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Cervidil induction: Katherine’s natural birth story January 21, 2008

Posted by guinever in : birth, birth stories, birth story, health, labor, midwifery , trackback

This is a cervidil induction story submitted by Katherine. In her words, she was committed to an un-medicated, un-managed, natural birth, but was also birthing at a big university teaching hospital, albeit with a team of very cool midwives. She and her husband took a Bradley® class, followed the Brewer diet, did yoga once a week, and walked 2-5 miles per day.

41 weeks along in my pregnancy

On Thursday, my 1-week postdates checkup, I had borderline low amniotic fluid levels (which increases the chance for a “cord accident” and are an indirect marker of potential placental insufficiency, which can both be serious complications) with 1 cm dilation and 50% effacement, so the midwives wanted to induce me the next day. As I suspected, they “don’t do inductions on the weekend,” but I didn’t want my son to be born based on the hospital’s scheduling practices. I got them to agree to give me an extra day to research and think and see if labor would start on its own.

inaAfter reading in Ina May’s Guide to Childbirth that low amniotic fluid was a reason that Ina and the other midwives who work with her would transfer to the hospital, I decided it might be serious, and I’d better see what I could do to get labor started on my own. I got acupuncture twice, did nipple stimulation, sucked my thumb to stimulate an acupressure point on the roof of my mouth that helps get contractions going and helps them be stronger once they do start, visualized and told my cervix to efface and dilate because the baby needed to come out.

cervidil induction

By Friday night when I went in for what I was hoping was just a check, I was still 1 cm, but 75% effaced and having small contractions every 10-15 minutes. I was thinking I’d be told, “Yes, you’re in early labor. Go home.” No such luck. The midwife and nurse weren’t convinced I was in early labor and told me that I needed to start a cervical ripener in preparation for a pitocin induction the next morning. The midwife inserted cervidil at about 8:30 p.m. I was still pressing the acupressure point in my mouth and chanting in my head for my cervix to efface and dilate. By 10:30 p.m., the nurse had decided that maybe it was real labor after all. I remember the nurse kept asking me to rate the pain of contractions on a pain scale, and I went from, “Oh, maybe a 1.5″ to “That was…mmmm, a 3.” to “Um, 4?” The nurse said at one point, “Are you sure that was only a 4?” and I told her that I was trying to save the bigger numbers for later. My husband said I never went higher than a 5, although some of the contractions were pretty painful. For the most part,

I would say that labor wasn’t so much painful as it was all-consuming. It’s like being in the ocean and being carried up and down in huge waves. If you give in, accept it, and ride out each contraction, it’s not so bad. But if you tried to avoid it, I am sure it would be more painful.

labor is like being in the ocean quoteI did a lot of ‘vocalizing’, i.e. moaning like a zombie or mooing like a cow, and that helped dissipate the intensity of the contraction and kept me breathing. Or, I would be quiet, but trace the outline of a cabinet door with my eyes or stare at a speck on the floor as a distraction from the contraction. My husband talked me through a lot of contractions too, putting up with me saying, “No touch!” or “No talk!” for some of them. He called our doula to come be with us sometime in the dead of night, but I don’t really remember when…

laboring in the tub, floating like Ophelia

The Cervidil fell out (it’s on a little string like a tampon and is supposed to stay in for 12 hours) at about 2:30 a.m., and the midwife found that I was 6 cm dilated. My first question was, “Do you have to put it back in?” to which the midwife and nurse both started laughing, “No, you’re in labor and progressing well.” My next question was, “So, this means I can go in the tub now?” Thankfully, I was able to have the rest of my labor in the deep whirlpool tub they had in the bathroom, floating like Ophelia and dozing between contractions,then flipping onto my hands and knees for mooing and pelvic rocks when one was starting.

pushing

After some indeterminate time (being in labor is really an altered state of consciousness, and I had no idea about time except when I looked at the clock and marvelled that it was so late at night), my doula recognized that I was getting pushy and asked for the midwife to come in. I had noticed that the

felt different, like I was being wrung like a dishrag from the inside out, but I didn’t recognize it as transition. I thought some part of my BRAIN would say, “Wow, I really have the urge to push.” But in a homuncular version of a laboring woman, the head is about the size of a cherry tomato, and the abdomen is the size of a VW bus — there is nothing intellectual about birthing a baby.

The midwife listened to one contraction (think yodeler being strangled, and that’s the noise I was making) and told me to get out of the tub NOW (they are not certified to do water births at the hospital). She checked me and said I was fully dilated except a little lip of cervix that she pushed back.

I pushed in a number of different positions for about 2 1/2 hours, changing when it seemed right to squat or kneel or lunge, made more primal noises, but did the final pushing on my hands and knees, smelling coffee and marvelling that I could see daylight through the venetian blinds. My son came into the world easily and gently with some minimal guidance and lots of encouragement from the midwife, nurses, my husband, and my doula.

analyzing my birth

I feel really lucky that my labor was not too fast, and not too long either, and that I never felt the need for drugs. I am glad I had a midwife who literally sat on the couch drinking a cup of coffee until it was time to catch the baby. And she told me just what I needed to hear,

“You’re doing a great job working with your body. Remember that half of pushing is molding the baby’s head, so even if it doesn’t feel like anything is happening, you’re doing a tremendous amount of work with every contraction.”

I am also lucky that after pushing, I came away with a minor skin tear, but no terrible damage to my anatomy. I think pushing for 2 1/2 hours gave the tissues a lot of time to stretch, and the midwife was really good at telling me to push and hold, push and hold, so the baby came down really slowly.

I managed (somewhat awkwardly) to flip from my hands and knees to sitting up, passing my leg over the umbilical cord and having the baby handed to me, wet and warm, by the midwife. The first thing he did was poop all over me, but I didn’t even notice until later. I was just amazed that he was finally HERE, that he was so big (8 1/2 lbs, 21″ long), but so little, and that he’d just come out of my body, that I’D DONE IT! I’d had the un-medicated, unhurried, relaxed, un-traumatic birth that I had hoped and prepared for!

After the cord stopped pulsing, the midwife clamped it and asked my husband if he wanted to cut the cord. At first, he declined, afraid that he might hurt me or the baby, but the doula, nurse, and midwife all said, “C’mon, neither of them can feel it. Just do it,” so he did. Severing the umbilical cord strikes me as kind of a funny ritual, like the human equivalent of a ribbon cutting ceremony at a library or a new shopping mall. I think new fathers are encouraged to do it so they can feel like they really had their hands in the birth process in some active way. I kind of wished that they had waited longer, but I was in a bit of a daze and not really capable of speaking up at that point. I felt kind of loopy, almost like I was stoned.

After my placenta came out (I’m pretty sure the midwife asked if she could give it a little tug to help it along, and at that point, I figured she knew best what to do), the medical staff got down to business. I had a little 1st degree tear that the midwife stitched up while the nurse helped me try to get my nipples perky so the baby could latch on. The stimuli from the stitching and this motherly but energetic L&D nurse trying to help me was a bit much, but the babe latched on like a champ and the repairs were done soon enough.

Aside from the family practice doctor coming in to check the baby over and take his height and weight, some hard pushes from the L&D nurse on my uterus to make sure it was involuting (shrinking) and checks that I wasn’t bleeding profusely, they left me and my husband and our baby son in relative peace, free to stare at each other and be totally amazed that in just nine months, a being who didn’t exist had come into being inside my body and made his way into the world.

postscript

As it turned out, the amniotic sac didn’t burst until three contractions before my son came into the world, there was plenty of fluid, and the placenta was perfect. I could have waited for labor to start spontaneously… In the final reckoning, though, with all the negotiating between my desires and hospital “standards of care,” I am glad that I got to give my son what I consider the best birth we could possibly have had, given the setting and the small, but real, possibility that we could have ended up with a true complication.

Comments»

1. Aimée Sturley - January 22, 2008

Beautiful. Thank you so very much for sharing this story. I am a doula and breastfeeding counselor in Vancouver, British Columbia, and I have a client who has been asking for positive stories of hospital births; I will certainly be sending this one along to her.

Thanks again!