Thursday, August 27, 2009

Lansinoh Product Review and Giveaway!

I helped write a review of some Lansinoh products at Lansinoh gave us the products to review and is sponsoring a giveaway of diaper rash ointment. Go check it out! Also, Lansinoh run an interesting blog worth having a look at, By Moms, For Moms.

There will be a second review and giveaway coming soon!

Wednesday, August 26, 2009

Our Birth Story

My friend and doula, Jessica Lenz, was by my side throughout my pregnancy, labour and delivery, and she was invaluable as a support person and source of information. She wrote the following and I have added my commentary and thoughts in italics.

I would have loved to have a home birth, and I think the process would have been a lot more mellow. But our apartment is just too small.I don't know what the square footage is, but it's wee and feels cramped when we have two visitors! So the birth center was a good compromise.

Even after CaroLyn’s estimated due date came and went, it wasn’t a huge surprise that little Emily was taking her time considering everyone anticipated her appearance later rather than earlier given that most babies in CaroLyn’s family are overdue by weeks…even CaroLyn herself as a baby was overdue by 4 weeks!

Ready to take a few days off of work to catch up on sleep, prep for baby, and just relax as a couple before two made three, CaroLyn decided Tuesday July 28th would be her last full day at work until the baby arrived. The plan was to return to the office for a half day on Wednesday to wrap up a few things and attend a final change management meeting... Little did she know that Emily had her own ideas about what would start that day rather than the next!

At around 7:40pm on Tuesday night after a single intense contraction that was definitely the first non-Braxton-Hicks contraction, her water broke.

I was standing in the kitchen when the contraction came and it was so intense that I knew something was different. I somehow had the presence of mind to look at the clock to note the time and then noticed water running down my leg!

Being completely prepared, CaroLyn knew that the first stage of labor could take hours and sometimes days, so at this point after making a quick call to Alex, the midwives and her doula, and sending an email to her supervisor and maternity leave replacement, she settled in for the evening with a glass of wine and attempted to sleep. (At this point in your pregnancy, a glass of wine to help you relax and sleep is perfectly fine for both mom and baby.)

Little did I appreciate that this would be the last largely uninterrupted rest I'd get for a long time!

Throughout the evening and into the morning her contractions began to pick up, but were irregular, only coming every 7 to 10 minutes, lasting 15 to 20 seconds. Occasionally there was a 4 minute, 1 minute in length pattern, but it never made it passed 4 or 5 contractions in a row and therefore the common 411 contraction call (4 minutes apart, 1 minute length, going on for 1 hour)—the call you make to the midwives to say, “I am coming in!”—never quite got there.

So, around 1pm the next day, it was time to go to the birthing center regardless because CaroLyn had tested positive for Group B Strep (GBS) and this requires a dosage of antibiotics every 4 to 6 hours after about 18 to 24 hours once your water breaks to prevent infection from spreading to the baby. The infection rate is extremely low, but the antibiotics further reduce the chance of infection. Unfortunately, testing positive for GBS, however, does require regular visits to a healthcare provider until the baby is born and thus throws off your ability to comfortably labor at home without distractions…this would definitely prove to be the most frustrating part about the entire labor process! (Note for future reference: eat tons of garlic and take tons of vitamin C before going in for GBS test for all future babies!)

On entering the birthing center there were quite a few smiles from the midwives and staff eager to see CaroLyn starting labor.

First things first, time to establish whether CaroLyn was actually in labor and whether her water really did break. A simple test with a strip that changes colors can indicate if the fluid really is from the amniotic sac; and sure enough, it was! Therefore, the administration of the antibiotics did need to get started. After carefully checking to see how CaroLyn was progressing, MidwifeC indicated that CaroLyn was 4cm dilated, 50% effaced and at 0 station. Contractions at this point were still between 5 to 7 minutes apart but lasting only about 30 seconds. So, although moving along, CaroLyn was not quite at active stage labor, but still progressing steadily.

After receiving her first dose of antibiotics at 2:10pm, CaroLyn, Alex and her doula decided to try to jump start labor by walking around Eastern Market—no need to sit around and wait at the birthing center when active labor had not kicked in. After a quick stop at Starbucks for a bite to eat, all three hit the streets walking and stopping briefly during contractions.

Starbucks? I know, shocking.

Although the trio looked like a normal group of people walking around, the fact that CaroLyn had a heplock IV on her wrist (for the intravenous antibiotics) that was leaking blood, not to mention the fact that she looked very pregnant, got a few stares from folks on the street. That did not faze the team, though, as they continued to walk around the area with CaroLyn briefly stopping and leaning into Alex during a contraction.

That heplock was a mess! I never should have let MidwifeC put it in my left hand - that's the one I use, um, in the bathroom. It was a constant annoyance. And after I got sent to the post partum recovery room, I was told had to keep it in awhile longer, just in case. Two days later, I asked if they could take it out now, as it was really gross, and the nurse was horrified at how nasty it looked, and took it out right away.

This stage of labor, although long, can sometimes be the most special part of labor for a couple because they begin to bond ever so much closer as they realize their baby is finally coming. CaroLyn and Alex spent a few special moments holding each other while Alex sweetly spoke to both CaroLyn and the baby. At one point during a brief contraction, the team looked up and noticed a pair of pigeons on the roof of one of the local bars…as if mimicking Alex and CaroLyn, the pigeons groomed each other giving the care and love the other needed at that very moment. It was a sweet symbol of the love that was all around.

After a few blocks, CaroLyn’s doula suggested that they climb stairs as a way to increase the contractions and get them a little bit more intense and closer together. Stair climbing is one of the best things for moving labor along. So, where to find stairs….the Capitol of course! As the team headed over to the Capitol (about 6 blocks away), they realized that access to the steps was blocked off, so instead, they headed over to the Library of Congress that also had a good number of stairs.

With a quick trip inside the building for those ever frequent bathroom trips that are needed (especially during labor), scaring the security guard as he thought CaroLyn would have the baby on the steps, and grabbing a bit of cool air conditioning, CaroLyn and her doula proceeded to go up and down the stairs of the Library of Congress. They found a section of the stairs right next to the water fountain in front that was shaded and when the wind blew slightly, a mist of the water sprayed up making the breeze and water a refreshing place to do stair climbing.

While Alex went to park the car and rest a bit, CaroLyn and her doula climbed up and down the steps for an hour and a half from 4:15pm to 5:45pm. Contractions were steadily increasing, becoming a bit more intense and typically peaked at the top and/or bottom of each set of stairs. CaroLyn would lean over the side towards the fountain, feel the breeze and breathe through the contraction while her doula rubbed her back.

The Library of Congress of course is a tourist attraction, and so there were plenty of people taking photos….We are sure a few captured the lovely pregnant woman in labor in their pictures without realizing it! Comically, at one point, CaroLyn leaned over the wall near the fountain during a contraction, and I suppose tourists in the area thought there was something interesting to see, so they proceeded to lean over too, to look down at the view, not realizing at all that CaroLyn was actually having a contraction. Pictures were taken and they were off.

After a good 4 hours out walking around and climbing stairs it was time to head back in for the next dose of antibiotics…so it was back to the birthing center.

Although CaroLyn was definitely progressing and the contractions were getting stronger, she was still able to speak through every contraction and most were still not lasting longer than about 30 seconds. So, the midwives suggested that Alex and CaroLyn have some alone time to try to move things along. (Intimacy can trigger all kinds of things…including labor!) From 6pm to 7:30 CaroLyn and Alex enjoyed the shower, and then settled in to a great pattern of nipple stimulation using a breast pump and rocking on the birthing ball. (Nipple stimulation is often suggested by midwives to induce contractions as it sends a signal to the uterus that it’s time.)

Using the nipple stimulation and birthing ball definitely kicked up the contractions and CaroLyn herself had a wonderful glow around her face as each contraction intensified. At times during a contraction she would cry out, “awesome” or “excellent” as a way to remind herself and encourage her baby that this meant more progress. Through each contraction CaroLyn would lean forward onto the chair in front of her with Alex rubbing her head and her doula behind her stroking her back helping her visualize bringing the baby down.

I don't know where awesome and excellent came from, but I was definitely channeling my inner Ninja Turtle during labor!

As time went by, the team changed positions slightly to allow CaroLyn to stand on one foot with her other leg bent and resting on a chair. She continued to do the same rocking motion as on the birthing ball to help move the baby further down. Alex stood in front of her giving her support and through each contraction CaroLyn would lean forward onto Alex and breathe through the waves going through her.

Unfortunately, around 8:30pm this wonderful progress slowed down dramatically when the midwives indicated they did not feel CaroLyn was in active labor and advised her to go to the hospital for a dose of Pitocin that would speed things up. This was quite surprising to hear from the midwives who tend to be very pro birth center and usually do not push for interventions like Pitocin, but they were concerned that CaroLyn’s GBS status, her bag of waters being broken and her slow progress to get into active labor could jeopardize the baby’s health.

I don't even remember Pitocin being discussed at this point - it must have alarmed me so much that I've blocked it from my memory. Going to hospital and getting Pit was such a deviation from my birth plan that I could hardly bear to hear it.

MidwifeS, did another vaginal exam to see if there was progression and at this point she indicated that CaroLyn was still between 3 and 4cm and was only at -1 station and about 70% effaced. She also indicated that she could push the baby’s head up (meaning the baby was not engaged in the pelvis) and that the baby was still surrounded by water and another membrane. This should have been a clue to all the midwives that CaroLyn had not fully ruptured her bag of water and that she was progressing perfectly given where her body was at this stage in labor. In addition to this, it is also interesting to note that the midwives reading of the baby’s station was also different, indicating that the baby had moved backward in the process, or that one of the midwives had read CaroLyn’s cervix incorrectly.

Wait - membranes are still intact? Huh? Kinda wish I'd questioned that at the time.

Instead of allowing CaroLyn to just stay at the birth center and sleep (as it was now approaching 10pm), the midwives asked that she go into the hospital. This was after repeated discussions with CaroLyn and the midwives, and CaroLyn calling MidwifeL, the medical director of the birth center and questioning the center’s policy. AHHH frustration!

I felt at this point that I was being extremely abrasive with the midwives - I remember saying to MidwifeS and later to MidwifeL "so to be clear, you're kicking us out now?" I wanted to make sure I didn't have any other option. The decision was driven by policy, and I assume - I was not told this, I am assuming - that the policy is driven by lawyers' paranoia or insurance restrictions. Their policy stated that a women who tests GBS positive can only be at the birth center for 18 hours after waters breaking if she's not in active labor - it had already been 24 hours. I still tried to fight them but lost. Thankfully, they're professionals and understood where I was coming from - because I needed them on my side when we got to the hospital!

CaroLyn was definitely strong at this point and knew her body would progress at its own pace and there was no need for any medical intervention to speed things up. Unfortunately, because of all the stress, the pressure from the midwives, and being exhausted, labor was slowing down. This can often happen to women in labor when they feel threatened or stressed—they can literally close up their cervix and progress only when they feel they are in a safe and comfortable environment again. (We see this often with animals giving birth in the wild.)

After speaking with her doula who continued to remind CaroLyn that she was progressing and that at this point there was nothing wrong with either mom or baby and that CaroLyn did not have a temperature (an indication that there could be an infection), CaroLyn, Alex and their doula decided to get the last dosage of antibiotics at the center and instead of going to the hospital, go home and try to sleep for a few hours, regroup and proceed to the hospital by 2am for the next dosage of antibiotics.

As frustrated as they were, the team packed up and went home to sleep.

Alex took this opportunity to really catch up on his sleep…he was out like a light after crawling into bed. For CaroLyn, although she tried resting, the anxiety was still with her and instead of sleeping; these few hours back at home were more about de-stressing and getting her body back to a comfortable place where she could feel at ease to continue with her labor. She also had a few phone calls around midnight from family to see if baby Emily had arrived yet. Being back at home, resting without constant pressure and a brief chat with family helped give CaroLyn a second wind and by 1:15am everyone was back in the car heading this time to hospital for the required dosage of antibiotics at 2am and to “check-in” permanently to the hospital to give birth to Emily.

I also repacked my bags. I had packed for the birth center, lots of snack food and some clothes, but not much toiletries, nor a laptop (no wifi at the birth center but I rightly guessed there would be at the hospital), plus - pessimistically, I guess - a copy of my living will and medical power of attorney. And a nightgown that I don't think I put on once... Or maybe I did and then took it off shortly thereafter?

After arriving at the hospital and checking in (which also included a room change because of an irritating noise coming from the ceiling), CaroLyn continued to speak with the nurse who gave her a lengthy survey questionnaire on her pregnancy and labor. This process took over 30 minutes and included all kinds of questions from “what kind of birth education did you take during your pregnancy,” to “do you have a history of abuse,” to “do you plan to use cloth or disposable diapers”. At 2am in the morning and trying to get back into labor, this was not the kind of survey you wanted to be doing. CaroLyn was a good sport about it, and finally once finished she was able to get her next round of antibiotics and then was left alone until 5am.

The survey was hilarous. I can't believe they do that to women in labor. MidwifeS was there and said, after the nurse left, she'd never seen anything like it.

For the next 2 ½ hours CaroLyn and her doula walked the hospital floors trying to restart the labor that had slowed down because of all the chaos and moving about. What seemed to do the best at bringing on stronger more intense contractions were squats. We couldn’t find stairs, so doing squats holding onto a bed in the hallway by the elevators seemed to be the best alternative, and it definitely helped tighten up those inner thigh muscles!

Because CaroLyn was now in the hospital, we had to sneak food to her instead of openly eating and drinking whenever she wanted. During the squats and walking she snuck in a few granola bars, honey and juice…all great sources of energy.

I don't think anyone told me not to eat but figured Jessica knew of what she spoke (and of course hospitals are famous for not letting women eat or drink in labor) so I accepted her help in concealing my consumption!

By 5:10 in the morning on July 30th (now 34 hours since her water broke) MidwifeS (who followed us to the hospital and who would be in charge of her birth instead of a doctor), offered to check CaroLyn’s cervix again to see if there was progression. At this point, CaroLyn was now 5cm, 90% effaced but still at -1 station. CaroLyn had made tremendous progress considering everything she had just been through. She managed to de-stress, put herself back into a calm state despite the many changes in her environment and get herself ready for a more active labor.

Although the midwife was suggesting the introduction of Pitocin at this point, her doula suggested that perhaps at this point why not try to break the other membrane/bag of water to see if that would encourage her labor. MidwifeS agreed to do this, and sure enough this would definitely do the trick in helping CaroLyn progress more steadily. It turned out that at 7:40pm on Tuesday July 28th CaroLyn had actually only broken the first layer of her bags of water. There are actually two bags of water and the one that CaroLyn had ruptured before was the very thin one that sits between the other bag of water. So, in actuality, she hadn’t fully broken her water!

With a huge gush of water flowing out now, her contractions sped up and became more intense.

Whoops! I thought my water had broken earlier, but I was by myself and figured maybe a cup or two of amniotic fluid was all she wrote. I'd also read about babies' heads blocking the exit of much of the fluid, so I thought maybe that's why there wasn't huge quantities. In all the excitement, I forgot to mention that to anyone... It wasn't just one gush either. There were multiple gushes. Wow, that was a lot of fluid! It was like what you've seen of a huge gush of fluid when women go into labor on TV. Except it went on and on and on!

Over the next several hours CaroLyn and her doula continued to work through each contraction. The room was dark and in the background was the sound of the Hypnobabies CD that played positive affirmations to help CaroLyn get through each contraction and focus. CaroLyn continued to do squats for a little while, but what she found most comfortable was sitting on the birthing ball and then leaning over a chair with each contraction. To get through these more intense contractions, now coming on every 3 to 4 minutes and lasting 50 seconds, CaroLyn had to stand through each one. She would sit on the ball rocking back and forth and then stand, taking deep breaths through each contraction. Her doula was there continuously reminding her how to breath, how to focus, and to encourage her that with the intensity that things were getting closer…and for the first time, CaroLyn had trouble speaking through her contractions. She was definitely in active labor!

By 7:45am MidwifeS came back in to check to see how CaroLyn was progressing. She was now 6cm, 90% effaced but still at -1 station. Contractions were holding steady at 3 minutes apart and lasting 50 seconds. The midwife suggested again that perhaps CaroLyn introduce Pitocin to help move things along. After speaking with her doula, CaroLyn decided that by introducing a small amount of Pitocin (the lowest possible dosage) and then taking her off of it once things really progressed and contractions were only 1 to 2 minutes apart, would be a suitable compromise at this point.

I was incredibly discouraged to hear that I'd only dilated one centimeter in all that time, after rupturing the membranes artificially, which I'd hoped to avoid doing.

By 8:23am 6 units of Pitocin were administered. Unfortunately, this put CaroLyn on a continuous fetal monitor and lessoned her movement a bit. However, she still managed to stay on the birthing ball and stood with each contraction leaning against the chair.

The continuous fetal monitor means I got hooked up to a machine with a fairly long cord. Plus the Pitocin is administered through a constant IV drip. So my belly is hooked to a machine on one side, and my left hand is hooked to the IV pole all the time on the other side. Up til then, I had been getting intermittent monitoring and just hooked up to an IV periodically. This was my first leash that really limited my movements.

Contractions definitely started to pick up and the intensity was very strong. CaroLyn moved to the edge of the front of the bed and we put the birth bar up so she could lean into the bar during contractions. She had a few more rounds of honey, but by this time she was so exhausted and tired that she just wanted to sleep….unfortunately, right when contractions were getting the worst!

CaroLyn was amazing! Somehow she trained her body to sleep between each contraction. She literally would fall asleep, snoring even, and wake for each contraction and then fall right back asleep….she continued this pattern even when her contractions reached 1 minute a part and were lasting over 90 seconds.

I don't know - I think my body did this on its own. I was just trying to chill between contractions. I normally find it hard to fall asleep.

Alex helped to hold her as she slept for one minute and soothed her as she went through a contraction. Her doula was there by her side the entire time reminding her to take deep, slow breaths to help her get through the peak.

At 12:55pm (now 8 hours of active labor, 41 hours of labor total); the midwife and doula were certain that she was entering transition (the hardest part of labor) and it was suggested that CaroLyn get checked one more time to see how far along she was and how close she was to pushing.

Looking back at this, we probably never should have had another vaginal exam and just continued through the contractions using the coping techniques and deep breathing that CaroLyn was doing so well at. Unfortunately, the exam only brought on frustration. CaroLyn had not progressed at all over the last 8 hours. She was still 6 cm and at -1 station. Her cervix was just not opening up yet despite the fact that her contractions were becoming more intense and closer together. This can sometimes happen with women who have a history of cervical damage or who are carrying large babies. The cervix will open up; it just takes time and patience to get through the next phase.

I've had some cervical damage. Emily is a large baby. Nuff said.

Discouraged doesn't quite cover it. At this point, being told I was still 6 cm, I saw myself being wheel off for a c-section right then. I think I would have been too, if not for the care of the midwives rather than an OB.

The news, however, sent discouragement CaroLyn’s way. She was so exhausted that the only thing she had on her mind was sleeping….and she definitely deserved some sleep at this point after being mostly awake for over 41 hours. While MidwifeS tried to tell her some options, CaroLyn fell right asleep in the middle of the conversation. After one minute and another contraction, CaroLyn indicated that she just couldn’t go on with this much pain if she was progressing so slowly. Against her own plan, she asked for the epidural, and by 1:20 in the afternoon she was able to finally sleep without pain…a courageous and wise decision knowing that the hardest part of her labor still lay ahead.

So now I've got the epidural - that's a needle giving me painkilling drugs right into my spine - plus all the above stuff. Because I'm numb from the waist down, I also got a urinary catheter which I had to be careful to not yank out. I'm a fricking pin cushion at this point!

At some point, can't remember when, I got an internal fetal monitor - which means another cord, going off to my right (the catheter tube went to my left) was a cable connected to a machine at one end, and Emily's head, via my vagina, on the other. Fun and games for the whole family!

Getting the epidural in my back was a huge deal. They kicked everyone but MidwifeS out of the room. I had to sit on the edge of the bed and lean over her shoulder with my legs apart to make room for my belly - I needed to curl my spine forward so the doctor could insert the needle. The doctor was really nice about it - I was expecting him to make some kind of remark about me having had enough of the natural labor process - I was feeling guilty about my choice and projecting it on him, I guess. I had a few contractions while he was inserting the needle and that was insane - I was in this weird position, in intense pain and couldn't move or I'd be paralysed (or at least I thought I might be - I don't know how actually risky that was).

Almost a week after Emily was born, my back still ached where the epidural went in. My chiropractor did something to make it better in one wonderful adjustment!

By 1:45pm on July 30th her epidural had kicked in and she was dilated to 7 cm but still remained at -1 station. CaroLyn was completely taken off of the 6 units of Pitocin she was on early as the baby could not handle both the epidural and the Pitocin at the same time. (This is very common when women first get the epidural. A drop in the baby’s heart rate can happen very briefly because of the change in the woman’s body due to the epidural. Giving the woman extra oxygen can help get needed oxygen to the baby and all is fine. This can be a bit scary for the mother because all the nurses will run in and the room is a bit chaotic without really telling the mother what is going on.) Once CaroLyn took a few deep breaths of oxygen, her baby was doing great.

Even though I wasn't on the Pit any longer, they kept my left hand hooked to the IV, giving me fluids and the every four hours antibiotics. So the pin cushion continues. Those fluids were wild - I got so much that my hands and feet swelled up insanely after birth, and when I got home from the hospital, I'd only lost 3 pounds from my maximum pregnancy weight! It took me awhile to figure out the fluids were to blame for both. Four weeks later, I'm in the middle of my normal pre-pregnancy weight range.

I think it was shortly after this excitement that my Dad called and I think I was kind of incoherant and tried to explain I was sucking on oxygen and probably shouldn't be using a mobile phone, due to some risk of fire that I invented on the spot. Something about mobile phones and gas stations, you know.

CaroLyn’s doula took this opportunity to explain various options to her once she got to the pushing stage of labor. Because the scenario was now very different than CaroLyn had imagined it, her ability to push the baby out in the water or on her knees/squatting would be more difficult because of the epidural. Also, due to the fact that they were now in a hospital and not the birthing center, there would usually be a time limit in terms of allowing her to push before they might use other medical interventions as forceps, the vacuum, an episiotomy and/or a cesarean section.

CaroLyn’s doula spoke to her about taking herself off of the epidural once she was 10 cm dilated and ready to push as a way to better feel the baby coming down the birth canal. Most women who have an epidural lose feeling in their legs and pelvic area and therefore have a very difficult time pushing the baby out because they don’t know where to push. Many women end up pushing in their face instead.

After this discussion, at 3:25pm CaroLyn was finally 10cm dilated and was at +2 station! Although she had an epidural without Pitocin, she went from 6cm to 10cm in 2 hours and 25 minutes completely on her own with that extra bit of sleep and comfort that she needed…she was ready to push and she was ready to reduce her epidural strength to allow for the feeling of labor to come back to help her experience the birth she wanted and get her back to her original birth plan.

At 3:30pm, pushing began. It can take a bit of time for the epidural to wear off and so the first hour was slow, but with progress. Given the fact that CaroLyn’s labor was long we were all hoping for a short pushing stage, but Emily just was not ready to come out yet.

Alex stayed up by CaroLyn’s head the entire time, wiping her brow with a cold washcloth and giving her ice chips. One of the nurses (we had now gone through 4 nurses because of shift rotations!), and her doula held up her legs and helped her focus on where to push and for how long. MidwifeL, was now the midwife on call as MidwifeS had been on call for 24 hours with CaroLyn prior. MidwifeL helped CaroLyn focus and continued to give her continuous perinea massage and mineral oil on the perineum to prevent tears or an episiotomy.

Once the epidural wore off enough, CaroLyn was able to change positions and move around to help the baby come out more easily, as anyone can tell you that gravity is far better for pushing a baby out then lying on your back horizontally. CaroLyn was up on her knees and used the birthing bar on the bed to help push the baby out.

Once again, CaroLyn had that glow. Just as she did when she was making her first real progress in labor at the birth center using the birthing ball and nipple stimulation, CaroLyn had an excitement come over her and her face radiated a beautiful shine of empowerment. She was determined to push her baby out the way she imagined her labor and birth to be like. She regained her strength and energy and continued to push in several different positions. CaroLyn used the birth bar while kneeling, she tried kneeling towards the back of the bed on all fours, and she lay sideways to help position the baby in the best position to come out. She also decided to use the mirror to help herself focus and see the baby coming out.

After 3 ½ hours of pushing, although her strength was still there, CaroLyn was starting to feel discouraged. Her doula gave her a few pep talks about visualizing the baby coming out and that all she needed to do was push a bit harder to get the baby to crown. Emily was right there for hours just going back and forth between each contraction and we just needed her to stick.

What we didn’t know at the time, was that while CaroLyn was trying to push with the doula and another new nurse, the nurse who had been with us for 3 ½ hours of pushing was out in the hallway arguing with the midwife that CaroLyn had gone passed the allowed time before a c-section is performed. The hospital protocol does not allow women to push past 3 hours (let alone be in labor for 40+ hours!).

MidwifeL made a comment to CaroLyn about reaching the end of the line and said that she would not use a vacuum or forceps to get the baby out and that the only way would be through a c-section. MidwifeL stepped out of the room for a minute to regroup, and at that moment CaroLyn had another contraction. On her second big breath in, she pushed as hard as she could and finally her baby crowned! Both the doula and the new nurse told CaroLyn to stop and hold the baby in place and to breathe short breaths. MidwifeL came back in quickly, along with MidwifeS who was just coming back on shift, and slowly CaroLyn started to push the baby out further.

Unlike doctors who would have encouraged her to push fast and probably would have given CaroLyn an episiotomy a long time ago, MidwifeL guided CaroLyn in her pushing and helped her stretch so that baby Emily could come out smoothly and safely.

After 47 hours and 52 minutes (with 4 hours and 2 minutes of pushing…defying all hospital rules and protocols) at 7:32pm on July 30th, 2009 Emily Alexandra entered the world without a single medical intervention (only a bit of an epidural to help her mom recoup) by CaroLyn reaching down as Emily’s shoulders appeared and pulling out her own 9lbs and 4oz baby. Alex and CaroLyn enjoyed her first cry as she looked at them both in the eyes and let them know she was finally here.

Welcome little Emily, you made quite an entrance to the world!

Thanks Emily, Alex and CaroLyn for letting me be your doula and also letting me have the wonderful pleasure and privilege to cut the cord once Emily was born.—Jessica A. Lenz

Whew! So that's our birth story. It was rather intense and the outcome rather wonderful!