I spent the days after my 41 week, 2 day prenatal doing internet searches on induction by AROM. Since my midwife seemed to think it would go well, I figured I could hear opposition on mothering.com, where indeed, people warned about how it starts the clock. I'd never gone for interventions of any sort for my labors (including watching Peter's bag of water go in and out for an hour and not breaking it) and it felt weird making such a blatant choice to start labor this time. But by Thursday morning July 3rd at 41 weeks 5 days, after waking up not in labor AGAIN, I was ready. I'd gone on a long walk Wednesday night and thought maybe my bag of water was leaking, but there wasn't any further evidence and I was so discouraged. I did see something that might have been mucus plug on Thursday morning. It wasn't the bloody gooey mess I've seen with my other kids, but it was better than the no signs of anything I'd been having so far.
So on Thursday, my parents came in the morning with their suitcases, we all hugged, and they brought the kids to swimming while we went to the birth center ready to AROM. We left the house early to eat lunch at the nearby Midtown Global Market (where I mentally dared everyone to ask when I was having the baby but only got scared looks) and then I walked the quarter mile through the hospital's passageways to the birth center. I got there at 12:50 for my 1:00 appointment and the midwife K was leading a tour. I told them I didn't mind waiting and it was 1:15 before I was set up in the recliner for the non-stress test. My birth center was established two years ago by a perinatologist tired of low-risk women having high-risk care by OBs. It's pretty easy to risk out - no gestational diabetes, multiples, high BMI, grand multiparas, or breech births. But for those who make the cut, it's covered by all major insurance carriers and encourages waterbirth, which recently was denied by a chain of local hospitals. For my early prenatals, it felt more clinical than even my hospital CNM experience with Tim, but I only saw one CNM then, so it was easy to connect with her. The birth center has 4 CNMs and after my first appointment, they kept to the 30 minute max length and relied on me to bring up questions and concerns. Nothing beats homebirth prenatals for feeling like the midwife cares about your whole life and is looking out for every possible issue. So it took until my third trimester before I'd met all the midwives and prenatals were only once a month until 36 weeks. But then I went every week for 6 Mondays in a row and I was feeling more comfortable there.
I settled in for the non-stress test and K sat down to talk to us about what would happen now that I was closing in on 42 weeks. Unlike Monday's CNM, she didn't mention AROM until I brought it up. She seemed to be more in favor of stripping my membranes that day and seeing if that would be enough. I felt weird pushing it because part of me didn't want to push AROM, especially if the CNM didn't think it was a good idea. But after some hemming and hawing, I finally said yes, if my cervical check indicated that I was a good candidate, I wanted to go ahead with AROM. K was the clinic CNM that day but M was the midwife on call, so at that point, K called M to tell her that she should be ready to come in. Meanwhile, the baby must have decided to take a nap and was not reacting much for the non-stress test. 30 minutes went by and there was only one long acceleration, so K kept waiting to see if there would be another one. Eventually we gave up and she said Monday's test was great and there were a couple shorter accelerations she could count if necessary.
So we went down to the exam room to do the cervical check. I was 3 cm dilated (and she could stretch to 4 cm), soft, 60% effaced, and pretty low, at -1 station. She said those numbers were safe to AROM at the birth center (if he was higher, they'd have to do it at the hospital in case of prolapse), and did we want to go ahead? Yes, yes we did. Then we moved into one of the birthing suites and waited for the on-call midwife M to arrive. It was now just after 2pm and we essentially spent the hour fiddling with my phone and the iPad, trying to get the wi-fi to work. At 3pm, M and the student midwife J arrived and set up for the amniotomy while K returned to clinic appointments. The amniotomy hook was less pointy than I expected. First J tried to do it but they weren't sure if it had worked. His head was low enough that they said it probably wouldn't be a big gush of fluid, but they wanted to see some so we weren't all wasting our time. M got a new hook and was able to get more fluid and be sure the bag was broken. They both were impressed by how strong my bag was. I felt like claiming it was due to my finally getting around to making a pitcher of red raspberry leaf tea the day before, ha ha. Since Peter and Leo were both born in the caul, I wasn't surprised.
We had a discussion about what to expect next. Since it was now 3:15pm, I had no interest in going home unless rush hour finished without labor starting. The 20-25 min drive would take at least 40 min, and I didn't even like having 2 contractions on the 6 minute drive to the hospital with Tim. The midwives required us to stay at the birth center until 4pm so they could check the baby's heart tones twice before we left the building. We decided that we'd drive a couple miles to Lake of the Isles, walk around there for awhile, and if nothing happened, we'd have supper in Uptown before deciding whether it was time to go home to rest. The midwives said that if contractions didn't start by morning, they'd want me to come in for another non-stress test. If that was fine, by lunchtime, it would be time to go to the hospital for Pitocin. But they stressed that they fully expected me to be back at the birth center within a couple hours.
That waiting hour was weird. I wanted contractions to start, but wasn't worried yet. To not even be uncomfortable, just hanging around knowing labor was imminent, was confusing. The baby's heart sounded great, so at 4pm, we headed out.
It was a pretty warm day at the lake. We walked along the path, checking out the paddleboarders, bikers, and canoers along with the mansions on our other side. We must have walked about 15 minutes before turning around back towards the car. By now we both had to pee and we realized we didn't see any public bathrooms on our side of the lake. Just as we got into the car, I realized that the pressure in my pelvis was actually a contraction. We decided to drive around the lake until we found a bathroom and if there weren't any, we knew nearby Lake Calhoun had port-a-potties along its beaches. As Dan drive around the curves, I had another contraction or two and although I still called them mild, experiencing them while moving was not much fun.
It took us awhile to figure out where to park nearest the port-a-potties and my contractions kept coming. By the time I used the bathroom, Dan called Kara to tell her to meet us there and then called the midwife. She had said that if I felt regular contractions at any interval, or if I felt strong pressure, we should call. Essentially, the contractions were 3-6 minutes apart and lasting a minute right from the start. I didn't really want to talk through them and I slowly walked through shady areas and realized I didn't want to be stuck out there surrounded by people in a parking lot. Meanwhile, Dan talked to the midwife who asked if I wanted to stay there or come back to the birth center. Dan looked at me and correctly figured it was time to go back. He also called Kara, who immediately guessed that she should go directly to the birth center instead of the lake.
It was 5:15 by now and we only had to drive a few miles, but it was through Uptown and its stoplights. I couldn't believe I somehow had managed to get stuck in the car for so many contractions. I talked to Dan a little between them but spent most of my energy willing the car to get there sooner and trying to relax despite the seatbelt and constant stopping and starting.
M and J, the midwives, met us back at the birth center and we returned to the birth room where we'd waited before the amniotomy. They asked if I wanted to be checked and I must have given them a strange look and asked them if it was necessary since I'd guessed we would minimize cervical exams now that my membranes were ruptured. It turns out, they just offered since most people want to know how far along they are when they arrive to make sure they're in active labor before settling in. It was clear pretty quickly that I was in active labor and I didn't feel any need to know if I was 5 cm or 7. I had no idea if I would be there all night and didn't want to introduce chances for infection unnecessarily. As it turns out, I was never checked after the amniotomy.
I wasn't sure if I would feel cooped up in the room and tried lying down on the bed for a couple contractions. That didn't feel all that good. I was calling out "Button!" to Dan to tell him when to indicate the start and end of a contraction on the iPad. He told me we could stop tracking them but there was something comforting to me about knowing they were ending and not just going on and on.
At 5:45, Kara arrived. It felt like she was setting up a buffet in the corner and although she was just trying to make sure I knew there were snacks if I wanted them, I didn't want them and in hind sight, I'd definitely hit that irrational time when things bugged me without good reason.
The contractions felt different than those I'd felt with the other babies. I worried that I might be having back labor and a posterior baby because it reminded me more of Peter's birth than the others', but it wasn't exactly the same. I didn't get whole-uterus-squeezing contractions. Mostly my pelvis felt a lot of pressure and as time went on, my low back bothered me more and more. The best way to cope with contractions was to lean on something sturdy, ideally while someone provided counter-pressure on my back and hips. Kara was great for finding the best spots to squeeze and rub but Dan was always nearby and willing to step in, too. Every couple contractions, I tried to find a better way to deal with them, but nothing seemed to work. At 6:30, someone suggested I try the shower, where at least I'd be able to focus the spray on my lower back. I finally stopped tracking contractions because the back pain didn't really go away between contractions and I wasn't sure when to say they began or ended. I'd tried sitting on the toilet, but it felt like I might inadvertently push if I stayed there and that seemed like a bad idea. While I was in the bathroom and feeling overwhelmed by how nothing was helping me cope much, I asked Kara if it would be much longer. She responded with something non-committal like "you're doing exactly what you need to do right now, everything's going perfectly," and I wanted to force her to give me a real answer, even though I knew she'd say something like that before I said it. Kara later said that I was probably entering transition around that time in the bathroom.
At 6:45, I tried getting into the tub and laboring there but the edges felt slippery and it felt like there wasn't a good way to steady myself. Maybe my push-against-something-sturdy preference didn't work there. After a couple contractions, I got out. Kara reminded me at one point that it takes half an hour for hormone levels to catch up and when labor's going quickly, that's tough. It just seemed like keeping on top of the contractions and not getting overwhelmed was more difficult than in my other labors. I couldn't tell if it was because I skipped right into active labor instead of slowly leading up to it over 12 hours or if my active labor really was harder. I thought about how it was going to keep feeling worse until I pushed out a baby and I didn’t even know how long that would take.
When I got out of the tub, Kara was trying to get me to put on a robe, I started vocalizing and bearing down, and I noticed the midwives around me for the first time. J had come every 30 minutes to check the baby's heart tones (which was a welcome way I recognized the passing of time) but I was otherwise unaware of the midwives' presence. I had to ask Dan and Kara later whether they were in the room much (their answer: not often). As I fought off the robe, the midwives asked if I wanted to deliver the baby in the tub or not and I realized that I was starting to push and was not going to be in labor much longer. Hurrah!
With the midwives’ encouragement, I got up on the bed on hands and knees, leaning over a birth ball (sitting on it earlier had been another abandoned coping mechanism). It was 7 pm. I guess my baby would not be sharing a 4th of July birthday with my grandfather. It felt good to push. During Tim's labor, the urge to push came slowly and I worried about pushing prematurely. This time, it was more obvious and encouraged. The pain in my back was finally gone and between contractions, I was able to really rest. Dan stayed up by my head and I joked with everyone during the rests. I wondered how long I would push - I had maybe 6 pushes total with Leo, most of which were before I'd climbed onto the bed. I pushed for 15 minutes with Tim and knew I was making progress. This time, I wasn't as sure that I was getting closer to getting him out. Not to put too fine a point on it, but at this point, I could understand why some people choose to have enemas before going into labor. I may have told everyone that I was just going to have a poop baby, not a human. As soon as I felt like I was never going to get anywhere, I had a longer, stronger push and the midwives behind me told me to stop pushing and wait for the next contraction. I couldn't tell if I was in the midst of crowning or if I'd pushed the baby's head out. It had hurt, a lot, but not ring-of-fire level hurt. For the next three minutes, I talked to Dan and waited for the urge to push. When it came, I quickly felt his body sliding out (such an odd feeling, body parts going all directions!) and heard him crying out. Yay, a breather! And I was done! No more contractions, no more pushing! Knowing the hardest part was over was such a relief. It turns out, his head was out for those three minutes but the midwives patiently waited for my body to be ready to do the rest. The time was 7:22pm and I’d been pushing since 7pm.
Kara and the midwives helped me roll over and lie back on the bed as they rubbed him and covered us up. His one and five minute APGARs were 9’s, I think, since his color was great and he kept yelling. His cord was fairly short, so I couldn’t hold him up very high on my chest until they cut it after five minutes when it was mostly done pulsing. I sort of felt like pushing again about ten minutes later and my placenta came out easily. I ended up with two stitches for two small first-degree lacerations. It was my first time having stitches. After recovering so slowly with Peter and Leo, I was glad to be stitched up instead of hoping it would heal easily on its own. He latched on to nurse pretty easily and mostly stayed there for the rest of our time at the birth center.
After about an hour, the midwives took him across the room to weigh him and do his newborn exam. 8 lbs 8 oz, 21 inches, 14.25” head. Finally, a baby between 7 and 9 lbs! His head was perfectly rounded without any molding. While he was there, they had me get out of bed and back into the tub (which felt quite nice without contractions coming every few minutes). Once the baby’s exam was done, he joined me in the tub (he liked it too). While we were in the tub, Kara mentioned that she had seen M point something out to J when I’d gotten out of the tub during labor. In fair-skinned women, when they are fully dilated, a dark line shows up at the top of their butt crack (http://birthwithoutfearblog.com/2013/06/06/alternative-methods-of-checking-dilation-the-purple-line-and-more/). M had seen this and it let her know I was ready to push without doing a cervical exam (the way I was starting to bear down and vocalize made it more obvious). Neither the student midwife nor the nurse who’d been practicing for 20 years had ever heard of it. It was fun being a teaching moment (although I’m glad they waited until later to chat about it.) The midwives showed all of us his placenta. It was large, probably close to two pounds, and had come out all at once with the bag of water still intact except for where they’d cut it and he’d come out. They were impressed by how strong it still looked. The placenta was calcifying a bit at the edges but was otherwise in good shape.
The midwives left after two hours, leaving us with the nurse A-M. I finally agreed to finalize his name – Linus Augustine, a name we’d just agreed on the week before. If he’d waited until midnight, we were considering naming him Edmund to honor my grandpa Eddie, whose birthday was that day. I stayed in bed and Linus nursed and A-M went over everything we needed to know to bring home a 4 hour old baby. I got to eat the lasagna we’d brought with us along with fresh bread that had been made in a bread machine while I was laboring (a great birth center perk!). Kara’s food was more appealing now that I wasn’t laboring, too.
Eventually Kara left to run home before heading back to our house and Linus and I got dressed and ready to leave. The last hour there, we mostly were just getting our vitals checked and waiting to go. I started yawning around 11 and the midwives were right – the 4 hour postpartum stay was well-timed for the parents to go home and rest in their own bed. I was worried that Linus would cry for the whole car ride, but he did well. He looked so little in the car seat.
When we got home, the older boys were really excited to see us. They’d thought that they’d go to bed before the baby was born and when they heard we’d be home before midnight, we told my parents they could stay up until we arrived.
The first night went okay. I find it tricky to nurse in bed sitting up but side-lying to nurse wasn’t working yet, so we had to arrange a giant pile of pillows every time. We did get to sleep for some decent chunks of time. We had to wake up enough at 3am to take Linus’s and my vitals, and then it was hard for me to fall back asleep. Within a day or two, I moved myself primarily to the couch during the day to make nursing easier. By day 5, I was nursing lying down.
Although Linus’ labor and birth was definitely the shortest of my four, I’m not sure if it was the easiest. I felt a lack of control that I don’t remember from Leo’s or Tim’s. Actually, that goes for late pregnancy and the first couple weeks, too. The unknown of when he would arrive was much harder this time and Linus has had much more trouble nursing than either of the middle boys. I’m grateful that each boy has breathed more easily than the last – it’s going to be hard to beat a screaming, not-yet-fully-born baby. I do wonder what would have happened if the midwives hadn’t broken my water. I had seen some mucus plug that morning and my babies have always been born the next day. Maybe I would have labored all day on the 4th of July. Maybe I wouldn’t have gone into labor before risking out of the birth center on Saturday. Maybe he would have had breathing problems and been born in the caul like Peter and Leo. I don’t regret any decisions we made and I’m certainly not going to complain about my short labor. It’s hard not to be curious about the what ifs.