Kaylin Michelle

Kaylin Michelle was born at 11:00 pm on Thursday, June 21, 2012.  She was 7 lbs, 8 ounces and 20 inches long.

*Warning - this is a birth story.  If you think that's icky, read no further*

I was remiss in documenting the last few months of my pregnancy. Allow me to sum up. Mostly it wasn't too bad. I was tired a lot (no surprise - that was the overarching theme of my pregnancy), but otherwise okay. Due to some unfortunate incidents with one of our neighbors, we no longer felt safe living in our home and put our house on the market and moved out to house sit for some family friends.  This happened in late April.

In May my blood pressure started creeping up, which we initially attributed to the stress of our living situation. I also started having some swelling and eventually protein started to appear in my urine samples at my prenatal appointments. My midwife had me increase my protein intake to 100 grams per day minimum. This successfully brought my blood pressure down and reduced the protein levels to trace amounts until the week that Kaylin was born.

That Tuesday my blood pressure was high and I was +4 for protein (that's bad). Margaret, my midwife, sent me in for lab work and she called me the next day with the results. The labs indicated that I was in the early stages of preeclampsia. My official due date was that Sunday, June 24, so she wanted me to come in again so she could see if I was close to going into labor. I went to the chiropractor first (I'd been going for several weeks because of pubic symphysis pain) and had him do his thing to try to push me into full on labor. I'd been having mild contractions off and on since Saturday. Well, I'd been having contractions any time I got up or walked upstairs or got in and out of the car for weeks, but that Saturday they started being regular for several hours regardless of my activity. After the chiropractor, Michael and I went to see Margaret and I was already three centimeters dilated. She was happy about that because she wanted me to have the baby sooner than later so as to resolve the burgeoning preeclampsia as soon as possible before it could get worse. She stripped my membranes and sent me home and told me to relax and get as much rest as I could.

That evening I started having regular contractions again. Nothing terribly strong - they felt like Braxton-Hicks contractions. We went to bed around 9 or 10, but I couldn't sleep at all. The contractions kept pushing the baby into my bladder, so I had to get up to use the bathroom every 10 or 15 minutes. I really wanted to sleep, but couldn't because of the frequent bathroom trips. The contractions were stronger than any I'd had so far, but weren't terribly intense. I timed them from 12:30 to 1:30 am and they were 3-4 minutes apart that whole time. I called my doula and told her I wanted her to come over because I thought this was the real thing. My doula, Liz, often works with Margaret, so she was aware of everything that had been going on from both of our perspectives. She came over and told me to call Margaret as well. Liz sat up with me until morning and let Michael get some sleep.

After it was light out she had me relax in the hot tub for a little while and eat breakfast, then told Michael and I to go for a walk. While walking my contractions were more intense and closer together. They were uncomfortable, but not painful. Putting pressure on my belly made the contractions less uncomfortable. We walked for quite a while with occasional bathroom breaks. After an hour or two of that (I have no idea how long it really was), Liz said that Margaret wanted me to eat something and rest for a bit. The walking made the contractions intensify, but when I stopped they were less intense and further apart. I was able to sleep for a couple hours, and when I woke up Margaret had arrived. She checked me again, but I hadn't made much progress from the evening before. I was a bit disappointed by that. She was concerned by the fact that my labor pattern seemed to be slowing down and recommended that we go have an ultrasound to see what was going on. She was afraid that the baby was in distress, which was why labor was stalling. I wasn't excited by the idea of an ultrasound because that, to me, was the first step away from my planned and desired home birth. She gave Michael and I time alone to discuss it and we agreed that it was a good idea and that we should trust Margaret's judgement (that was why we hired her, after all). She called the OB's office that I had used previously (prior to the pregnancy) and discussed her concerns and plan of action in case she was right and we ended up needing to transfer care. The doctor agreed with her plan and gave her his cell phone number so that she could keep him updated. We then got ready for the appointment at the imaging center for the ultrasound and left. My doula had us get some things together in case we did end up in the hospital so that we were prepared for the worst, but still hoping to be able to come back home for the birth.

I think at that point that both Margaret and Liz knew we weren't coming home for the birth. They didn't ever say so to me or Michael, I think mostly because they were trying to keep me as relaxed and positive as possible.

The ultrasound didn't go quite as swimmingly as we had hoped. The baby wasn't moving and wasn't practice breathing. We technically passed the biophysical profile with a 4/8. However, my fluid levels were just barely passing (and the tech rounded up). The only good thing was the strong heartbeat. Honestly, the most painful contractions I experienced were during the ultrasound. I was lying on my back and she was pushing the probe thingy into my belly and it hurt.  I suppose I could have said something, but everyone was so focused on the screen that no one even noticed I was having contractions.  No one except Michael, whose hand I was squeezing every time I had one.  Toward the end of the 30 minutes, Margaret must've looked down and saw me grimacing because she asked if I was having a contraction.  I said yes, and the tech stopped pushing so hard with the probe.  

After the ultrasound, since it wasn't so great, we went across the street to the hospital to have a non-stress test.  Even then they kept acting like there was a chance that I could go back home, but, really, Margaret had decided that she was transferring care.  I cried.  I cried on the way to the ultrasound.  And I cried on the way to the NST.  I was trying really hard not to cry when they wheeled me up to Labor and Delivery.  One of the nurses said hi to me and asked how I was in a really friendly, cheerful way.  I choked back tears and said, "I've been better."  We did actually pass the NST (the baby started moving for that and had two spontaneous heart rate accelerations within 10 minutes), but by then it had been decided that we needed to be in the hospital.  I knew that by being in the hospital they were going to do something to speed up my labor.  My biggest concern was how hard and fast that was going to happen.  The doctor said he wanted to break my water and would give me a few hours to see if I went into active labor on my own before giving me pitocin.  I was glad of that much, as I really wanted to avoid pitocin.  I didn't want an epidural and I have heard that pitocin makes contractions much harder to handle.  I wanted to avoid those things.

Michael went back home to feed our goats while I changed into a hospital gown and got the IV port placed.  The doctor came in to check me before Michael got back and asked if I wanted him to go ahead and break my water then or wait for Michael.  Since Michael had been present for the conversation about the plan of action, I had him go ahead and do it, since I didn't really think that Michael would be too upset about missing that part.  When he broke my water there was thick meconium.  If that had happened at home we would have transferred to the hospital, so it was a good thing that we were already there.

My water was broken at about 7:30 pm and I was at 4 centimeters dilated at that point.  When Michael got back we had to choose a pediatrician.  We hadn't really worried about that before because Margaret takes care of the well checks for the baby during the first six weeks along with the postpartum care.  Now we had to choose one within an hour.  So, I asked Liz who she uses and how she likes them and we went with her recommendation, which we've been quite happy with.

Liz had told me to order dinner before the cafeteria closed at 7:00, but I hadn't gotten to eat it yet because of all the activity going on, so I ate some while we waited for things to get started.  Breaking my water put me into active labor pretty much immediately.  My next contraction was significantly stronger than any prior to my water breaking and they started getting closer together right away.  I was managing fine in the bed while I was eating, but as things progressed I noticed that I was starting to tense up during the contractions instead of relaxing into them.  So, I decided that I wanted to get into the bath tub.  I was on constant monitoring because of the meconium, so the nurse got the portable telemetry unit so that I could use the bath tub.  The warm water helped with the contractions quite a bit until I started having back labor.  At that point I was trying to find a comfortable position to be in during the contractions in a narrow tub.  I ended up on hands and knees, swaying my hips or rocking forward and back.  Liz started massaging my low back and providing counter pressure during the contractions.  Shortly after that I decided I wanted to go back to the bed.  I was really tired and needed to lay down.  I was operating on two hours of sleep in over 24 hours.

At one point while I was still in the bath (before the back labor really got started), Liz kept telling me to stay as much on my left side as possible.  The baby was having heart rate decelerations after my contractions.  Not badly enough that they wanted to do a c-section, but still a beginning sign of concern.  I remember silently telling the baby that I needed her to work with me and that we were in this together.  I would do my part and she needed to do hers.  A c-section was not what either of us wanted.

Before I got out of the bath, they checked me and I was 6 centimeters dilated.  It was about 9:30.  Liz told me that I was right on track, that they liked to see one centimeter dilation progress per hour.  I remember thinking, "I have to do four more hours of this?"  As I got out of the tub and walked to the bed, I thought, "I totally get why women get epidurals."  The whole giant needle in the spine thing still freaks me out, but I do totally get why women get epidurals.

I labored for an unknown amount of time on my side in the bed.  I don't think it was really that long, though, maybe a half hour or so.  They checked me again and I was at 8 cm.  A few contractions later I was starting to push.  Liz noticed and mentioned it to the nurse.  The nurse told her to tell me not to push because I was only at 8 and it might cause my cervix to swell, which would make things take longer and to have me breathe in some particular way through the next contractions.  Liz started to tell me how to breathe through the next contractions and my response was, "I can't do anything except what I'm doing.  I'm not in charge of this."  Liz told the nurse to check me again because she thought I was complete.  The nurse did so and, lo and behold, I was at 10 cm and had permission to push.  I remember thinking something along the lines of, "Oh, thank you so much.  I was just waiting for your permission."

At some point during transition they sent in the pediatrician to talk to us.  We had wanted delayed cord clamping so that the baby could get as much blood from the placenta as possible.  When Liz mentioned it to the nurse earlier in the labor, the nurse said we couldn't do that because of the meconium.  So, they had the pediatrician come in to talk to us about that.  When they said she was coming in, I was thinking, "Are you kidding me?  You expect me to talk to someone now?"  Fortunately, Michael knew enough to talk to the pediatrician, because I was too busy dealing with contractions to speak much to anyone.  She explained that the risk of waiting far outweighed any benefit due to the increased risk of respiratory distress and that waiting a minute could make the difference between a healthy baby and one who was on a respirator in the NICU.  Michael said something to the effect that we wanted what was best for the baby and wanted as much of our original plan as possible, but realized that things had changed and so we were okay with them doing what was necessary.  Liz then asked if the doctor would milk the umbilical cord, which means that he would push blood down the cord to the baby immediately after delivery to get her as much of the blood from the placenta as possible without waiting so long as to compromise the baby.

Apparently, I make a lot of noise during labor (I was moaning through every contraction from about 7/8 cm on), but I don't communicate verbally much during labor.  I think I only said a handful of things during late stage labor.  When my doula was adjusting the monitors on my belly to try to get the baby's heartbeat, I told her that she couldn't do that anymore, at which point she stopped immediately.  I told them I couldn't help but push when I had started pushing.  At one point between contractions Liz was talking to fill the silence and I preferred the silence, so I said, "Shhh."  Michael, who was in front of me, heard it and said that I wanted everyone to be quiet.  I also recall saying that I wanted labor to be over a few times.  I was exhausted by that point and my contractions were one right after the other without much space between them.  I was having trouble staying on top of them.

I pushed on my side for a while - I have no idea really how long.  It was at that point that they were getting concerned for the baby because the monitor had moved off her and they hadn't had a good heartbeat reading on her in a while.  When I wouldn't let Liz adjust the monitors she called and talked to Margaret, who had gone to be with her daughter in law who was in the hospital in Spokane with preeclampsia (she hadn't expected me to labor so quickly and was planning on being back in time for late labor and the birth).  I believe Liz had called to see if she was on her way since I was already pushing and informed her of the lack of monitoring ability.  She recommended putting in a fetal scalp monitor, which Liz communicated to the nurse and was done pretty quickly after that.  I didn't object because I knew they needed to find her heartbeat and I wouldn't let them push those monitors into my belly during contractions again.  Normally, if she'd been doing fine all along, I wouldn't have agreed to the scalp monitor.  They referred to it as an internal monitor, and Michael didn't know what that really meant until sometime the next day when I told him.  He was rather horrified, so I think it was a good thing he didn't realize what it was until later.  The wound in her scalp healed pretty quickly.

Shortly after that, they decided that I needed to be in a more upright position to facilitate getting the baby out more quickly.  They were getting a squat bar for me and had Michael getting up in bed behind me to help support me when the doctor came in and told them he didn't want that (or something of the sort - I don't really know, I just know they didn't get the squat bar, Michael got down and I leaned back against the bed, which was put into a more upright position).  I was so tired, that I was glad I didn't have to squat.  Around then they tried to cut off the belly band that had been holding the external monitors in place, but for some reason couldn't get it to cut through all the way.  They gave up because there was too much else going on that was more important.  They also put on the blood pressure cuff to get a blood pressure reading and told me they'd take it off soon.  They never did, so I ended up giving birth with a belly band hanging off me and a blood pressure cuff on my arm.

I was given an oxygen mask and told to breathe really deeply and hold it in.  I tried, but holding my breath between contractions wasn't really happening because I was trying to breathe.  Then they were telling me to hold my breath and push hard with the contractions.  I just pushed as hard as I could and largely ignored what they were telling me to do because it seemed to be self-contradictory.  I had long since surrendered to what was going on in my body and couldn't really do much about it.  Liz was holding the oxygen mask on my face and it was sort of poking me in the left eye.  I reached up to pull it down slightly so it wasn't in my eye anymore and she thought I was trying to pull it away and pushed it in harder and told me I needed it.  At that point I said probably the last thing I said in labor, which was, "You're poking me in the eye!"  She said, "Oh!  Sorry!" and allowed me to put it where I wanted it.  Near the end, the baby's heartbeat was in the 60's and she needed to come out quickly.  The doctor told me he might need to use the vacuum to assist because of the dips in her heart rate, but in the end didn't need to do that.  I was able to push her down far enough that it wasn't necessary.  She was crowning, but I wasn't able to push her out fast enough, so the doctor cut an episiotomy and dragged her out.  The cord was loosely wrapped around her neck, which he undid after her head was out, then pulled her the rest of the way out on the next contraction.  I could see him holding her in his hand and she was just draped there, motionless and not crying.  It didn't really register with me that that was not really a good thing.  I was just staring at her as he milked the cord, then clamped and cut it and handed her over to the pediatrics team.  At that point I laid back on the bed and Michael followed her over to the corner of the room where they were working on her while the doctor stitched me up.  She cried, and I heard the pediatrician say, "She cried on her own.  That's good."  They told Michael she was a girl and he turned and said, "You were right, it's a girl.  You get to say, 'Burn,'" to which I replied, "Burn."  (While I was pregnant we kept arguing over whether it was a girl or a boy and Michael said that if it was a boy he was going to look at me and say, "Burn!"  So, since I was right, I got to say it.)  They suctioned out all the meconium and wiped her off. Michael cut the cord shorter and the pediatrician brought her over to me and put her on my chest and the nurse covered us with a warm blanket.  She said something to me, but I have no idea what she said. I was too busy staring at my beautiful little girl.  Her face was all scrunched up like she had a bad taste in her mouth (which she probably did) and it took her a while to open her eyes.  At about that point, Margaret came in.  She had missed the birth by about five minutes.  I was glad she was there afterward, though.  I think having my husband, midwife, and doula all there helped the nursing staff to not rush me too much.  It took a little while for Kaylin's temperature to get up to 98 degrees, which I think was another reason they didn't rush us.  Who knows - maybe they would've been quicker to put her under the warmer if I didn't have so many people there looking out for us who weren't employed by the hospital.  Either way, I was allowed to hold onto her for as long as I wanted before she was weighed and measured.  I told them not to bathe her because she'd been under enough stress already and it had taken so long to get her temperature up, I didn't want them to make her cold again and stress her out more.  She did latch on a little bit while we were still in the Labor and Delivery room before they weighed her and everything.

My parents and Michael's parents had come to the hospital and waited in the waiting area while I was in labor.  The dads had gone home before Kaylin was born because everyone thought it would be such a long time.  Her official birth time was 11:00 pm, putting my active labor at right about three and a half hours.  When Liz went out to tell the moms that she was born, they were both really surprised.  When I gave her back to the nurse to weigh and measure, Liz went and got the moms so they could come in and see their new granddaughter.  After that the nurse got me up and cleaned up and ready to go to my Postpartum room.  By the time I got over there it was about 1:40 am.  The nurse helped me get started with breastfeeding to facilitate the uterine contractions necessary for proper involution and to prevent hemorrhage.  They had started me on pitocin after the delivery for the placenta, but I hadn't finished it, so things weren't as firm as they wanted when the nurse checked me in the Postpartum room.  Twenty minutes of breastfeeding later, everything was on track.

Overall, I feel good about the way things went with the birth.  There were more interventions than I would've chosen if we'd both been healthy, but I feel the ones we had were necessary and I wasn't bullied into anything.  I was informed of the plans and given the time to consent or refuse.  Because I trusted that my birth team wasn't recommending anything that wasn't necessary and I was included in the decision making process.  I do wish I could've had my home birth.  I think the immediate postpartum period would've been more restful if I'd been able to be at home in my own bed.  But with the distress Kaylin was experiencing, I'm glad we were where that could be dealt with quickly and appropriately.  I honestly attribute our good outcome largely to my planned home birth and my excellent midwife.  If I'd been planning a hospital birth I wouldn't have recognized my stalling labor for what it was - I would've thought it was just another bout of prodromal labor that I'd been experiencing all week.  I would've waited until I grew concerned by the baby's lack of movement, at which point I most likely would've had a c-section.  Because of Margaret's experience and instincts, we transferred care before things got really scary and we both came out healthy and intact.