The story of Kieran's birth

We spent this pregnancy planning a homebirth for our second child, but it was not to be. Instead of being in the peaceful space of my bedroom with my family around me attended by the midives I had grown to love and trust, I gave birth to my son in an emergency room full of strangers who didn't even know how to spell my name correctly.

My pregnancy had been pretty normal and ordinary. I started having early labor symptoms around 37 weeks or so; lots of contractions, I lost my mucous plug and my cervix had started dilating and effacing. The babe had been head down for about 2 months and starting to engage, when he suddenly flipped head up just 3 days before my EDD. All my labor symptoms stopped when he flipped.

Because the American College of Obstetricians and Gynecologists has declared that breech births are high risk (when they are actually lower risk than cesarean births), our midwives were not allowed to attend a home birth with us as we had planned (their medical licenses only cover low risk birth). We knew of only one doctor who regularly attends vaginal breech births, but he doesn't practice at any of the hospitals in our HMO network and we couldn't afford to pay out of pocket to have the baby at the hospital he practices at. All the other doctors we contacted, including our assigned HMO OB, will only do a cesarean for breech births. Since Ben's overmanaged hospital birth 4 years ago I've educated myself a great deal about birth and I am very against c-sections for anything but emergencies, so it was very hard for me to even consider having one for a breech, let alone scheduling one as the Dr's wanted to do. It had been my only worry during this pregnancy and now it felt like my worst nightmare was coming true.

We tried all sorts of things to get him back around; lying in slant position with my tush in the air, moxibustion, herbs, talking him down, etc. We had a consultation for an external version (where the Dr turns the baby from the outside) the day after he flipped; the ultrasound showed he was in a frank breech position (with his legs up). He was facing the back with his spine lined up right down the middle of my belly and a leg on either side, like he was climbing a tree. The Dr said that this is a great birthing position for a breech, but he was unturnable, that he was braced in there and there was no way to bend him to flip him around. This wasn't really good news, but I felt relieved by it. Seeing the crazy position he was in made it all out of our hands, I realized we could do what we needed to but it was ultimately up to him to turn or not.

We decided to take the weekend to consider everything and give the babe a chance to turn back (my due date and Ben's birthday were Saturday). By Monday night, after a moxibustion treatment, we thought he'd flipped or at least changed position, so we made an appointment to see Dr. B, our OB, for an ultrasound. He was still in the same place and his butt had not dropped, leaving a good chance for a cord prolapse should my water break. I also seemed to be less dilated than I had the previous week. With both our midwives and our Dr very concerned about the situation and our alternatives tapped out, we decided to schedule a cesarean for the next morning at 7:30. We were to be at St. J's by 5:30am to prep.

Dan decided to go into work to finish some things up in preparation for his leave. Ben and I hung around the house getting prepared and spending time together. I had quite a bit of pain through the afternoon but nothing regular, I just didn't feel well and chalked it up to indigestion. I called Dan at 6 to ask him to come home soon cause I was in a lot of pain and wanted to get Ben to bed early since we had to be up before dawn. He was home a little before 7 and we put Ben to bed. It took him a while to fall asleep and he woke up in a daze a few hours later, but fell back to sleep easily. Dan joined him around 11 while I stayed up fixing my email settings and getting ready to be away for a few days. I tried going to bed at midnight, but I'm not used to sleeping until around 3, so I laid awake for a couple of hours, talking to the babe, who'd gotten very squirmy, telling him this was his last chance to flip around. Just before dozing off a little after 2 am, I prayed that I would go into labor by the morning, just so I could know for sure it was the right day and that we'd made the right decision.

A little before 4, I woke up needing to pee very badly. I laid there for a minute, not wanting to get out of my warm bed, but the pain got worse so I staggered to the bathroom. I found I couldn't pee when I sat down, and I had to push to get anything out. Instead of going away when my bladder was emptied, as usual, the pain kept getting more intense. It occurred to me that this was a contraction and that it was not stopping. Then I thought that I really wanted to get to the hospital asap and get an epidural cause there was no way I was going through this pain only to have them cut me open and take the baby. I lurched back across the hall into the bedroom and threw myself on the bed, telling Dan to wake up and call S (one of our MWs). The contraction finally started to subside, it had been about 5 minutes long. Dan gave me the phone and I told S what happened. We figured that since there wasn't any pressure on my cervix (we thought his butt was still up high) and my body wanted to go into labor (and had been working on it for a few weeks) so it was contracting irregularly just form the hormones. She said she was just getting up anyway and to try and rest and she see me in a couple of hours at the hospitals.

About 5 minutes after that first killer contraction, another one started. Luckily it was normal length, about minute lone. Realizing this was really labor, an not just irregular contractions, we called our OB's office and left a message with the service (our Dr was the second on call that night). We got a call back from the on-call Dr who said to head over to St. J's immediately and that she'd let Dr. B know we were coming.

We started to get dressed and the contractions kept coming, another in 5 minutes, followed by one in 3 minutes and then one 2 minutes later made me feel like I had to poo (which I really believed since I thought all along it was just indigestion and it was too soon to feel the need to push) I went in the bathroom in my shorts and bra. I bore down a bit and felt something coming out of my vagina. I reached down and felt the amniotic sac bulging out. It popped in my hand like a soap bubble and my hand was filled with meconium. I wasn't worried about the mec because I knew that breech babes poop when their butt gets squeezed out, so I dumped it in the toilet. I felt around for the cord, but there was only pieces of the sac can more meconium. My cervix seemed completely dilated and I felt the babe's butt right there. I called to Dan (who was back on the phone with S telling her about the change of plans) that my water had broken and the baby was coming NOW.

The next contraction came and I had to push. I told Dan that I was pushing and S told him to get me on the floor with my butt up and to pant through the contractions but to not push. There is one thing more painful than the transition phase of labor, that is not pushing when your body wants to push. I found the only way to not push was to scream through the contractions. S asked Dan to check me for dilation and to make sure the cord wasn't presenting. He said he couldn't tell the dilation but could feel the butt. I was telling him that I was dilated this much (holding up my hand to show him how open I was) andthat the cord wasn't there, but he was too panicked to notice. S wanted to talk to me, but he kept holding up the phone in the middle of contractions and I couldn't speak. She was already in her car heading over, but thought she couldn't get here in time and we were all worried that the baby might be caught in the cord (the U/S had shown a loop of it under his chin) so she told Dan to call 911.

Poor Ben was sitting on the bed watching me in the bathroom and wailing. I told him I was OK, that the baby was coming really fast and I was trying to slow him down. He said he wanted to come and give me a hug and I said he could come over but that I might have to scream again. He decided to stay where he was.

The EMTs arrived very quickly. I just saw 4 pairs of boots surround me in the bathroom, where I was lying with my face to the floor trying not to push. One of them checked me and they asked me a bunch of questions. I begged for a sip of water, my throat hurt so badly from the panting and screaming, but S had told Dan not to let me drink and he paramedics wouldn't let me either. After assessing me for a few minutes, they started talking abut where to take me. Dan and I kept saying that they were waiting for us at St. J's but they wanted to take me to Kaiser because it was closer. Was asked them please not to, that we had HMO and Kaiser wouldn't be covered. They even got on the phone with S who begged them to take me to St. J's, that Dan had just timed it and it was only 7 minutes away. They got me to crawl onto the stretcher, which they had covered with towels. I was only in my bra now and asked them to cover me, they told me they'd do it at the truck and I begged to please be covered, I didn't want to be carried down the entire walkway of my building naked with amniotic sac hanging out of me. They just kept strapping me down and said it wasn't important. There was a beach towel hanging on the top of the banister so I reached up and grabbed it and covered myself. I asked if Dan & Ben could come in the truck but they said there was no room and they could meet us at the hospital.

We set out towards Kaiser, but after a block or so they were on the radio with their dispatcher, who told them they should go to C-S because Kaiser didn't have a NICU. I told them again to take me to St. J's, that they were waiting for me and they had a NICU. They argued back and forth with the dispatcher for a while, but ended up agreeing to go to C-S. I told them to please call Dan and let him know where we were going. They said they'd tried but he wasn't home. I couldn't remember his cell phone number (I always use speed dial) so I just hoped he'd get the message and make it to C-S.

Along the way they just kept telling me to breathe and not to push. Each contraction made me scream to not push and they would all tell me to breathe over and over. I had been bearing down a little bit with most of the contractions, I couldn't stop my body from doing it. I finally decided that I had to let my body do what it needed to and I stopped trying to stop the pushing. The EMTs were so relieved that I'd stopped screaming; if they only knew why I had they would not have been happy about it. They tried to start an IV in my right arm with no luck, and when the latest contraction stopped (they would not wait for a contraction to stop before doing anything) I told them I could only get IV's in my left arm. I was on my side with a strap over my shoulders and one across my bent knees (I had horrid muscle aches in my thighs for days after from pushing in this position) and I grabbed onto one of the seat belt buckles to support myself. We pulled into the ER in the middle of a contraction and, when I wouldn't let go of the buckle, one EMT pried my fingers off of it even though I begged him to wait until the contraction was over. They rushed me into triage and moved me to a bed, where the nurses tried to strap a fetal monitor around my belly while asking me the pertinent questions. I heard some heart tones, but no one else noticed because they had checked my cervix and were now rushing me into the operation room.

I had expected that the moment we arrived I would have a mask slapped on me, be knocked out and sliced open. I was really surprised at all the other things they were doing. I was moved to another bed in the OR, and they had to work a bit to get the IV working (it was a bloody mess). They asked more questions about my pregnancy, about the baby being breech, when was my last c-section, no, my last birth was vaginal, we are only having a section because this one is breech, etc. There were a zillion people in there and I couldn't tell who was who. Some guy in a mask and eye shield (turned out to be the OB resident) called to the nurses to get my legs and 2 on each side lifted them up and apart. He checked my cervix and it burned so badly, I thought he was trying to push the baby back up so that he could do the surgery. I screamed that it was burning, the fingers were burning me. One nurse said, "that's the baby, your baby is coming". I said again that his fingers were burning me and then saw that the doctor's hands were no where near me, that it really was the baby coming. The Dr said "OK, now push" I stared at him for a moment and said "you want me to PUSH the baby out??" He looked at me funny and said "yes". It was so bizarre to me, everyone had spent the past hour or so telling me not to push and the past week telling me I could not have this baby vaginally. I was still waiting for them to slap on that mask and cut me open, so I was amazed he wanted me to push, that he was letting me push. I told them I needed to sit up (I was flat on my back on the table) and they cranked up the head of the bed as far as it would go. Then I said, "I need to put my feet down", the nurses on my left dropped my leg and I said it again to the other nurses, "I have to have my foot on the table" They let go, too, and I pulled my feet up as close to my butt as I could in sort of a squat. The next contraction came and I pushed as hard as I could past the burning and felt the baby sliding out. The Dr said "baby's out" and I said "all of him?", thinking for sure I'd have to push more to get his head out. I looked over my knees to see him stretched out at the end of the table by my feet looking very confused.

Kieran was born at 5:18 am, about an hour and 25 minutes from that first contraction. He weighed 10 lbs, 5 oz and was 21.5 inches long. His head was 15" around. His apgar scores were 5 and 8, with some points off for color (he was a bit pale) and irregular breathing. His nose and mouth were full of meconuim, so they suctioned him on the table with a bulb syringe. Then they whisked him over to a warming bed at the side of the room. He was sort of in my view, but there were about 5 people hovering around him. They did some deep suctioning and cleaned him up but mostly they just stared at him. As I laid there waiting to deliver the placenta, I was wracking my brain to remember Dan's cell phone number, as I feared he was wandering around Kaiser looking for me (which he was, along with S and Ben in tow). I remembered that my mom was coming to join him to take care of Ben but I didn't know her new number either. I finally remembered that my dad was at home and, since my parents have had the same phone number for 30 years, I knew that number and had a nurse call and tell him where I was and that the baby had been born and we were OK. My mom got the call from my dad just as she pulled into the Kaiser parking lot and met Dan & S coming out, not having found me. They all headed up the street to C-S.

I delivered the placenta fairly quickly and it was sent to the pathology lab for testing. I'd originally wanted to keep it and plant it but that seemed a lot less important now as I laid there. The Dr stitched up my 2nd degree tear (did I mention his head was 15" around?!?! The average head size of a newborn is 13 1/4". Thanx so much to my big-headed hubbie for passing on that gene, lol!) and the nurses cleaned off as much of the meconium as they could, it was all over my feet and legs and the table and floor. I was amazed the next day when he was still pooping, I figured he'd gotten rid of it all in those first couple of hours. They finally brought me the baby all bundled up. They said he was having some respiratory problems and might have aspirated some meconium so they were taking him upstairs to the Neonatal Intensive Care Unit. I got to hold him for about a minute before they whisked him off again. Then I was wheeled up to the recovery room on the L&D floor. We met Dan and S in the hall. I sent Dan up to see the baby and S came in to wait with me.

It was several hours before I was sent to a regular room and allowed to go and see Kieran; the wait was excruciating. He wasn't allowed to eat anything (he was on IV fluids, which made him gain 6 oz in the first day!!), so I spent hours just holding him while he sucked on my finger. I pumped what little colostrum I could, mostly to get my supply started. When a doctor finally told me I could nurse him the next morning, I practically ripped my gown off to get him to my breast. It was a rough start, but, with some help from our other midwife we quickly made up for lost time and my milk came in by the third night.

I wish there had been less panic during my labor on everyone's parts and that I had been able to listen to my own heart a bit more. I had spent a week convincing myself that there was something wrong with my baby in order to be able to accept the inevitability of surgery and that made it hard to trust my own body in the end. I only had 2 birth dreams during my entire pregnancy, one very early on and one in the last month; they both involved me giving birth in a bathroom by myself. I never mentioned them to anyone, they didn't seem significant until it was actually happening, and by then I was too scared to even entertain the notion that I could do it myself. I believe that Kieran knew all along what he was doing and that everything we went through served a purpose, but I also believe all the fear around it made it much more difficult. He spent 12 days in the NICU recovering from what was eventually diagnosed as meconium aspiration. After I was released from the hospital myself on the third day, I spent about 14 hours a day at the hospital with him, coming home to sleep and pump. I am so grateful that I did not have to go through the NICU experience while recovering from surgery, and that I had the strength on the first day to be with him instead of recovering from a long labor. I am grateful to my baby and my body for allowing me to give birth vaginally, as I had wanted, but I do wish that the American College of Obstetrics and Gynecology had not taken away my right to do so in the first place.