Ann wrote up the story of the labor and delivery leading up to Madeleine's birth and submitted it to the journal Midwifery Today. It was accepted and has just been published in the Winter 2008 issueas "A Surprise Posterior Brow Birth." The article is not available on the MT website to non-subscribers and we decided not to publish it here because of some graphic anatomical details, but we can email you a copy if you let us know you want to read it. They published a few photos of Madeleine with the article: a family photo with her as a newborn, a family photo on her second birthday, and one with her breastfeeding her baby doll.
Ann's water broke at 4am on 7/8/2006, and contractions started at around 2am on 7/9. We were pretty excited, as they were under 5 minutes apart when they started, and over 45 seconds. But over the next 60 hours, the contractions alternated between slowing way down and speeding back up, and Ann only got a couple hours of sleep. We tried a whole number of options for encouraging labor, stopping short of castor oil. We were becoming concerned that Ann may get too exhausted to push the baby out if the labor didn't progress more quickly, and of the greater potential for infection with the water breaking over 72 hours earlier (or perceived dangers and hospital protocol if we had to transport later).
On the afternoon of 7/11, we decided to leave home to go with our Plan B, to give birth at St. Luke's Hospital in San Francisco with their Homestyle Midwifery group. The main decision point to do so was to get pitocin to encourage Ann's contractions. And indeed they did. Ann went from 4 cm to 10 cm in about six hours, and then pushed for 2 hours and 13 minutes. To everyone's surprise (there was no good way to tell before the birth), Madeleine came out in "posterior brow asynclitic" presentation, forehead first, facing up and tilted to the left. That only happens in 1/1000 births and means the head is coming through in the widest possible angle. We found out later that obstetrical textbooks say it is almost impossible to give birth vaginally in such cases and it usually means an automatic C-section. (Only 3 in 10,000 are born that way vaginally.) Well, Ann pushed her out without pain meds, but ended up with 70+ stitches because of the fourth degree tear it created. The birth was apparently the talk of the Labor & Delivery floor the next day as none of those who worked there had ever seen such an occurrence.
Ann did an amazing job through the labor and birth. Her sense of humor came through, and the midwives wrote down some of her choice quotes on her charts ("I am woman, here me roar!"). She startled everyone an hour after the birth when she jumped up to start pushing out the placenta... she must have had some good hormones going!
While we obviously would have preferred a home birth, we were happy with our decision to go to the hospital, and felt that the "home-style" experience at St. Luke's was the closest we could have come to our desired birth at a hospital (despite some minor annoyances with hospital protocol). There was a great midwife there and a very helpful midwife in training who capture much of the later labor and birth on camera and videotape. Our midwives were able to pretty much do what they would have with us at home, and one of them caught Madeleine as she came out. (In the end, we went through the entire pregnancy and birth without ever having to see a doctor.)
Lots of people keep asking about our birthing tub—what does it look like, how does it work, how big is it, etc. We rented an AquaDoula tub from someone in Oakland. Basically it's like a collapsible small hot tub. We set it up in the corner of our bedroom and filled it for a trial run recently.
It takes about an hour to fill it with hot water, from a hose run from the kitchen sink. There is a heater we plug in to maintain the temperature at around 100 degrees. When you're done with it, you pump out the water through the same hose (our new Fuji apple tree got a good drink when we emptied it the other day).
It's an option to give birth inside the tub, although we're imagining just using it for during contractions leading up to the birth.
There are several folks in the East Bay that rent them and they are becoming more and more popular because women attest that they ease labor pains and make it easier for them to feel comfortable by taking the sensation of their extra weight off.
We still haven't settled on a name for this baby due on July 12th, but we've taken to nicknaming it the "Shape Shifter" because of the shifts in tectonic plates that regularly seem to take place under the skin of my belly. Paul recently saw a picture of an infant boy who was born with three arms and suddenly we wondered if our child has that many limbs. When most people hear how active this little kiddo is, they usually reply "It must be a boy." My thought on this is "They must not know us very well, because if that's the case, it's more likely to take after me than Paul."
As of this posting, we have a little less than a month until the due date. Most things are in place for the planned homebirth and we're feeling excited and confident about our choice after taking a great homebirth education class through the Bay Area Homebirth Collective, (of which our midwives are members). I thought I'd be more nervous and fearful the closer the time came at the thought of not going to the hospital, but in fact, the opposite has been true. We are so relieved at the idea of laboring in our own home, surrounded only by the people we want to be present, and having the freedom to move about and go through the labor as we please with two midwives we trust who have attended 1,100 homebirths. For those who are wondering, yes, we're renting a birthing tub, but mostly we're assuming we'll use it just for the labor, not necessarily for the birth. But stay tuned - we'll let you know if we have a water baby (and if the baby has three arms).
By the way, we're still taking suggestions for names: first, middle, and last, for a boy or a girl, so let us know if you think of a good one.
Our biggest news of the year 2005 was that we discovered Ann is pregnant and we are expecting our first child in mid-July 2006. No, we don't know if it is a boy or a girl, and we aren't planning to find out until he or she makes it's arrival, although Ann is fairly sure it's a boy and Paul is equally as sure that it's a girl. In the tradition of Ann's Oregonian friends, we have hired two midwives and are planning a homebirth.
We announced the good news to our families at Christmas. We printed up "gift certificates" with the following text:
Good for the redemption of one (1) new grandchild*
Valid July 2006.
* No substitutions or returns. This offer is not transferable. Gender based solely on availability. Void where prohibited. Not responsible for damage caused by spit-ups, hair-pulling, chewing, or bowel movements. This card may not be redeemed for cash, check, or credit. Batteries not included. Baby may be unavailable for social interaction for long periods during the first year due to frequent naps. Use only as directed. Small possibility that this offer may be immediately doubled or tripled, but the parents sure hope not. No warranty of any kind is made, neither express or implied. Any and all risk on entering grandparenthood is assumed by you, the recipient. Do not use while operating a motor vehicle or heavy machinery. Resemblance to any real person, living or dead, possibly even you, is not coincidental, but is to be expected.
We will be having a home birth, and this revelation has gotten a variety of reactions from our friends.
We are not anti-medical in general, and would go to a hospital in the case of a significant complication. Ann has worked at a hospital chaplain at the Alta Bates-Summit Medical Center, and has counseled mothers/families after neo-natal deaths.
Certainly, there are risks to having a birth, whether one has them at home or in a hospital. A number of medical studies have been performed to compare the risks of low-risk births in hospitals (attended by doctors) vs. those outside hospitals (attended by midwives). A study of over 5,400 home births was just published last year showing deaths at 1.7 per 1000 home births (vs. 1.9/1000 average at hospitals). This study, which also surveys other past studies, can be found here.
While medical intervention can be life-saving and we intend to take advantage of it if we find ourselves in a high-risk situation, it it not always the best option. Unfortunately, hospitals can be very aggressive at pushing for medical intervention when it is not the best option. Unnecessary epidurals, episiotomies, C-sections, etc. can significantly increase the risk of giving birth. The study found these kinds of interventions much lower with intended home births compared to planned hospital births: episiotomies (2% vs. 33%), caesarean (4% vs. 19%), vacuum extraction (0.6% vs 5.5%). That's 16x, 5x, and 9x higher rates for hospital births than planned homebirths. The rates of death/health problems were about the same (if not lower) for home births. Rather than letting nature take its course, hospitals are more concerned with hastening births. Also, the rate of infections for mother and baby increase 1% every hour that someone is in the hospital. Thus if mom and baby are in the hospital for 2 days, there is a 50% greater chance that one of them will contract an infection from all the germs going around at the hospital.
We interviewed a number of midwives, and decided on a team of two who have performed over 1,100 home births between them (more than many doctors). They draw blood for tests, can give IVs if necessary, have certification in neo-natal resuscitation, can supply oxygen to mother or baby, give medication to stop hemorraging, do stitching, etc. They have seen all the complications, and we trust their judgment in recommending a hospital transport. We also feel we are getting excellent service and attention, and get at least 1 hour pre-natal visits every three weeks (more frequently closer to the birth) and six post-partum visits. Unlike being in the hospital where it is not guaranteed that your ob-gyn will be at the delivery and nurses pop in and out frequently, we are assured of having our midwives with us during the entire labor process as soon as we request their presence.
While home births may sound like something from another time, medical studies show them to be as safe or safer than hospital births for low-risk pregnancies. This is not to mention all the other advantages of home births, such as giving birth in a comfortable space, having a greater sense of control and decision-making in the birthing process, and avoiding psychological effects of aggressive intervention on mother/baby. Almost all of Ann's friends in Oregon gave birth to their children at home, and as one of them remarked "It is the most empowering, gentle, and loving way to give birth that we can imagine." We are definitely looking forward to the experience.