Stephanie's Story

Stephanie's water broke at 12 a.m. on Wednesday, October 24, two days after Soren's due date. She hastily roamed into my room (we're such fussy sleepers, we use two different queen beds!) and excitedly told me that her water had broken. She was elated and excited and certain that her two-days overdue pregnancy was about to end. She began to have spotty prodromal  labor, which became increasingly painful. We timed the contractions and I was certain that although they were increasing in intensity and frequency, their regularity was still lacking. Nonetheless, Stephanie called the birth center shortly after the breaking of the waters and spoke with a midwife, who told her to continue to monitor the contractions, not to be alarmed, and to call if their regularity and frequency became more pronounced. Stephanie and I didn't sleep Tuesday night; I knew that if the labor were as sporadic as it had been, I would probably wind up at work the next day and that Stephanie's body required sleep for the extensive journey ahead, but we were too excited and Stephanie's contraction pains too pointed to allow us to sleep. 

That morning, I was already feeling weary and sluggish, which was really unfortunate considering how much longer we had to go to reach the end of this race. Stephanie called several times. The birth center staff assured her that her labor had begun and urged her to be patient and wait for more contractions. Her prenatal exam had been scheduled at 11 a.m. this day, but was canceled, since her really active labor seemed due to commence any time now. I decided to go to work, since my vacation time is sparse and I wanted to be with her at the most critical moments of her labor, pregnancy, and postpartum experience. If the intensity or regularity of the contractions was just too much, I told her to call me, so I could take over the good stewardship our two dogs were providing. 

Steph called me at work at 3:30 p.m. and insisted that she really wanted me to come home and take her to visit the midwife. Another midwife, the second we would work with, urged her to come in, so that she could ascertain how the labor was progressing. I promptly left and began to steel myself. I felt that active labor was imminent. I drove her down the bland stretch of interstate highway to the birth center. She moaned and groaned a little on the way to the birth center, but the sulfur and the wailing and gnashing of teeth had not yet arrived. 

As soon as she arrived at the birth center, she was prompted to urinate, which she did. She then mounted the vinyl-sheathed examination table for a vaginal examination, which I had never previously witnessed. She was only 3 centimeters dilated. She had been 1 centimeter a week ago. We were encouraged that she had made some progress, but were discouraged that it had been so little. Why weren't these contractions accomplishing more significant work, we wondered. We thought that the baby might be occiput posterior. We weren't sure what was going on, but we were still patient at this juncture. We had faith that her uterus knew what it was doing, even if it was stubborn in doing it. The midwife suggested that we take a stroll and return later. She suggested we visit the mall, take a tour, and eat some dinner, or return home and try to sleep. We opted to return home, let the dogs out, and try to sleep. We are both fairly private people and tend to relax better at home with our dogs, who needed care anyway. 

I knew that Stephanie was keenly reacting to and monitoring every contraction. Combined with her heightened focus, I knew that she would want to return to the birth center sooner rather than later. I resolved to dissuade her from calling the midwife again too soon, since I was now beginning to comprehend that our ordeal would not pass lightly or quickly. Around 8:45 p.m. though, Stephanie started feeling intense pain from her contractions and told me she wanted to go to the birth center. The pain was giving way to fear and she felt that the fear would be eased by the professionals there. 

We called and met the midwife at the birth center at 9:45 p.m. on Wednesday. Unfortunately, Stephanie had not dilated beyond 3 centimeters yet (she may have been a "loose 3" said the midwife), so we were concerned. All that fretting, anxiety, and discomfort had not even bought us a centimeter. We felt a little silly for having come in so early and Stephanie was troubled because her contractions were incredibly painful but were doing no work to expand her uterus. A student nurse was there, as well as a CNM-in-training, which Steph had agreed to. The two helpers soothed Stephanie and talked to her about her contractions, the baby, how other women had felt in similar situations and other soothing conversation to placate her. The CNM-in-training was quiet, calm, and steadfast, and her deep-set eyes rarely wavered from Stephanie. I believe that this was one of her first birth experiences and she attended to it with all of the diligence, eagerness, and patience of someone with a passion that has not been diluted by years of repetition and struggle. 

She took Steph's vital signs, which were positive. Steph's temperature was only about ¾ of a degree above normal and the baby's heart rate was methodically thumping away at 140 beats per minute. Concerned that her temperature might ascend to more dangerous levels, they waited 20 minutes after Steph's shower to check her temperature again. The shower really toasted her, so they ignored her high temperature afterward. Nonetheless, the midwife approached us about taking a Morphine-Phenergan shot to allow Steph to sleep. All of Steph's vitals indicated that she was in perfect condition and as an unmedicated birth was incredibly important, we declined and tried to sleep, which didn't happen. We felt that the midwife was a little forceful in her suggestion although we had not been at the birth center for long at all, which troubled us. She asked that we reconsider in several hours and we accepted this admonition. We worried though that if she heard she wasn't sleeping, she would pressure us even more to take the shot. We resolved to bear it as best we could and as silently as we could. Steph's contractions became more and more painful. I witnessed the tacit longing and suffering her in her eyes, felt the anguished squeeze of her hands along her arm, and whispered into her ear as she writhed on the bed. She was not happy. 

At about 3 a.m., the midwife returned and we informed her that Steph's labor seemed stronger and more regular. They returned to time the contractions and they were arriving every three minutes with a remarkable intensity. We were certain that active labor had arrived. Stephanie was using the birth ball as a prop on all fours and walking at this time. We walked around the deserted parking lot, Stephanie propped against my arm to ward off the pain and prevent her from stumbling. A full moon shone ominously and portended more suffering to come. I wished that the gravity of that full moon would exert extra pressure and bring the baby down, down, down. 

We returned inside and played musical positions with some seriously cheesy New Age tunes owned by the birth center. Steph started crying and protested that she couldn't do it. The trepidation, fatigue, and hollowness in Steph's voice and mine alarmed me. Obstinate though we are, I knew that Stephanie would never be able to muster the energy to birth this baby in her current condition. I knew that we would not be failing the human spirit nor Soren's future if we were to succumb to demands to take the shot. Indeed, I was convinced that the shot was the only way she would recover enough to cope with active labor when the time came. 

At 6:30 a.m. and only 4 centimeters dilated, we were reminded once again that her uterus would operate at its own pace and exact a vengeance upon Stephanie for what I had done to her. I wondered just what I had done and felt like I could do little to help. She rejected most of my pleas with her to breathe. I even breathed with her, but the pain was too great for her to concentrate. After 36 hours of pain and no sleep, she couldn't go on any longer. I told her to take the shot even though it deviated from our birth plan. Disappointed and wearied, we lay down to sleep. I wish they could have given me a potent morphine injection also, but after so many hours without sleep and the dissipation of my adrenaline, my body was ready to sleep. 

I awoke around 9:30 a.m. and conferred with the next midwife on duty, and our last, about letting the dogs out. We measured Steph's dilation at 5 centimeters and she returned to sleep. I drove frenetically home to let the dogs out, not wanting to be away after Steph had awoken again and entered transition. By the time I arrived, she was up and had started having contractions again. These were patently doing real work. They were so powerful she could not speak or move through them and they were unerringly regular. They were for real this time and she was at a loose 6 centimeters dilation. Recuperated and rejuvenated, Steph seemed psychologically and physically prepared for the extensive chore at hand. She had contractions in a myriad of positions for many hours. She would tell me she was thirsty and then that she wasn't thirsty, ask for her chicken sandwich, then repulse me as I tried to give it to her. Her favorite position seemed to be on all fours up against the birthing ball. Lying down, her contractions were too intense, but sitting on the ball, they were absent altogether. 

She asked me several times what I had done to her and told Soren to stop being stubborn and come out. She was beginning to have excruciating pain. The agony seemed to plateau in terms of intensity, but the frequency increasing. Steph complained that she was getting no break and the contractions didn't seem to ever stop. Our midwife insisted that we walk around some and frequently change positions. Even though it was painful, we tried to make sure Steph frequently peed, which she did rather reluctantly. It ailed her to do so and she found that she could not always excrete any urine despite the fact that her bladder was full. 

She labored mostly on all fours against the birth ball or on her side. She hated being on her side, but that seemed to increase the intensity of the contractions, which the midwife liked. What she disliked the most fervently always seemed to be the perfect condition for her. At some point, the midwife asked her to walk with me around the birth center, but she was in so much pain that she felt like she couldn't walk. She took miniature steps with her eyes unfocused and her dirty blond hair disheveled; her steps were unsure and she clutched me and almost fell to her knees when the contractions came upon her. She kept asking for drugs, which led the midwife to believe that she was coming along. The greatest misery was producing the greatest result. 

We checked her, 8 centimeters; we comforted her by telling her she was in transition. This news heartened her; the pain was with a purpose. At this time, she was allowed to go into the shower, where she squatted, then thrust her pelvis out as she stood again. We had an occiput transverse baby and were trying to get his head into a better position. The midwife had ordered her to perform this exercise to move the baby into position. She bemoaned these instructions, but still attempted to grasp the steel rails in the shower and undulate through the motions. She was as fickle as with the food and her senses and speech were bewildered. 

The shower was always too hot or too cold for Steph. Sometimes she begged for the water stream. Other times she had me remove it. After a while in the shower, we returned to the room where we walked and did the hanging standing position. She also labored on her side a while, which she detested. 

The contraction interval was still only at about three minutes, but their length was expanding, so much so that Steph kept saying she wouldn't be able to do it and needed drugs. The midwife told her "no," that drugs would just slow a labor that had already been too long and checked her again -- 9.5 centimeters, just the anterior lip of the cervix was present. She told Steph she would shortly feel the urge to push, which was a great comfort to Steph. The marathon was nearing a close; her intractable uterus had decided to cooperate. 

She then permitted Steph to do what she dreamed of all along, which was enter the bathtub. All those birth stories she had read and the childbirth classes had convinced her that the universal panacea for her ills was to be found in the tub and she was not mistaken. The jets and the water seemed to soothe her considerably, unless she was having contractions, during which time the water was incredibly aggravating. Her contractions even began to slow down, which worried me, but made her elated because she wanted the breaks. I knew that we had to get on with it. Our midwife even asked her to push a few times until she realized Steph had no urge to push. Steph said that the contractions were too painful to push and overwhelmed the desire to push! So Steph just breathed through the contractions and continued to wait. 

When the enchantment of the tub began to fade, Steph left the tub and was shivering. We dried her off and took her to the bed where she attached to the birth ball on all fours. She finally felt an urge to push (speaking to her later, she said that she "made" herself start pushing, knowing her body would follow suit). Her labor was so long and had been so painful that she pushed heroically. She had told us in her early prodromal labor from the day before that she would push like no woman had pushed before. So we joked with her now when she said she didn't want to push through the contraction, because the contractions hurt too much. 

Steph did not have the fortune to be one of those souls who pushes an hour to convince her treasured newborn to come into the world. Soren was more unyielding and ready to put a more protracted fight than that. He would not leave the comforts of the womb. Her pushing became more intense, although Steph was decidedly exhausted and could barely open her eyes. Her face was redder, her grunts deeper, her stomach more taught, and her brow more sweaty. During the entire pushing stage, we encouraged her to drink Coke and Mello Yello for the caffeine intake and placed some homeopathic drops for endurance, Carbo-veg, underneath her tongue. Mental fortitude was not enough to open her eyes wide enough; indeed, her mind was barely with us any longer. The midwife commanded her to be in the room, to look at us, which Stephanie mustered up her energy to do. We pushed with her in the birthing chair, a wooden contraption handcrafted for the center, with a hollowed-out seat and wide arm span. We pushed with her squatting and supported by holding onto my arm on side and to the nurse's arm on the other. We pushed with her in the left lateral position quite a bit, with her right leg pulled back. This seemed to be the most effective pushing position despite the fact that she bitterly complained about her legs being arched backward. 

We alternated back and forth between the chair and the left lateral position. Then, the midwife asked Steph to sit on her lap. I held one leg back and Dow held the other one back during contractions. Steph continued to push and I was disheartened, because she seemed to be accomplishing nothing through her pushing. The midwife told her she loved her and kissed her, stroked her hand, and massaged her thighs and buttocks. She was so kind and non-clinical, alternating between the role of a stern and uncompromising mother and soothing caretaker. Without her, we feel that the birth would not have been possible. Her stamina, fortitude, wisdom, experience, and genuine concern were irreplaceable. The lap position seemed to work well, but wasn't pushing that baby out. So we tried pushing with Steph on the birth stool while I sat behind her. I held her belly up as she pushed down, which made me feel as if I were holding the baby up when I thought that he ought to be going down. I am not ! exactly sure how this position worked with her anatomy to improve the baby's position, but I had faith that the midwife knew the position would work. 

Steph had been pushing for over three hours now and a large portion of that had been directed pushing. Soren's head would move forward, then slide backward to its previous position. His hair was visible for an extensive length of time, which was a beacon of hope. We kept remarking how long and dark it was (Steph and I both have light hair) and marveled that his head kept slipping backward. Our midwife was visibly troubled; Stephanie could not continue to push so vigorously much longer. Soren's head was so large that it could not mold around the curve in Stephanie's birth canal. She called the backup physicians to plan for a hospital transfer if Steph couldn't get the baby out soon (15-20 minutes) and told us Stephanie required an IV. 

Now I was alarmed. Our hopes, our note cards from birth class, our birth plan were crashing to the ground, demolished by circumstances beyond our control. I protested that Stephanie had a pathologic fear of needles. I told the midwife that all of our hopes, our desire for nonintervention were fading and she responded that the health of Stephanie and the baby were more important than anything else, an observation to which I readily assented. If she were to receive an IV, I feared that her resolve would be sapped and she would not psychologically recover to perform the work of pushing. 

The midwife told us that Steph was not in a good condition and that an IV would either be used at the birth center or at the hospital. The threat of a hospital visit convinced us and we put Steph on an IV, which she wept about profusely as she detests needles. The midwife told us that she needed the IV for fluids and Pitocin after the delivery of the placenta to prevent hemorrhaging because of the horrible, extended labor Steph had had and to rehydrate her. The volumes of Coke, Mello Yello, Sprite, and water she had downed were not sufficient to stop the ascent of her temperature. She was just working too hard to replace the fluids. We agreed, and with all the pain and pushing, Steph didn't even notice the IV going in, notwithstanding that the nurse couldn't get the vein on the first try due to dehydration. 

I wept for Stephanie, because I knew how important to her avoiding an IV had been, but I think that she was too embattled for sentiment. She pushed unabated by the setback. The head had been beginning to show for a long time, but just wouldn't come. Steph had tried to pee, but just couldn't do it, so they introduced a catheter, which made a surprising amount of room, about 400-500 milliliters of room to be precise. The midwife told Steph to visualize the baby's head going down, around, up and out. Steph was pushing as hard as she possibly could and we were doing directed pushing, holding the breath 10-15 seconds. I was lachrymose and despondent while I stroked Steph's hand and told her that she could do this, because I saw a hospital birth imminent with complications compounding. 

At this time, I withdrew from the room and told the midwife we really didn't want forceps and she said they would try a vacuum first after the transfer. My head was replete with images of brain damage and dyslexia, skull fractures and retardation. I could not believe that our prenatal obsessions and loving care had come to this. 

She and I returned to Stephanie. She exhorted her to get pissed, really pissed, and eventually asked if Steph cursed. We said "Yes." She told Steph to say, "I don't want to go to the hospital. **** you. I don't want to go." Steph started pushing and said, "Come on baby. **** you, Soren. **** you, Soren. Come on baby. **** you, Soren ..." The midwife laughed and told Steph to tell her to "**** off," not Soren. Although the cursing did seem to exercise a mysteriously beneficial effect, Steph's mouth alone was not going to bring this baby into the world. The staff gathered up an array of formidable steel implements, which rested on blue cloth draped inside a platter, and I knew and Steph knew they wanted to do an episiotomy. We also both knew she would end up in the hospital if they didn't. We readily acceded; Steph shouted, "Do it," before they asked. With all of the pain of the contractions, she bore the episiotomy quite well. In fact, she didn't feel it. 

Steph continued to push. We could see the head, which had now parted the inner and outer labia without the midwife holding them back with her fingers. Steph didn't want to see the head as it became prominent on its own, but we showed it anyway. We told her to keep pushing and that eventually the head would stick. The midwife put several fingers into Steph's rectum to hold the baby's head in place, and Steph remarked that her ass did not feel as it should when the midwife told her that she was holding Soren's head, because his head had slipped backward repeatedly. Steph finally agreed to look at the mirror and saw that the baby was almost out, if she could just push one more time. "**** you. Ahhh," she screamed and Soren's head rushed out along with his shoulders. 

Soren came so fast after such a long ordeal that it seemed like he was going to shoot across the room. The CNM-in-training adroitly caught him and brought him to Steph's arms. She was relieved, but the labor wasn't over yet. I waited for her to push out the placenta, a red and gray, meaty sac, with the ruptured membranes that had been ruptured so long. I held Soren as they administered a local anesthetic and stitched up the episiotomy. Soren cried and enjoyed me rocking him in the chair. Steph really disliked the reception of the local anesthetic for the episiotomy and was a little uncomfortable as the CNM-in-training stitched her up while the midwife helped. He was so pink and yelled so much, she said his Apgar was off the charts, which comforted me. I thought he was dead at first when he came out gray and made no noise, but then the lusty cries burst forth. The midwife said he was a big, big guy. 

Eventually, we weighed him in at 9 pounds, 10 ounces and 21 inches long with a 15-inch head. The worst was over and Steph could try to feed. Soren wasn't too avid about latching on to Steph's rather flat nipples, but that would come with time. 

We had not anticipated such a brutal or lengthy labor or the interventions, and we didn't get many of the items we had so readily scribbled in birth class when asking for our ideal birth. We had wanted no drugs, no episiotomy, no IV, and the eventualities of our birth had forced these upon us. I also remember that Steph had almost no respect for my direction, that is to say when I told her to breathe, she didn't care. Without bringing to bear the weight of medical training, she saw my opinions as irrelevant. When a nurse or midwife told her to breathe, she breathed. I had not anticipated this, so I was relegated to just rubbing her back and suggesting different positions. She tells me that I was indispensable to her labor, so this must have been what she wanted, but I wish that I could have been more active in her coaching. 

Despite what went wrong, lots went right. We are convinced we would have had a Cesarean Section had we delivered the baby at a hospital. We know that we would not have received the same degree of human compassion and involvement. And I don't think that our midwife could be replicated, even among midwives. Her compassion, wisdom, vivaciousness, and professional acumen were all astounding. We had the CNM-in-training, who, sleep-deprived, endured the entire labor with us, indefatigable and never losing patience. We're glad she decided to quit her job as a computer programmer at IBM. The student nurse who we had expected to merely watch, ended up being an active and integral contributor, rubbing Steph's back and telling her it would be okay, constantly fetching her drinks and other items to help with the labor. 

Medicine as a whole may have declined into a profession in which spirit and genuine concern have been entirely evaporated into a vacant mist, but the practice at this North Carolina birth center is a decided hindrance to this decline. I am so thankful for the support they gave us and the patience and devotion they exercised in Soren's delivery. Peace be with them. May our midwife be sainted when she dies.

Please send your birth story to Lara@ABetterChildbirth.com.  I look forward to hearing from you!

Copyright 2002 A Better Childbirth, Inc.