December 21, 2003
Hospital Birth - First Baby

Part One: You Don't Know What You Don't Know

Read Part 2 Here

by Jennifer Pinch, RN, BScN

I was recently challenged by a friend, to reflect on the many ways in which God has softened my judgemental spirit, by asking myself a simple question. In answering her question I have found it exceedingly logical to extend grace to others and honour the truth in the old adage that it is only when we know better, that we do better. Her question was simple: What have you changed your mind about? What did you “used to believe”? For me, there were many trivial things and a few deeply rooted beliefs and judgements that I held dear. That is... until I knew better.

I used to believe that doctors, nurses, and other health care professionals knew the answers to all of my questions. Then I became a Registered Nurse. I received my Bachelorreate Degree in Science and Nursing (BScN) from the University of Saskatchewan (in 2000) and graduated with distinction. Although I love my job and I care for my patients with knowledge and skill, I have discovered that I do not have all of the answers. I have also discovered that a variety of sincere people, with good intentions, also do not have all of the answers. I used to believe that babies should be delivered by doctor.  Now I believe that they should be birthed by their mothers.

My first child was born at a hospital in Calgary. My thoughts going into her delivery were quite simple. I would try to labour without any pain medication but, if I felt I needed an epidural, I would not feel any regret about my choice. After all, I wouldn't attempt to endure a “natural migraine”; I would take some ibuprofen. You see, I used to believe that women who were passionate about natural childbirth were just trying to show off. I also felt confidence in the medical community to take care of me and my soon to be born babe. My intention was to rely on what I knew about birth from nursing school and the advice from (well meaning) friends and family members. When I look back at my firstborn's arrival into this world, I  see clearly the cascade of events and interventions from the onset of labour. Watching “The Business of Being Born” documentary, hosted in Calgary by Birth Unlimited and Healthy Birth Choices, was such confirmation of what I had already peiced together following my own two birth experiences. The fact that births like my first are so typical in North America makes me ache for women who simply do not know, what they do not know...

My first birth: Hayden Alois (December 21, 2003)

On my due date (December 16th) my sister Kelly and I walked about 5 miles down town Okotoks, to Darren's shop, and back up the steep Fountain Tire hill, to try and get the baby moving down and start labor. It didn't work, but the weather was nice and the walk felt great. It was fun to stop and visit with people who asked “when are you due?” “Today actually... just going for a walk.” I felt so invigorated and ready for my day, that rite of passage to arrive. I began to get annoyed being “overdue” and asked my doctor if she would induce me 7 days post dates. Thankfully, she is smarter than me and she said no. “You are healthy. Baby is healthy. Leave it alone and if you go 10 days post dates we can discuss stripping your membranes or using cervidyl.” I felt like the baby wasn't going to come out. I worried, knowing that despite my sister having a normal vaginal birth... she “needed” to be induced with cervidyl 7 days past her due date. My mother had all three of her babies by ceasarian section due to breech presentations. “What if my body doesn't know how to do this?” I worried. I desperately wanted a normal and healthy vaginal delivery. After working as a neonatal and pediatric nurse for several years, I had too much undersanding of the implications of birth complications. I was afraid of the unknowns.

Looking back I see how uneducated and unprepared I was. Based on the women I knew who shared their stories with me up to that point, I just did not know any differently. In the years following her birth I began to read and soak up the wisdom of natural childbirth and midwifery. For a time, I felt a deep sense of loss at the experience I settled for. However, I simply did not know any better. I had let go of regret and celebrate all the good in my birth story and forgive myself all of my shortcomings. I truly believe that we do the best we can at the time, with the knowledge & experience we have.

I woke at 5am on December 20th feeling contractions that felt like period cramps. Being a first time mommy-to-be, I knew I should go back to sleep, but I was too excited. I thought to myself, “statistics show the average first time labor and delivery is about 14-16 hours. I should get to meet this little one by this evening!” I also thought about my good friend Jill, who had her first baby in only 3 hours, start to finish. I wanted to have a shower and get a little make-up on... just in case. I told Darren (my husband) to go to work and I would go over to my parents' home, spend the day with my family and call him if anything changed. All day I continued to have cramp-like contractions. Nothing painful, just uncomfortable every 5-7 minutes. I ate and drank, visited with my mom and sisters, ran a few errands, and tried to pretend everything was normal. The entire time I was quite aware of the clock ticking in the labour process. I went home in the evening and spent time relaxing with Darren. My contractions were still regular every 5-6 minutes getting stronger, but I could still talk through them easily.

By about 6:30pm, we thought we should go into Calgary and get registered at the hospital and get me examined to see if I was progressing, despite the mild labor experience so far. We didn't want to travel the 30 minutes in a big rush if things changed quickly, and it had been 13 hours. Admittedly, I was preoccupied internally with the statistical 14-16 hours. I was so nieve. We were admitted, assessed, and told I was only 2 cm and should go home and sleep. They said staying in the hospital often slows down labor and it would be better to go and come back only once I felt the contractions were much stronger or closer together, or I needed something to help with pain. I know now that we should have gone home to bed, but at the time we did not have the confidence to labour alone. Rather than drive back to Okotoks, we went to Tanya and Donovan's (Darren's sister & brother-in-law), to wait out some time. Truly we were in a mindset of waiting. We were both totally uncertain and simply... waiting. So now we were only 15 minutes from the hospital. They had friends over for drinks. We visited for a while. I got up and walked around when I needed to. In retrospect, there is no wonder that the baby did not make an appearance for such a long time. I was not relaxed in front of anyone (other than my husband) to just walk and breathe and vocalize in a way that would have helped. The contractions began to feel quite painful and I needed to have privacy more than anything, so I told Darren I needed to go back to the hospital around 10pm. (Imagine going to the hospital for privacy! Ha ha.)

At the hospital, they checked me again and I was only 3cm. I was very discouraged knowing there was no turning back and we had so far yet to go before the baby would arrive. We walked the halls a lot. I felt more comfortable on my hands and knees rocking back and forth and moaning through contractions. I tried a vibrating electric massager on my lower back. That lasted about 5 seconds because it made everything hurt more. I had no understanding of how to help myself cope. I tried to take it one contraction at a time, rock and moan. It seemed to be the least painful option. I was “winging it” as I had planned and very quickly discovering that I should have done some preparation. I should have been home in my own house. Not on a skinny exam stretcher. Lying down was impossible, because I had to get back up when contractions started anyways. My insticts told me to be upright and move, but I was too self-conscious to do that in the public hallways and had no room to roam in the assessment room. Darren looked helpless and worried and tired.

This is where I lose most of the concept of time. Sometime in the night, on the uncomfortable sterile gurney in the antepartum assessment unit, a nurse came in and offered me something to help with the pain. I asked her what implications it had on labor and how it would effect the baby. Despite my lack of prenatal education, I had this idea that I could just “suck it up” and go through labor until at least 6cm and then get an epidural, only if I needed it. She told me that this early in labor, it wouldn't affect the baby at all. It would just “take the edge off” so that I could “rest a while”. My gut instinct was that narcotics couldn't possibly be a good thing for a pregnant woman and unborn baby. I had not even taken an Advil in 9 months. It seemed illogical to take a narcotic now. Feeling unconvinced, I said I would labor alone for a while longer. Alone is most cetainly how I felt. Alone, afraid, frustrated, tired, and totally unsure how I was going to cope with the rest of the labour. I continued to wait. I fought every contraction and braced myself against the pains. The nurse came back in an hour or two and checked me again. I was only 3-4cm. I could not believe that was it, after all the hard work my body had seemed to be been doing. I was very frustrated at the slow progress. I was very tired. By now I had been awake for almost 24 hours and hurting through every contraction, which Darren and I had intermittently timed at every 2-3 minutes for several hours. At some point the nurse offered me morphine “to take the edge off” again and I took it. She assured me that many women use it once or twice for a “rest” during labor. She started an IV with one swift and easy poke, for which I was thankful, and in went my IV push dose of morphine. Within minutes I felt relief. It was a great feeling, like I was able to leave the situation for a little while. I thought I even slept for an hour. My husband says I did not sleep at all and continued to labour as usual.

The day shift was coming on then and I felt like I was capable of waking up and working at birthing this baby again. (After all, this was all work in my mind; something I needed to complete). The new dayshift  nurse came in and checked me and said I was about 4cm. (Still!? It is 8am! I nearly died from frustration). However, they finally felt I had suffered it out in their small, hard gurneys long enough that they would permit me  to move to the delivery room and to another nurse's care now. I was very thankful just to move across the hall. I secretly felt that maybe if we moved to the room intended for babies to come out, our baby might do just that! I had a great nurse in the delievery room. She was very kind. After a few more hours of contractions, she was given the grim task of coming in to warn me that I had to hurry up and make progress somehow. She very gently told me that I could either go home for a while, get induced, or run the risk of having a ceasarian for “failure to progress” (which scared the hell out of me) but I could not just stay at 4cm in the delivery room all day long.

I was coping reasonably well until that bit of news. I went to the bathroom and my dear husband followed me. I love my husband more than anyone in this world. I started to cry. I started to totally lose all composure. I was so tired and so frustrated and so scared. I wanted a nice, healthy vaginal birth. I was beginning to totally doubt my ability. I did not want other people making decisions for me that I would regret later. But... I didn't know what I wanted either. I had no “birth plan”. I had never even attended a prenatal class. I thought I could fly by the seat of my pants. I am a nurse for Heavens sake! I fell into Darren's arms and sobbed. After several minutes, I stood up and told him, “I am having this baby normally and I will not be having a c-section! They better call Sheena (my doctor).” I went back to bed and Angela came in to see what I decided. I told her I could not even fathom the thought of leaving the hospital at this point. I wanted to have the baby today. Call Sheena, she will know how to help me.

She came back a few minutes later and told me Sheena said I could have an IV induction to get contractions going stronger, an epidural to help me endure the harder labor because of the induction, and she would come and rupture my membranes soon. She was in the middle of delivering two other babies that day. I did not hear the word C-section in that proposal, so I agreed. It was about 2pm. I received an IV induction, followed by an epidural. The epidural scared me to death. It took several attempts because I would jump every time the huge bore needle touched the area between my vertebra where it needed to puncture. I could not control my fear and stay still. Darren sat in front of me holding my arms and talking calmly to me. I have no idea what he said but I had never needed him more. I was so vulnerable and afraid. The anesthesiologist was finally able to get it inserted and the pain relief was great. I could feel the tightening of contractions but they no longer hurt. I do not remember when Sheena arrived, but I know she came in and it made me feel much more safe to see and talk to a familiar face. She broke my membranes and I began to contract one on top of the other shortly after that, with the IV induction pushing things along as well.

By 3:20pm I was told I was fully dilated and ready to push. I tried pushing with Darren and the nurse holding my legs for me and it felt totally akward. I realized I needed to take control and do what felt most natural. I said, “Just don't touch me. I'll do it myself.” I sat almost upright, held my own ankles and feet and pulled them to my chest in a Yoga type pose and beared down hard. My sister's only advice to me was “push hard”, and so I did. The nurses, doctor, and random assortment of interns commented that my intuitive pushing pose was a great way to open my pelvis to make way for the baby.

I heard Darren talking to me and saying “you are doing so good Jen.” I remember feeling connected to him like never before, as I was anchored to him and this place and time when our baby was coming. Listening to his quiet and proud voice. Calmly giving me the courage I needed. He was perfect.

I kept pushing every time I felt the contractions. The nurse seemed surprised that I knew when each one was coming, despite the epidural. An epidural is a bit of a guessing game and many women lose much of their urge to push and control of their muscles. Thankfully, mine was good. I had sensation and felt control. Pushing felt so good after all the labor and not being able to do very much to help things along. It was so powerful to finally be involved actively to birth my baby into the world.

Once the head began to crown, Sheena gave me more incentive to keep working hard. “There's lots of black hair, Jen!”, she said. I had told her during many office visits previously that I didn't care if it was a boy or a girl, but I wanted my baby to have hair. After a few minutes, the fetal monitor showed bradycardia with pushing. The baby's heart beat kept slowing down significantly with contractions. This made my heart sink. Sheena put an internal monitor on the baby's scalp and yelled for the vacuum extractor. The two most painful parts of my birth experience were getting the suction into my vagina and onto the baby's head and the so-called “ring of fire”, which lived up to its name as her head came out. Finally, after I tried to crawl off the table and up the ceiling as Sheena got the suction on, I was able to push again. As I heard the fetal monitor beep ominously: “beep, beep, beep.... beep.... beep.........beep.........beep”, Sheena looked me directly in the eyes and said, “with the next contraction you are going to push as hard as you can with all that you've got.” Being a nurse myself, and having seen what a bad birth can do to permanently damage an otherwise perfect infant, I took her at her word.

Her head came out with the next push. It hurt so much I clearly recall thinking, “I can not believe I am conscious!” It was the first time my vocalized pain probably sounded very scary for Darren. I felt no control over that pain. I have heard that some midwives call it the “perineal scream”. Thankfully, it was over quickly. Her shoulders and body came out quickly following her head. A beautiful baby girl named Hayden Alois Pinch was born at 3:56pm on December 21st, 2003. 35 hours after the birth adventure began.  She weighed 5 pounds, 15.6 ounces, and was 19 inches long.  Small but completely perfect.

It was so weird to finally meet her. She looked so unfamiliar. I kept staring at her. The feeling of intense primal protectiveness was shocking. I knew instantly I would give my life, I would die, for this person that I had only just met. I looked at Darren and said, “you are going to be such a great Daddy”, which made him tearful for the first time during the whole ordeal. The special care nursery team was ready to assess Hayden shortly after she was born, because after all the bradycardia episodes, she now was ticking away at 200 beats per minute and having tachycardia. She did not appear distressed in any way. She looked calm and alert, looking around at the big world. They considered taking her for overnight observation, but thankfully her heart rate calmed down within about ten minutes. She had her first attempt at breastfeeding soon after birth and she never once left Darren and my sight, from the moment she was born until we left the hospital.

After she was born I felt so energized. It was so surreal to think that this person just came out from inside of my body to join our family! And through my vagina no less! I realized my family must be worried sick by now, having not heard from us since the evening before. I asked Angela, “can I have the phone to call my mom?” And from below me Sheena replied, “can I finish stitching you up first?!” Apparently, I wasn't quite thinking clearly. I had a few sutures internally, likely from the trauma of the suction insertion and delivery of her head, but my perineum was intact. I hardly remember delivery of the placenta. It did not hurt at all and came out with one small push. I remember seeing it and thinking that it looked big, like raw meat, with blood vessels.

A few minutes after sutures, the nurse removed the epidural and she and Darren helped me to walk to the bathroom. I had a shower and went pee, which burned the first couple of times. My bottom felt very swollen and bruised for a few days, but it was very manageable discomfort. I used the squeezable water bottle to rinse after every time I used the toilet and that felt comforting.

We called family by about 4:30pm and by 5pm we moved to the maternity ward room and our families arrived. We thought Hayden was beautiful and were very happy to show her off. It is funny looking back, because she had one ear totally bent in half and her nose was squashed sideways from the birth trauma. I asked Sheena if Hayden's nose and ear would straighten out. She later told me, she briefly considered teasing me and saying it was a deformity, but she kindly reassured me instead saying, “It is just temporary molding of the connective tissue and will be fine in a few days.” My brother-in-law brought me a Tim Horton's coffee. (Bless his heart). Everyone took turns holding Hayden and taking pictures.

I was so glad labor and delivery were over and I felt really good. It is amazing how the pain of contractions is gone immediately once the baby comes out. With a long labor, I started to sincerely wonder if it would ever end. Darren looked exhausted and relieved it was over with too. He was instantly a pro at holding Hayden and wrapping her in a receiving blanket, and even changing her meconium diapers, despite the fact that she was the very first baby he had ever held!

We stayed over night but did not sleep at all. Darren was not aloud to sleep with me in the bed. They also frowned upon the fact that we refused to be separated and  Darren would not go home for the night. He  half slept sitting up in a chair at my bedside. I half slept in bed between feeling sorry for Darren being unable to lie down after being awake for two days, and getting up to nurse and look after Hayden every few hours. The next morning, as soon as the day shift came on, I asked to go home. I got up, showered, got dressed and waited to be released. We put Hayden in a red fuzzy sleeper with white snowflakes. Sheena wasn't able to come in until noon because of her long night of three deliveries, including mine. She told us that she had gone home and fell asleep fully clothed, on the floor, with all the lights still on. When she awoke at 11am, she hurried to the hospital to assess us and sign the discharge papers. Around noon, we were putting our tiny new family member in her seemingly huge bucket car seat and were on our way home. Finally! We could not wait to get home to our house, our bed, and our privacy. Just the three of us. And so, we became a family of three.

In retrospect, there are so many things I would have done differently. I would have stayed home much longer. I would have gotten into more comfortable clothes. I would have snacked more frequently to replace energy. I would have vocalized more through contractions and tried more positions to relieve pain. I would have become educated prior to labor so that I would have been well prepared with coping techniques and understood the progress of labor and how to work with it. I would not have fought labor! I would have been less inhibited while I labored simply by protecting my own privacy, with Darren, to do what I needed to do to comfort myself. And the list could go on and on. Most importantly, I would have learned about and prepared for a Natural Childbirth.

I accepted medical interventions without hesitation, from external & internal fetal monitoring, to cervical checks, to induction, medications, epidural, and vacuum extraction, not even knowing the risks I was taking or whether I ought to refuse. I did not know my options. I did not know that the medical system and procedures I trusted in my professional life as a nurse, would not be well suited to support me in my own personal labor experience; It would prolong everything and hugely contribute to my “failure to progress” label. Mixing my professional life with my private birth experience was akin to performance anxiety for me! However, as I said when I began this birth story: I have to let go of regret. I want to celebrate all the good in my birth story. I was given my beautiful daughter Hayden. She is an amazing gift that God uses every day to challenge me and develop my character. I forgive myself for my lack of knowledge at her birth. After all, I do know better now. And her arrival was not the end of my birth story.

Jennifer Pinch is married to the love of her life, Darren. Together they have two beautiful daughters. She is a Registered Nurse with a passion for educating women. She teaches natural family planning, breastfeeding, and has just started the adventures of being a labour support person for other mama's with a heart for natural childbirth.

Read Part 2 Here

 

Stay tuned for “Part Two: When You Know Better You do Better” in the Winter Issue of Birthing Magazine.