Several months ago I saw an email form Ashia on our local listserv. She was experiencing pressure from her midwives to be induced at 42 weeks and sought advice. I asked if she would share her story and was delighted to find her story in my inbox last night. In an email conversation, Ashia noted that despite the strong pressure to be induced, she was very aware that she did not have to show up for the induction and that her midwives would have caught her baby if she showed up at 43 weeks in labor. I am hoping that as care providers gain a better understanding ofinformed consent and refusal, there will be less pressure to induce in cases like Ashia's and instead an open exchange of information that includes, benefits, risks, alternatives, and the space to say no. A big thank you to Ashia for sharing, you are a strong momma!
Ashia and Don Mann’s Birth story for our second child, Bennett.
Measuring 1cm at my final 2 appointments with the MCA midwives and because of previous induction with my daughter’s birth at 43 weeks and no signs of imminent labor, we had already been trying everything we could to get this labor started. Walking, primrose oil, sex, (literally Don says “I swore I would never ever say this but I don’t want to tonight” one day and we both have a good laugh) we are often talking to baby, I drink red raspberry leaf tea all day, chiropractor every week… Discussed castor oil with Ursula (our doula) as a last resort but I vetoed it because it just doesn’t seem right for me.
My 3/10 due date came and went- and our induction was immediately scheduled for 3/24. I was very upset because it seemed like a confirmation that I would not go into labor on my own. The midwife just hands you a piece of paper with these dates on it (nonstress tests, biophysical profile and induction) and tell you to schedule with the receptionist within the next 2 weeks. Yuck. I thought that having midwives, you would never feel like you were told what to do, that it would be a discussion and a consensus. I cried and immediately called Ursula on the way home. I was not feeling confident. She told me we had options and went over our game plan of sex and primrose and castor oil and reminded me that people sometimes don’t show up on induction day but also that I had a very successful induction last time and its likely this time will be even better.
A week of me just not returning phone calls, (everyone wants to know ‘why isn’t that baby out yet!’) crying and lots of angst. In-laws are here waiting to watch our daughter, Madeline, while we are at the hospital… but we never go to the hospital so they help work on the house- every day another room is being spackled, painted, drilled or caulked- sometimes multiple rooms at once!
On 3/16- at MCA exam, Ashia was 2cm when Chris (midwife) measures (finally progress!) She said she’d like to strip the membranes and we agreed it was a good idea (with Madeline, the OB just did it on my due date with no explanation and I didn’t realize until it was hurting). Chris Stretches me to 2-1/2 or 3cm. Non stress test was normal. The baby outperformed all the standards for heart rate and kicks etc. There was a little blood with the sweep but not too painful. Madeline, our toddler was there in the room so it was a good distraction and way to keep my game face on. Talking about cheerios and cranberries during the procedure was funny.
Chris says to try drinking castor oil and I object so she doesn’t push. We talk re the need for induction. This practice routinely induces at 42 weeks. She explains induction with a midwife is less aggressive than with an OB especially since they control the pitocin levels in very low doses and because they do the least they have to and are happy turning it off if I show progress. I resign myself to some sort of induction but want it to be cervadil instead of pitocin because I have been through it with cervical ripening and pitocin scares me still. She explains that they do different things so it depends what my body needs at that point. I leave feeling better about being induced by a midwife than I did with the OB but still really bummed because I feel ready to have this baby without any induction. I thought maybe I just never got emotionally ready with Madeline but that this time, actually wanting labor to happen, it would. I have crampy and small erratic contractions that day. Discharge and clearly part of my mucus plug came out. I go for a long vigorous walk with music and hope that I will kick-start labor. Nope.
3/16-3/20 sex every night, primrose every night, red rasp tea all day, walking etc
3/18 Jill and Mike, our very close friends arrive and Madeline is thrilled and Ashia is so happy and relaxed to have them here. In-laws went to jersey for a few days.
3/19- Bio-physical exam was performed. Don, Madeline and Jill are there. The tech was lame and not like last time when they showed me Madeline’s face and hands and made it fun for me to be there seeing my baby every few days towards the end. This time she said ‘he is too big, you cant see anything anyway’. But health wise, everyone received thumbs up and its all laughs and smiles until the doctor comes into the room, grim. There is concern over Bennett’s size. Ultrasound has Bennett at 11 pounds 2 ounces and neonatologist want to schedule an emergency C-section for a large baby. She says I should call my midwife because trying to naturally deliver a baby this big means pinched nerves and nerve damage or the baby getting stuck and needing c-section anyway or having a dislocated shoulder or worse and leaves the room at that. We thought she was coming back and then the technician came in and said “you can go now”. WHAT!? We leave and Ashia is crying and we call Ursula who says this means nothing, call the midwives because these things are always wrong. Whew. I knew she was smart.
We get home and Jill takes Madeline inside so Don and Ashia can talk about our coping plan. We call the midwives and Sharon says just come in tomorrow and she will tell us if this baby is 11 pounds or not with her hands. Ashia is relieved because Sharon gives the impression that these tests are often wrong too and Sharon is nonplussed by the size comment. She asks was there something else they told me like heart rate or adhesions etc? nope-okay then, this is fine. Don assures Ashia that the baby is healthy now and that one way or the other he is going to be born soon so we need to start being really positive. We call to Don’s parents to make sure they will be back soon because I think I’m having a baby in the next 24 hrs one way or the other.
Just for giggles, Ashia tries an enema- thinking maybe something is in the way…didn’t do much but cause one regular BM. Took two primrose and one inserted. No sex tonight.
3/20- Ashia sees Sharon (CNM) at 10am in Frederick office with friends there in office w/Madeline. Laughed a lot w/ don because yesterday they said the baby is so big and today the nurse we had was all of 10 lbs herself. Don says ‘our baby could totally take her’. Membranes are swept again. This time Sharon meant business! Ashia leaves at 4 cm and 80% effaced. She schedules an induction for 3/21 at 9 am. Sharon explains that she knows the doctors on call this weekend and the OB on call tomorrow will go for induction whereas the one who is on 3/24 would not. Talk to Sharon re using cervadil instead of pitocin. She says if a mom is 4cm or more they wont go that route because its job is to thin and I will already have begun that. Erratic but strong contractions start right after midwife appt.
We decided to go to lunch. Today I think I’ll really work with the contractions instead of wince from them and not lay down but continue to walk and be active. We had a huge lunch in Frederick w/ friends and Madeline and then I went to the chiropractor and asked him to do some magic. He did some final adjustments including the Webster technique (usually used to turn breech babies but really is just a sacral adjustment to relieve inter-uterine constraint which prevents baby from moving where he is supposed to) and a neck adjustments too. He wishes me luck and says he imagines he will not be seeing me next week.
Ashia is gathering strength and advice from friends for the rest of the day/eve. Asking friends and birth group acquaintances for positive stories of big babies and induction. We researched natural birth of big babies. Several positive stories come in and a few phone calls urging me to listen to my body and be strong. Lots of talk with Ursula about still being able to go natural with an induction.
Harder contractions began later that evening around dinner which no longer felt like crampiness. They were discernable. Its nighttime and I know I need to rest. After a wonderful night with friends, wine, music and laughing, labor starts gently and naturally. (I start pooping like every 30 min). Lost lots of mucus plug. We call to let Ursula know. Labor continues during the night with irregular frequency and intensity. By midnight most contractions are 1 min long and between 5-7 min apart. Ashia copes by relaxing into them and telling Bennett- “lower” with each slow breath. Trying to work with the baby to make the pressure move lower in her body seems to help cope and increase the intensity of contractions at the same time. Using contraction master online program for timing leaves something to be desired but Ashia was not willing to tell Don that ‘this is it’ yet and so, not writing them down in front of him was a good technique.
3/21- Around 8am Ashia and Ursula speak about the night’s activities. Castor oil is no longer an option. Also seems obsolete after the night of bathroom trips. Ashia showers, Don and Ashia eat a huge waffle and sausage breakfast with family, friends and Madeline and prepare to leave for Shady Grove Hospital. Call to midwife stating she is in early labor and doesn’t need induction. Sharon says we should go in anyway at this point. She will meet us there at 9:30.
Ashia would stop during packing and would have contractions on all 4s then get up and continue. Friends were laughing at this. They say too that looking at this baby belly this morning- looks nothing like yesterday. Its low now. YAY! He got lower! We leave our house at 9:45. OOPS. Not going to get there at 9:30, Sharon- sorry!
Driving there- the bumps hurt when having contractions so Don is as careful as he can be to avoid potholes. It is a 7 minute drive that seems to take 20. Don makes Ashia suck her thumb and tweak nipples the whole way because of Ursula’s stories about how this could regulate contractions. Turns out they never really ever came like clockwork for me, but this probably helped a lot.
We walked from the parking lot carrying pillows and a suitcase inside. We are still joking but pausing for contractions a few times along the way. It is so weird being somewhere without Madeline. Ursula meets Ashia and Don at Shady Grove with birth ball and bag of goodies in hand and everyone is admitted by 10am. At 10:20 midwife Sharon says she just called our house- where were we? I told her I had to have waffles and sausage first. She said it was good, I needed a good meal.
Ursula does some voodoo pressure points and massage. Essential rose oil etc. Changed into hospital gown- I really didn’t like that. Should have brought nightgown for labor instead of this. Sharon says I can change into my own clothes but I didn’t bring anything but pants- DUH!
Sharon performs an exam at 10:40. Ashia is 6 cm and 80%! YAY! I feel like my body DOES know how to do this after all- just needs some prodding. I’ve now chalked it up to being a control freak. Like if you say you are going do this FOR me I say ‘Fine ill do it myself!’
Having contractions and Sharon says she is going to break my water. I ask Sharon about breaking water before the baby is too low and cord wrapping etc. She assures me that this baby has a nice big head and its low so the cord cant get up under it. Whew. I relax re the water breaking. I was scared about this procedure from material I had been given stressing that this is not a good idea. Now im relieved and can relax into birthing this baby. She ruptures Ashia’s membranes. I remember tensing a bit when Sharon asked L& D nurse to hand her the ‘amnio hook’. Why do they have to call it that?. After the giant flood of hot water, labor becomes more regular. Using coping techniques like aromatherapy, massage, cuddling, and loving talk, labor progresses. Don is at the ready with Jack Johnston on the ipod and is holding my hand. We decide to call our friend Zygo to sing the song from last night that we all loved and he sends it via tokbox. My husband is a tech guru.
At 11:15 am Ashia is on the birth ball, facing don and breathing through contractions. A big one leads to Ashia letting loose a flood and Bennett slips into position. Ashia is amazed at how clear amnio fluid is.
Ursula suggests we move to toilet after 2ndcontraction on birth ball. Sharon supports any positions or moves Urusula suggests. Monitors are removed and we change positions and have a new venue for discharge. Toilet is more comfortable and room feels more private without random nurses walking in. Ashia labors well there. Don is on the floor, Ashia is draped over him and Ursula is behind her. Ashia wants to get up and go to the bed on all fours, but contractions are too close together. Didn’t think id have time to get ‘comfy’ and would have to endure one of these strong contractions enroute so I stay put.
Don’s back and shoulders are killing him but he says nothing about it. Ursula works to help him be more comfortable suggesting he try different places for his knees and rubbing his back for a bit. He is a man on a mission not to leave my side and thank goodness because he was where I was getting all my strength from. A contraction would come and I would get tense and he would remind me to loosen up. Ursula would touch my forehead, chin and chest to relax me through these. Ursula is great at reminding me to relax my body. When she sees my arms or legs are tense she reminds me and I quickly go back to jello which helps. We are using the contractions instead of fighting them away.
11:45 Ashia starts burping and then the nausea starts. She begins vocalizing. On Ursula’s suggestion, we move back to the bed, backwards facing pillows. A big contraction comes just as I get into this position and I switch to moaning. Deep vocalization seems to help relax me. Im totally surrendered but I feel hip pain from all of the time on the toilet. Ursula applies strong pressure to my lower back with her two elbows. (Later Sharon comments she has lots of experience with back labor obviously!)
I’m Talking to Bennett in my mind just like through the night- relaxing instead of clenching. Telling him ‘lower’.
11:50 Sharon enters. Ursula says something to her (something like “Hey Sharon, she is moving really fast”). She had heard the vocalization and now knows im ready. She performs another exam and Ashia is complete! Sharon says its time to push the baby out. My hip hurts badly from being on the toilet for so long. I need to give it a rest and stretch it out. I really thought for a moment I could just take a break. Yeah right. Someone asks what the baby’s name is and we share it. Bennett James Mann. Sharon says I can push Bennett out as soon as I am ready.
Ashia takes a 10 minute breathing break to mentally and physically prepare for pushing. Though planning to push on all fours, she is happy to lay down and give her hips a break. Sharon asks her to push on her Left Side. This was the same way as Madeline’s birth and that locks in for me that it is a good position. I shift, putting my right leg on don’s shoulder and my foot on ursula’s chest/hand for counterpressure- like a human stirrup. I was so grateful not to have to hold my own leg’s weight but pulling back on my own knee helped.
Im afraid to make the first push. Its fear of pain and also of committing to pushing through to the end. Don got me back in the zone talking me through holding our baby, nursing the baby and other imagery. Ok, I can push now. Sharon says to take a deep breath and do not breathe the air out. Here goes.
“Good pushing”. I remember how to push! I remember this feeling. This part is the working part. It feels good to be able to do something actively rather than leaving it up to Bennett to do all the work. Now I can help my baby- I like this feeling of being powerful; its my body and the only way out is to push. I feel that Bennett did his job, getting lower and now he needs me to do this part for him. They offer a mirror and I decline. I just want to push with eyes closed so I can feel what Im doing.
Pushing is not directed like it was with the OB. With Madeline they would tell me when to push, when to slow down etc. With Bennett, I pushed when I felt I could more or less. Sharon didn’t really tell me to push or not to- she let me decide- like she knew that my body would do the right thing. It was more primal this way; intuitive. I know im being noisy- grunting or moaning or perhaps shouting but it’s the only way I know how to make these pushes really work for me.
I can feel his head engaged. It has only been a few minutes! With a few pushes I feel it at the edge but cant keep it there between contractions. I Have to muster enough strength to get him all the way out. More coaching from don and Ursula right behind him. I think these pushes are way more focused than with Madeline. When I pushed with her it felt more like a bowel movement. This time it felt like pushing in the right place. I feel ring of fire, but less so than last time because Sharon massaged around and around his head and stretched me open all around. Seemed like she ran her hand all the way around the opening along his head to loosen the skin. I ask if he has hair- Sharon says yes we can see his hair, lots of it. I think ‘Ok its not fair they can see him and I cant. Lets get him out”!
One more push and a scream, some sort of tribal shout. Head is out. Sharon asks do I want to see the head with the mirror?- nope I want to go for another push. Two or three more pushes and Bennett’s body floats out on a wave. He makes a tiny little cry but not much of a complaint.
12:35 Bennett James enters the world. After a post-birth meconium he weighs in at 9 pounds 14 ounces and 21-3/4 inches.
I try to hold him and pull him higher on my chest to kiss his head. They all are telling me not to pull him up so high. The cord is not that long, Ashia. He has a little vernix, lots of dark hair, little furry ears and shoulders. He opens his eyes within a minute and is comfy on my chest though not eager to nurse. He is mellow and relaxed within minutes and falls back into sleep.
Sharon tells me it is time to push out the placenta and a few good pushes later she tugged and its out. I asked to see it and explore how cool it is. We all look at how it is perfectly intact. She stretches out the membrane side so we can see where he has been living for nine months. This is cool.
Sharon waits for the cord to be all white. She consults with Ursula before offering to don to cut it to make sure that our birth plan is honored. Don cut the cord this time. He said it was tough.
Sharon Stitches a small tear for a long time, carefully. I felt the pinch a few times- ouch. But Ursula assured me its worth this time. Sharon is really working hard to make sure I don’t have any problems down the line. She tells me its not a new tear, just along the old scar tissue from the tear with Madeline.
I Realized that these midwives did a lot of the work for me from sweeping membranes to breaking water to stretching. Its like they were an extension of me- working to get the baby out from the outside while he worked from the inside. All I had to do was be the vessel and the strength. I am so grateful in that moment for the amazing birth team we had. This was exactly what we would have hoped for, for Bennett’s birth. Ursula totally delivered on her promise “the birth you desire”.
Update: Postpartum was a snap this time. After my first birth I wanted to lay in the bed and be taken care of, was afraid to get up like my insides would all fall out! But this time I was up and in the bathroom within a few minutes of Bennett’s birth. No pain in my bottom whatsoever this time (Ursula gave me arnica tablets and gel which I used for several days and it was awesome). Nursing was easy and has not had any rough patches (Bennett is almost 4 months). I felt healed within a few days and the only discomfort was the uterine contractions while nursing. I took my first pain killer- an ibuprofen in the hospital, for those afterpains which they say get stronger with subsequent births. Bennett did not lose much weight in the hospital and was back up to his birth weight within a few days. He was born on 3/21 and we left the hospital the next day 3/22. Bennett and Madeline are so happy to see eachother every day. She is a great big sister. He is a happy, smiley baby and I believe that has a lot to do with his happy birth.
Thank you to our amazing birth team.
The Cochrane Review, on induction of labor for improving birth outcomes for women at or beyond term, has this to say:
"A policy of labour induction after 41 completed weeks or later compared to awaiting spontaneous labour either indefinitely or at least one week is associated with fewer perinatal deaths. However, the absolute risk is extremely small. Women should be appropriately counselled on both the relative and absolute risks." http://www.cochrane.org/reviews/en/ab004945.html