Birth from the perspective of a midwifery student (conference presentation)

A month ago I had the honour of making a presentation at the Ontario Student Midwives Conference at Ryerson University.  As a midwifery student, currently on maternity leave, it was a great opportunity to reconnect with old friends, and meet in-person virtual friends.  It was also a tough place to be given the tenuous position I have as an actual student (more on that another time), and given my topic.  I had submitted two proposals and both were accepted.  One, was an editorial piece I've been working on for a while but a presentation I didn't actually get a chance to make due to a mini family crisis when my 3 year old dislocated her elbow! The other, was this piece below, one that I cried when writing but somehow managed to get through without crying.  Though, I made many of my fellow classmates tear up. Keep in mind, this was written to be spoken, and to be listened to for about ten minutes so it is long and the tone may be a little different from my "blog" writing.

Being a midwifery student is hard work.  Maybe harder then we thought it would be.  Maybe not.  Those of us who are mamas have so much to re-learn, how to see things from the other side, how not to interject every five minutes with “During my births…in my pregnancy…when I was breastfeeding’  and those who aren’t mamas have to learn that they are not at a disadvantage so stop feeling like that and move on!  I do remember, in my first year, during With Woman actually, thinking, how amazing it would be to have all of this information before having a baby.  To be able to tap into all of these extra resources, and wealth of knowledge.  Um, yeah, not so much.

As I was preparing to write this presentation I spoke (aka, Facebook’d) with a few mamas from the program.  They had vastly different experiences from me and from each other.  Planned home birth.  Planned hospital birth.  Things went according to plan.  They didn’t feel like they’d had any amount of pressure or expectations as an MEPer.  Maybe it was just me then? And then I read an amazing paper by one of my classmates.  She had looked into the experience of giving birth as a birth professional.  Of the women she had surveyed, all of them a birth professional of one kind or another, many had felt that there was a certain expectation around the kind of birth they were going to have, felt that there knowledge both helped and hindered them, and that it was hard to not be in control. 

Now, I’m a planner.  To a fault.  But I had worked really hard at not having a birth plan, though every one does to a certain extent.  I felt I had learned a lot about myself, my body, the way I give birth, and my babies during my first two pregnancies and births and during this pregnancy.  Unbeknownst to me at the time, I would come to learn a lot more about myself.

My girls...and Mark like to dress up as Superheroes. And as a mama you feel like one. I obviously have an innate power, two really: the ability to incubate and nurture a human life inside my very own body and the awesomeness that is lactating boobs!

So when things went a little sideways with my planned home birth I felt like Supergirl faced with kryptonite. Actually no, I wasn't on the ground squirming in pain, I was more like WonderWwoman being harnassed by her own lasso. In case you don't know, that's her main weakness.

  

I initially though of this analogy to bring some humor to my story, keep myself from crying, but the more I thought about it the more accurate it seemed. As a mama-midwifery student aka Wonder Woman, it was my own knowledge that was tying me up and forcing me into the ambulance and to the hospital. From a midwifery student perspective, that was the ultimate villain's lair. But from a regular mama perspective, it was the extra knowledge, the extra help from fellow students, the "extra" that was tying me up and imprisoning me in my decisions.

You see, non midwifery types, still amazing mamas of three, Breastfeeding, baby wearing, loving their kids mamas, they did not understand why I was so defeated at having given birth in a hospital and having stayed there for 23.5 hours. They understood that it had not been part of the plan; but these women, whom I didn't know all that well, simply said " but you made the right decision for your baby. You didn't really have a choice. Not one where one or more of the outcomes would have been acceptable.". My friends, the students, they all had a lot of different things to say. Sympathy instead of empathy, sorrow instead of support, shock instead of agreement.

So why didn’t I have a homebirth? Poop.  I suppose the more appropriate way to say it, is that there was meconium.  A lot of it.  Thick, pea soup sludge seeping into the birthing pool. 

And the reason I had to stay at the hospital was a GBS positive screen with insufficient amount of antibiotics administered prior to delivery. And here’s what I have to say to my fellow midwifery students:  Stop.  Stop thinking about the odds ratios, the research, the facts, the myths, and the alternatives.  As your classmate, I know now, and knew then all of that information. But what I also knew, was that the institution I gave birth in had a mandatory 24-hour stay policy for mamas and newborns with a GBS positive screen or they would call CAS. 

CAS.  These three little letters.  Letters every parent – good or bad – dreads hearing.  Imagine, if you will, having just given birth to a beautiful, perfect little girl.  A beautiful birth.  An emotional high.  Conflicting emotions – the “wrong” kind of feelings are bubbling below the surface but you are pushing them down as you stare into the eyes – are they hazel?  Are they brown? – of your daughter.  Your midwives doing post partum things.  Your partner, leaning over you and your babe, kissing your head, pushing back your hair.  And all of a sudden arrangements are being made for you to stay overnight.  It doesn’t matter that the odds of your baby being affected by GBS are 1 in 300 to 1 in 1000.  It doesn't matter that you had some IV antibiotics.  You are free to go.  But if you check your beloved newborn out against medical orders, you will awake to Children’s Aid Society at your doorstep.  Now, consider again all of the informed choice, research, self-rightousness, strength, mama-bear protectiveness of not just your two older girls sleeping soundly at home, but of this new life you have never been away from.  And imagine, for a full minute, the idea of a stranger holding that baby and seriously considering that you are unfit.  

Being a midwifery student can really screw with your head and your heart sometimes and this was one of those times.  I knew my baby was fine, and safe.  I knew what to look for.  I knew the odds.  I knew my rights.  And I knew that my girls were going to wake up and be surprised at best, heartbroken at worst, that I wasn't there with the new baby.  But none of that compares to the even the most remote possibility of having to deal with CAS bureaucracy within the first 24 hours of my newborn’s existence.  I mean, honestly, I wasn't planning on letting the grandparents in the door!

As I prepared for this presentation I was searching for images and I came across the cover for a children's book about homebirth. And I came across gorgeous waterbirth photographs including ones of mamas with all of their children clambering to look at the newest sibling. And looking at these images, breaks my heart.  Every. Single. Time.  And there is no excuse for it.  When I speak to my partner, when I go over my story, when I speak to other mamas who aren't in the midwifery circle, it’s not really a big deal.  I had a beautiful labour.  I had a beautiful birth.  But most importantly, I had a beautiful baby girl.  But the fact that I read that damn book every single night for months, watched homebirth videos, and practiced birthing sounds and positions with my girls – all for nothing, that breaks my heart.  And, you can argue that they are young so they are fine.  To which I say, my middle monkey, she had to be reminded that we got to keep our baby.  And my oldest monkey who saw the middle one born, was also heartbroken and angry and we had a good long cry about it together. It’s hard to hear about other people’s wonderful water births with their children present because I didn't get that.  But that’s the midwifery student in me.  The mama in me, is grateful for having three healthy daughters.

 Sometimes I think that I’m not going to ever fully get over disappointing my girls by not having a homebirth for them.  And then, Mark reminds me that my girls are six and under and that sometime much sooner than I would like I will disappoint them in what appears to be a frivolous way to me – like, saying no to an Abercrombit Fitch sweatshirt, or to party they want to go to – and that will be the moment that sticks with them not that they missed Baby C’s birth. So, while many mamas probably dread the conflict of the teen years, I say, bring it on, it will totally  help me heal!  

So what does it mean to give birth while an MEP student? And what doesn’t it mean?

• Maybe because I wasn’t in Clinical Skills with my peeps, it didn’t result in numerous belly palpations, pulse takings, fundal measurements or fetascope listenings.
• It did mean that during Bruce’s lecture when he put up the graph of oral contraception – the one explaining why you have to take your pill at the same time every morning – even if you just hosted the end of the year party and your children aren't home to wake you up - that 50% of the class will turn around to shoot you a knowing look, and laugh.
• It does mean that at least twice you will be told you are huge and you will wonder how a future midwife feels like that’s an okay thing to a pregnant woman
• It does mean that you have a plethora of information –far more than even a well educated mama
• It means that you have expectations of being with a midwife, most likely a doula, that you will not freak out, that you will not request pain relief,
• It does mean when you go for your ultrasound and the technician makes assumptions about your sexual orientation, your desire to have the baby, the man in the suit being your husband, you hear Nadya’s voice in your head gently reminding you how you should never ever make those assumptions.
• It may or may not mean that you will cook and serve a delightful vegan meal for a dozen or so of your closest friends and family who all invade your house immediately.  Personally I came home and crammed my belly full of braised pork shoulder curry and rice.  And a Strongbow. And didn’t let anyone in the door for 48 hours.
• It means that when you are stuck in the hospital bed checking your facebook, one of your school friends will notice that you are at the same hospital she is making rounds in and will be the first to visit you.
• It means you can argue with the pediatrician and convince her to let you leave the hospital early.
• But it also means the L&D nurse will call you “one of them” for not letting her bathe your baby.
• It means that when you are forced to make a quick decision, it’s no longer impulse nor even informed choice that is guiding you, but information overload, and graphic visuals, anecdotes,  facts and figures clouding your brain.  And that no matter which way you lean, someone you go to school with, will offer their unsolicited opinion telling you that it was a misinformed decision.  And they do so because of the information in their head, not as a judgment, but it comes out very much as a judgment and a sentence “Guilty of not fulfilling the MEP student edict of perfect home birth!”  "Guilty of allowing the institution to dictate what you could do!"  "Guilty of submitting to the will of non-midwives!” 
• It doesn't mean that any of your decisions would have been different. Because you are a mama first.
• It doesn't mean that you are at a disadvantage.
• It doesn't mean that you are being judged.
• It doesn't mean that you failed in some way.  Unless you know, you actually failed.  But despite my hormone addled brain, I managed to pull off decent to hey-not-bad grades in my courses!
• It does mean that you will receive lots of love from wonderful women who will make the trek all the way to Mississauga just to visit you and your girls.

Baby C is my baby Hulk.  That is to say, she’s a happy baby, until she's not.  (And you don't want to make her angry.) Which is to say she is perfectly healthy.  Ultimately, there is no guarantee that she would have been had I stood my ground and not gone to the hospital.  But just looking at her, while she nurses, or laughs, or yells at the floor for not letting her defy gravity, I can’t say that I would make any decision differently except for – and this is the most contentious issue – maybe, just maybe, planning on a hospital birth.  If I’d planned a hospital birth with my girls present then they would have been there for the birth.  But, that wasn't really the images and experience I wanted for them, for me, for us.  R has one homebirth under her belt already, and while L will never get to see a sibling being born at home, neither will Baby C just by being the baby.  But, I figure most of my friends and classmates are younger then me and a few of them will probably have babies of their own one day – so hopefully, they can witness that.  You don’t mind do you ladies? 

A google image search is never as innocent as you claim.

So I sat down tonight to finish my conference presentation. One of two. I thought I'd start with the less formal one, the more personal one. Every night for the last week I've tried to finish it but seven gazillion programs needed to update on the laptop and the netbook and the router was slow and Mark was looking yummy so there was always a distraction.
Tonight started out well enough, no tech issues save a concern about the "quality" of images that was going to pop up given my search terms which included "Wonder Woman tied up" But I digress. I was almost done when poof an image came up, (not of Wonder Woman) and it reminded me of something and bang!!! I was a sobbing blurry eyed mess who ended up curled in a ball around her baby. I was caught off-guard, thinking I had closed the door on any regrets or questions. But seeing a picture of that damn book cover, one we read every night together for months, the girls and I. I felt walloped by what they had-we had-I had missed out on. I doubt it makes much of a difference to L right now. And I'm equally sure if I bring it up to R she too would cry. But I won't being it up and I wouldn't go hug them in their sleep because I don't want to make them sad. I'm not that kind of mama.
And seriously, ultimately I was being very self involved. I couldn't talk to Mark about it as he is not my therapist and while I did spit out the basics of what was making me cry he couldn't have understood how deeply I was aching. I suspect he thought I was reading sad stories online or lamenting not being allowed to have another baby.
The irony is, reading a sad story, linked to by Glennon at Momastery who is just, wow-made me snap out of it. There I was sobbing over my big girls having prepared so well for so long for the homebirth that never was, while someone else was mourning the one year loss of her son. Seriously, I was breathing in the warm milky breath of my baby with two sleeping healthy girls in the other room and I had the nerve to turn into an emotional wreck because we didn't get to have a home birth with the big sisters present?!??!! Studying Midwifery can really screw with your mind and your priorities. Hmmm, I wonder if I can use that as my presentation title?
Also, watch out for those google image searches!

Home birth at it's best: The story of L's birth three years ago

It was about this time (8:40pm) three years ago that my water broke all over my bed.  I was watching an episode of The Wire with Mark.  R was hanging out with her aunt in the other room watching a movie on the laptop and playing with the new fairy sticker book Mark had bought her just for this very day.  It was L’s due date and I’d been having some mild contractions throughout the early evening.  I’d called my sister and Mark before their work day ended to let them know, that despite the odds (of having a baby on their estimated due date) it seemed like I was about to go into early labour. 

My sister came by and Mark came home with fresh fruit and fruit juices as per my request.  I gave my midwife the heads up but she didn’t seem overly committed – given that my labour with R had been 36 hours, there was no rush especially considering I didn’t feel like I was in labour.  I played with R, I puttered, I ate dinner, I showered, I settled in for a night of TV on DVD watching and warm kisses with Mark.  And then I was hit with a pretty big contraction and started to climb off the bed to work through it and my water broke all over the bed.  The bed I had not yet made up with the double layers of bed sheets and plastic sheets for our planned home birth.  We paged Chris our midwife again and she said she’d head over to see where things were.  Mark filled the birthing tub and I drank some juice, talked to R to let her know we were definitely having the baby soon and climbed into the tub. 

Getting into the birthing tub was such a blissful experience for me.  During my labour with R, we didn’t have one and the only place I’d found any relief or comfort had been in the shower but that had still not been great.  Climbing into a pool of warm water provided me with a cocoon of heat and safety.  I genuinely felt like I’d managed to carve out a safe and private space for my labour.  The birth pool was set up in our living room, there were two soft lit lamps on, a music mix playing on low on my iPod, and not a clock in sight.  (I had unconsciously created an environment the exact opposite of my labour with R.)  R came running through the house to pour some water on me, rub my back, and then ran back to hang out with her aunt.  Her aunt who wanted to stay as far away as possible from the whole “birth thing” as she put it.  Being present for someone else’s labour is clearly not for everyone but my sister is the best aunt one could ask for and it was very generous of her to be there given her feelings on my nudity, blood etc.

My midwife and her student arrived shortly and set up all of their things and wanted to check me.  I reluctantly got out of the tub and let them do so, asking spontaneously that they not tell me how far along I was.  R came back to the living room where we’d covered our couches and floor with old but clean sheets and towels, and fed me ice chips.  After dealing with my midwife and the student being horrified we didn’t have a pile of postpartum supplies in a special box (I swear they were obsessed over the fact I didn’t have 8 receiving blankets and a baby hat in the living room but still in the closet about 12feet away- our old place being small.)  I climbed back into the birth tub and moaned “open” out loud, rocking in the water on all fours for what can only be described as bum labour.  With R, I had twisting cramping, rolling never fully ending contractions.  But this time, everything was happening in behind and it was actually something I could cope with, work through, and quite honestly, wasn’t too bothered about.  Mark poured warm water on my back, wiped a cool cloth on face, fed me juice and ice chips.  He was an incredible birth partner.  I don’t know how he managed to do all of that in a way that made it seem like it was happening simultaneously and in exactly the way I needed it to. 

Just before 10pm Chris asked me to come out of the pool so she could check me again.  She wanted to know if it would be okay for the student to check afterwards.  I didn’t want to get out of the tub but if I had to, I didn’t mind the student checking as well.  So I lay down on the couch, Chris told me I was at around 8cm and then I got hit with a wave of contractions and I told her and the student to get out of my way and that I needed to stand up to work through them.  It seemed so much harder and faster.  I started to panic.  I was standing and Mark was holding me, and the student was encouraging me to climb back into the birthing tub because I was screaming that I thought I had to go to the bathroom, and that I didn’t know what was going on and R was in the room and started to cry so my sister took her away.  And then I felt a burning sensation.  I put my hand between my legs and much to my surprise…I felt a head!  I had gone from “about 8cm” to baby crowning in the time it took me to stand up and take a few steps.  The panic and screaming had only been about 90 seconds long as I went through transition.  I really wish my midwife had explained this to me; however she wasn’t in the room and it happened insanely fast. Knowing this, being able to explain it to myself, helped me focus. I was flooded with relief and everything became crystal clear.  “Mark!  That’s her head!  That’s our baby’s head!”  I said excitedly.  I happily (yes, happily!) called for R to come back, promising her that I was okay, that our mini monkey two was coming right now. Meanwhile, baby’s head was descending rapidly, my midwife was across the room still on the phone with the backup whom she had been telling I was at 8cm not that I was actually giving birth!  I now had two hands on the head and was laughing from the very pleasant sensations of birthing.  I wouldn’t necessarily go so far as to call it an orgasmic birth; but it was tickling!  R was watching from the arms of my sister, both wide-eyed, for different reasons.  Mark was holding me as I stood. Encouraging me and later he would admit to thinking he was going to have to drop fast to catch our baby because he didn’t think Chris was going to walk over to us in time.  But she did and knelt in front of us and said seriously and rapidly that I was going to have to do some movement as the shoulders were sticky.  “Ok!  What do you need me to do?”  I asked and in an instant I had one leg propped on the couch and out came baby L.  I honestly don’t think Chris thought I’d be able to move that fast into such a position.  I went from 8cm at 10pm to holding my baby at 10:08pm. 

I sat down on the couch as our baby was placed on me.  They couldn’t actually bring our baby all the way up to my breast because the cord was so short.  R was right beside me at this point and as she had wanted, she got to tell me that the baby was a girl.  Mark told me that R just kept checking on me and when he asked what she was doing she said “Waiting to see the placenta come out too.”  Eventually it did and it took a while – they had to remind me to focus on pushing and massaged my uterus too.  But I was so enthralled with our new baby, I didn’t pay too much attention.  I did see the placenta which we kept in and actually not only froze but moved with us to our new place for burial.

Mark dressed little L in the clothes R had picked out for her.  We had a shot of bourbon.  We impatiently waited in bed, where we’d relocated after my shower, for the midwives to leave.  It seemed to take forever when all we wanted to do was lock the door and go to sleep.  R climbed into bed beside L despite the fact that her own bed was actually attached to our bed, she wouldn’t leave her baby sister.  And in the morning when she woke up and found that Mark had moved her, she climbed right back over him and put her arm protectively, lovingly, and gently around little L and it has pretty much been there ever since either literally or figuratively – and I hope it’s always there. 

While I truly believe any birth that results in a wonderful new addition to the family is the perfect birth; I will admit that little L’s birth was about as midwifery home birth perfect as one could hope for.