Saturday, July 24, 2010
Stella by Starlight: The Most Important Birth I've Ever Attended (HBWAC with Inverted T)
My friend Amy gave birth to a baby girl last night at my home in the water. It was an HWBAC with Inverted T. For those of you, not deeply involved in the birth world, that stands for Home Water Birth After Cesarean with Inverted T incision.
Amy and I started talking through my blog and over e-mail a few months before the Passion for Birth conference that Amy organized. When we met in person it was instant sisterhood. Just like the decision to marry my husband, there was no asking, I just knew: I would be with her at the birth. Due to the higher risk of rupture associated with her scar type*, the military hospital risked her out of a VBAC attempt. As a result, they were planning to request posting in Georgia with an early return of dependents so that she could VBAC with Dr. Tate outside of Atlanta. I own at house in Georgia because my sister is going to medical school there so I planned to go to Georgia for the summer and wait for her to give birth. In the midst of all these plans, I asked her why she didn't want to use Dr. Chung. She thought he wouldn't take her on, but hadn't asked him. Since I knew that he had attended a vaginal breech, I encouraged Amy to meet with him. Amy is very prepared and wanted to be taken seriously so she assembled a packet of information including a copy of the Landon Study (huge VBAC study) that shows the risks of rupture, no matter what the incision, to be very low. The study includes VBACs that were induced or augmented and women with multiple c-sections and alternative scar types and the rupture rate was still very low (1.9%, not the 15% that Amy was quoted by the doctor who performed her c-section). Dr. Chung accepted Amy and thanked her for providing the information. He encouraged her to give him anything she thought would make him a better doctor for her.
Anyway, from the Passion for Birth seminar (which was right around conception), we have been planning for this birth. I worked harder to prepare for this birth than my own VBAC, and I worked pretty hard for Eva's birth. Thankfully, Amy and I have the same cell provider or I would have had to re-mortgage the Georgia house to pay the bill.
When I scheduled my cesarean for breech, I felt like I had no other realistic options. After attending an ICAN meeting after Ian was born to support a friend, I left horrified and traumatized. My c-section was a very positive experience, but I heard woman tell stories of being brutalized and bullied by their care providers. The level of trauma was so deep and terrifying that I wanted to schedule my next c-section right then and there and I wasn't even pregnant. Carol Peterson, the childbirth educator from my pregnancy with Ian and Michelle Totleben, my doula from my pregnancy with Ian talked me off the ledge and I knew deep in my soul, that I would never feel powerless again. I decided that having a truly supportive care provider was the most important factor that I could control in a VBAC attempt. As such, I changed care providers three times and flew halfway around the world and still had to drive 2 hours to find the right provider for me.
Amy and I connected deeply because I understood exactly why she was planning to go such great lengths to have a VBAC attempt. In order for her to process her c-section, she researched and became a doula and childbirth educator. I told her that for my VBAC I decided to choose a supportive provider, do everything I could to prepare physically and emotionally and then choose to be at peace about whatever happened as long as I preserved my autonomy and was respected. I committed to her that we would work to do everything possible to prepare her in every way and that is what we did.
In order to support her, I became a doula. I attended 5 births before hers. I found it very intuitive, but there is a lot of processing for doulas to do after births and I am glad I had practice so that I could be the support she needed.
Amy took a 12-week Bradley Method class during her first pregnancy. I used Hypnobabies for my VBAC and encouraged Amy to try it. I had a quick, manageable and intense but virtually painless VBAC. Amy is an internal laborer and I thought Hypnobabies on the iPod would work well with her style.
My friend and current doula partner, Rachel, had an incredible birth experience. The fact that she did not have a c-section, especially in Korea was astounding. She used the Pink Kit and it got her through. Because Amy had malpositioning problems in her first pregnancy, I thought the pelvic mapping might help. She had been in communication with Gail Tully of Spinning Babies since her first birth, but having the Pink Kit mapping allowed her to speak to Gail in Gail's language, which enabled Gail to help her from such a distance. Gail said that with Amy's anthropoid, yet, roomy pelvis, that engagement would be a problem, but birthing would not. That proved to be true.
Amy visited the chiropractor, drank red raspberry leaf tea and other herbs, ate a high-protein diet and watched her sugar in-take. She exercised and worked on Optimal Fetal Positioning using Spinning Babies exercises. We read birth stories and she was in touch with other inverted T moms.
I can't express how much physical, emotional and intellectual energy we put into the preparations. It was as if I was giving birth myself. We are both planners and were about to talk and plan for every scenario in detail. We had plans for ideal homebirth, hospital transfer and c-section. I believe in acknowledging all possibilities to create the best experience no matter what happens.
I threw a Blessingway for her to get her used to receiving, instead of giving. I invited some of the clients whose births had most impacted her an all of the local doulas. I wanted to make things beautiful and special to show her that she was worthy of effort and give her an opportunity to practice receiving.
Amy's husband had to go to the field and she lives 2 hours from Seoul. She was nervous about being away from home because she likes routine and structure and loves her dogs and her garden, but she was also dreading the 2 hours ride and didn't want to go into labor in Dongducheon. So, I urged her to just come. She arrived on her due date and began settling in. We ate good food made from vegetables from her garden. We walked a lot and readied the house. The kids played well together and we just tried to establish a routine. During the time she was here, her son Graham, helped Eva move to the next level of potty learning (going by herself) and Eva started talking A LOT. She came on Thursday, July 15 and started having contractions on Wednesday, July 21. They were noticeable, but mild so I tried to distract her with another walk to IPark Mall. We ate Ja Jang Myeon and sweet and sour chicken at a Chinese restaurant that she used to frequent when she lived in Seoul.
She didn't have a girl's name and didn't know the sex, so I got out some baby name books and we started playing on the Nymbler baby name site. I kept saying names and she rejected most of them. Finally, we had a list of 6 and I said,"I like Stella the best. That name was on my list before. It's very yell-able, an important quality in choosing a kid's name. "
Then I yelled,"Stelllllll-laaa!"
She said,"That's what Josh said when I mentioned it before."
I said,"What about Stella by Starlight? She didn't know it, so I played it for her and she liked it. Instantly, we knew that Stella was the name. She texted her husband and he texted back that he liked it.
She told her husband that she was having some mild contractions and he decided to come to Seoul. They left my house and checked into the Dragon Hill Lodge on Post to spend some private time as a family of three.
Thursday, the contractions were more regular and a little more noticeable. They walked and walked. I spent the evening nesting. I mended the birds from the Blessingway (that represented the clients she'd doula'd for), washed the sheets and made up the birthing bed, used her steam cleaner on everything and cooked a big pasta salad. My body must have known something was happening because I posted on Twitter that I was nesting. I went to bed at 1am, the same time that Amy was awakened by a contraction. She texted me about 3am that she was having contractions that she couldn't sleep through. We decided they should pack up and come back to my house. I moved Ian into my room so they could put Graham down and waited for them to arrive.
They came about 4:30am and I sent a text to Dr. Chung letting him know that she was warming up but didn't need him, yet. She put on Easy First Stage of Labor (Hypnobabies) and worked through the contractions all day Friday. They were steady and more intense, but she was still social in between. She was surprised by how different the labor felt from the first time. Even though we had lots of nanny help during the week leading up to the birth and throughout the birth, managing the children was a challenge. The nannies saved our sanity and kept the chaos to a manageable level. Josh (her husband) went out for supplies and to get lunch for their son Graham. The nanny took my kids to the playground and we took a short nap. After lunch, Amy and Josh went for a walk. She continued to labor on the birth ball and she had most of the day because, in accordance with Pink Kit principles, it made the contractions come and it made her feel open in the pelvis. She kept herself amused by updating Facebook. Her contractions started to space out so at 3:32pm, I tried a Hip Lift (Pink Kit maneuver) and she said,"That did something!" With her pelvic shape it made a lot of sense to create space that way. I tried the other side and contractions picked up in intensity. I texted Rachel (my doula partner) and she happened to be near my house. She came over. Amy took a shower and then we tried the Hip Lift again. Again, there was a major shift in intensity and she was no longer talking between contractions (and I could no longer make note of important details like,"Ticklish right butt-cheek during Hip Lift"). It was about 6pm. At 6:15pm, Danica (Dr. Chung's midwife) called to check in on us. (I told her it was time for her to come. I had to start doing her Facebook updates!)They were eating dinner so I told them to take their time, but make their way over. Danica arrived and checked o the baby. Dr. Chung, Midwife Rosa and Danica ate and camped out in the office. (My husband, was frenetically cooking because he didn't know what else to do. He made chicken, risotto, carmelized mushrooms and chicken wings. We got him to make chocolate covered strawberries as well since Amy was beyond making them as a labor project).
To doula for a mom who is also doula is a difficult job because it is hard the doula mom to stop being a doula and just be a mom. Because she had been a very internal laborer with her first, I tried to be present, but hands off. She was managing well and we just hung out for the first day. It was interesting because there were some things that she wouldn;t accept from me, that she accepted from others like pouring water over her back or light touch massage. I tried to do them, but she said to stop before she gave herslf a chance to see if she liked it. Then Danica did those things and she didn't feel as free and quick to tell her to stop so she realized she liked them and later asked me to do it as well. Mainly, she needed the temperature adjusted (a/c on and off), water, and chapstick. Pretty easy to meet except that Eva had destroyed the second a/c remote so the one we had kept disappearing to other rooms. Finally, I found another remote. Her chaptick kept getting lost on the bed or walking out the room in someone's pockets. While trying to manage the kid craziness, the birth pool and laundry, we struggled a bit to find our rhythm to help her with these needs and handle the chaos in the house. There were 12 people there at one point so it was a bit mof a mad house, but the room she was birthing in was on the far end of the house so I think we did quite well considering.
About midnight, she requested a vaginal exam. She was complete, but still at minus 2. I put the champagne glasses in the refrigerator because I thought she'd surely be done by morning. Rosa had Amy do 30 minutes of abdominal lifting followed by 30 minutes of hip swaying, followed by an hour of laying on her side with her bottom arm under her (classic Bradley position that Amy hates). Everyone went sleep by Josh, Amy and I. Amy started to lose it during this point. She said,"I can't do this. It hurts too much."
I stayed right with her and said,"Yes you can. You can do it until 4am. Rosa said to do it for an hour. Just do one at a time."
She struggled and lost her focus and control. She said,"I'll do one more contraction and then I have to get up."
I said,"OK, but stay down during this last contraction."
She did and I looked at the clock,"You did it, you made it to 4am!"
She got back in the pool. Everyone was asleep at this point and telling me that I should sleep also. "I'll sleep when it doesn't matter." I knew I couldn't leave her. The light was coming through the window and she said,"I can't do this anymore. It is time to go to the hospital. I need an epidural or a c-section. It's just not worth it. A VBAC at what cost?"
She said this with a bossy, confident tone. I chose not to believe her. I had to muster my strength and get tough with Amy Fuller. I remembered all the things she said to clients or said about certain labors and just calmly looked at her and said,"Your water hasn't broken, you still have options. No one else is talking like this so why even go there. And besides, everyone is sleeping."
She glared at me as if to say,"Wake them up."
I gave her "the Korean shrug and smile".
She barked back at me,"I'm tired."
I said with complete yoga perfection,"So sleep."
She huffed and laid her head on the side of the pool and went to sleep. She was in an extremely relaxed sleep between contractions. When she had one, she'd wake and rocked her hips in the pool. I just sat on the bed watching her and thought about the yoga principle of "faithfulness". In my yoga class, during Sambhavi Mudra in meditation, You had to think of images to conjure feelings of Pride, Artistry, Ego, Solidity and Faithfulness. I always chose to visualize myself by Amy's side in labor. After awhile, I dozed on the bed between contractions. She woke up about 2.5 hours later. She had gotten a good rest and her contractions were spacing. She got out of the pool and Rosa checked her. The baby was still minus 2, but had changed position. Dr. Chung told me to rest. I left the room and went to cry.
Out in the livingroom, I told Dr. Chung that I felt guilty that my VBAC had been so easy and that Amy's was so hard. Dr. Chung told me that we have different bodies and that," Amy just needs more time. Everything with Amy takes more time." He also said,"Empathy is good, but sympathy won't help anyone. You have to be strong in your face."
I told him that I had been strong with her overnight, but I was starting to worry. But, I realized that he was not worried and neither was Rosa, so I went to take a short nap and relaxed. He said,"The body is wise and she probably needs to rest, so she should rest."
Her contractions had spaced to the point that she went in the livingroom. It was like she wasn't in labor anymore. Rachel left when the nanny arrived for the day. After I woke up, I got her something to eat. She puked, ate and puked again. Her contractions picked up. Dr. Chung discussed the options of going to SCH to break the water. Amy asked if he could do it at the house,"He said he's consider it." Rosa had wanted to break the water earlier and was confident that she could do it safely. So, after everyone, including Amy discussing things, we decided that they would go to lunch and break the water upon their return. When they got back, they monitored the baby and then Rosa broke the water during a contraction. The baby's head moved down and Amy started pushing. There was light meconium in the water and baby's heart rate elevated so they put Amy on oxygen. After the baby recovered, she got back in the tub. I knew she'd have to be loud, but might not want to be so I told her to be a lion and "roar the baby out". She did! She pushed and pushed with her urges in the pool. It took a few hours, but finally the baby's head was out. I said,"The head is out Amy, you did it!" Josh poised himself to catch and Stella slid out. Amy's son Graham, who had been watching quietly during pushing and her roaring and was not disruptive at all (except when he full-on peed on the wall next to the birth pool and cracked us up by saying,"Oh shit" over and over) lost it when he saw the baby. He shreiked and cried and had to be taken out of the room. Poor, little guy! Amy held her baby and looked around. I hugged her while trying to run video and take pictures and said,"You did it! A freaking miracle!" I started crying from relief and joy. Amy lifted the baby's leg and said,"It's Stella."
I grabbed my laptop and played,"Stella by Starlight". It was 8:10pm, so it was indeed by starlight.
But, the story wasn't over, because, as Dr. Chung says,"Everything with Amy takes more time." Her placenta didn't pass. She was bleeding so he massaged her uterus to slow it down and tried to gently help the placenta release. Danica nursed Stella with Amy's breast while Amy endured. After a few hours, Dr. Chung suggested transferring to SCH for monitoring overnight. Josh put Graham to bed and I wrapped Stella in the Moby. Then, we made our way to SCH. I got them settled and helped Josh wrap Stella in the Moby. I got home about 1:30 am and relieved the nanny.
Dr. Chung visited her the next day. Her bleeding was normal and labs showed no signs of infection. He decided to let her come back to my house and monitor daily to see if the placenta would come out on its own before attempting a manual or surgical extraction since she had an anterior placenta and a partial vertical incision. About 1:30am, Josh knocked on my door and said,"Karen, the placenta's out!"
I went to the bathroom and there it was on the floor. I got a bucket to put it in so Dr. Chung could examine it the next day, but remarkably, it looked complete. Then I grabbed my camera. Amy laughed at me and I said,"Well how are you going to do the blog post if I don't take a picture?"
They were trying to come up with a middle name and I said,"What about "Kim" or "Rose" or "Rosa" to honor the Korean team (After the Korean Midwife Kim Ok-Jin, also known as Rosa) that helped make this possible. Amy thought that Rose was perfect and so they called her Stella Rose. Stella means "star" and the stars had to be aligned for this to happen. What a perfect, beautiful and meaningful name for a gorgeous baby girl.
She was able to go home today. We are all amazed and inspired and have learned so much from this journey and this birth. Here is the story from her perspective. Even though both of these posts are incredibly long, we are leaving out lots of details. We could really write a book.