The Birth of Soren (birth center transfer)

In honor of Soren’s first birthday I’m posting his birth story here, written by the lovely Sara. Thanks for sharing, Sara! Here it is:
I noticed regular, mild contractions late Sunday night. On Monday morning, I woke up around 7:00 and started timing my contractions again. Still seven or eight minutes apart. They were very mild in terms of pain, but I was feeling them slightly more than I had in the past few weeks. I called my midwife, Chris, a little after 9:00 and updated her on the contractions, and her advice was to rest, eat well, and hydrate throughout the day. “These things usually rev up in the evening, and you’ll need as much strength and energy as possible,” she said.
I took a walk with my best friend, Chelsea, and then had a quick nap. After I woke up, I discovered my preferred laboring position — on my knees, with my chest and arms draped over the top of my blue exercise ball, resting my head with eyes closed, swaying my hips and butt really slowly from side to side. I was making big-time use of the breathing techniques and calming mantras I got from our Hypnobirthing class, and overall, I still felt really mellow. The house was quiet and focused. My husband, Craig, was doing all he could to help me stay relaxed and happy.
Around 3:00, I decided it was time to ask my doula, Erica, to come over. I had kept her posted since the night before on the state of my contractions, so she was on alert.
We were timing the contractions intermittently, and they were roughly two minutes long and every five or six minutes. My midwives’ “rule” about coming in to the birth center was a 3-1-1 situation — contractions every three minutes, lasting one minute each, for one hour. I didn’t know what to do with the fact that my contractions were lasting longer than a minute, but I just waited for Erica to arrive and go from there. She arrived around 5:00, and I don’t know if it was her presence or just a coincidence of timing, but things started to feel very real when she got there. I started feeling the gravity of what was happening, and I knew I was going to have a baby soon.
Craig had been doing a light touch massage thing on my back, which was really soothing, and Erica kind of took over that job; Craig would do it whenever I asked, but Erica seemed to know when I needed that help without me even asking. It was a huge comfort.
We called Chris, my midwife, again, and she asked to listen to me through a few contractions. Humorously enough, she thought I had hung up on her because I was being so quiet through the first contraction! After we cleared up that confusion and talked a little bit, she said it definitely sounded like “the real thing,” but she thought it was still a little early to come in. I was handling the pain well, and I was talking intelligently between the contractions, which led her to think I still had a while longer to go. The hypnobirthing classes we took were really helpful in allowing me to breathe through everything and stay calm, which could be deceiving in terms of making an outsider think that the pain wasn’t serious. I also have this self-conscious tendency to want people to think I’m smart and well-spoken, so I think I was really forcing myself into coherent sentences between those contractions when my real desire was to speak in short, disconnected phrases. Basically, I felt like I was further along in the process than Chris probably realized. I gave myself a little time after that phone call and then called her back to have her listen to me through a few more contractions while I was leaning up against Craig, and I tried my best not to overdramatize what was happening while also not holding anything back. She agreed that it was time to come in if I felt like it was right, but she also suggested that we might want to wait 15-20 minutes to avoid the tail end of rush hour. We hung up and I told the crew that, no, we needed to go now. Just an intuitive thing. That was at 6:30.
Craig and Chelsea had been collecting all the things we needed, so we were ready. I waited for the next contraction to end, and then we walked out the door. By the time I reached the bottom of the stairs (just one flight!), I was already having another contraction. I had to lean up against a concrete retaining wall, and Erica stopped with me to put that same light pressure on my back while Craig and Chel loaded things in the car. Just as my contraction was getting underway, the apartment door that I was standing right next to opened up, and this guy came out walking his little curious dog. What a scene: a hugely pregnant, sweaty woman having a contraction, with a doula at her side, interrupted by a man with funny glasses and a dog who wouldn’t stop sniffing at the pregnant woman’s ankles. I think I even apologized for standing in the way. I got in the car, with Craig driving and Chelsea helping me through contractions in the backseat; Erica followed us in her car.
Things became a lot more difficult, and at the time, I though that it was just because we were in the car, which was uncomfortable, and because I didn’t have my same comfort measures that I’d had at home. In hindsight, though, it became apparent that I was actually transitioning into the final stage of labor. It was a rough drive, but I really was pleasantly surprised at how quickly we reached the birth center (thank you, carpool lane, and thank you, skilled driver). Erica stayed right behind us the whole time and even kept timing my contractions; she could see me through the back window and knew by my body language that they were getting more intense and frequent.
We pulled up to Eastside Birth Center at 7:10 and walked in to find we were the first ones there. I curled up on the bed like a sad little cat and just waited. It was only a matter of minutes before I had two midwife assistants (Brittany and Marja) and Chris with me, along with my original crew of three. Someone started filling up the birth tub with warm water, and I just kept laboring on the bed until it was ready. Five minutes after we arrived, I was throwing up all the watermelon I’d eaten that day, which was embarrassing but ultimately okay; bodily functions of all kinds are welcome at the birth center, and throwing up is a textbook indicator of transition.
Once I was in the tub, I knelt down and rested. The midwife crew was bustling to record information and gather supplies, while my support team of Craig, Erica, and Chelsea were stationed really close by. I felt my water break and noticed that some brown stuff came out of my body and into the water, which I figured was blood or my poop or the baby’s poop (called meconium) or some combination thereof. Chris did eventually say that some of what I had released was meconium, which indicated that the baby was stressed. I knew from my past research that this could be a problem but wasn’t necessarily something to worry about without more information, and Chris seemed like she had everything well in hand, and I honestly didn’t feel uneasy at all about the baby’s safety or mine. I was starting to feel a mounting sense of fear, though, that the next part was going to completely overwhelm my senses and that I wouldn’t be emotionally strong enough to persevere. I had this fear inside of me for several contractions before I finally felt humble enough to say it out loud (at 8:20, according to Erica’s notes). I believe my exact words were, “Guys, I’m so scared.” I know all three of them responded, but Erica’s voice was what stood out. She said, “What are you scared of, Sara?” And she said it in the most sincere and honest tone of voice; it made me feel really safe. I told her pretty much the same thing as above about fearing the emotional intensity. I can’t remember exactly how she responded, but honestly, I think just saying it out loud was enough to make me feel okay about things. Oh, I’m scared? Of course. This is a really big deal. It’s normal to be scared. Let’s keep going.
According to Erica’s notes, it was two minutes after my scared confession that I said, “I feel like I need to push.” And thus began a whole new stage. The urge to push was quite strong right from that initial pushing contraction, and it just mounted as time went on. Chris checked me at 8:30 and found that while I was fully dilated, I had a little lip of cervix that was still in the way, so she tried pushing it out of the way over the next few contractions and coached me into effective pushing. She was able to move the lip out of the way and we carried on. It was about this time that my friend and birth photographer, Lori, showed up and started clicking away, but I literally never acknowledged her presence until after the baby was born. I was too inside my own mind and body to even look up and say hello.
Marja, one of the midwife assistants, started checking Soren’s heartbeat after each contraction with her little doppler machine. It was usually totally fine, but every four or five contractions, his heart rate would come up a little slower and they would give me an oxygen mask to breathe from in an effort to get it back to a healthy level. He always recovered just fine, but between that pattern and the meconium, it seemed like there was a little more pressure to get things moving and make sure that the pushing was effective. The tone from the midwifery crew became a little more urgent. Chris started prompting me to get into different positions that might help his body move down in my pelvis. Craig and I tried to remember after the fact, and as best we can figure, I changed positions at least ten times at the birth center. Marja was still checking out Soren’s vitals inbetween every contraction, and the same pattern was holding steady where his heart would occasionally slow down and they would fix it by giving me the oxygen mask. Throughout all this pushing, I was completely oblivious to the passage of time. I know it was light outside when I started pushing and that it eventually was dark outside, but other than that, it didn’t seem like things were taking a long time at all. I’ve since figured out that I was pushing in all these positions at the birth center for around 2.5 hours, which is a long time as these things go, especially since I was making almost no progress at all.
Chris told us that even though I was pushing effectively, the actual bones of Soren’s head weren’t moving down as well as they should be. She could see the skin of his head being pushed through, but the bones themselves were not. She didn’t know what was causing that exactly, but given the amount of time I’d been working and the many positions we had tried to correct the problem, at 10:15, she said it was time to transfer to a hospital (it would be another 45 minutes-ish until we actually left, during which time I kept pushing). Soren was still doing okay and we weren’t in an emergency situation, which meant we could go to the University of Washington Medical Center; there was a closer hospital we could have gone to, but Chris’s past experience at UW had shown her that they would treat her midwifery patients with more care, so that was her preference (and I am so very happy that she made that call). I kept pushing for a while longer with Marja taking Chris’s place while Chris went to contact UW and make arrangements for us.
I didn’t process this at the time, but really, transferring to a hospital was heartbreaking for me. I of course wanted to do whatever was safest and best for Soren and me, and I trusted Chris’s guidance wholeheartedly; there was no hesitation whatsoever about going to the hospital in the moment, and there’s no regret. But I can feel the disappointment of not having the birth I desired and the frustration of how this might impact any future births of mine.
The time came when we really were leaving for the hospital. I remember some confusion over who was going in the car with us, but it was eventually cleared up; Chris was driving, I was in the front passenger seat, and Marja and Craig were in the back seat. Brittany stayed to clean up the room. Erica and Lori each drove their own cars to the hospital, and Chelsea drove mine and Craig’s car after she gathered up all of our stuff from the birthing center.
The drive to UW was where things actually got difficult. The birth center was this haven of peace and sisterhood and power. Chris’s car was completely different, and the drive from Bellevue to the University District was really and truly hellish. Trying to restrain the pushing brought a whole new level of pain, because — and here’s what I never could have fully understood beforehand — my body was in charge of everything. I didn’t have the choice to not push; my body was going to push whether I wanted it to or not, and the contractions were going to continue no matter what.We were making turns and changing lanes, and there was no position I could get into that helped me cope even remotely. My only outlets were to hold on to the hand support above be and one of Craig’s hands behind me. It was the beginning of the hardest, worst thing I’ve ever experienced.
We took our exit onto Montlake Boulevard, where we needed to cross a short bridge. This was at around 11:00 at night, and — oy vey — THE DRAWBRIDGE WAS UP. This blocked our progress for 5-10 minutes where we were just stopped in a sea of other cars. No one told me the drawbridge was up, and because I had my eyes closed almost constantly, I didn’t see it, but I eventually figured it out. It was one of those man this sucks, but complaining won’t make it better moments for all of us, and we didn’t mention the situation directly until Craig said, “Okay, hun, the drawbridge is coming down.”
Chris drove us into UW Medical Center’s underground parking garage, where Marja, Craig and I exited so she could park. I got into a wheelchair and we made our way to the elevator. My clearest memory of this was approaching a certain part of the sidewalk that was made of bricks, sort of in a cobblestone pattern, and I. WAS. FURIOUS. with whomever had made the decision to put those bricks there instead of regular sidewalk. That was my literal thought process: “I hate whoever did this, I hate them, I hate them.” Because going over even those small bumps in the wheelchair hurt so badly.
Once inside the hospital, I was wheeled through a waiting room full of people. My hospital records show that we checked in at 11:15 pm. Things for the next hour are a huge blur to me. The pain was nigh unto unbearable, and my only safe place was inside my own head, so I was shutting out everything I could. I knelt down on the bed, buried my face in the pillow, and tried not to see or hear anything that I didn’t have to; I followed simple instructions just to get by. It was like I was trying to create a little cave for myself. I know there are big gaps in my understanding of what happened.
The nurses and doctors who attended to me at UW were beyond amazing. They respected me. They respected Craig. They respected my midwife. They read my birth plan and talked to me about it. They were as gentle as possible. They helped us make hard decisions. My nurse, Jenny, was incredible. That said, even being in a hospital room was a huge departure from what I wanted, and making the mental transition was tough. I felt very vulnerable and sad and just in such tremendous pain.
Erica’s notes are really my only guide to how things progressed after that. At 11:30, I got hooked up to an IV and started receiving fluids; I believe I also had a catheter put in around this time. At 11:40, they placed a fetal scalp monitor in/on Soren. At 12:00, I received my epidural. It all happened pretty quick, evidently (definitely didn’t feel so quick at the time). All of these things were thoroughly discussed with Craig and me, and what was really wonderful is that by this time, our entire birth center crew (minus Brittany, as previously mentioned) was in the room with us. Chris was regarded by the hospital staff as the total professional that she is, so she was able to be right in the thick of things — not administering any medical care, but advising us and giving needed insight on my medical history to the team. There were so many times when the doctors would suggest something and explain it through my pain, and I would look at Chris for her blessing, and when I received it, I knew it was the right decision. She was a guiding force for me. I trusted her entirely.
Shortly after I received my epidural, I asked the nurse if it was supposed to have taken effect yet. She said that yes, I should be experiencing a lot of relief at that point, but I wasn’t. A short conversation with her revealed the following (and this is my understanding of what she said, so don’t take this as medically accurate info necessarily): an epidural is meant to help with earlier contractions, the ones you feel high up in the uterus, the ones I was experiencing at home. The contractions I was experiencing at this point were felt down in the actual birth canal, and the nurse explained to me that the epidural doesn’t really alleviate that pain; it’s important for the woman to be able to feel that at least somewhat so that she knows when it’s time to push and where to direct that pushing. So, if you’re keeping up, that meant that the epidural I’d just received was kind of worthless. I literally laughed like a movie villain at the nurse and said something along the lines of, “Yeah, that doesn’t help me.”
Weirdly enough, this was the moment when things turned around for me and I started to feel a little more mentally and emotionally okay. Somehow it all came together and I knew with certainty that I was going to have a cesaerean. I didn’t have to resign myself to that fact; I just suddenly knew that it was going to happen, that it was always going to happen this way, that this was how Soren was going to be born (and maybe even how he was supposed to be born). And I felt total peace about it. I am so grateful for that moment of clarity. It put a beautiful glow on everything that was about to happen, so that I could appreciate it and feel empowered in something so different from what I’d originally planned. Once I let go of something that wasn’t to be (ie having a vaginal birth), I was able to think clearly and feel pretty okay between the contractions
Not too much later, my main doctor (whose name I don’t know — I’m sure she told it to me when I wasn’t listening to anything that wasn’t essential) sat down by the bed, right next to Craig. Chris was standing immediately behind her, and we had ourselves a heart-to-heart. I think it was at this point that the doctor told us that Soren was coming out forehead first, which is why we were having so much trouble. (I learned later that this is called a brow presentation; you can look it up and learn more, if you want, but suffice it to say that it occurs very rarely and that it’s nigh unto impossible to deliver a baby vaginally this way.) Soren’s heartrate was also getting into a dangerous zone more frequently. In between contractions, the doctor explained our options.
The first was to labor a little longer and use pitocin to strengthen the contractions. In doing that, the doctors would try to reposition Soren in such a way that he could be delivered. There were some risks to both Soren and me if we went with this approach.
After she explained this option, I said as firmly as possible, “I want to discuss the option of a cesaerean.” The doctor told me that, yes, the other option she was going to bring up was a c-section. She told me what the preparation process would be for that and also conveyed to me that this was serious abdominal surgery and not something to be taken lightly.
With all our facts and options on the table, Craig spoke first. He said something like, “Here’s what I think: let’s try the labor for a little longer and see how it goes.” He told me later that, really, he thought an immediate c-section was the best call, but he knew how much I didn’t want that, so he wanted to give me time to come around to the idea. He also didn’t want me to feel pressured into something so huge. Little did he know that my mind was already made up.
I looked at him and said, “I want to do the cesaerean.” He asked me if I was sure, and I quickly ran through all these persuasive reasons in my head, trying to figure out how to explain my change of heart, but what I landed on was the simple truth: “I just think it’s the right choice.” I looked at Chris again, looking for that confirmation from her, and I got it. “It’s time, sweetie. You’ve done so well, and this is the way to go.” We made the decision at around 12:30.
I assume they switched some new medicine into my IV or epidural or whatever. I started numbing up a bit and said goodbye to everyone in the room — Lori, Erica, Chelsea, Marja, Chris, and finally Craig (the protocol was to wheel me into the operating room first and get me prepped, then to bring Craig in once he was all dressed in his awesome scrubs). Everyone gave me love and support; it was truly beautiful.
As I left the room, I saw a new guest right at the door — my mom! Her flight had landed and someone from church rushed her to the hospital. It was just a magic coincidence that she got to my door at the exact moment when I was being wheeled away. I told her I loved her and proceeded down the hall; she didn’t even know what was happening until she went in the room and everyone inside told her that I was going in for surgery. Craig apparently had a huge emotional release once I was out of the room, finally feeling like it was okay to cry a little bit, and being that he was the lone man in a room full of very caring women, there were lots of people to offer him a shoulder to do that crying on.
A crew of surgeons and nurses were waiting for me in the operating room. As the medicine took hold more and more, I became sort of loopy but a lot more aware than I had been before. The pain of the contractions went away, and I eventually became numb from my chest down. I was shivering a lot, which led the nurses to put some warm towels over my arms (that felt awesome). I was laying on the table with my arms straight out on each side, and just before Craig came in, they hung a blue curtain up right over my chest so that we couldn’t see anything. He arrived dressed in blue scrubs with a little mask over his mouth and sat down on my left side. Everyone was bustling around, preparing tools and whatever else, and Craig and I had a chance to just be together and stare at each other and wonder at the total craziness that had been the past 12 hours.
It was finally time for the surgery to start. There wasn’t pain from being cut open, but there was plenty else to experience. The surgeons were pulling and moving and shaking and pushing my body a lot, tugging me around, enough that my head and arms were jerking in response. It was pretty tough to take; I had to employ my hypnobirthing breathing techniques as much as I could, and Craig tried to keep me calm and focused by telling me to look into his eyes. I asked the nurses who were at the top of my body if everything was okay, and they confirmed that the baby and I were both fine, that everything was going smoothly. As things wound down and they pulled the baby out, Craig was asked if he wanted to look over the curtain or cut the umbilical cord; he refused, and I was glad — I wanted him to stay with me. Soren was born at 1:22 AM.
And finally — finally, finally — we heard Soren’s first cry. It was mild and wonderful, and Craig and I both cried a little bit in response. He was moved to another part of the room to be taken care of; with the decelerating heartrate issue and the presence of meconium, the team needed to make sure that he was healthy and safe as a first priority. Once he was in the clear, a nurse asked Craig if he wanted to come over and say hello. Soren had been keeping up a strong cry throughout, and I told Craig that he was welcome to go and comfort him. Once he stepped away, though, I felt really alone; I was still being jostled quite a bit as the doctors started sewing me up. I said, “Umm, can someone else come hold my hand?” And one of the nurses came and took Craig’s place, holding my hand and comforting me.
When Soren was all bundled up in a blanket and cap, Craig brought him over to me. We stared at him and talked about him while the doctors proceeded to sew me up (every so often, I’d hear them update each other on the progress – “Sewing up the uterus,” “Sewing up the skin layer,” etc.). It was so very very bright in that room; Craig was shading Soren’s face as best he could to encourage him to open his eyes. It was just a beautiful time. Soren was a very good-looking baby, right from the start. He was with us and we were fully in love.
We went back to the room. Everyone was still there except for Chris; there were actually two other moms in labor back at the birth center (two! that never happens! good thing I cleared out of there…), and they needed her more. The following two hours were lovely; everyone met Soren and shared their thoughts, I started breastfeeding, Lori took pictures. People were telling me I was a warrior princess, which felt pretty nice. I felt total relief and happiness. Marja, Erica, and Lori trickled out as they needed to, and then my mom, Chelsea, Craig, Soren, and I were taken to a recovery room, where I’d stay for the next two days.
All in all, I am satisfied. No, I didn’t want a C-section, and if I could go back in time and do something to prevent it and still get Soren here safely, I would. That said, on an emotional level, I still ended up with the birth I wanted. I wanted to challenge myself and dig deep — check. I wanted to go into labor on my own — check. I wanted to labor without medication and draw from my inner strength and the support of the people around me — check (I dilated fully and pushed for several hours without any intervention; if it hadn’t been for the brow presentation issue, I definitely would have been able to have him without pain meds). I wanted to trust myself and trust the knowledge of my care providers — check. I’m happy with every decision we made from the beginning to now, from when we first found out we were pregnant to this very day. We picked excellent midwives, we hired the perfect doula we prepared ourselves with research and hypnobirth training, we enlisted the right help from the right people, we called Erica at the right time, we went to the birth center at the right time, we tried a lot of different positions for pushing, we went to the best hospital ever at the right time, we evaluated our options correctly and made the best decisions that were available to us. And Soren is here, healthy, lovely, wonderful. He is seriously the love of our lives now. We love love love love him.

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