#physiologicbirth

After dilating quite quickly from the time labor started, Jessica arrived at the birth center expecting to have her baby in her arms in no time. However, the nature of childbirth isn’t always that predictable and labor carried on. Despite Jessica’s own annoyance as to how long the birth was taking, she was reassured by the calm presence of her birth team, which helped her stay positive and patient. 10 hours later and laboring in every imaginable position, she pushed through and gave birth to her baby girl.  

What interested you in a birth center birth? 

In addition to seeing the Business Of Being Born, I have a few friends who had birth center and/or home birth deliveries. In fact, one of them had her youngest at Del Mar Birth Center. From what I heard and learned, I liked the idea of having more options, a quiet and calm delivery room and best of all: midwifery care!

You started your care at the birth center almost half way through your pregnancy, how did you make this switch? 

I started at an OB/GYN for monetary reasons. I wrongly assumed that my insurance wouldn't cover midwifery care. I didn't get to meet my doctor until right before I transferred, and when I did it just didn't feel right.

Harper was due around the holidays, and my doctor said he probably wouldn't be available to deliver her unless I scheduled a cesarean or induction beforehand. This was moments before I was about to tell him about my wishes for a natural birth. I called Del Mar the next day. 

I had actually toured the birth center before I conceived, so I knew when I called that I wanted to make the switch there and then. I requested to have my records transferred and had an appointment a few days latter. It was easy! 

What was the difference of care between an OB/GYN and a midwife. 

It's very different. You see nurses at an OB/GYN’s office and very rarely meet with the doctor. Everything is rushed since they have so many patients.

At the birth center, every appointment was with one of the midwives who would potentially deliver my baby and thus a relationship and trust was built in their care for me and my baby. It's such a safe feeling getting to know your care providers.

Also, you don't do a urine test every appointment at a midwife’s office and only do a few ultrasounds in the whole pregnancy. Our appointments consisted of acquiring vital signs for both me and the baby (hearing her heart beat via the Doppler was my favorite part), but mostly it was a nice chat about how I was feeling, my diet, exercise, sleep, work, etc. I even had a cup of tea brought to me during our meetings. This care for women by women was the most important thing to me. I never feeling rushed which was a bonus in the trust and safety in knowing your care provider. 

You took an 8-week childbirth education course. Can you talk about the benefits of a series of classes like this in preparation for a natural birth outside of the hospital?

My husband and I took Kathy Killebrew’s class. It’s a preparation course for natural birth and child care for both in hospital and out-of-hospital settings. 

Kathy covered all the stages of labor, breastfeeding and early home care. My husband started calling it “Baby University” as it was a lot of information! But knowing all the stages and gritty details of labor and birth as well as ways to relax through contractions was so helpful. I knew what my body was going to do (for the most part!) and it was empowering to allow it to do so without being afraid or wanting to control it. 

You tested positive for Group B Strep (GBS) in the pregnancy, which is typically treated in labor via IV antibiotics. While 30% of women are colonized with GBS, there's a 1-2% chance that if left untreated, a baby could become very sick from being exposed to the bacteria while coming through the birth canal. However, treatment with antibiotics come with its own host of issues. How did you receive the news that you were positive? How did you navigate all the information out there and come to a decision regarding treatment that you felt comfortable with?

When I got my test results, I was crushed. I phoned the on call midwife and cried. I'd been working so hard to have a healthy pregnancy, so this just felt like a failure. She reassured me I probably had GBS the whole pregnancy and that it’s pretty normal and common.

My husband Max and I studied the options together and ultimately decided against IV antibiotics. We read a study by Evidence Based Birth, which showed how other countries handle GBS in addition to speaking with a few of the other midwives.

In the end, we decided to use am antibiotic soap called Hibiclens. When applied to the vagina every few hours, it kills the bacteria where it counts and was much more appealing to me than an IV drip every two hours. 

Tell me about your birth experience.

I went into labor just a few hours before Christmas Eve. I had some mild early labor contractions after dinner and followed the advice from the on call midwife, Callie, to try and go back to sleep. Right around midnight I woke up just as my water broke! After that things moved very fast.

By 4 am, my contractions were super close together and very strong, so after speaking with the midwife, we decided it was time to go the birth center. When we arrived, I climbed right into the tub to relax in the warm water and have my cervix checked for dilation. I was pretty excited to be nearly 8 cm dilated! Max and I figured the baby would be born in no time!

Laboring in the tub felt great, but after a few hours things (contractions and progress) had slowed down. By this point, I was pushing so I moved to the toilet to try a new position – followed by moving to the bed and back in the tub. It felt like my baby was taking forever to come! 

Callie’s shift ended and Shayna came in. We realized I still had a tiny bit of cervix left – what the midwives call “a lip” – which was most likely getting in the way of my baby’s descent. So, in order to remedy the situation and get this show on the road, I lay on one side for three contractions without pushing and the switched to the other.

It’s hard to explain how hard that was. I was fighting every impulse to not push, as that was also when I realized pushing relieved the pain of the contraction. Thankfully, my hard work paid off and the lip went away.

But labor still dragged on. At some points I felt like I was so close and then something would stall.

All during this time, I felt I handled the pain okay. I knew going into it that it would be painful (and it was). Each contraction brought this whole body pain, but I knew it only would last a moment and then I would get a break. What got me though was how tired I was getting. Max was giving me water after every contraction and as the night wore on the midwife and nurse were getting me to eat some fruit for some energy.

I moved to the squat bar/ladder and started to make some real progress. I moved between the bed and bar for the last few hours. Finally, I got to the point where I just knew she was coming. I could see it in my midwife’s face and hear it in Max's voice. But then I saw this look of disappointment on Shayna's face – my body was stalling again! No way! I got out of bed and waddled over to the squat bar with everyone's help.

After just a few contractions it was finally time. One contraction on the birthing stool and my beautiful daughter was born. I've never worked so hard in my life! It was amazing to see her come into the world and to have Max right by my side as it happened.

You dilated quite quickly from the time your water broke, but then pushing took some time. What was going through your mind at this time? 

I was annoyed as I had this idea that she should have been born in a certain amount of time. I knew I could do it but my body seemed to be taking forever to push her out! I was starting to get so tired by the end, but I refused to give up. 

How did you stay present and positive? What kind of support was helpful?

Max really believed in me, and I did too. I think the whole birth team taking care of me is what did it. I didn't feel rushed and that allowed me to stay positive. If everyone was letting my body take its time then I knew things were okay.

Specifically, when Shayna helped direct my pushing efforts was very helpful. She put her fingers in my vagina and told me to push against them. Holy cow did that make a difference! Once I knew where to push into, my mind and efforts were much more focused. 

Did you think you were going to end up transferring? Did you want to transfer at any point? 

I didn't. In my mind as long as Baby and I were both healthy transferring was not an option for me. Later in labor the midwife or RN checked her little heart rate after every contraction so I knew we were both safe as we could hear it was at a solid rate.

I knew I could work through the pain – I just had to keep up my strength. I actually used her name as a battle cry towards the end. Ha! 

There needed to be a little resuscitation for the baby after the birth? Were you nervous?

This is funny to look back on as I was so high from the rush of endorphins after the birth that the building could have been burning down around us and I would have told you we were fine.

I saw the little mask go on her face, and heard Max's concerned voice but I just knew she was okay. It must have been a mix of mother intuition and total trust of my birth team that I didn’t feel fear or anxiety. We had been through so much together. She was also on my tummy skin-to-skin the whole time, so I could see and feel her making breathing efforts and knew she would come around. 

How did you feel a few hours after the birth going home? 

It was like waking up from a dream. I'd been pregnant for 37 weeks and now she was here – on Christmas Eve of all times! She was born at 4 pm, so by 9 pm, we were on our way home. We just crawled into bed and slept that night with Harper on my chest skin-to-skin.

We woke up the next morning and had our little Christmas traditions. While I was in early labor the day before, I made my Christmas cinnamon rolls from scratch. So Christmas morning I frosted them and we opened our presents as usual. It was a lovely quiet time to bond with our new daughter.

How do you think your experience being pregnant, giving birth and as a parent has changed the way you view yourself? The world?

I’ve been learning a lot about myself since even conceiving Harper. The pregnancy was all about being the best little vessel I could be for her: relaxing and eating a balanced diet.

Since her birth it's been learning to go with the flow and to take the little quiet spaces in my day to take care of myself. I love being a mom, it's a lot of work and there have been frustrated tears, but I wouldn't trade it for anything.

Knowing all of the hard work it took to bring this little girl into the world makes me feel really proud of myself. I feel strong and more connected with my body than ever before. I wish more women would consider going route of having un-medicated, out-of-hospital births. It’s not scary as some may think, and most of our bodies are made to do it!

I’m amazed at how my body has changed, what's already sprung back into shape and what I’ll keep as a souvenir of Harpers time in my womb. 

Tell me about your experience giving birth to your daughter. 

My experience giving birth was certainly different than how I had imagined it. I thought I would labor at home for most of the day and then at the birth center for several more hours before her birth. I thought labor would take a long time. It didn’t. 

I woke up at 4:30 am with menstrual-like cramps, got up to pee and then went back to bed. At 5:00 am, my water broke. It felt like a tiny explosion inside, like my baby punched me in the cervix. I actually heard a loud “Pop” sound along with the sensation of the water releasing. 

Immediately after, I started having contractions that were already two minutes apart but short in length (30-45 seconds long). We called the midwives a few times and were advised to get in the shower and labor in different positions to encourage the contractions to get a little longer. Each contraction was intense and came on quickly after the previous one. I couldn’t wait to get into the tub at the birth center. Luckily, around 9:30 am, my contractions were in a solid pattern of occurring every 2-3 minutes with each one lasting 60-90 seconds, which was the ticket that it was time to go to the birth center. 

When I arrived, Hayley checked my cervix and I was 5 cm dilated. While the birth center can’t admit a laboring woman until 6 cm (as anything less dilated is not considered active labor), I was told that I was clearly having active contractions and it seemed as if my labor was progressing quickly, so they allowed me to stay. I slid into the deep, hot tub which allowed for immediate relief and relaxation. So much so that only a couple hours went by before I felt the first urge to push. That’s when Hayley checked my cervix again and I was nearly completely dilated (10 cm)!

During the pregnancy, I had symphysis pubis dysfunction (condition in which pelvic ligaments become too loose prior to birth that makes walking and other movements incredibly painful) and the pain of it flared up during labor. I couldn’t get the stability I needed in the water laying on my side or on my back as I kept floating up, so I spent most of my time kneeling or on my hands and knees in the water resting my head on the side of the tub. 

When I started to feel the urge to push, my lower back began to hurt (which Hayley explained to me was the baby moving down and pushing my sacrum out of the way). I moved to the bed to aid my baby’s positioning and to allow my husband to have better access to my back to soothe the pain. I have to admit, I was a little disappointed to end up on the bed pushing, but a water birth just wasn’t working for me. 

When I was told to get out of the tub, I felt like I was drugged - my whole body was heavy and when I opened my eyes I saw flashes, and I couldn’t focus on anything except my breathing. (I guess that’s what they meant by being in ‘labor land’). But with the help of the team, I was able to get out and crawl onto the bed. 

I had been on my hands and knees on the bed pushing for about 20 minutes before the midwives could start to see my baby’s head. After her head finally came out, there was some relief but not entirely as I knew her body was not out yet. I was told to flip onto my back as they had to help get my baby out. I wasn’t aware at the time, but her shoulder was stuck behind my pubic bone and changing positions helped her body slither out of me (with the help of one of the midwives putting her hand in my vagina and getting her out. Ouch!). That last part was intense but over in a flash. 

As soon as they put my baby girl on my chest, I felt like I could breathe, see and think clearly again. She was pretty blue and wasn’t crying as much as I expected her to (which was a little scary) but she was fine. Her first noise sounded like a cat. It all felt like a dream. 

What was your exposure to natural birth and midwives prior to your own experience? Did you know a lot about birth or have a sense of trust in the ‘design of natural childbirth’? 

My sister, three brothers and myself were all born at home with midwives. I was lucky enough to get to witness the birth of my youngest brother. From this experience and knowledge of my other siblings’ births, I have always had an understanding that a woman’s body is designed with the purpose to create new life - a design that functions best when not tampered with i.e. drugs and other interventions. 

Besides family tradition, why was having a natural birth important to you? 

Having a natural birth was important to me for a few reasons: I hated the thought of any drugs given to me being passed to my baby. I had a soda once when I was pregnant and immediately felt guilty. :) I had a deep awareness that everything I did and put in my body would directly affect her, so I didn’t want to expose her to anything unnatural. 

It was also really important for me to be present during the time of birth. I was afraid that any kind of drugs administered during labor would prevent me from truly experiencing her birth. I didn’t want the fog brain. Turns out, the pain, exhaustion and hormones of natural birth create an interesting fog, but it goes away the second the baby is born!

Why did you choose a birth center vs. home birth?

It was obviously a natural decision to choose midwives for the care and health of me and my baby, but my concern with home birth, funnily enough, was not the safety of it but disturbing my neighbors and scaring our cats. So, a birth center seemed to be the closest thing to home with the privacy. 

Also, I don’t think I even considered the option of a hospital, as I always thought hospitals are for sick people and pregnancy is not an illness. However, when I became pregnant and had some issues early on, it forced me to consider it as a possibility. I am glad everything resolved for me and I was able to have my baby at the birth center, but it made me appreciate the medical technology available to women, if need be. 

Some women considering natural birth are afraid to go the birth center route because they believe they have a low threshold for pain and want to be in a setting where drugs are offered, just in case they need it. In planning a birth center birth, would you have considered yourself as someone with a high pain tolerance? 

Yes and no. I can deal with pain when its is purposeful. I have a low tolerance for non-purposeful pain i.e. migraine or leg cramp. If there is a good outcome from the pain, I can tolerate it much better. 

Were you at all nervous about experiencing the pain of natural childbirth? 

I was a little nervous, but I knew I could deal with it because I had to. There wasn’t an option of an epidural at the birth center, which was part of the reason I wanted to give birth there. If I had the option of one when I was in labor, I absolutely would have taken it, although I knew I would have regretted it afterwards. 

How would you describe the sensation of a contraction? How did you best cope with them? 

People had told me that contractions felt like more intense menstrual cramps. I didn’t think so. For me, it was a sharp and squeezing sensation along with a lot of pelvic pressure. I felt sure she was moving down the birth canal much faster that she actually was. 

Labor pain was nothing I could have prepared for - it’s enormous and all consuming. However, I got through it because I knew it would bring me what I wanted more than anything in the world - my baby girl. 

The only way I could cope in the moment was to yell and swear. A lot. And loudly. I remember thinking that I didn’t want my daughter to come into the world hearing loud, scary noises but that was the way I had to birth. 

My husband was also extremely instrumental in my capability to cope. He was confident and calm the whole time, holding my hand, which kept me grounded. He reminded me to breathe and offered me water after every contraction. 

What did you feel in the breaks between contractions? 

I stayed very internal between contractions - keeping my eyes closed. I didn’t fall asleep but I felt a combination of being exhausted and utterly focused on my breathing, the comfort of my hand in my husband’s and staying calm. There was no time for dialogue - neither external nor internal. 

How did you prepare for the birth? 

My husband and I did a private childbirth education series with his cousin who is a naturopathic doctor and licensed midwife. I read books and watched a lot of natural birth videos to try and familiarize myself with the range of what normal, physiologic birth looks like. 

I had watched many videos specifically of water births as I really wanted to have one myself. The women looked so calm - trance like. They didn’t scream or yell during contractions. None of them pooped (as far as what the viewer could tell). There was hardly any noticeable activity at all. I thought, “Hey, a water birth looks like the most comfortable, relaxing and peaceful way to give birth, so let’s go for that.” But in the moment, it was not entirely Zen or cinematic as I had hoped for. :) 

Most women hope for a fast labor like yours (8 hours from water breaking and first contraction to birth), however, the truth is that it isn’t any less difficult or painful because its shorter. In fact, some women may say that it might be more intense when it’s shorter. A normal labor length for a first time mom is 18-24 hours, so when all of that work is condensed in a smaller window of time, it can be a lot to cope with all at once. Did you have difficulties with this?

I think since it happened so fast, the pain was more intense than I had expected it to be. Even though my mom had a history of fast labors with all her children, I, for some reason didn’t think that would be the case for me. 

So having my labor start and take off made it difficult to catch my breath and wrap my head around it. I felt like I was dying, which was a little scary. At that point, I just wished for it to go even faster just so it could be over sooner. 

I think maybe a longer labor would be less intense and a bit easier to cope with but I don’t know. I am sure it’s hard no matter what!

What was your feeling right at the moment of birth and immediately after?

It was both the peak of the most pain experienced and then immediate relief. It was almost like a suction when she came out of me. After I felt her body come out, I just wanted to hold her right away. Sometimes I still can’t believe she’s mine!

How has your birth experience changed the way you view yourself? Your baby? Motherhood?

I learned the value of humility and humbleness from my experience of giving birth. Everything gross they say might happen happened to me! My vision of a quiet, serene water birth went out the window. And that’s okay. Both childbirth and motherhood is the greatest challenge and teaching of learning to surrender and staying present. 

While I no longer wear make up and don’t have the alone time I used to have (things I valued prior to the birth), I have never felt more complete. 

In a paragraph or two, can you tell me about your experience giving birth? 

My birthing experience was the most important thing I have done in my life, and the experience was a gift for me to remember.

At around midnight on Saturday morning, the contractions that I had been having on and off for about 24 hours had become too intense to sleep through, so I began laboring at home with my husband. We labored in the tub, in the shower, and on the bed, until it seemed as though it was time to go to the birth center. The intensity was immense and I felt as though it couldn’t get worse, but that I had worked hard, and it was now time to have the baby.

Upon getting to the center, I was checked by the midwife (Hayley), and found that I was only ONE centimeter dilated (the same as I had been at my checkup the day before), and that we should go home and continue to labor. For some reason, this didn’t upset me the way it should have; I had had such an easy, beautiful pregnancy, and, in a way, wanted to experience more in labor. I wanted to see how far my body would allow me to go, and go even further past that. I wanted to experience the rite of passage that made me want to have a natural birth.

The next few hours at home laboring allowed me to have that experience, where I turned inward and animalistic, and just existed in between contractions. 

We went to the birth center for the second time, labored for a few hours, and then pushed for a short amount of time in the tub and gave birth to our son, Milo, at around noon on Saturday. 

The rest of the day I felt like i was floating and I couldn't believe the previous twelve hours. It felt like a vivid and powerful dream that left me a changed person, a new mother.

Why were you interested in having a natural birth?

I have had many anatomical problems with my body before getting pregnant. I always felt that part of me wasn’t built correctly, that I would have to experience pain when others didn’t and I would always have to watch myself to make sure I didn’t worsen the injuries.

When I got pregnant, I felt, for the first time, that my body was strong, powerful, and purposeful. I had a healthy pregnancy and a healthy baby on the way, and I wanted to celebrate this beautiful rite of passage by experiencing it fully. I was sick of hospitals and doctors diagnosing problems, and I wanted to bring my son into the world without fear and clouded judgement. I wanted him to have a beautiful birth story, and to embrace the unknown with my eyes open.

What made you feel the most prepared for planning a natural birth? 

Jeff and I took Britta Bushnell’s class, “Birthing from Within,” and I found it to be one of the best preparations for the unknown in childbirth. Although there were some exercises about the physical aspects of labor, it was really focused on allowing yourself to prepare for not being prepared, and allowing yourself to let go of expectations. Spending every Wednesday for 6 weeks focusing in on fears and concerns, and sitting with them, acknowledging them, and letting go of them was not just a great preparation for childbirth, but it helped Jeff and I with aspects of our relationship, and it helped me in so many other facets of life.

Who or what was a helpful, key ingredient to ‘embracing the unknown’ while in labor?

Once the contractions started to build in intensity to where I couldn’t talk or rationalize my way through them, I found myself vocalizing the pain with low, loud moans. I didn’t plan on it - they just felt right. Somehow the vibration of the sound in my body helped overcome the pressure that I felt in the lower part of my body, and expressing this with my voice helped make the pain more literal and more manageable.

However, the most important coping mechanism was my husband, Jeff. The comfort of having him assume the responsibility of watching over me, of keeping in contact with our midwife, Hayley, and just breathing or making noise with me when I needed it was immeasurable.

There was very little that I communicated to Jeff through words during this time, but he intuitively understood what was needed, and did it as efficiently and helpfully as possible. There were a few times that he needed to step out of the room to speak with the midwife or to use the bathroom, and I immediately noticed that he had left - it felt like the floor beneath me began to crumble and I felt my strength wavering. The trust and power that he brought to the birthing process is one of the most memorable things about the entire experience to me.

Can you talk about your perception of the intensity or ‘pain’ of labor? 

The intensity of labor was beyond what I could have imagined, but somehow it was extremely possible. I would feel each contraction coming and know that the level of intensity was always going to be a few steps ahead of what I thought I could handle.

Each time a contraction would start I would tell myself, “I can handle this, I can feel this and experience it - this is natural” but it would always push me past what I thought it was going to be, and at the very top of the contraction I would have a moment where I would think, “Can I take this?” and then it would pass, it would end, and I would rest and feel relief, knowing I was one contraction closer to giving birth.

I think the nature of the “pain” in labor is fascinating because with most physical pain experiences, we don’t get breaks - they are continuous, and they signal that something is wrong and that we need to do something (rest, eat, move differently, take medicine) in order to fix it. Having the breaks, albeit 30-60 second breaks, during labor was a way to bring me back into myself and calm me down from the intensity. In a way, I would almost forget how intense the top of the contraction was each time until I was there, experiencing it, and then the minute I would reach that point of “no,” it would pass.

About a week or so after the delivery, I had already let go of the painful part of the experience, and the intensity has become one of the things that has made the experience so special for me.

What surprised you the most about this intensity of childbirth?

I had heard that labor was going to be the most intense, if not most painful, experience of my life. I had heard that I would revert to animal instincts, that I would find my own ways of coping with the pain, and that I could prepare for something, but anything could happen. However, it really wasn’t until I experienced this shift in labor, from a verbal, human place, to the instinctual, non-person that took over, that I understood what that actually meant.

I feel as though I experience a lot in my life as an observer, and along with the joys and thrills and sadness that I go through, I also find that I watch myself experiencing these moments - always observing not just my own reactions, but those around me. Labor changed this.

In a matter of hours, I let go of the ability to observe myself and really just felt as though I was existing. It’s hard to describe, but I kept visualizing the physical structure of my body getting stripped away and, with it, all the civilized things, the niceties, the learned personality traits that seem so ingrained just falling away. What remained was a warm, glowing, amorphous thing that was just the essence of who I was. It was who I actually was, and it was the most powerful and true version of myself - it’s the part that labored and gave birth to my son. It’s the part that took over in the hardest and most intense moments. 

Although, after the labor I seemingly went back to who I was, I feel as though that experience has forever stripped away the unnecessary aspects of myself that existed before. On a daily basis I find myself honoring the loss of an aspect of myself pre-baby, and welcoming a new, stronger and also more vulnerable self.

What would be your words of wisdom to pass on about childbirth? 

“Birth is a vibrantly sexual event,” says Elizabeth Davis (midwife and author of Women’s Sexual Passages), “physically and emotionally, something that we are not reminded of as a culture far enough. After all, birth is an intensely physical experience centered in the vagina with the entire pelvic region highly stimulated – the clitoris, rectum, anus, and supporting tissues and musculature – therefore, why wouldn’t be considered sexual?” 

Sex can be passionate and forceful with moments of discomfort or pain, but by finding relaxation, rhythmic breathing or a new position a woman can find ease without losing the momentum or focus if she were to tighten up or stop completely.

As a childbirth educator, I often encourage my students (parents-to-be) to really set the mood once the laboring mothers are in an active state of labor i.e. darken the room, enjoy a bath by candle light, play soft music, give a light touch massage and most importantly whisper words of affirmation and validation. This will not only help the laboring mother feel more at ease, safe and relaxed, but help her progress and sink deeper into the labor process. Otherwise, the normal, intense feelings of discomfort one experiences in childbirth can be perceived to be very scary and traumatic and cause a state of panic or distress which then slows down progress and causes more pain, fear, panic, etc.