Joshua's Birth Story
as told by his mother

Tuesday, August 28th, I sat at the computer doing random searching of birth related sites, as usual, when the baby seemed to be playing tricks on mommy. I kept "wetting" my pants, as he seemed to be pushing on my bladder. Or so I thought, until I had changed my pants for the third time, and realized that each "trickle" was accompanied by a small contraction (Braxton Hix) each time. Our membranes had spontaneously ruptured at 36 weeks!

I sent Dan a note (to his cell phone) to not dawdle coming home, but not to panic, which of course got his adrenaline pumping! I then called my doula Linda to discuss the situation. I was not laboring, and knew that if I called my doctor they would want me to come into the hospital immediately. I hoped to be able to stay home until labor started. Linda advised me to go ahead and let them know that I would be in later that night, but that I really preferred not to rush in. Thankfully the on-call doctor was very sweet, and thought it would be fine if I had dinner at home, and made my way to the hospital later, but she wanted me there no later than 10 pm, so they could make sure there wasn't a problem that caused my membranes to rupture.

Totally excited, we tried to calmly gather things to take with us, call family that needed to know, clean out the car, and pretend to eat. But we would be having a baby soon, so who could actually eat?! As we headed to Fort Collins from Evans (about 45 minutes) I felt grateful that we were able to have a calm and leisurely trip. We had bought our home 4 weeks prior, and had worried about the drive if labor kicked in quickly. Thankfully, all of the awful images we had conjured were for nothing. We dropped Rebecca off at Joe and Angel's (Dan's brother and his wife) house, and they were so excited it got my butterflies going too. At the same time, it all seemed surreal. I had given birth 3 times before, and had never had PROM (premature rupture of membranes), so I kept giggling like a little girl, excited, scared and having fun all at once. I also was feeling so deeply in love with Dan at the time. He was about to have his first baby, and I so wanted it to be a beautiful experience for him.

Early labor pains, being comforted from all sides.

We arrived, and were expected. They took us to the room that would become our residence for the next adventure, and it was the room I had given birth in last time! I was hooked up to the monitor to look for contractions (there were none) and check hear trate (which was perfect), and then an intern and resident came in to do a cervical check and make sure I had in fact ruptured my membranes and see how dilated I was at that point. I was only 50% effaced and between 1-2 cm dilated, as I had been the week before at my checkup, and of course my membranes had ruptured. They wanted to also take a sample of the fluid and send it to the lab to check for lung development, as we were 4 weeks premature. We sat happily in our room waiting for labor to begin, not knowing that the major trial was waiting to begin. Fortunately we were able to bask in a glow of excitement for a little while longer.

The results came back showing that the baby's lungs were underdeveloped, a risk with premature deliveries. I went from being able to walk about and be active to sitting in bed, being monitored and anxious. They wanted me to not labor for the next 24 hours so he could get that little bit more time, and they would also administer steroids to help boost his lung growth. It also meant that I would have to begin IV antibiotics to keep the chances of uterine infection down since my membranes were ruptured. So far a significant part of my birth plan was out the window! But I have to say that every person we came into contact with in those first 24 hours were so supportive and comforting it helped a lot to counter the feeling of being totally assaulted with interventions I had wanted to avoid.

The first night was restless, with poor Dan sleeping on a recliner in my room. Labor and Delivery rooms are not typically set up for long stays! He was so supportive and loving, making it a little easier to handle. It was a hard time for both of us, and equally so for family who were all perched on the edge of their seats waiting for news.

First thing in the morning (Wednesday) the on-call doctor came in with two resident doctors to discuss the game plan. He advised me that they would like me to stay resting until my membranes had been ruptured for 24 hours, and then they would want labor to start immediately in order to avoid increased risk of infection. This would most likely require an induction with pitocin, but it was what is really best. This was the first of many times my hackles were raised and I had to assert myself as a woman, mother and doula. I let him know that I am very aware of increased risk of infection, but I also know that they can watch for signs of it, as well as continue the IV antibiotics. I also knew that the risk of induction (as well as the difficulty with an induced labor) were greater in my mind than the risk of giving my body more time to go into labor naturally. I voiced myself firmly, and absolutely refused to even consider an induction at that point. I agreed to be watched closely, but insisted on time. The doctor reluctantly agreed, noting that he would have to have me sign a form stating that I had gone against his medical advice. He acted as if I had taken my life, as well as that of my baby, into my own hands! Defensive medicine is challenging to argue against, but I felt very empowered having done it. (I also swear I saw the resident doctors suppressing smiles as I was arguing effectively!)

So we spent the rest of that day resting and waiting, and were out of bed at 5 pm on the dot. Unfortunately labor did not begin. But we did have some fun that evening making our belly cast, which we had put off thinking that we had plenty of time. The Intern who was in charge of me that night added his tips and hints, as he and his wife had done a few, and we also had an audience of nurses for the creation. The evening took on a celebratory feeling, even though what we wanted to be doing was having a baby!

I have to add that at this time, my doula Linda as well as her partner Carol were there lending me support and encouragement, in between helping two other women labor. I was pretty restless, and kept asking if I could go doula with them. Everyone insisted that it was my night off, which was not the answer I wanted to hear! (They had two successful deliveries, one a VBAC, in the early hours of the morning. I was grateful that they kept me updated with the progress of each woman, one of whom I later met. Cheering them on helped to pass the time.)

Thursday morning I finally get to see my doctor, Pam Webber (she had been off). She came in bright and early to talk about my choices and options. I knew that the clock was ticking, and I had been lucky to get each moment past 24 hours that I had. At 36 hours, I knew it was time to really get serious, but I also knew that drastic actions didn't need to be taken as long as baby and I were looking good. Pam offered me a couple of options. I could start pitocin, to get things going. Or I could go with a more passive attempt at getting things going. I was thankful that she let the decision be mine alone, constantly reassuring me that things were going fine, and I could follow my heart. I agreed to try inserting cytotec (a small tablet that will often stimulate cervical change and labor) behind my cervix, and letting things proceed naturally. I have to add that when she inserted the tablet, it was only the second time my cervix had been checked since we entered the hospital. This was just one more way I felt in control of the situation and my delivery, though it was so out of my control. Everyone respected my need for minimal intervention.

Standard protocol for cytotec is inserting one tablet every two hours. We inserted 4, with no change, no significant contractions, and little hope that inserting more would change things. At 48 hours ruptured, I finally made the decision along with my husband and doctor, to start a slow protocol of pitocin. I knew that I had been fortunate to have as much time as I had, hoping for things to start. I also knew that 48 hours was a long time to be ruptured, and we needed to really get serious about getting my son here. My doctor reassured me that if things didn't happen quickly, and I was getting tired as the evening wore on, we would unhook the pitocin and sleep. I know that this is a rare opportunity with pitocin. I didn't have to brace myself for sudden hard labor, and could still be in control.

As with all of our intentions up to this point, this short round of pitocin did not get labor started. After 4 hours of slowly increasing doses (slow enough that at 4 hours I was at the dose the standard induction protocol has at 1 hour), I was having slow contractions that were noticeable, but not challenging. I was having a small amount of cervical change, evidenced by some pink tinged mucus, but nothing exciting. I called it a victory in preparation for the following day, and got a really good night's sleep. Dan and I curled up together in the tiny (smaller than twin) birthing bed, and snuggling him was so comforting. That was the best either of us slept during our LDR (labor, delivery and recovery) stay.

Early the next morning (Friday) we started again. My doctor stopped by with reassurance that we would stay with the slow protocol, no hurry as long as baby and I were doing good. She also mentioned that if late afternoon we weren't having success, we could once again stop the pitocin and get some sleep. This was so comforting because I had awakened feeling like I would have to deliver that day, no matter what, so a cesarean felt like a possibility.

Slowly things picked up, with my two doulas there for support, as well as my dear husband who was twinkling eyed and loving through it all, and family stopping in to check in often. By late afternoon I was having a truly great time in labor. I have studied so much in the past 6 months while learning what I need to be a good doula, and having a chance to experience it and understand what was happening was really amazing. The contractions got harder, but in between I had a lot of fun with family and friends, joking and laughing, not really regretting each contraction as it started. I found this amazing low tone in my throat that somehow vibrated just right, relieving the peak of each contraction. I loved hearing Dan matching it in my ear, and Rebecca (my 9 year old) chiming in as she sat on the end of the bed. It felt like something we were really doing together.

There were quite a few family members on hand to watch me labor and eventually deliver. Joe (Dan's brother, who filmed the event with their camcorder), Angel (Joe's wife), Mary (Dan's mother, who had driven 6 hours from her home in Paonia to be there), Jupe and Debra (Dan's dad and stepmom), and Cheryl (my mom, who rubbed my feet during the whole labor). My daughter Rebecca was of course on hand, excited by the event and by so many family members all gathered in the same room.

The last family member to arrive was my son Aaron. He is a brilliant 6 year old, who had been thoroughly prepped in the labor process. (His sister was there when I delivered my surrogate baby 2 years prior.) I knew he would be okay during my labor, but I had no idea just how great! He spent the first half hour or so sitting with his grandma Debra, watching, then slowly warming up to the rest of the crowd in the room. Just as labor was really peaking, I suddenly noticed his head lying next to mine on the pillow as I rested between contractions, and he would slowly stroke my arm through each contraction. I loved that he became so comfortable and participated fully!

My labor was going full force, and I could feel the baby moving down through the pelvic bones, shifting each contraction. I tried sitting up on the bed rocking my pelvis, then became really attached to sitting on the edge of the bed, leaning into Dan each contraction with my doulas putting counter pressure on my back. I felt so sure that I was approaching transition, and was grateful that the doctor kept asking me how I was doing, how I felt it was going, but never asked to do a cervical check. She truly allowed me to be in charge of my labor and chart the progress. Suddenly it became almost unmanageable, making me believe I was fully dilated. I also found that pushing lightly through each contraction was actually relieving some of the discomfort and sharpness. Amazing to feel so aware and in control. The doctor asked if the intern could check me, to see if they needed to get the pediatrician. I said okay, as I had a few concerns about scar tissue on my cervix from surgery almost 2 years ago. Sure enough, she got in there, and I was only 3 cm dilated! So discouraging, as it felt like I should be so much more! She worked the cervix through that contraction, and I believe now that the little bit of attention broke up the scar tissue and I fully dilated within the next couple of contractions. But we had no way of knowing that.

She had also found that the baby was still high in my pelvis, turned in a transverse position (facing my hip, with a shoulder pushing on my pubic bone and my tailbone, very uncomfortable). In the next two contractions, not only was I discouraged and scared, but suddenly the energy and feeling of the contractions changed. Understanding later that the baby was almost wedged in the most uncomfortable way, I had the most awful contractions imaginable! Instead of feeling on top of things, I felt out of control, which was not pleasant after the great feeling I had up until then. For the first time in my life I suddenly didn't think I could do it, and asked to see an anesthesiologist. Everyone in the room knew it was very serious for me to even mention an epidural, so they worked quickly to help. My doula got me into a new position, standing with one foot elevated on a stool, for the next couple of contractions, which were agony. I know it is a great tool for doing exactly what we needed to do, but actually managing to make it through each contraction in that position was the hardest thing I ever experienced. My hero the anesthesiologist arrived, and they quickly administered the epidural.

I have to say here for all of you out there who know me so well, that I am so glad I made the decision for the epidural. I feel like it was a really valuable tool that was entirely appropriate at the moment.

I had about four more contractions with decreasing intensity as the epidural took effect. The baby's heart rate started dropping, so the nurse wanted to put in an internal monitor. She discovered that the baby was almost crowning! It seems that all it took was a little relaxation in my pelvis and the baby shifted right down. Thankfully, the epidural took away all urges to push so the doctors had time to get ready, and Dan had time to get gowned, as he was going to deliver our baby.

The next ten minutes were the most amazing of my life. I was able to totally focus on what was going on with the delivery and not focus on the pain of contractions. I held the mirror and watched the head, reaching down to feel it. Dan did a great job of supporting my perineum, preventing any tears. I loved watching him work to deliver our baby and seeing our children at the foot of the bed, eagerly watching. I slowly and purposefully pushed out our son into the waiting hands of his father. The cord was wrapped around the baby's neck, but the doctor was able to slip it off before the baby was fully delivered. Aaron was waiting with a warm blanket, his sacred task, and Rebecca was called on to cut the cord. Because he was so early, they had to take him to the incubator quickly. I only saw him for a few minutes, and I knew he was in good hands with his daddy. He had to stay in the nursery for about an hour and a half and daddy was anxiously there most of the time.

But despite his smallness (5 pounds 13.5 ounces), he's strong. Once he left the nursery, he stayed with us for the rest of our time in the hospital. The rest of our stay was quiet and uneventful as we fell in love with our son. At this moment, he's sitting with me as I write this at home. We're battling jaundice, which is common for newborns, especially preemies, but we should be able to handle it all at home with no hospital stays. We're so grateful for our little miracle, Joshua.

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