After a month of pre-labor, seventy-two hours of steady contractions with back labor and nearly twenty-four hours of true active labor, I was finally complete and ready to push. I'd been doing squats every day for months, preparing for birth. I knew that the squat can often be the best position to push in because it opens the pelvis by up to thirty percent, so I had always planned to push in a squat, when and however my body directed me. My midwives spread a plastic sheet on my couch and placed large absorbent pads on the living room floor where I had parked myself. This was the second point in my labor where it became very mentally and emotionally influenced. Suddenly my living room did not feel safe to me. It was too open. There were too many windows. I felt painfully vulnerable and exposed and every time I had a contraction I would pee myself a little bit, and I did not want to pee on my sofa. I needed a cave. I needed to be in my bathroom where I could let my body relax and do its thing and not be embarrassed. I wanted to get in the bathtub! My plan was never to have a water birth. I had the option of renting a large tub to deliver in but had decided not to. But suddenly, I needed to be in my tub.
My midwives obliged. They warned me that I would not be able to actually deliver Eloise in the tub since it would be too shallow, but decided there was no harm in letting me get in the water and start the process of pushing there. When my baby was ready to be born we would move - to where, exactly, we weren't sure! I climbed into the water and instantly felt relief. Completely private and "safe" once more, I tried to get a grasp on spontaneous pushing. With each contraction I squatted and bore down. It was more uncomfortable than I expected and didn't feel quite right. It felt good to push, but I didn't feel like I was really accomplishing anything. In between contractions I rested in the warm water, thankful to have some relief from the excruciating back pain. Time passed - an hour, maybe two, of resting and trying to push. The contractions were slowing. I needed to get out of the water.
Chloe poked her head into the bathroom and then came in and sat on the side of the tub. The gist of the conversation was this: It had been a long time. My attempt at spontaneous pushing wasn't working. None of us could go on too much longer like this. It was time to get this baby out. It wasn't any of our ideal, but we would try directed pushing in bed for a time, at least, and see how it went. I had three hours to try and push Eloise out and then we were looking at a hospital transfer.
Like heck was I going to the hospital! Let's push a baby out!
I'm not stalling on purpose. I'm willing to do whatever it takes. I want to do this, you know.
We set up in my bedroom. Out of the hot water, the contractions were back in full force and I began to panic. What do I do? What do I do!
"Just breathe through the contractions like you were before."
This was different though, because now my body finally needed to push. Jake climbed into the bed and leaned against the wall, and I sat between his legs, leaning against his body for support, knees pulled up to my chest. It was nearing noon on Friday at this point, day four of labor, and I was exhausted and hungry. Somebody brought me some juice and yogurt and I managed to take a few swallows of each before we began.
"When the next contraction starts, I'm going to find your baby's head, and then I want you to try and push my fingers out."
Ouch-ouch-ouch-ouch-ouch. Okay. Let's do this.
"Woah! You did it! Mandy, check out how far you just moved your baby down!"
I could do it! It hurt but it was way better than NOT pushing. I'd finally found my groove. The pushing position I never thought I'd use was actually working for me. Susan and Chloe both complimented me on being a "very effective pusher" and predicted that I would be holding Eloise sooner rather than later! We continued, breathe in, push, breathe out and in, push. Susan held up a hand mirror and I saw my baby's hair! Breathe in, push, breathe out and in, push, with each contraction, and I drifted further inside myself and lost track of time. It was the hardest I had ever worked in my life. A an hour or more passed. The atmosphere in the room began to change. Something wasn't working. Later, Jake would tease our midwives about their need to improve their "poker faces" as they shot concerned looks back and forth with raised eyebrows, whispering in what could have been secret code for as much as we understood. Self doubt began to creep in. What was I doing wrong? They said I was a good pusher. Why couldn't I get her out?
Just tell me what I need to do differently. Just tell me what I'm doing wrong.
"It's not you, honey. You're doing it exactly right."
After seventy-five hours of labor, Eloise was trying to come out ear-first. Susan looked at me with what I knew was pain in her eyes and said, "Mandy, with the way things are looking, I'm not sure your situation is conducive to a vaginal delivery."
I was a quiet laborer and a quiet pusher. It's just my personality. During contractions I breathed in and out and during those hours of pushing I turned inward. But when I heard these words, my spirit split open and I wailed. I had worked so hard. I had labored for so long and pushed for so long. I did not want a c-section. I thought (and looking back I'm not sure this is actually true) that they would have to put me under general anesthesia for a cesarean and I wanted to BE there when my daughter was born. I wanted to hold her when she was still slippery and wet and hear her first cry and breastfeed and soak in her very first moments. I wanted to give birth at home as planned, vaginally as planned. I had worked SO hard.
"We're going to keep trying!" Susan said. "I'm going to try right now to get her to turn."
My midwife reaching inside me and turning my baby hurt worse than any contraction. I don't know if I screamed or yelped or moaned, but I know some sounds escaped me and they scared me. But relief and pure gratitude flooded over me when she said, "There! She turned!"
We kept pushing. With every contraction Chloe would listen to Eloise's heart rate and as always, she was fit as a fiddle! But it wasn't working. This is the point where my memories really start to become scattered and muddled together. We tried every trick in the book to turn my baby. I squatted and pushed. I pushed on one side with a leg in the air and then on the other side. I got on all fours with my chest down and my bottom in the air and pushed. Jake and Chloe took turns using a long piece of fabric called a rebozo to jiggle my belly while I pushed. Eloise danced in my belly like she'd danced for nine months. The midwives would check me and feel an ear...then a mouth...then hair!...then an ear again. She should not have been able to move like this, so far engaged, but apparently I have a very "roomy" pelvis. I was so tired. I absolutely hated pushing in any position other than semi-sitting, leaning on Jake with my hands behind my knees. For some reason, maybe the back labor, any other position was ten times more agonizing and my pushes were not nearly as strong.
My back hurts. My back. My back hurts so bad.
It was more of a plea for help than a complaint. Maybe even just a plea for understanding.
I was becoming weak and Eloise would not stay where she need to be to finish descending and be born. My cervix was beginning to swell. I don't remember who told me or what they said, but it was time to transfer to the hospital. I knew they were right. I knew it was time. I wasn't quite to the point of giving up yet, but I was very close. This was the first and only time in my entire labor and delivery that I felt like, "I can't do this." I was ready. I would go to the hospital and they would offer me a c-section, and I would say yes. They would put me under and I would finally have relief and rest. When I woke up I would get to hold my baby that I had worked so hard for.
First, I wanted to take a shower.
This seemed to surprise everyone but to me it was absolutely necessary. I stood under the hot water for maybe five minutes, pushing through one contraction after another, crying, overflowing with grief because I knew that my efforts were doing no good. During those longest and shortest of minutes, I came to an acceptance. Some babies must be born by cesarean. I had done everything I could. My team had done everything they could. God would be with me and his plan would be perfect and beautiful. I had wild sorrow but an unexplainable peace.
"This is not an emergency transfer. Your baby is just fine. This doesn't necessarily mean you still can't deliver vaginally." I knew she was wrong.
We drove the longest mile of my life and I pushed in the car - again, knowing it was doing nothing, but my body had to respond to the urge. Susan came with me. They were expecting us when we arrived, but we still stood for what seemed like an eternity, answering questions about my health insurance and medical history and how long I'd been in labor.
I'm not in labor! I'm pushing a baby out! Please help me! Someone help me!
I was wheeled into a triage room and a midwife from the hospital named Karen came in to examine me. A nurse went over all my charts and birth plan with Susan while Karen made an assessment. An OB was in the room but he stood back and let her do her thing. I later found out that Karen had stayed past her shift in order to help me when she heard of my situation. I will forever be grateful to her.
"She's good to go! Let's push, mama!"
They were going to let me push!
We walked a very short distance down the hallway to our delivery room. That walk is the last of my visual memories. Once we reached the door, I turned completely inward, shut my eyes, and did not open them again until Eloise was born.
The nurses strapped the EFM to my belly and gave me an IV with antibiotics since it had been so long since my waters broke. My veins are notoriously difficult to find and I was stuck in several places in both arms before finding one that would work. Nothing else hurt anymore compared to the radiating pain in my back and the pressure of Eloise trying to be born. Everything after that is a blur. Jake and Susan could probably tell you much better than I what was going on in the room and even in my body from then on. The monitor beeped, telling me my baby's heart was beating. I pushed and Karen reached inside me to turn Eloise's head. I squatted on the floor with a wonderful nurse named Emily who would be my friend during recovery. She held my hands and called, "Push from your bottom!" while I groaned. I got back in bed. Like at home, I pushed on one side with a leg in the air. I pushed on the other side. Jake was on my right holding my hand and giving me sips of water after every contraction. Susan was on my left holding my other hand and whispering, "You can do this." Karen stood ready to catch Eloise. The OB was nearby, counting in a firm voice, "One, two, three, four, five, six, seven, eight, NINE, TEN! Breathe! Push again! One, two, three..."
There were so many voices. I don't know how many nurses were in the room but it was a lot. Susan told me later that the whole team was ready and waiting for when the c-section inevitably became necessary. Maybe they were also a little curious about this crazy home birth girl who had been in labor for four days? I don't know. But every contraction brought on a chorus of voices, cheering me on and sustaining me.
"You've got this."
"One, two, three..."
"Push from your bottom!"
"...four, five, six..."
"Worst constipation of your life!"
"That's fantastic! Great job!"
"NINE, TEN! Breathe! Push just like you did before and you'll be able to hold your baby!"
"Take a sip of water, babe."
Every contraction was the last one. Every contraction if I just pushed one more time, my baby would be born. But she wasn't. She was stuck. I didn't know why she was stuck but I became angry and pushed with every fibre of my being. I grunted and groaned and cried a little bit.
Beep. Beep. Beep.
"Deep breaths, Amanda! Slow, deep breaths! In, out. Get her some oxygen."
I didn't know it at the time but my baby's heart rate was dipping with each contraction and rising again as soon as I breathed in. I think it is a good thing I didn't know - I would have panicked and probably couldn't have taken the slow, deep breaths I needed in order to bring her heart rate bouncing back up. I was so weak. In between contractions I couldn't lift my arms or even move my head. My body had gone completely limp. I needed some juice but couldn't ask for it, I was too inside myself to speak. But as soon as each contraction hit, I came to life and pushed with a strength that could only come from God. Looking back, if I hadn't taken those few bites of vanilla yogurt and those sips of cranberry juice before pushing at home, I probably would not have had the energy reserved to push my baby out all those hours later.
Eloise was crowing. I could feel her - I could feel her moving down and out of me. Somebody took my hand and let me feel her thick hair. Jake said, "Wow." But she could not be born. Susan told me later that I had a very thick hymenal ring and that was why she was so stuck. I don't know how exactly Karen and I got her past this but I know it hurt. Eloise was so close! We just needed a little bit more help.
Karen: "I'm going to have to make a little cut."
Susan: "Tell her what you are going to do first!"
Karen: "Amanda, honey, I need to make a tiny little cut to help your baby come out."
Agony. I think I screamed - I'm not sure. I had read before that cutting an episiotomy while the baby is crowning provides enough pressure that the mother hardly feels it. I felt it. That tiny cut was worse than the contractions, worse than the back labor, not quite as bad as the midwives turning my baby. I pushed and tore a little further. I only needed three small stitches but it felt like my entire body was being ripped open.
It was exactly what was needed. I pushed again through the splitting pain and my daughter was born! It was like she finally slipped out - sunny-side-up, with her extra-long cord wrapped twice and a half around her slim little torso. "Good job, Amanda! Reach down and pick up your baby!"
But I couldn't. I couldn't lift my arms. After more than seven hours, the pushing was finally over and I was once again completely weak and limp. I tried to open my eyes but couldn't see! I had burst so many blood vessels and my vision was double and triple and completely blurred, my eyes seemed to be swollen half shut from the effort. I blinked and blinked but I was still blind. I managed to hold my arms out and someone put my baby on my chest. She was not breathing quite yet but she was squirming around and I knew she was just fine. The nurses untangled her and rubbed her down and soon she let out a little squeak. Oh, that sound! The sweetest little voice I ever heard. Jake bent down and kissed me on the lips. Oh, that kiss! It was the sweetest kiss of my life. Our first kiss all over again but a thousand times more. I wish I had a photo of that moment but I know I will never forget it.
Susan ran to the waiting area to tell my parents and Tessa the news. Karen stitched up my torn perineum and I soaked in the sensation of Eloise on my chest. She was so perfect. I wanted to look at my baby and count her fingers and toes but I still couldn't see or move. My first memories of my daughter are not what she looked like, but simply how she felt in my arms. I struggled to open my hospital gown and put her to my breast and a nurse saw and hurried over to help. They took off my gown and cut the thick band holding the monitor off my belly. Skin to skin at last. She wasn't interested in nursing right away so I leaned back and just relaxed with my baby on me. After a little while my parents came back just in time to see Jake hold our child for the first time. Through blurry eyes I watched my husband become Daddy, my mother become Grammy and my father Papa. That was such a special moment that will never happen again.
When we finally arrived back home a few days later I was hit with a wave of grief, for the first time, over the loss of my home birth. It was surreal - seeing the house I had circled again and again, the same tree in my front yard I had leaned on for support when contractions hit, the ball I bounced on, the stairs I climbed again and again, the couch I transitioned on and the bed I pushed in but did not give birth in. For a moment I tried to stifle the sadness but then did what I had learned to do throughout labor - I leaned into the pain. I cried a few tears and then moved on. My hospital transfer was as blessed and beautiful as I could possibly have hoped for, and I could not be more grateful for all the angels who made it so. Everything about my labor and delivery happened in God's timing and according to his plan. I am a different person now - not only am I a mother but I know I am a warrior and can endure all things through Him who gives me strength.