for limiting vaginal exams, huh?).

The nurse put her hand inside me while I was in the middle of a push and her eyes nearly popped out of her head! “YOU’RE COMPLETE!” she exclaimed, surprised that things had changed so much in only 20 minutes. As the contraction eased off and I stopped pushing she paused, looked confused and said, “No wait, you’re only an 8 but very stretchy. Someone go get Dr. L NOW!”

Dr. L came in and talked to me first. She told me that she was going to check me but that if I wasn’t complete she would stay with me, help me breathe through contractions and fight the urge to push. She was so reassuring. The nurses had put oxygen on me at some point and she told them to take it off. Once she got a glove on she examined me. A huge smile spread across her face and she replied, “Jessica, you’re there! You did it! Let’s have a baby!” I have never felt so much relief. What a difference 25 minutes makes! The nurse with the narcotic was still standing there holding the syringe of medication looking like a deer caught in headlights. I remember her asking me if I still wanted it. I think I laughed at her in my delirious state. No I didn’t want that stupid medication! I was complete! I was having this baby all naturally just like I had hoped and prayed and dreamed!

Dr. L stepped back to get suited up and the nurses began prep for Gabriel’s birth. I asked Larissa to run down to the waiting room to get my mom who was sound asleep thinking we still had hours to go. While everyone else was distracted with preparations I was still pushing. I felt the baby’s head sliding far down into the birth canal and I yelled out, “His HEAD, His HEAD!” Dr. L looked up and saw the baby crowing. Larissa and my mom walked in right at that moment – perfect timing. Dr. L quickly slipped on clean gloves, jumped up on the bed and helped ease his head halfway out. She said to me, “Jessica, take a breath. With your next contraction your baby will be born.” And she was right. With the next push Gabriel Lee squished out of my body and into the world like a bolt of lightning! His lusty cry filled the room.

a reverend hypnobirthing

We were all in shock. I went from 6cm to complete in 25 minutes. I went from complete to holding Gabriel in my arms in less than one minute. The nurses were amazed. Dr. L was beaming and exclaimed, “It isn’t often I have to jump up into the bed to catch a baby!” I was so thankful it was over. So grateful to finally be holding my beloved child!

Gabriel and I spent some time skin to skin while Dr. L waited for the cord to stop pulsing. She informed me when it had stopped, we waited another minute or two and then Matt cut the cord. I was so thankful for her intentionality with this part of my birth plan. I lifted Gabriel to my breast and he latched on right away. I delivered his placenta 15 minutes later with one little push and Dr. L showed us all the different parts of it and explained how it all worked to help Gabe grow. Gabriel weighed 7lbs 1.6 oz, was 20.25 inches long. He scored 9s on both Apgar tests. He never left my side during our entire 24 hour hospital stay. All of his newborn assessments, with the exception of the hearing test, were completed in the room; he spent three out of his first five hours earthside nursing like it was his job (which it was!) and I gave him his first bath. After Gabe’s birth I walked around with ease, laughing and joking with the nurses who kept saying, “You don’t even look like you just had a baby.” Even the housekeeping staff (who had seen me in labor) marveled at how great I was feeling. I never needed more than a Tylenol for soreness.

a reverend hypnobirthing

 

The next morning Dr. L came to check on me and commented about how fun and exciting Gabriel’s birth was for her. We talked about how my labor was slow, slow, slow then FAST. How it was calm, calm, calm then CRAZY. We noted that my body takes a long time with early labor but then blasts through active labor and transition like a freight train. I wondered aloud if Anderson’s birth would have happened that fast if I had not had a dose of narcotics at 6cm. Dr. L told me that Gabriel’s cord was wrapped around his neck once, thus contributing to the heart decelerations that caused so much drama near the end. I couldn’t thank her enough for her patience, her faith in me and her trust in the birth process.

In hindsight I am so thankful that I managed (barely) to have the natural birth that I desperately wanted. I owe it all to Matt, Larissa and Dr. L who encouraged me, supported me and held me off when I was asking (make that begging) for relief. If I had not had their support, this story would have taken a completely different turn. There’s no denying it – the end of my labor was incredibly intense. The hardest part was trying not to push and there’s no doubt that I asked for the medication more to help me relax and resist the urge to push than to relieve any “pain”. I am so grateful that I never got that first dose. If anyone is wondering if a doula is necessary – hear me when I scream YES at the top of my lungs. Gabriel’s birth story is proof of their effectiveness. I am so thankful for ours!  Achieving the natural birth that I hoped for – from start to finish – makes me feel like I’ve conquered the world and when I look at my two precious sons I know for a fact that I am the most blessed woman in the world. Thanks Be to God.

 

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