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A Husband's Tale of a Homebirth After Two Cesareans

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[This was our first natural birth experience, since the first two kids (both boys, ages 2 and 3) were Cesareans. This story is kind of long. I tried not to editorialize (that will come later, if anyone wants my two cents), but I have included some comments in square brackets.]

Laura started having "real" contractions on Saturday night around 10:30 PM. They lasted between 20 and 30 minutes, and she didn't seem to think they were very strong, so I went to bed.

Sunday morning around 5:30 AM I awoke to find Laura having contractions every three to four minutes and they were 20 seconds from start to peak. About 6:30 AM we started to try to get the midwife on the phone. This began about an hour of progressively more frantic calling to various numbers she had given us. About 7:30 AM, we got the midwife on the phone and told her Laura was in early labor. She said to call back in an hour and/or when the contractions were coming every two minutes and lasting a minute. Meanwhile, the kids were up and I was running after them, so I lost track of time until around 9:30 AM. I think Laura spent most of the time in the bathroom, since she was drinking liquids and peeing almost constantly.

[The midwife's idea of contraction duration was from start to finish of a given contraction, so we probably gave her bad information about the duration. For some reason Laura and I thought that we needed to measure from start to peak. Each of Laura's contractions built slowly and subsided rapidly, so we had a hard time figuring out when a contraction had ended.]

Around 9:30 AM, we had about five strong contractions that were 40 seconds from start to peak, two minutes apart. No bloody show yet, but some yellowish stuff on the tissue when Laura wiped.

We called the midwife right away. Got a hold of her by 10 AM. She would come over at noon. Called the doula's husband, who said she would come over as soon as she got back to the house, around noon.

As soon as we hung up the phone, the contractions started coming in pairs, one 20 seconds from start to peak, then three minutes after that one started, another one that lasted 40 seconds from start to peak and was a lot stronger. Then two minutes after that one started, another "weak" one, three minutes later a strong one, and so on. This pattern of contractions (2-3-2-3) would prevail for the most part until transition.

We went outside to our back yard and talked to some of our neighbors. Laura was doing so well, some of them were surprised when we told them Laura was in labor.

When the midwife arrived, things had slowed down. Sometimes the "weak" contraction was not coming at all. Now we felt silly for getting frantic when we could not get a hold of her earlier. A walk seemed like a good idea, so Laura and I went for a one mile walk and the midwife watched the kids. It took about 30 minutes with plenty of stops for contractions and embraces.

We started to get into a rhythm. We would embrace at the start of a contraction. I would start out telling her she was doing great, I know she can do this, this is what she wants, and so on. Before it peaked, I would remind he that each contraction was one step closer to the birth she wanted, and that she needed to breathe. As it peaked, I would breathe with her. When it was over we would kiss and walk on until the next one.

By the time we came back, the 2-3-2-3 pattern was back and the strong contraction was pretty strong. But Laura was feeling pretty good by now, and everything seemed to have reached a steady state.

The doula showed up about 1 PM. While Laura made lunch, the doula hooked up small crock pots with Lavender in them and got the hot compresses going. Laura barely made it through making lunch. I was laying on the couch talking, so I didn't notice. The doula and midwife did notice, and they prodded me into going into to support Laura when she was just finished making the sandwiches.

[I did not feel the need to "be there" for every contraction. I had to watch the kids (our babysitter was not available on Sunday until 7:00 PM.) What ended up happening is that the doula and midwife (mostly the doula) took up the slack. Having other people around made the time go faster, and promoted a kind of light atmosphere that helped our mood. Also, there were plenty of people around to keep the kids busy. Your mileage may vary, but I like a full house for a birth. ]

Early afternoon until late evening, Laura needed almost constant support. She was tired, and I was getting tired. I took a break in mid-afternoon to put the kids down for a nap. After they woke up just before 5PM, Laura took a bath, which spaced out the contractions to five minutes and made them less intense. Getting Laura out of that tub was a major effort, but we talked he into another walk. This one (one the same route as the first one) took over an hour. We were getting our familiar 2-3-2-3 pattern as we limped home just after 7PM. During this walk was when I really had to talk Laura out of going to the hospital and getting a Cesarean. She was beat. Somehow we made it home and she crawled into bed, or so I thought. Actually, she ended up in the bath again by 8PM and slowed down the contractions back to five minutes, not as strong, 20 seconds to peak.

The midwife and the doula all but accused her of stalling, and things were getting heated, when somehow they work it all out. Laura agrees to get out of the tub and they agree to go get something to eat. Meanwhile, the babysitter and her mom had been trying to put the boys to sleep without success, so I took over and put them down. By 10 PM, the midwife and doula were back. Laura was hiding out upstairs. I check on her, find out she is OK but wants to be left alone, and go downstairs. There I learned that one bone of contention was Laura's refusal to allow the midwife to monitor the baby with the fetoscope or do an internal exam to check dilation. What produced the compromise that got Laura out of the bathtub was their backing off of these requests.

[From the beginning, Laura had demanded that no internal exams be done, and that no Ultrasounds/Dopplers be used. So we bought a really nice fetoscope and used that instead.]

At 11 PM, the doula decides to call it a night and gives me a number to call when something changes. I go up and check on Laura, and discover that she is very grouchy, but still in the same pattern of contractions. She tells me to "go away." When I check again at midnight, I see a pair of scissors on the table and ask what they are for. When I get a non-reasonable answer, I look around and notice that one of the throw rugs in the bathroom is soaking wet and is wrapped around a small yellowish mass (with bloody streaks). Hello mucus plug! Now I suspect that Laura is going to deliver any time now, and is prepared to do it unassisted if she has to.

I report this to the midwife, who rushes upstairs and manages to get in a check of the baby with the fetoscope. Everything is OK.

Meanwhile, I call the doula. Laura still won't see me. The midwife is sitting on the floor in the dark. Fine by me, I go back downstairs and wait.

When the doula arrives at 1 AM, we go back up together. Both of us are promptly told to get lost, and when we back off to the main part of the bedroom (Laura having retreated to the master bath), we are cursed for making too much noise (we have creaky floors) and for whispering. After a few minutes of this (and the midwife telling me it is normal, she doesn't really hate you), I decide to go back downstairs.

[I was not upset that Laura was mad at me as much as worried that she would reject all assistance, even assistance that could help make the VBAC successful. In many ways, her rejection of any help during transition echoed her rejection of all things medical during the pregnancy. In both cases, I think she took it too far. But who can argue with success?]

I come back up a half an hour later and Laura is still pissed off. Back downstairs.

At 2:30 AM, Laura actually greets me when I go up to see her. She is sitting on the toilet with her legs braced on the doula and the shower stall. The midwife has been telling her to push for some time now, but no baby. The midwife finally gets Laura to consent to an internal exam to check for effacement and dilation. We move back into the bedroom. The only light is coming from the bathroom, and Laura doesn't want me to turn any on in the bedroom. So we will have to conduct this operation by flashlight.

At first, the midwife can't even tell if the baby is effaced (hope I spelled that right) but then she says it is. Now we get the bad news. There is a small lip and Laura is not fully dilated. She guesses that we will have to wait about an hour. Then she checks the baby and tells us that the baby is doing fine. So we wait.

[That hour was the worst hour of my life so far. It was like working third shift after having been up all day before, while trying to perform some intricate operation that is very important to do right. We breathed our way through it, and I did my best to encourage this very tired, very depressed wife of mine to keep going. Looking back, I think that this is the time where I really contributed to a successful VBAC. I was the only one who stayed awake working with Laura to keep her going. She kept saying that she could not do it and that she wanted a Cesarean. I kept telling her that she could do it and that she was almost there. She believed me, at least until that next contraction came, when I had to convince her all over again. ]

Finally, the midwife checked again and Laura was fully dilated. She began to push in earnest, starting on the toilet and then moving on to Laura's favorite, the supported squat.

[Note to other husbands/attendants: Avoid the one-on-one version of the supported squat. It doesn't sound so bad, but what really happens is that she grabs you around the back of your neck, puts her full weight on her arms, and then squeezes you to death. If you manage to keep your balance, and your neck is not broken off, you get to do it again until the baby gets pushed out. On the other hand... I would have stood on my head to get that baby out by that time.]

Despite the great physical pain (and Laura's comments that "I picked this position because I wanted to give you a taste of what I am going through") we both feel that we are making progress because Laura is passing feces onto the pad on the floor every time she pushes. Wiping her and making sure what lands on the pad is cleaned up keeps me and the doula busy between contractions. The midwife is monitoring the baby.

We are standing in the dark on the floor next to our bed on the far end of the bedroom from the bath. Pads are on the floor, but they keep getting kicked around, so there is blood on the carpet. [I'm thinking "I hope that's blood I just stepped in, otherwise it would be really gross."] Laura is complaining because we are spending time trying to keep the pads in place.

We move back to the bathroom. Laura tries the toilet position again, but the midwife is immediately trying to move her off of it saying that the baby won't fit between her and the front of the toilet seat. We start seeing some head, and the midwife has Laura touch it. Now she is really happy and ready to go. I am wishing I had found the time to really scrub the toilet bowl. The midwife prevails and Laura wants to do some more squats right next to the bathroom door. [Ugh, maybe the toilet wasn't such a bad idea after all.]

After what seems like ten rounds, I finally bail out and ask that the doula and I share the weight by holding on to Laura's arms as she squats and pushes. The feces have stopped coming out, so the doula is free to help.

The head crowns. One of our boys (the three-year-old) comes into the room and looks at the baby's head. Then he goes back to bed.

[Later that day, he tells me that it "looked pretty scary, so I went back to bed." Every time after that, whenever we are talking to someone about the birth, he will say proudly that he "saw the top of the baby's head when it was still coming out." Several people had cautioned me about birth being traumatic for kids, but ours seem to be more proud than anything. They are also bonding very well to the new arrival, and mom seems to have more energy and tolerance than she did after the Cesareans.]

I check the time, and it is slightly after 5 AM on the (lighted) digital clock next to the bed. The midwife is massaging the perineum between contractions, and Laura says it is burning. There is a lot of talk about slowing things down, but all it is is talk. A couple more pushes and the head pops out. It looks awfully pale to me, and there is a loop of cord stuck between the baby's chin and the vagina. The midwife takes one look, orders Laura around onto her hands and knees, and orders her to push hard with the next contraction. Laura starts pushing right away. The midwife has me run for her suction bulb, which I have no hope of finding in the dark. I turn on a light, and search for the bulb. The doula starts looking too, and by the time we find it, the baby is out.

The midwife takes the bulb from me, asks for some kind of oxygen equipment and suctions out the mouth and nose. Before we can find the equipment, I hear the baby cry. I come back without the equipment and the baby is in Laura's lap. There is blood everywhere (soaking into the carpet), but I don't care, the baby is alive. It is wrapped in a towel, and the first thing I notice is that the cord has two knots in it.

In the process of looking for the suction bulb, I had found a camera, so I take a picture. The midwife asks that we put the cord on the towel so that people will believe that the cord has two knots. She also says that this is a very long cord.

Nobody has bothered to sex the child. The midwife asks Laura to lift the towel so that we can see what it is. It is a girl, and Laura and I start crying and gibbering. We had wanted a girl, and a natural birth, and we got both. We are very happy. Our little boys come in to take a look, but then retreat back to our bed.

It takes Laura almost two hours to pass the placenta, mostly because she doesn't try to push it out until we get her into the bathtub. The doula rushes to clean out the bathtub, but it still takes us almost an hour to get Laura in there. Once she is in there, the midwife convinces her to take some extracts to help get the placenta out.

Laura is still holding the baby, and once she is in the bathtub, I cut the cord. The baby starts nursing in the bathtub, and our little boys come in and take a look. Everything is great, but Laura has yet to pass the placenta. Now the midwife starts insisting, and Laura finally lets me hold the baby while she pushes the placenta out.

The midwife examines the placenta, and says that we got it all.

The only problem is that Laura has torn herself pretty badly. The midwife checks out the baby, and then gets on the phone to a doctor who can sew her up. Six hours later, the doctor explains to us that the floor of the vagina, the top of the vagina (just missing the clitoris), the bottom of the vagina near the anus and the side of the vagina all have tears. It takes him about 90 minutes to sew her back up.

Even though Laura required a lot of sewing to put her vagina back together, I have noticed that she has been able to hold this baby more easily, and recover more quickly than from the other births.

Mike Sorsen

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