Becoming a Mother
The story begins on Wednesday, November 19, 2003. I was in my favorite yoga class at The Mindful Body when the thought occurred to me that I was exactly where I wanted to be. I had experienced doubts about being mentally and physically strong enough when my body reached the limit of this pregnancy and when labor and birth would become imminent. Oliver's illness during the pregnancy had left me drained and doubting that I had done everything I could have to ensure "preparedness" for our birth. Yet there I was, halfway through the class and engaged in a prolonged squat and feeling so incredibly strong when a sensation came over me that was altogether new and different. I had been experiencing contractions over the course of several weeks, mild to strong tightening of my uterus that made me smile and left me giddily anticipating the inevitable. But this tightening of my uterus was different. It ached, and it made me feel slightly nauseous. As I thought in my mind "this feels like a strong menstrual cramp," I heard myself saying this very phrase to patients in my work as a perinatal nurse at UCSF. "Aha," the light bulb went off, "this is what I have been talking about all this time." At the same time I felt some wetness between my legs and questioned its significance. Much to my delight, in the bathroom I discovered what was surely "the mucous plug" or perhaps better described as a tenacious rubber band that had found its way into my panties and was begging to be slingshot across the bathroom stall in celebration of the beginnings of labor.
I resumed my yoga practice and afterwards set off about town on foot with a new sense of awe and excitement, fueled by a constant supply of adrenaline pulsing through my veins. The following day was officially 41 weeks gestation and I knew that this marker meant a trip to the UCSF Antenatal Testing Center to assure everyone of what I already intuitively knew, that everything going on inside my body was just fine and that it was only a matter of time. My new "developments" in moving towards labor land left me only more confident in my feeling that this baby would arrive before Thanksgiving.
Contractions continued into the evening, spaced apart anywhere from 5 to 15 minutes, with increasing strength. I remember sitting on the couch eating a burrito when our friend Dan came over and watching me struggle to get comfortable on the couch said "whoa, it looks like the baby is coming any time now." I remember thinking "he has no idea... and truly, neither do I." Oliver and I went to bed, though sleep was difficult to come by.
I remember feeling grateful to see the break of dawn, as I was ready to get up and stop pretending like I was sleeping. Time to get onto something more productive. I had a light breakfast and walked up to UCSF to have my NST/AFI. The nurses attending to me were very kind and encouraging and were excited to learn that I was seemingly going into labor on my own at 41 weeks. The visit was extended due to hospital protocols, but I remained calm and assured within so the monitoring and ultrasound really didn't bother me. The irony of this visit was that it would normally be the prelude to being told to go across the street and be admitted to L&D, only in my case with the advent of contractions every 3-5 minutes apart, I was anxious to scoot home and get on with labor the natural way. Nancy, our midwife, arrived at our house soon thereafter and we decided to do my first cervical check in order to ascertain any progress and therefore to set the best course of action for the day. She found the cervix to be softening and effacing with the head quite far down and applied to the cervix. She called it 1/50%/-2. The plan was to remain active until early evening, then if things hadn't picked up, to try and tune down my activity level and focus on sleep. And so I embarked upon an ambitious afternoon of preparing a pot of Moroccan lentil soup while sweeping and mopping the hardwood floors throughout the flat. The squatting of my efforts felt good, though the frequency of contractions remained somewhat erratic and the strength of the tightening variable.
The sun set on another day and I poured myself a glass of wine per Nancy's suggestion and attempted to get into bed early. Now that the night was announcing itself, of course the contractions had become strong and regular and uncomfortable enough to prohibit me from lying still through them. Around two in the morning I decided that I had had enough of laying sleepless listening to Oliver's snoring and decided to see what walking the hallway might do for the contractions that were making remaining still an impossible proposition. I renamed our fat black feline Niger "the labor cat" as he faithfully followed me up and down the hallway and then planted himself at my feet as I sat in the rocker in the baby's room and attempted to write in my journal. He kept his eyes half cocked as if to watch for any changes in my facial expression that might signal the need for him to go and wake his master, aka Papa O. At this point I would still describe the sensation of contractions as very strong menstrual cramps, the type that make me want to curl up into a ball, fetal position, only this was impossible due to the belly's protrusion.
The night passed slowly and I was consumed with watching the hands of my watch move their way towards a new day. Eventually the sun did rise and despite my increasingly fatigued state I was excited to face what I felt likely to be my baby's birthday. I had scheduled a visit with Anju, Oliver's acupuncturist and herbalist, to work on some natural labor augmentation and spent some time questioning whether altering labor that appeared to be advancing naturally was in fact a good idea. We decided to go for it, and her hands felt great on my body, though breathing and writhing through the contractions with 23 needles stuck throughout my body was a challenge.
We returned home and after a light lunch headed into Golden Gate Park for a walk. As always, I gravitated towards the AIDS Memorial Grove and labored for some time amidst the coastal Redwoods. It had rained the night prior so the earth was damp and the air crisp and fresh. As we approached another night it was clear that things were picking up so we decided to get revved for action. I called Nancy in the late afternoon and she arrived around 5pm to assess the progress. My contractions were still somewhat irregular, from 3-10 minutes apart but they felt stronger than they had ever felt before. Despite my previous thoughts about not having any cervical checks, I asked Nancy to check me to give us an idea where we were. My cervix had dilated to 3cm, 80% effaced and the head was lower than before. We decided I was officially in labor and that Nancy would join her family for a dinner party, then return later to conceivably welcome the baby later that night. Oliver called our phone tree to get our support crew in gear and set about the task of filling the birth tub.
Various friends and family started to trickle in and the house began to be filled with warm quiet energy. Meanwhile, my own voice announced itself rather loudly and I surprised myself with the vocalizations that began to accompany contractions. My lower back and hips were aching with the contractions, thus many hands were called in to apply pressure and give massage. We lit candles and with soft music in the background, time began to take on an ethereal quality. With contractions, I tried to focus on breathing slow and deep, feeling the intensity of the contractions building and staying in the moment with each ebb and flow. Already I was developing immense appreciation and gratitude for the minutes in between contractions, however short, as they provided me with a moment to laugh, smile, receive a hug, drink or change position.
Nancy returned around 9:00pm and continued to encourage me to stay present in each moment, to breathe into the discomfort and not to distract myself from it. She reminded me how resisting or tightening up against the contractions made it harder for the body to do the work of opening and birthing. She helped me keep the tone of my voice low, my brow relaxed and my shoulders loose.
In the more lucid moments of my labor I remember reflecting on the sensations that were washing over my body, often questioning myself with "is this painful?" As someone who has always been interested in pushing the limits of my physical body, I approached labor as yet another means of exploring the outer limits of my mental and emotional capacities. I had always felt keenly interested in knowing what "labor pains" would feel like and did not feel afraid of this great unknown. I have always chosen to reject what I perceive to be the western notion of associating pain with pathology, instead acknowledging that the discomfort of labor is the healthy pain of an intensely physical process. I knew that in order to cope I would need to remain fully present from moment to moment and that this would require great concentration, courage and the loving support of those around me. I knew that it was important not to have strong expectations about how labor might progress, and that if it were possible to focus my mental energy, that I would focus on surrendering to the natural birthing process. Also a key factor in remaining present and strong throughout my labor was the knowledge that those around me believed in me and trusted me, knowing that I had the inner resources to meet the pain, and that they were able to put aside their own expectations and judgments about what labor is or was like for them.
Later that evening we decided to do another cervical check to determine how far along I had progressed in order to know when the second midwife, Erin would be called. My cervix had continued to open and was now 5/90%/-1. Erin was called and would be at our house by midnight. People kept encouraging me to drink or attempt bites of food, although only fluids appealed to me, and the smell of others eating at the other end of the house began to repel me. Although I had thought that as I moved through active labor I would do everything possible to stay upright and moving, all my body seemed to want to do between contractions was lay on my side on my delicious bed. With each contraction I found it helpful to have one of my support people with me to apply warm compresses and pressure to my hips, back and sacral areas. Around midnight my body was begging for a break so I spent a bit of time in our rented Aqua Doula. The water allowed me to become a mermaid, floating and dancing gracefully with the intense work of my uterus. I remember having the thought only moments after entering the water that I shouldn't get too used to this incredible treat as I was not advanced enough in labor to be able to stay in the water for the duration. Despite my doubts, I remember Nancy encouraging me to stay in the tub for as long as I wanted. After 15 minutes, I listened to my own thoughts and regretfully exited the water. As I walked the halls for several hours after this, I began to feel what I thought to be increased pressure in my vagina. This prompted another cervical check and I remember feeling disheartened by the news that I was "only" 6 cm. It took me a few contractions to acknowledge and accept this disappointment and to move on to a more positive space. After all, 6 cm was over halfway there, and at this point there was clearly no turning back.
Given my sleeplessness over the past few days, I opted to try to lay down with Oliver in bed and rest. Even the idea of 2 minutes of sleep filled me with immense pleasure, but despite my best efforts, I was not able to fall into slumber and the work of getting up and down from my side lying position on the bed with each contraction overshadowed how good it felt to actually be lying still. At some point in these early morning hours during my nonstop trips to the bathroom to pee, my bag of waters spontaneously ruptured and to my delight it was clear.
Begrudgingly, I gave up on the idea of sleep and decided to embrace the birthing ball to see what it could do for me. I found it relaxing to sit on in between contractions, but still found little relief other than breathing, gyrating and moaning intensely guttural sounds through each surge. I remember recalling the words of a very courageous and wise lay midwife I worked with in Togo, West Africa, who said to me to always remember the three "R's" in labor: rocking, rhythm and repetition. For several hours I worked on focusing my thoughts on all the strong and fearless women I had known and had the privilege of working with in Togo as I rocked rhythmically and with repetition. I was beginning to see why this greatest of life passages is an act of extra-ordinary courage.
As dawn of November 22nd approached, I recall having what I call "my first breakdown." I understand now that emotional breakdowns are integrally connected to one's ability to surrender to labor. I knew that I had to give up all rational thought and reasoning about what was happening in order to live fully in each and every moment, accepting and trusting that the uterus has its own agenda. I remember clearly the faces of Oliver, Nancy and Erin who surrounded me with love and patience and faith as I let go of the mental energy that was so tied up in reason and control. It wasn't long after that Nancy suggested that we do some nipple stimulation in an attempt to augment the strength and frequency of my contractions. As a L&D nurse my only exposure to "nipple stim" was when we used mild manipulation of the nipples to induce 3 contractions in 10 minutes in order to qualify "fetal tolerance" to uterine activity. Now in retrospect I can say that I had absolutely no idea what I was getting into.
The routine was for me to sit on the birth ball with Oliver supporting me from behind with either Nancy or Erin in front of me simultaneously pulling and squeezing the nipples, not dissimilar to how one milks a cow's udders. Though my body memory recalls the experience of being milked as sheer torture, I can now acknowledge and appreciate the technique and skill of Nancy and Erin and I am thankful to them both for their perseverance in continuing through nearly two hours of stim. Similarly I thank Oliver for staying by my side throughout and providing me with encouraging words and unconditional love. With each contraction brought on by the nipple stim I would get off the ball and dance, sway, kneel, cry, moan, squat and rock until the surge subsided only to sit back down for more. It was clear to all of us that all the stim was working as the character of the contractions was significantly changing as were my vocalizations. Despite the new sensations of incredible discomfort brought on by this process, I began to feel stronger than ever before and experienced my body in an altogether new and primal state. Added bonuses during this period of stim were various herbal and homeopathic remedies given to me skillfully by Erin in order to increase stamina and energy in my body.
After nearly 2 hours of potentially the hardest work I knew up until that point I began to feel disheartened, as the sensations in my perineum did not feel like they were changing. I thought I would begin to feel my baby's head descending down the vagina, but I wasn't. I remember saying to Nancy that I felt like I needed another cervical check to determine if this "torture" had helped me to make any progress. At that point I wanted so badly to sleep and felt that if I hadn't made any progress that I would sleep and resume the effort with renewed energy. Much to my excitement the cervical check revealed that my cervix was 8-9cm and now 90% effaced. The difficult information to process was that the baby was definitely presenting in a posterior position, which would explain why progress was slower than expected. This was the moment of my second breakdown. I remember being overwhelmed with a feeling that was a combination of relief that I had almost made it to 10cm, along with anticipation that I would get to see my baby so soon. I recall saying aloud through my tears that although it didn't make sense the word that came to me in that moment was "divine."
The words that brought me back into my body were Nancy's saying that she thought we could turn the baby. She had me get into a hands and knees position with my bottom high up in the air and with Erin's hands beneath me stimulating my nipples, Nancy inserted her fingers in the cervix and with 2 very forceful contractions she skillfully turned the head to an anterior presenting position. Oh the joy that we all felt as Nancy said with conviction that the head had turned 180 degrees to an anterior presentation. At this time the house was waking up, and I could feel the gentle and quiet excitement of the many friends and family members who had dozed on various chairs, couches and pillows through the night. Much to my relief, Nancy said we would not need to do any more stimulation of the nipples as the contractions were now coming closer together than ever before. I remember feeling a renewed sense of energy, strength and an attentiveness that had been lost in the fog of fatigue and long labor. It was as if I could completely let go of all the effort that had gotten me to that point and focus only on the moment and the imminent birth of our baby. After a few squats and rolls around on the floor with the birth ball, it became clear that I was pushing. Alas...the birth tub.
No words can describe my pleasure at that point. Although I knew that hard work still lay ahead of me, I knew also that the prize of all my efforts was so very near. Excitement was definitely bubbling in our back room and sunlight was streaming in the big Victorian windows. As I floated about in the tub, people bustled about quietly preparing for the birth. This phase known as pushing was a surprise to me for I did not feel as if I was in any state to control my actions, and therefore to push, rather I had to completely let go and give way to the bowling ball plowing down my vagina.
Why we don't all give birth in water, I don't know. The water was the perfect medium for allowing my body to float, squat, lie, swish like a mermaid, and bear down. I recall the hands of my incredible support team offering counter pressure, massage, a cold towel on my brow, a sip of something cold, quiet words of encouragement. It was all I could do to stay present in each moment, and an awareness of my surroundings alluded me. With each contraction and with the immense pressure building on my perineum, I tuned into only Nancy's voice and Oliver's face. He sat before me with an intensity that was vital, tender and focused. Opening my eyes occasionally to meet his allowed me to feel great comfort and love and assured me that it was all real and truly happening. I remember Oliver's hands reaching out to me to grasp with the pushing effort of my uterus, and in between his hands would show me how much of the head was emerging. Despite my frequent attempts at feeling for the bulging head between my legs, my fingers always seemed to meet the vagina when the head had just slipped back up. Hence, I had no idea I was so close to meeting my baby when all of the sudden Nancy said, "Heidi, your baby's head is out, reach down and grab it." I opened my eyes and saw the purest expression of love and happiness on Oliver's face and as our hands dove underwater to meet the emerging life, the babe rapidly shot out into the water as if swimming to a finish line. Nancy helped to release the loose cord from her neck and up to the surface of the water she came. Birth time was 11:51 on November 22nd, a Saturday.
I think now that I was in a type of shock, for as I held her to my chest and watched her little mouth open and let out a soft cry I felt suspended in space... weightless and speechless. Being the crier that I am, I had expected the river of tears to be flowing but my eyes remained dry. The first thing I said to my baby was "you are perfect." There were voices and expressions of awe around the room, but it wasn't until Oliver said, "well what is it?" that I felt back in my skin. I was so focused on her face, which was turning all shades of purple to pink from the blue that she had emerged that I hadn't even thought to examine what still lay below the water. Her legs were quite tight, so it took prying to peek at her genitals. A girl it was, much to our surprise...here she was, supremely divine energy emanating from her little being, she opened and closed her eyes to explore her wider world. The cloudy orbs of her eyes searched my face as if trying to recognize me. I am her mother.