Sweet mama Toki submitted her birth story for me to share, but when I read it, I felt the sadness amidst the joy of having a baby. I felt I needed to embrace Toki with much love, compassion, and support. And then came the outrage. I hear stories like these all too often, and every time I feel this way. I do not like to judge any provider or mama doing her best with what is known and faced at the time, unless I have been in their shoes...which is never. I know what happened was meant to happen, because it did; and I do believe it was a gift even though we do not always understand why, nor comprehend each of our soul's unique journey. Nevertheless, I told her I could only post her story if I could write how as a midwife, I would have dealt with a situation like hers, and she agreed I could add my editorial. My comments are based only what she reported. I am forever grateful to modern medicine when medical and surgical intervention are truly needed for serious illness or life threatening complications. But when they are used on healthy pregnant women having healthy babies, I speak up about avoiding unnecessary risky procedures and major abdominal surgery, I speak up about prevention, and I speak up to support mamas who have had such experiences.
Mama said she was "tremendously scared about the entire pregnancy... It was my first and I was 38 years old. Everything was frightening to me including the tests, the OB visits, and the internal ultrasound! Mostly, I was afraid that something would happen to my baby. I was always in a state of worry. I worried about the heartbeat, if she was getting squished inside me... all those silly crazy things that we worry about!" When a mama has such anxiety and fears, it concerns me; they must be addressed comprehensively throughout the pregnancy, as they negatively impact labor, birth and life. Sometimes all that is needed is some education and calm reassurance; but in many cases, we need to take a look at lifestyle as a whole, ways to reduce stress and enhance a more relaxed inner world. I also draw upon many holistic modalities, depending on the needs of each individual. I would definitely urge hiring a wonderful doula and taking my Love Your Birth online course!
But there are red flags here, that make me question the entire philosophy of maternity care that has become standard. Healthy women today over 35 are unnecessarily placed in a high risk category simply because of their age, and are scared into an array of testing to screen for problems. Looking for problems when there are none or there is a very low chance of having them, alone creates anxiety. Also aside from the prevalent horror stories of others who birthed in typical hospitals and the media hype and dramatization, many modern women have not been exposed to normal birth as women supported women during the process throughout history, before birth was moved to the hospital setting in the 1900s. There is much fear in the unknown. Another characterization of today's mom is disempowerment to a patriarchal system, placing full trust in technology and modern medicine rather than confidence in herself as a woman and the process of childbearing. That being said, we are a generation bereft of spiritual connection, with a false expectation of perfect outcome always, without tolerance or ability to cope with anything less.
"Saturday morning, I wake up with this crazy urge. Pee. I get up, or rather I roll out of bed and head to the bathroom (I am on my 38th week of pregnancy). Everything goes as normal, so I head back to bed.
Check the time… it’s 3:30 am. I’m lying there WIDE awake at this point, just trying to flop around and get comfortable when I feel a small warm surge flow out of my “va-jay-jay”. Whoa... Felt like I went an extra tinkle, it happened before. No biggie. Then, this warm surge happens again and once more but on the latter, it was a wee bit more or a LOT more! I whack my partner on the bum and say, “I think my water broke!” Of course, I have no clue and I was freaking out. Normal, right?! I roll out of bed and the moment I stand up completely, a much larger surge flows out! Yet, I am still clueless and asking out loud if my water broke because, again, I am freaking out."
I do my part to prevent mamas in my practice from freaking out about a normal sign of labor, as I make sure they are well prepared about what to expect, and to embrace it with calm. I want mamas to be empowered with the brilliant wisdom they possess within, so they are not clueless, so they do not become scared - but rather are excited about the adventure ahead. Also, at 3:30 am in the middle of the night, if the fluid is clear and all is well, mamas need to feel relaxed to go back to bed so they are well rested for the challenging work of labor.
"Could it be true? Is this really happening? I don’t know what to do, what to think and want dearly for this not to be happening. Back to the story, I went into the bathroom to see what this was and my bottoms were fairly soaked with a slimy type substance. And as I am standing there, more is coming out. By this time, my partner is up and waking my mom up because it’s time! I make the call to my OB office and they said for me to come in immediately."
To go the hospital immediately after suspected water breaking, without other signs of labor, is a set up for induction that often fails, resulting in a cesarean birth - which can usually be avoided if managed differently. That is what this mama was told by her obstetrician. Maybe the hospital or malpractice insurance has these policies. But this is not evidence based care. This is not in the best interest of mother or baby. Unless there is an emergency, something wrong or cause for concern, a reassuring phone call which includes basic assessment and guidance, would be all that is needed, with follow up in the morning after a night's sleep. I also like to make sure it was not simply the outer bag of fore waters that commonly breaks prelabor - which is often mistaken for the main sac of amniotic fluid. Babies are double wrapped in the chorion and amniotic membranes. There can be up to 2 tablespoons of fluid between them, which can make a pancake size stain on mama's clothing, if the first outer sac breaks. If indeed it was the main inner bag of amniotic fluid that broke, there is usually a puddle, or as if you poured a few cups of water on your pad, panties, or surface beneath you; and that puts mama on the clock to birth before a certain time in which the risk of infection increases. But there is time to wait for mama to go into labor as most do, and natural remedies to try before rushing to medical treatment. There is time in the morning to discuss the pros and cons of watchful waiting versus induction in the hospital, for informed decision making.
"I change while my mom is getting ready and I am standing there chanting, “I can’t do this, please, why did I do this to myself, I don’t think I can do this!” Over and over… Side note: I was saying why did I do this to myself because I went through a IUI process to become pregnant. If you are interested, you can read my pre-pregnancy story here - https://www.rockthebabybump.com/intrauterine-insemination/ "
I do wish I was in mama's range here, to whisper repeatedly "Yes you absolutely CAN do this, like the billions of women who birthed before you. since the beginning of time," and remind her of her capacities when she doubted it.
"My mom, just listening to me, says, “Get in the car because I am not calling the wammbulance to come get you.” Yes, mom, real funny. Oddly enough, amongst all my chanting and on the drive, I was feeling NO pain. When I calmed down, I was still feeling nothing. The car ride was filled with even more chanting and just talking to myself about how I can’t believe this is happening. My mom, just smiling.
At The Hospital!
We get to the hospital and check in. At the hospital, everyone is being so nice. Too nice. I wasn’t expecting this kind of treatment. I actually didn’t know what to expect. All the nurses were just making sure I was as comfortable as possible. (Emerson Hospital in Concord, Ma. was where I had my baby girl.) My OB came in, did the ultrasound and tested my amniotic fluid. It’s a GO! Next I am being hooked up to all the many monitors to make sure the baby has a heart beat and mine hasn’t exploded! Next, they need to know how far along am I. Pelvic exam. Let me preface this by saying I am NOT a fan of pelvic exams. Who is? But for me, it’s just not a happy time for me. Painful."
The evidence does not support internal exams prior to labor, in a healthy women whose main bag of amniotic fluid has broken and the amniotic fluid has released. The word broken implies something is wrong that needs to be fixed, when it is all as right as can be. Internal exams increase the risk of infection, which is what we want to avoid or at least minimize. Especially when such a woman who is not having surges or waves of contractions looks this happy, I do not need to do a pelvic exam to determine what is going on. She is not in labor. Period. I do like to confirm that the main bag is intact or not and releasing clear amniotic fluid (this can often be done by history and assessing fluid on the pad), there is no sign of infection and check baby's heartbeat, but there is no need for ultrasound. Basic hand skills to assess the uterus and baby via mama's belly are sufficient...unless there is a concern.
"So when it came time to see where I was at in dilation, well it wasn’t pleasant. My OB attempted the exam and an epic deathly scream filled the air. Failure. My OB walked right out of the room saying only, “get the epidural!”. She stated I was NOT dilated past 1 cm. As a result, the nurses had me going through a 10 hour regime of walking, squatting, bouncing on a medicine ball, hugging that medicine ball and just trying everything under the sun to get my body to dilate. Not happening. After all was said and done, I never dilated."
I value talking to the moms in my care as human beings, and discussing my findings and possible options with them. And there is no failure in labor. Zero. I cringe at the word. I would not expect you to dilate when you are not having waves of contractions/expansions, and I would not expect you to go into labor under this stressful pressure. Animals in the wild do not labor well when afraid or stressed, nor do humans. The mind and body are intricately connected. And the facts speak for themselves. Here is an anxious first time mom whose main bag of amniotic fluid has released presumptively, and is not yet having other signs of labor. Normal findings. Go home (even if you are planning a hospital birth) and do what you can to relax, cuddle, have fun, eat, drink, stay active but make sure to rest, prevent and monitor for infection. Most mamas go into labor naturally within 24 hours, a small percent by 48 hours, rarely longer. This is what you can do to help bring it on. These are the risks and benefits of watchful waiting versus medical induction. And we stay in touch.
"Leading up to getting myself and the epidural ready, I was being induced with Pitocin. (My water broke only but I was not in labor. If that is even possible?!). With being induced, I started to feel the twisting and straining of labor. Not bad until the dosage was being raised higher and higher and then the pain. I was then offered, laughing gas. Never heard of this and surely didn’t think this would ever work for the pain of labor. I had a myriad of questions about this but the main one, will this hurt my baby? They assured me that inhaling this does not hurt the baby but helps with the pain. I was given the mask and told to breathe it in very deeply. I remember taking 3 deep breaths in and on the third I felt my entire body just instantly relax."
Yes, mama, it is normal - sometimes your water breaks before labor. And now there is the medication Pitocin creating contractions that are more painful than natural ones. Natural oxytocin secreted in labor stimulates the top of the uterus to contract so the bottom part, known as the cervix, thins and opens for baby to be born; this also leads to the production of opiate like hormones, beta-endorphins, that naturally lessen pain and produce a high that is reported after natural childbirth. The natural hormonal balance within the bodies of mama and baby has been disrupted here. There are serious short and long term consequences to this disruption that are downplayed and even disregarded by many in the medical world. For a wonderful discussion about the hormones of labor and the importance of not disturbing them, check out this amazing book by physician Dr. Sarah Buckley. ->
"My hand holding the mask dropped and I began to literally laugh. Laugh in a tone I have never heard before. So loud that the nurses had to ask my mom if this was normal! It was not normal, I could not control this screeching high pitched laugh at all. I had NO control over my body. It struck me as so funny that I could not control a thing and felt so relaxed... I was just as fine as can be with no pain. All I could feel was extreme pressure.
By then 15 hours passed, exhaustion set in and I was asked that dreaded question (meaning I knew it was going to be a c-section), “Do you want to have this baby?” I replied, “Yes.” I was truly and utterly exhausted, though. So it began, the preparation for getting ready for the c-section. Just breath, the anesthesiologist said right before he slid the needle in my lower back. I didn’t jerk nor did I feel any pain. Just a prick. Felt like a rush of cold water flowing down my back but from the inside. Almost immediately my legs went limp and felt as if they weighed 100 pounds each! It was the oddest feeling to see my legs yet couldn’t move them or have control. While the team was prepping for the procedure, I started to regain feeling in my right leg. Not sure why but the anesthesiologist had said that my spine was twisted slightly in the middle of my back. So right before I was taken into the birthing room, I had ANOTHER epidural done. I was completely numb at this point. My legs felt like lead weights, made me laugh that I could not move them no matter how hard I tried."
The cascade of interventions had already begun when admitted to the hospital. I am not surprised about the cesarean. Mama was not given much of a chance, even to have a vaginal birth. Of course she was exhausted. She had been up since 3:30 am and scared. 15 hours in the hospital under this duress probably seemed like forever. I totally get why mamas in this position just want it over with.
"Into the operating room I went with only my partner. Upsettingly, my mom was not allowed in the room. It was a small room with white walls and 1 door in and out. I had one hand on my OB, the entire time. I was scared and felt so alone…I was also administered a spinal tap at this point. I was so out of it by now that I didn’t question why I even needed that… as well as why I needed morphine."
I am a huge advocate of what is termed the gentle cesarean, in which humanity is restored to the operating room. More and more providers are doing it. Mama can have her so needed support with her, and in this case, would include her mom as well as her partner. No mama should feel scared and alone, especially during a surgical birth. The drapes are lowered so mama is involved and can see her birth, baby is supported in gently emerging on its own from the incision (to simulate passage through the birth canal), into mama's hands and skin to skin bonding. Baby is allowed to receive the cord blood via delayed optimal clamping, and early breastfeeding is encouraged.
"What I Was Feeling?
I felt so drugged up and my mind was just so distant. I felt alone and so very nauseated. I was throwing up the entire time. Especially during the c-section. The only things I was feeling physically were the shaving, the harsh pushing (she was pushing hard on my chest for a while, knocking the air our me moments at a time) and a vacuum of sorts (for the blood I am guessing).
What Was I Hearing?
The first words I heard from my OB was, “Look at all that hair!”. Yes, she had a full head of hair. Then moments later, I hear my daughter's first sounds… her cry. The most beautiful sound I heard and I just lost it. I started asking for her and crying uncontrollably. I couldn’t see anything but my blue tarp! Then she came around the side and was brought right to my face to kiss, feel and just love. I almost don’t remember after this. I also never got skin to skin right away either. I felt so sad because they took her away and I didn’t see her for almost 45 minutes later. I was also so exhausted that I think I was sleeping most of that time, I was in and out. Granted, post birth, the doctors had to stitch me back up, make sure I was ok and clean up but I figured I would get some time with her right away. I felt a bit of a disconnect. Is that normal?"
Yes, sweet mama. It is totally normal and expected to feel this way, given what you went through. Aside from the powerful obvious effects of the medications, the delicate natural hormonal balance within your body, responsible for bonding and attachment has been disturbed. When you are given the medication Pitocin, it suppresses your own production of oxytocin, the love, bonding and attachment hormone. You can certainly compensate with breastfeeding and skin to skin bonding time as much as possible postpartum. But this explains why you felt disconnected at the time. Pediatrician Dr Sears gives some helpful suggestions here. You CAN heal... which may take some time and lots of support. But there is no place for shame and negative self judgement. You ROCKED your birth like a rockstar, despite being challenged to the max, and this is something to be immensely proud of. You have the strength of a warrior, strength YOU possess and can draw on forever.
"Overall, after all was said and done my little girl was healthy and well, just wanted to sleep. The next 5 days were of recovery and just learning the ropes of motherhood. I am sure that the mommy reading this knows all the highs as well as the lows. For having a c-section, I couldn’t get out of bed for the first couple days, so thankfully my mom was a huge help with feeding, changing and caring for my baby…I also got extremely nauseated and had vomiting for the first day post birth as well.. I couldn’t eat anything. Just drink water. BUT loved all those nurses, all hours of the night, who brought my pain meds every 4 hours because healing from this was extremely painful. But amongst all that pain, I had no feeling in my legs for a long while but I noticed they were put into a compression device, constantly being massaged to keep blood flowing for a good 24 hours post birth. It did feel good and after the feeling came back into my legs I was instructed to begin walking around… noting that my feet would most likely begin to swell. It was a double edge sword here because when I would walk, my feet became so swollen that it merged with the width of my calf! Then they told me to put my feet up but yet I was supposed to be walking as much as possible. That double edge sword.
After this week at the hospital was over, I headed home with my new baby girl and began a life changing feat that I just absolutely love. Well, sometimes.
Anani Pearl 7 lbs. 9 oz. 20 inches long
My name is Toki, mommy of Anani. Thank you for being a part of my little story… for me mothering will always involve long hours, heavy physical work and the type of worry that could bring down an elephant if put into a dart gun. I'm here to cultivate a sense of inner support to calm our mini little storms. You can read more about me and my family here: www.rockthebabybump.com ."
Toki, you are one amazing woman! Thank you for sharing your story and for allowing me to use it to raise awareness, empower and support other mamas, and do my part in helping to lower our country's soaring rates of cesarean births, especially those that could be prevented. Rather than creating more fear, I want to create more voices, who speak up respectfully in knowledgebale support of themselves, their babies and their families. Thank you for creating a blog to support other mamas.
Image by Megan Hancock Photography
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