Maxon's Birth Story
November
28th - 29th, 2002
Penny
Stansfield, Doula.
Rachel's
waters broke at 1 a.m. on Thursday, November 28th, Thanksgiving Day. Since she was on call that night, she was
already working at UMC and decided to remain on call until a colleague could
take over or until she was no longer able to work due to contractions. Mark
joined her, and they spent a sleepless night while Rachel continued to work on
the phone. Finally, they moved up to the 8th Floor, Labor and Delivery at about
5 a.m. A six o'clock, examination showed that Rachel was a mere ½ cm dilated
with a cervix which was still long and thick — not very encouraging news for someone who needs
to deliver her baby within 24 hours of her waters' breaking.
I
arrived at the hospital at 8 a.m. and found Rachel and Mark in good spirits
though a little weary after a sleepless night. Rachel was having mild
contractions every 5 or 6 minutes and was gradually moving into early labor.
Darlene, our nurse, pressured Rachel to have pitocin and an epidural as soon as
possible "to get things moving." Rachel, however, realized that
inducing a woman whose body simply isn't ready to labor frequently ends in
failure to progress and a cesarean birth, which she wished to avoid at all
costs. So she opted for some morphine to help her sleep and rest and take the
edge off the contractions, giving her body more time to move into active labor
of its own accord. She opted for patience and honoring her body to do what was
needed in its own time. By 9.30 a.m., Rachel was dozing in bed. Mark pulled out
the sleeping chair, covered himself in a sheet and tried to sleep a little too.
I noticed a strong contraction wake her momentarily at 10 a.m., but thankfully
most of the contractions were still fairly mild, coming every 3 to 4 minutes
and allowing her to sleep.
At
10.30, the morphine was wearing off, and contractions were too strong to
ignore. Rachel was very self- contained in the way she dealt with the powerful
sensations, breathing evenly, focusing well and remaining calm. Mark and I took
turns to apply counterpressure on her low back as she lay on her side, and the
morning slipped by. At noon, Vicky Murrain, Rachel's doctor, came to examine
her and pronounced that she was 80% effaced. This was excellent progress in two
hours, but there was still 10 cms of dilation that needed to happen before she
could push her baby out. In an attempt to really get things going, Rachel
decided to use gravity to increase the power of the contractions. She took off
the monitor belts and used the birth ball for an hour whilst Mark and I
continued to use counterpressure to ease the pain in her low back. However,
this caused little change in an hour so she decided that it was time for
pitocin and an epidural. At 1.20 p.m. the anesthetist, Dr Gong, came and
efficiently administered the epidural with the help of Diane, our new nurse who
was constantly assailing us with peals of laughter. By 2 p.m. Rachel was
sleeping comfortably, allowing the pitocin to increase the speed of dilation
while she rested and recovered her energy in preparation for the second stage
of labor.
The
afternoon crept by, contractions showing up on the monitor every 2 minutes.
Rachel and Mark were both able to sleep, and I sat mesmerized by the steady ups
and downs churning themselves out on the monitor screen as each contraction
came and went. At 4.30p.m., Vicky examined Rachel again and found she was 100%
effaced, 2 to 3 cms dilated, with the baby nice and low at 0 station. We were
all cheered by this news and subsequently delighted at 5.30 to be told that she
was now 5 cms dilated. There was a tense moment at 5 o'clock when the baby did
not tolerate 30 cc of pitocin, and his heart rate plummeted with every
contraction. The "pit" was immediately switched off and three highly
efficient women swiftly inserted an internal fetal monitor and an electronic
scalp monitor so that the baby could be watched more accurately. Mark and I
stood at the edge of the action, watching a little nervously as each woman
performed her task with alacrity. The baby responded immediately and
recuperated fast once the pitocin had been switched off. A much smaller dose
was started up again at 6 o'clock and was well tolerated.
Another change of shift at 7 p.m. and we had to say goodbye to Diane and welcome to Julie, efficient, strong and highly personable. Rachel was beginning to feel a little nauseated which was a promising sign that she may have been entering transition. At 8.15p.m., Vicky pronounced Rachel to be 8 cms with the baby still at 0 station. Textbook progress, 1 cm per hour! Rachel continued to doze while Mark cherished her standing by her bedside, gently massaging her neck and shoulders. The big moment arrived at 10.15 p.m. when Rachel was completely effaced and the baby had moved down to +2 station. It was time to wake up and push.
It
seemed to take a while for the energy to pick up in that quiet, peaceful room.
The first half hour of pushing was, I think, a learning experience for Rachel
as she gradually figured out through trial and error optimal positions and
places to push. Unfortunately, the epidural was still very strong — good for pain relief
but not helpful when it comes to feeling "where to push." After a
while, our roles became more clearly defined, and a great pushing routine was
established. Mark and I held a leg each, Vicky helped Rachel to direct her
pushing to the right area and Julie was always there with new suggestions on
position changes. Mark was also allotted the countdown task to encourage Rachel
to push to the count of 10 three times during each contraction. His voice was
always firm and encouraging, but he never yelled or got irate even when a
certain desperation crept in as the hours ticked by. At 11 o'clock the
anesthetist came in and switched off the epidural, but the effects continued
right through until after delivery which made pushing all the harder for
Rachel.
After
midnight, we all wished Rachel a Happy Birthday between pushes: she would be
having a very special birthday gift within the next couple of hours. The
baby did not seem to be able to come down under the pubic arch, and I could
tell that Vicky was becoming concerned that there simply was not going to be
enough room to birth the baby vaginally. In fact on a couple of occasions, she
got a second opinion in to check. Rachel desperately wanted to avoid a cesarean
but progress seemed to come to a standstill for a while, and the 24-hour
timeline from the waters having broken was getting horribly close.
It
was at around 12.30 a.m. on Friday that the energy suddenly picked up in the
room as we all realized that it was now or never. Rachel pulled her
legs back even further, curled her body up even more acutely, pushed even
harder, and it seemed that we all began pushing with her. On three
occasions, Vicky and her colleagues tried the vacuum extractor to help pull
the baby out of the birth canal, but it slipped off the head too easily. Finally,
third time lucky, Rachel gave an almighty push and the vacuum extractor stayed
on long enough to help lever the baby down through the final inches of life
inside his mother. At 1.11 a.m., an exhausted and jubilant mother gave birth
to a perfect baby boy weighing 6 pounds and 4 ounces, Maxon Bion Rubin -Toles.
With a name like that Max, you are going to go a long way! Rachel's dogged
determination, compounded with Mark's unfailing support, got her through all
the ups and downs of a challenging labor which could have gone in different
directions on several occasions had she not taken sensible and realistic options
and made them work for her. I admire you both so much for your tenacity, good
sense and strength during this labor of love. May the three of you spend a
happy and healthy life together. Thank you for allowing me to support you
during this special experience; it will forever remain the most memorable
and exhilarating Thanksgiving for me!
For Maxon
After Eight
First child, you were scheduled to meet
your landskind in the manger but got
your holidays mixed up. You couldn't wait.
According to the astronomers, B.C. is off by weeks
and several years - you're right on time.
Eager emperor, your dauphinage commenced
unexpectedly; but courteously you came
when your mother was on call - no wild cab ride,
pogo stick, Hell's Angels' pillion for you.
Green grape, the desert harvest comes according to the rains.
From your father: when inspiration calls you have to answer -
from your mother: it's good to know what to reply. So breathe.
"The readiness is all," said someone once who wasn't - but you were.
Early riser, first dawn snowball of the season, though
your eyes want to be filled with light, you ought
to bear in mind that sleep and darkness have their beauty too.
There's so much time for all.
Pink leaf, impatient acorn, when fall came your stem
let go and dropped you from the sea onto the sand.
The saguaros were astounded - tried
to lean over for a look. They aren't climbable -
I'm sorry - soon we'll find you trees that are.
Philip Hart
— November, 2002