First real dream about the baby- I had the baby in front of me and I was swaddling him. Baby was a boy with dark hair and looked like a “typical” baby. No features of Down Syndrome or Potters syndrome. I looked at Chris and said, should we tell them his name? He nodded and we announced our baby.
This is not how it’s going to play out. My original dreams of labor and birth have been packed away. As a midwife I know a few things: I know women are strong and with the right mindset, preparation and support, many women can have natural childbirth. I also know that we can set wish lists of what we’d like in childbirth (no Pitocin, immediate skin to skin, water birth, etc), but sometimes our health or the health of our baby takes control and not all wishes are met. Sometimes the institution we birth out has some restrictions. I once took care of a class D diabetic (ie someone who has had diabetes for a looong time with some complications). She had wanted a home birth very much, but because of her medical history she was not a good candidate, and so ended up with a hospital birth with my practice. I’ve had patients make very specific birth plans- some are fully accomplished and some have very little go their way. I encourage “wish lists,” things that patients would love to have if circumstances permit. Funny thing is, almost always, the patient’s wish list is my wish list too. I don’t want to give unnecessary Pitocin. I want to do delayed cord clamping. I want to avoid vacuums and c-sections when there is no clear indication. I want as little intervention as possible. But I also want the healthiest possible outcomes for my patients and their babies. I’m on my patients’ side.
I had a wish list. Natural childbirth. Labor at home in my awesome shower as long as possible. Avoid c-section at all costs. Pretty simple. I was ok with a 10lb baby that came at 42 weeks, if that was how it was meant to be. When we learned our baby had Down Syndrome, I re-evaluated some of those wishes. My priority was a live baby and because of the risk of stillbirth, I became very open to the idea of induction- at 39 weeks. In obstetrics we often induce around that time when there is a risk of stillbirth, so I adopted that plan for myself (and was having that conversation with my midwives). I recognized that I was giving up laboring at home and increasing my risks of choosing pain medication, but I kept my eyes on the prize- a live baby. When the oligohydramnios was diagnosed, my wishes and visions were wiped away. I had a clean slate. At first, I was thinking about laboring for a stillbirth- I held no expectations for myself in that scenario. I have been with some utterly remarkable women who have labored naturally through an induction for a stillbirth. They amaze me in ways I don’t think I can describe because anyone who labors, medicated or not, for a stillbirth is beyond words with my admiration. When I pictured myself laboring with a stillbirth, I left all the options open- no expectations for myself.
Now that I can feel comfortable that I’ll be laboring for a live baby, I am trying to prepare myself for childbirth. I told my midwife that I am in labor-denial. I have spent so much time learning how to live in the present so I don’t collapse in fear and grief, that I am neglecting to truly mentally prepare myself for labor. This is one of the tasks I have given myself while in the hospital. As part of the preparation, I can envision some of the scenario. Induction is part of the story- since I will be early (37 weeks) and likely unfavorable (my cervix will likely not have started the natural softening and opening that happens closer to the due date that would make my body readier to respond to induction methods), it will be a long process. I’m anticipating a three-day induction (give or take a day or two). I will receive Pitocin. I will have continuous monitoring. That means I can not labor in the tub (hospital protocol). I can use the shower- unless I have some special monitoring. Since there is no fluid around my baby, the stress of contractions might cause some distress (we’ll see) in which case my might use an amnioinfusion (a tube inserted though the vagina into the uterus that pushes extra fluid around my baby to help create a cushion during contractions). If there is distress they might also have to use an internal monitor to listen to the baby’s heart rate more closely. If I end up with either of these things, I will not be able to get in the shower. And in labor, the baby is the boss. If there is distress, I’ll go into whatever position they need me to (comfortable or not) to help the baby through the contractions. And if the baby can tolerate labor (too much distress with contractions could lead to a c-section), then I will be pushing out my baby in a different room. In our hospital, women usually labor and birth their babies all in the same room. For those women whose babies will need immediate intense attention from the neonatologist (preterm babies, known heart defects or other significant birth defects), they are moved for the final stages of pushing to what we call DR3- delivery room 3. It’s actually our third operating room- but it’s directly connected to the Newborn Special Care Unit and is set up for immediate resuscitation. That is where I’ll deliver. My baby might be placed on me for a second of skin to skin while my midwife cuts the cord, but ultimately the most important thing is my baby gets handed quickly to the awaiting neonatologists for evaluation and resuscitation. Chris may or may not be able to go with the baby. I will not because I have the placenta to deliver and stiches to be sewn. It’ll probably be at least an hour (minimum) before I can really see my baby.
So I am working on a new wish list for labor. A lot is beyond my control. I trust, reeaaaly trust, that my midwives are going to do everything that they can to minimize certain interventions without compromising my baby’s safety. So I feel good that I don’t really have to advocate for myself in labor- my midwives and nurses will do that for me. And because of that, if they say I need a c-section, OK. I know it’s really truly needed.
Things I think I want if possible- a second of skin to skin, maybe Chris announcing the gender, Chris being with the baby as soon as possible. That might be it. These are all presuming I do get the vaginal birth I really want. I know even some of those things won’t be possible with a c-section. But safety first.
Pain medication. As a midwife, there is obviously some sort of expectation that I will have a natural childbirth. And I would love a natural childbirth. This is a hard one. I said before with the right mindset, preparation and support, most women can do it- also if labor goes relatively smoothly. I’ve been with women who labor naturally with Pitocin, with every possible monitor and being restricted to the bed. But these women usually are laboring with the goal of holding their baby in their arms after birth. That is a powerful motivator. I know I want to be awake and not groggy for my birth- this may affect my choosing pain medication or not. If I have only a little time with my baby, maybe I’ll be more present if I’ve had some rest during labor with an epidural? I’ve also been struggling with so much emotional pain during pregnancy and in labor that pain might be amplified by the fear of what will happen shortly after that I’m honestly not sure how much physical pain I’ll be able to handle. I also am worried that psychologically I won’t be ready to let go of this baby. All this monitoring has proven to me that I’m doing a good job growing him/her and inside me seems like the best place for my baby to be. And our minds have a strong connection to our bodies- I worry that my emotional desire to keep the baby in might manifest in a slow labor, literally prolonging how long I keep the baby in. Also prolonging the work and natural pains of labor. These are all things that make me open to the idea of an epidural. But at the same time, I really want the experience of natural childbirth. I have been training for it. I’m tall- tall women labor well. When I’m exercising and something is hard or hurts, I tell myself, “well, contractions hurt- so get through this.” I guess I’m writing this so that no matter how my labor turns out, I won’t feel disappointed in myself. I know others won’t be “judging” me, but I guess I need some convincing of that.
Less than two weeks and all this begins.