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Tuesday, August 25, 2015

My birth story: Natural birth after a 4th degree tear

My birth story from my first child can be found here.

And my birth plan for the birth you're about to read about can be found here.

This story probably starts on Saturday morning, August 15, when I woke up feeling so fantastic that I actually decided to go to Zumba class. I couldn’t believe it – 39.6 weeks pregnant, the size of a house, and feeling awesome enough to actually go and dance through an entire hour-long Zumba class. I hoped maybe the exercise would help shake him loose.

The face of a genuine idiot!

The next day, still no baby. We took Audrey to the local spray park to play in the water, and then my mom and I went for a three mile walk that afternoon. I felt a bit crampy with a contraction here and there, but nothing noteworthy. Of course, I still made sure not to tell anyone about the crampiness, in case it was a sign of early labor. I didn’t want to jinx anything.

That night, I went to bed early and fell asleep quickly. But I woke up several times having strange dreams. Pain dreams. After the third or fourth time, I realized that I was being woken up by contractions. I let myself get a little excited.

At 10:20PM or so, I was woken up by another contraction, and then I felt the slightest trickle between my legs. My heart skipped a beat and I felt my adrenaline surge. My water must have just broken. It was going to happen tonight.

I reached over and tapped Jesse on the arm until he responded. “I think my water just broke,” I whispered. “And I’m having contractions. I think I’m in labor.”

And Jesse’s response? “No. Don’t do it tonight. August 17 is a terrible  birthday. Just go back to sleep.”

Deeply offended and annoyed, I went to the bathroom to inspect the situation, but there were no further gushes of fluid. The original trickle had been so minor … maybe I had imagined it. Pregnant women’s vaginas can be a bit … ahem … unpredictable in their fluid levels, after all. Dejected, I went back to bed and closed my eyes.

At 10:35, an unmistakably large gush of fluid came out of me. There was no denying it this time; I was in labor and we were going to have a baby tonight. I reached over and tapped Jesse again. “I wasn’t imagining it,” I said when he responded. “This is happening tonight. Get up.”

Suddenly, Jesse came alive. “Really? Really??! Oh my god. Are you having contractions? Did your water break?”

“Yeah … it broke a while ago. When I told you it broke.”

And then we realized that the entire conversation Jesse had had with me, where he complained about the August 17 birthday and told me to go back to sleep, had occurred while he was completely asleep. He remembered none of it. So I guess I don’t need to be mad at him for the shit he said. I don’t need to. I can still choose to. :-)

We got our bags organized, woke up my mom and told her she was on Audrey duty, and then took off for the hospital. Contractions started coming pretty regularly along the way – I downloaded an app to track them (of COURSE there’s an app for that) and found that they were about three minutes apart and lasting a minute each. Shit was on.

We got to the hospital and were overjoyed to find out that the midwife on call that night was the same one I had seen for every appointment when I was pregnant with Audrey (during this pregnancy, I saw a different midwife for every appointment, so that I would be acquainted with the whole team before showing up to the hospital to give birth). She was as excited to see us as we were to see her.

In the Labor & Delivery triage room, I was hooked up to a machine to track both baby’s heart rate and my contractions. Even though my birth plan specified that I wanted these to be tracked only intermittently throughout my labor, they needed to track them steadily for 20-30 minutes when I first arrived so that they could make sure that everything was going well in my uterus.

Ready to do it to it.

While this was going on, it was also time to sign some papers … and have a very difficult conversation with the midwife.

You see, as many of you well know, giving birth to my daughter Audrey was a bit of a disaster at the end. She got stuck in the birth canal and her heart rate was dropping, which necessitated an emergency episiotomy and vacuum-assisted birth to get her the hell out of there as fast as possible. Unfortunately, these interventions led to me getting a fourth-degree tear, which is when the perineum tears completely apart and the vagina and bumhole merge into one superhole called a vaganus. It sounds horrendous and I’m sure you’re all crossing your legs right now even if you were already well aware of this story, but I’m TELLING YOU RIGHT NOW that I did not feel it happen, it didn’t hurt as it healed, and it healed completely without issue. Stubbing my toe really violently hurts a lot more than that fourth-degree tear.

HOWEVER. Healing completely from one fourth-degree tear is one thing. Healing completely from two fourth-degree tears is asking a whole lot more of one’s body. There be scar tissue in them hills. Scar tissue tears more easily and has a harder time knitting back together when it does. So another fourth-degree tear would be really bad and could lead to me having bowel incontinence issues for a lonnnnng time.

Therefore, my birth plan specified pretty clearly that if we reached a point where those same kind of interventions were going to be necessary, I would prefer we ABORT ABORT ABORT and go for a C-section instead.

The midwife and I discussed this for a bit and she understood my perspective, but wanted to get the OB in there as well to have a chat with me (since if things reached that point, this birth would no longer be a midwife show and would be handed over to the OB-GYNs to handle). The OB’s point of view was essentially this: we will do our best to do as you request, BUT … if the baby is low enough down that his head is basically sticking out of you, we can’t really push him back in and give you a C-section. Or rather, we can do that, but it could take up to ten minutes to get it done, and you’d have someone’s entire hand in your vagina pushing the baby back up, which could also cause a big tear. Whereas using the vacuum on you for 15 seconds might be all it takes to pull him out. The only way to truly avoid your nightmare scenario is to do a primary C-section right now.

I only paused for a moment. As much as having another fourth-degree would suck, the chances of that seemed pretty low. Having a primary C-section and going home from the hospital with staples in my abdomen was a 100% guaranteed suck. So I told the doctor that I understood what he was saying, and that if things really got hairy I would of course defer to their judgment on the whole vacuum-assist thing, and that I would much rather have a vaganus and a healthy baby than an unhealthy (or even deceased) baby but HEY DID YOU SEE HOW GREAT MY BUTTHOLE LOOKS?? So that’s where we left it – everyone crossing their fingers that it didn’t come to any of this, but understanding that a C-section is preferable to another fourth-degree tear, but a fourth-degree tear is preferable to a damaged baby. And cross my fingers I did.

At this point, I was transferred to the birthing suite and hooked up to my antibiotic drip for Group B Strep. I’m allergic to Penicillin, so lucky me, I got to be hooked up to a mighty powerful antibiotic called Vancomycin that takes a full hour to dispense from the IV rather than the ~20 minutes or so most people have to suffer through when they’re GBS positive. Harrumph.

During all this, my contractions had slowed down somewhat, probably because I was lounging in a bed rather than walking around. In fact, the contractions got so manageable that I spent the entire hour of the antibiotic drip, from 1AM to 2AM, lounging in bed (minus the trips to the bathroom for the Labor Shits, which are like Period Shits but on steroids. Oh god it’s so terrible). When a contraction would come on, I discovered that for some reason, I really liked rubbing my face as hard as I could while Jesse rubbed my scalp as hard as he could. Like, this was not some gentle Asian lady at the salon giving you a friendly scalp massage. We were rubbing like we wanted the skin to come off. And it felt wonderful.

Finally, FINALLY, I got to ditch my IV at 2AM, at which point I knew it was time to start walking around so we could get this show on the road. It’s a funny thing, being so in charge of your own labor. I knew full well that walking around was going to make things suck a lot more for me, but I also knew that if I didn’t do it, we’d be here forever and they might start floating words like “Pitocin” if I couldn’t get things moving enough on my own. So I took a deep breath, and up I went. And of course a big fat contraction hit the instant I stood up and dropped baby’s head onto my cervix.

I turned on a podcast of trance music that I’ve loved for years and years and know every single beat of, and I just stood there with my iPod on my upper arm ‘dancing’ to the music. I put ‘dancing’ in sarcastic air quotes because my dancing was like the one guy at the rave who is so f***ing high he can’t even communicate in English anymore and only understands the language of the staaaaaaars. I closed my eyes, templed my hands in front of me, and bounced back and forth from one leg to the other, lolling my head along with my body as I bounced. And every time a contraction came on, Jesse would jump up and try to remove the skin from my head. It was going well.

The podcast went on for an hour and I listened to the whole thing … so that would put us at around 3AM or so. I then decided that I wanted to give the shower another try.

I am a big time shower relaxer. Nothing takes the edge off for me better than a supremely hot and endless shower. But when I was in labor with Audrey, for whatever reason, the water in the shower at the hospital was NOT hot enough. It was truly the worst part of my labor with her – cowering in that almost-but-not-quite-hot-enough shower, fighting through contractions and brimming with disappointment. I would take ten fourth-degree tears in a row before I’d repeat that shivering misery.

But this time, the shower cooperated. We turned that bitch up to 11 and in I went. And since Jesse was the only person in the room with me this time (last time I had my mother and doula in the room as well), I felt zero shame in just getting completely naked in the shower. Which was way, way more comfortable. Highly recommend.

I was in there for what seemed like ages. The midwife came to check on us and told me that when I have a contraction, I should squat down because that will put more pressure on my cervix and will help it open up faster. This sounded like a terrible idea because opening my cervix is painful and I don’t like it one bit … but alas, she was right. So with every contraction, I squatted down and Jesse adjusted the shower spray to be right on me as I huffed and puffed and shouted and moaned and shrieked “I DO NOT LIKE THIS I DO NOT LIKE THIS” on repeat.

It was while I was in that shower that labor turned on me. It all went from manageable to MOST F***ING UNMANAGEABLE. I asked Jesse to get me the egg-shaped birth ball, and I sat on it. And the contractions reached a point where I started feeling that urge to push, even though I knew it was way way WAY too early. But urge to push changes the way you sound during a contraction. Instead of just a higher-pitched AHH AHHHH AHHHH screaming sound, you get a nice mix of AHH AHH AHH UNNNGGGGHHHHHHH AHH AHH AHH UNNNGHHHHHHH as you start pushing uncontrollably like you’re having ferocious diarrhea (btw, thanks Labor Shits for clearing me all out so that I wasn’t actually having ferocious diarrhea in the shower). The nurses all know to listen for this change.

The midwife came back to check me again, and she found that my cervix was open a solid 6cm and fully effaced (thinned out). I was starting transition, a.k.a the worst part of labor. A.k.a THE WORST HOUR OF MY LIFE.

I’m not going to sugar coat this: transition this time around was the most savage, relentless torment I have ever experienced in my life. I hope to never go through something like that again as long as I live. I crawled out of the shower and it was all we could do to dry me off a bit before another contraction came. I waddled over to the bed screaming and grunting and shouting “THIS IS NOT OKAY. THIS IS NOT OKAY.” I sat down on the edge of the bed to try and put my hospital gown back on, but another contraction hit and I peed everywhere. I screamed for Jesse to get my sweat band out of the bag, and then another contraction hit. At this point, they weren’t even going away before the next one would start. The contraction would take off, peak within 10 seconds, remain at that peak for another 20 seconds, and then dissipate back down to a 20% level or so before the next one would take off. It never stopped.

The sounds I was making were terrifying and primal. Screaming, but not prolonged “I’m being murdered” screaming. Just these awful bursts of “AH AH AH AH AH” like a hyena caught in a trap. I wanted to put my mesh panties back on because I couldn’t stop peeing, but the thought of holding still long enough for Jesse to put them over my feet was inconceivable. So no mesh panties.

I screamed that I was too hot, that I was burning up from being in the shower for so long, that I was going to die. The nurse turned on a giant fan and aimed it directly at me. And by god, it was the best thing I’ve ever felt.

I decided I needed to turn around and get in the ‘open knee chest’ position, which is basically yoga child’s pose. It uses gravity to take baby’s head off the cervix, and I knew that if I couldn’t get a break, I was going to break. So I turned around and gripped the edge of the bed.

The midwife checked me again at this point, and said I was there. There was just one tiny lip of cervix left. “I’m just gonna go get some stuff and then we can do this,” she said, and I was in complete shock. I knew things had been moving fast and those contractions-on-top-of-contractions had probably been doing good work, but to actually be ready to push?

This was also a very strange emotional experience for me. With Audrey’s birth, I never really got to experience that “IT IS NOW TIME TO PUSH” moment. Things were already 1000% drama at that point, with my room full of nurses and doctors and anesthesiologists as I was given the instruction to “push NOW and if the baby doesn’t come out we’re doing a C-section.” But here we were, just me, Jesse, one nurse, and the midwife, and she was telling me it was time to actually push in a normal and controlled manner.

So I did. Contractions would come and I would push-push-push, and then the contraction would lapse and I would stop. It was all so normal. I could feel the midwife back there tugging and stretching at my perineum, rubbing mineral oil into it and doing everything she could to ensure I didn’t tear from bow to stern again. I pushed and pushed, and everyone kept telling me I was doing a great job, but I didn’t really feel that way. If I was doing such a great job, then why was the baby still inside me? Somehow, I had convinced myself that I could push him out with just a few big heaves. So I asked the midwife, how was it coming along? Was I actually making any progress? And she told me … to feel for myself.

I was reluctant. Even though my birth plan specified that I would like to touch baby’s head as it crowned, now that I was actually in position to do so, I didn’t want to. But she pretty much told me to DO IT NOW because when else in my life could I possibly get to experience something like this? And she was right.

So I reached down and felt that there was the top of a baby’s head sticking about a quarter inch out of me.



At this point, I realized that pushing in this position wasn’t working for me anymore. I was spending far too much energy just trying to keep my balance on my hands and knees, and my legs were getting tired. I asked if I could try something different, and the midwife suggested that I roll onto my side instead. That way, I could relax and let the bed hold my weight, but with one knee up in the air, my pelvis would still be wide open in a great position to make room for baby to come out.

This position was fantastic. I was comfortable, and I felt strong enough to keep working. I kept pushing with each contraction while everyone reminded me to tuck my chin into my chest for maximum pushing power. I’m pretty sure I pooped. I’m 100% sure nobody cared.

The midwife told me to reach down and touch the head again, and this time I did so without hesitation. It was definitely farther out than it was the first time I touched it. It was incredible.

With each push, I found myself experiencing the famous “ring of fire” that women talk about – that as the tissue of the perineum stretches to the max, it starts to burn like hell. But this didn’t even register as pain to me – it was just an interesting feeling that I didn’t get to have with Audrey. The midwife never told me to slow down or push less, so I just kept maxing out with every contraction and finally, they told me that his head would for sure come out on the next one.

In a state of complete disbelief, I buckled down and gave one more huge push, and sure enough his head was out! Then everyone started shouting at me that I wasn’t done yet and I had to get the shoulders out next, so without skipping a beat I gave another big push and screamed “OH F***” as I felt the weirdest and grossest and most indescribable thing I have ever felt in my life: a whole human person suddenly being expelled from my vagina in one single moment.

And that was it. I was finished. Trevor Elliott was born at 5:47AM, a mere ~7 hours after my water broke.

From there, everything followed my birth plan perfectly. I was not given a Pitocin drip even though those are standard protocol at my hospital (recall that I didn’t want one because giving Pitocin to someone who hasn’t had any drugs during labor can result in contractions that hurt even more than the ones they felt during labor. Yeah, no thanks, unless I’m actually hemorrhaging to death). We were not able to do delayed cord clamping because we had opted instead for cord blood donation, so the cord was clamped immediately and Jesse cut it. And my little boy was plopped down on my chest in a blanket for some serious snuggle time.

The final tally: he weighed in at 8 pounds 2 ounces, almost a full pound heavier than Audrey at 7 pounds 4 ounces. 19 and ¾ inches long. As for my bottom, I had a second-degree tear, which is when the perineum tears up to but NOT including the rectum – in other words, IT WAS A VAGANUS-FREE ZONE! And since people always end up curious about this, allow me to just reiterate: I had no pain medication whatsoever, not even local anesthetic down there this time, and I did not feel that tear happen. I did not feel any pain after the birth. I had no idea if I’d torn at all, and was somewhat surprised to find that I had even reached a second-degree because it didn’t hurt a bit. The recovery from this tear has been a total breeze. Complete non-issue. So if the possibility of perineal tears is the kind of thing that keeps you up at night, please remember this. I wouldn’t lie to you about something like that.

So there you have it! Trevor is born, I didn’t rip my asshole apart, I made it through without drugs, and I’m NEVER DOING ANY OF IT AGAIN SO HELP ME GOD.


Being born is the worst!

 Being a week old is way better!

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