Birth story - Mackenzie and baby Teddy

*Trigger warning* - use of word contractions, which isn't triggering to me; postpartum hemorrhage (minor); 1st degree tear; mention of postpartum depression after first birth.

FIRST BIRTH:

My first son was born July 1, 2020. I ended up being induced for very low amniotic fluid at 39+4. I was already 2-3cm and 80% effaced and was induced with a low pitocin drip. Water broke on its own 1.5 hours later and baby was shockingly born 6 hours after water broke!!

I got an epidural at 5 cm when contractions were already coming 1 minute apart and were extremely intense (thanks pitocin). Unfortunately, my epidural was never totally effective and I progressed very fast, but I also had a nurse who was dismissive and discouraged the check I was asking for when I was convinced I could feel his head. My amazing OB arrived and saw what was going on, immediately checked me, and I was complete. He stood up for me and was incredible. I pushed for 40 and baby boy Jack was here!

Immediately after birth I felt shocked and numb. I was stunned by a lot of what happened and had difficulty connecting with my baby. I experienced very severe baby blues that slid right into postpartum depression (PPD), which lasted 4-5 months, and am convinced my birth experience played a role in this. I do not consider my first birth traumatic, but it wasn't what I wanted for my second!

PREGNANCY:

I was very fearful of PPD happening again, so I was surprised when I felt really ready to try for a baby at 18 months postpartum. We did and conceived my now second son!

We'd moved to a new state when my first son was 1 (we live in the US and my husband is military), so I was with a new practice this pregnancy. I chose to see midwives at a hospital, and hoped to deliver at the midwifery birth center they have on the hospital campus that's in a separate building from the hospital and labor and delivery ward. I got covid at 4 weeks and was therefore recommended to take baby aspirin from 12 weeks through the remainder of the pregnancy, which I did. My pregnancy was uncomplicated and I was scanned at 36 and 38 weeks to ensure my fluid was normal and that my issues with pregnancy #1 were just pregnancy specific rather than repeating in my second one - fluid was always great.

I started having prodromal contractions on September 9 and had them for a couple hours a day for about a week. At 39+2 I asked to be checked and was 3 cm dilated and 80% effaced. I had a few days of non-stop prodromal contractions on 9/16, 9/17 (40+0) and 9/18. This was mentally tiring, but they were no big deal physically, and I had prodromal labor with my first so was accustomed to the sensation and to the mental challenges associated. I consulted my doula and decided to ask for a sweep at my appointment on 40+2 because I was already having so much uterine activity that I wasn't concerned about a sweep irritating things even further without sending me into true labor. Had it done that morning and went into labor late at night on 40+3!

LABOR AND DELIVERY:

I had some contractions during the day on 40+3 that just felt...different to me than what I'd been experiencing. They still struck me as very mild and came and went a bit until I went to bed, but they had a different, more powerful aspect to them that I could sense intuitively. My doula had me take an Epsom salt bath that evening to try and see if it was the real thing, and when they remained consistent throughout it (5 minutes apart and still more substantial than my prodromal ones) she told me she thought it would certainly be that night and to go to bed. I was still very doubtful because I'd only ever been induced with pitocin and was waiting to be ROCKED by labor to feel like it was the real thing. I had articulated this to her and was trying to be mindful of the potential differences between pitocin and spontaneous contractions, especially because my first came so fast that I didn't want to be caught off guard and let it go too late before leaving for the birth center! My husband is a doctor and has delivered babies, but not since medical school and I really didn't want to have him in the backseat of our car .

I went to bed around 930 PM. I then woke at 11:30 PM and, while I still was having no trouble coping on my own, I felt I had to focus on them and that they'd intensified. They ranged 3-5 minutes apart. At 1:30 I had been unable to go to sleep through them and just *felt* like it was time to go to the birth center. I had imagined waiting til I was having way more difficulty coping before going (I could still talk easily through them), but I was having labor shakes and instinctively felt like I needed to be at the birth center to really get into it. I felt like I was too nervous about it going too fast and missing getting there on time that I actually couldn't let things really kick off. The on call midwife I consulted said it was true they generally tell women to stay home if they could still speak through contractions, but that everyone was different and agreed it was time for me, so she told us to come in.

My husband and I drove in and got there right at 2 AM. I was doing absolutely fine in the car and kept saying I really hoped I was actually in labor and that I'd be so pissed if we went home . I then had my first contraction where I had to moan and couldn't speak right as we were pulling into the birthing center. I'd already been using up breathing but now really started focusing on it.

We got into triage and they took my vitals, monitored the baby, and checked me -- I was 5 cm dilated and 100% effaced. I was moaning through contractions during the time we were in triage and was finally unable to talk through them! Everything looked good and they brought me to the room I would labor in right at 2:30 AM. To me, it was magical in there. It was dark and there were a lot of votives that the birth center staff put out. The bed was beautiful and big...I'd been dreaming of this birth center birth for so long, it was almost emotionally overwhelming that it was happening for me after my induction experience with number one. I think I said to my husband: "wow, I can't believe this is happening."

I unpacked my bag which is funny to me in retrospect. My doula got there about 5 minutes later and said the midwife told her what I was doing on her way in and that things were likely about to kick off for me. I was still walking around talking and doing a bunch of stuff, and she told me I needed to stop doing things and get in the zone, relax, and let things happen! She was so spot on!!

We got some music going, I had a snack, and got on the ball. I leaned my elbows on the bed and started really focusing on the contractions, using my up breathing and doing figure 8s on the ball. Things immediately became more intense. I soon needed to switch positions, and told my doula. She grabbed a stool for me so I could lean into it in a sideways lunge-type position during surges. I did that for a while, changing to the other leg/direction after a bit, before saying I needed a new position again. I then got on hands and knees on the bed and we put a tens machine on me while I rocked backward and forward. I loved hands and knees with my first and it was great with this boy too! The pulses actually really helped me with my breathing rhythm. My husband also did consistent counter pressure during this time after I moved off the ball and my doula gave me a wooden comb to squeeze that I actually ended up bending/warping with my strength!

I'm very vocal during labor and my vocalizations had started intensifying. I was very focused on keeping my sounds low and opening my mouth, relaxing my body as much as possible. I asked if it was too early to use the shower, which I knew I would love, and my doula told me to go for the it and to use the restroom and then spend a few surges on the toilet if I could. I did so facing both forwards and backwards on the toilet, which I'd heard referred to in the past as dilation station, and then moved to the shower. I vividly remember hearing the nurse and my doula discuss starting the tub as I was getting in the shower and I was shocked, because I knew that my doula and I had planned we wouldn't go for it until transition. And I didn't feel that far along, or rather didn't think that could be that far along cause I still felt like I was doing really well.

I stayed in the shower for a while in different positions - using the bench and standing both with my belly and back under the shower head. My husband stood right outside watching me, giving me water, and saying affirmations, and my doula watched me from the doorway. Contractions intensified further and I became much louder in the shower. My vocalizations were very low and long, and I was thinking through affirmations in my head during breaks between surges. Some of my favorites were: "I can do anything for one minute"; "I am calm, I am safe, I am confident, I am powerful". During the surges themselves I was very focused on counting, and identified that generally I would go through three sets of up-breathing counts in each contraction at this point. So I would count the up-breathing beats themselves and then the sets to get to 3. Breaking things down like this and focusing on numbers all made things feel mentally manageable.

At some point - quickly - my doula came in and asked me if I wanted to get into the tub. I was surprised and asked "really? Isn't it too early?" And she said no, that it was a good time! The midwife also asked me if I felt downward pressure and initially I wasn't sure, but realized in the next contraction that I did feel things starting to press down almost with the surges. I yelled "YES!! I am!"

They turned some more of the lights on as I got in the tub, but that was okay, I was very much closing my eyes at this point and I kind of realized they were doing so because they thought they would be catching my baby soon. I asked if they thought I'd be transitioning soon, and they said they were quite certain I had transitioned in the shower. I was shocked and amazed and a little disbelieving -- I had expected transition to be much more intense than I had personally experienced it to be, and I felt extremely proud and grateful for hypnobirthing then.

They told me to listen to my body and do whatever it told me, that I could push if I felt the desire to. I did some but was sort of nervous about whether I was really complete - I was still very aware and in my head between surges. I gave some little pushes but then the midwife asked if I wanted her to check me because they could tell I was hesitant. She did and said baby was indeed there! My husband was in the tub with me now and things did really become very intense. The pushing stage was by far the most challenging for me. In the tub I began whispering: "I can do this, I can do this, I can do this" over and over because I was beginning to experience some fear and doubt. My husband, doula, midwife, and nurse were incredible - saying affirmations for me and providing counter pressure, offering me water.

I was shocked to find I actually didn't really enjoy being in the tub, since I love water and loved the shower. I tried a few positions and just....didn't really get comfortable. So I said I wanted to move and we went to the bed. I first tried hands and knees, and then, despite having asked to push off my back and not be coached....I asked to get on my back and have coached pushing .

I was having a very difficult time keeping the pattern of down-breathing and it just wasn't clicking with me. I wanted more help because I was unable to focus and was really losing my head with the sensation and intensity of those surges. They were quite overwhelming to me. I got a lot of help from the counting and from having help from ofhers holding my legs because I was resisting a lot and trying to pull my legs into a more closed position (thereby closing my pelvis) because I was so overwhelmed. They always asked before they did anything, and it was very empowering. I was in the driver's seat even though I was asking for help and losing my head a bit here.

I had asked at one point if my water had broken in the tub, because I never felt anything, and they said it likely did but they would check. Indeed it was still intact! They offered to break it but said it didn't matter to them and either way was fine, all up to me. I chose to because it could move things more quickly and the pressure from it was uncomfortable and felt weird to me.

All in all, pushing took only 25 minutes but felt like hours. I will never forget the intensity and sensation of this time. I was, frankly, screaming a lot. My husband was holding me the whole time and I experienced my only time of not wanting to be touched right before my son arrived. I felt the tremendous "ring of fire" for a couple of contractions and this was my hardest moment, but I got through it! Their affirmations and reminders to keep my legs wide and pelvis open were very helpful, and I finally felt the absolutely glorious relief of that moment when his head came out after my personal peak in intensity and struggle. I ended up having to actively push for the rest of his body - which I didn't with my first...he just kind of flew out after his head, but this one held on! He did turn out to be a full 1.25 pounds larger than my first. They also told me his fist was up next to his head, so they came out together!! I had a very small first degree tear that they almost didn't stitch, but the midwife ended up giving me one stitch to be safe.

When he was out I had the most unbelievably euphoric high. Seeing his little body be raised toward me - I specifically said I didn't want to catch him - and handed to me, and the rush of endorphins combined with the relief from the intensity of my surges was all overwhelming. I began sobbing that I'd done it, that I loved him. My husband was overwhelmed too and was kissing and hugging me. After having felt so numb when my first was born, this was the most unbelievably extraordinary moment. I immediately felt SO different. I truly felt like a superhero and so close to my son.

I soon delivered the placenta but did consent to a shot of pitocin and had a minor postpartum hemorrhage. I actually didn't even realize it until they told me and until I did feel weak and somewhat lightheaded in the hours following. All was very healthy after the first hour, and it was minor enough that it didn't change my care. I was monitored more closely but still got two hours of skin to skin solo with my son before weight etc. He was 8 lb, 2.4 oz!

POSTPARTUM:

We were released from the birth center after 8 hours and got to go home to introduce our boys. Our first has done amazingly well and nursing has been great. Perhaps most incredibly, I have felt radically different this time, when it comes to my mental space. My confidence is tremendous...I'm sure partly from being a second time mom, but I know also from what I did during birth. I achieved what was for me the ultimate physical and mental goal, which has been meaningful to me for a long time now, and I feel like I can do anything. The hormones from my spontaneous natural labor have undoubtedly contributed to my state of mind. My baby blues have felt very mild this time and I am praying and extremely optimistic that I will avoid postpartum depression this time. I am so grateful to this course for giving me the tools to do what I did and for giving both me and my husband so much confidence for labor. This was the most empowering experience of my entire life.