From Nurse to Gentle Birth Advocate, Part Two, S.'s Birth Story

Fast forward about 2 years and I was planning the birth of my second child. The memories of J.'s difficult birth were still fresh in my mind, but I was hoping things would be better this time. At 34 weeks gestation I was sent for a routine ultrasound scan. The technician took a number of measurements. I discovered that S.'s head measured 97th percentile, and was instantly filled with dread. Strangely, I was measuring a bit small at that time and the technician also noted large fluid pockets on the scan. My obstetrician seemed a little concerned about the fluid pockets and informed me that he would like to have me come in for a weekly NST or Nonstress Test. He told me that sometimes the large fluid pockets can indicate some type of problem, but usually nothing is found. So now I was really freaking out.
I remember coming in for the NSTs. The first time, the baby seemed to be running away from the transducer. When that happened, I wasn't concerned because I could feel the baby moving vigorously as the nurse tried to locate the heart tones. Another time the baby's heartbeat looked very flat with little variability. The OB came in and studied the strip and then decided the baby must be asleep. He applied a loud buzzer to my belly to wake him up. S. woke with a vengeance, so we got the desired variability and I went home. The next time I came in, the room with the nice recliner for the NST was not available so I ended up stuck on a stretcher. I couldn't see the screen or the monitor strip very well, and I couldn't get the stretcher to the right angle for comfort. I was extremely uncomfortable and it felt like I was abandoned, chained to this monitor. By the time they came back to check on me I was in tears. Not that I got any sympathy from the staff, because apparently they were busy. The strip looked fine.

At my 37 week checkup I was 2 cm dilated, which surprised me. I was experiencing some back pain and general discomfort around that time, but nothing that really felt like contractions. I was still working a couple of 8 hour shifts per week in the hospital. The census was running low and as a float pool nurse I was being pressured to use my PTO which I was saving for after I had the baby. They were obligated to guarantee my hours, so I was assigned to "sit" with a patient on a 1:1, something normally done by the paraprofessional staff. So there I was, 9 months pregnant and crawling around on floor mats after a 3 year old with a tracheostomy. I complained about it to the nurse manager, who asked "What do you do at home with your son?" Well, I lie down on the couch and close the baby gates to keep him in the living room, you %$@#. That's what I do at home. No sympathy for the very pregnant nurse. After another shift with the same child, during which the ENT decannulated the child ON THE FLOOR without warning me, I decided to cancel my one remaining shift that I had booked before my scheduled leave.

The following Tuesday I was scheduled for my induction. We arrived at the hospital at 7am and went through admissions. When we got up to the floor, the midwife was assigned to do the some of the preliminary paperwork and such. She kind of slammed on the brakes and suddenly decided that she needed to do an ultrasound before the induction, to see if the baby was head down. Seemed a little late to be wondering about that, and I was kind of curious as to why should couldn't tell by where the fetal heart tones were located and by just feeling my belly. I knew that the baby was head down and very, very low at my 34 week ultrasound. The technician had a hard time taking some of the measurements because of how low he was. I think she may have even used a vaginal probe to check some of them. I really didn't think it would be possible for the baby to flip given how engaged he already was. The midwife also wanted to examine me to see if my anatomy was suitable for breastfeeding. I thought that was very strange. After she examined me and proclaimed my body met her criteria, since I did not have flat nipples, I informed her that my first child had taken care of that problem in the 23 months that he was breastfeeding.

The OB arrived at 8 am. I had expected that we would use cervidil again but when I arrived for the induction, the doctor said I was already 3 to 4 cm dilated and there was no need for cervidil. I was a little anxious about the Pitocin, but it was either that or go home. Because of my concern about having a difficult birth if the baby's head got too large, I opted to stay. I really thought I was doing the right thing by delivering before the baby's head got any larger. After all, the ultrasound measurement of his head was at the 97th percentile. I thought if I went to term the baby wasn't going to fit.

The next thing I knew he was holding an amniohook and saying "I'm going to break your water." Now, he did pause for a moment after he said it. I had a few seconds in which I could have screamed "No!" but not really any time to consider it. He broke my water. My husband called work to tell them he wouldn't be in that day. We weren't sure exactly what was going to happen up until the OB broke my water. With J. we came in twice and went home twice before I actually went into labor. But we knew that we were locked in once my water was broken. Although I just asked my husband what he remembered about this and he said his reaction was "What did he just do?"

After several painful attempts by the nursing staff, an IV was placed. I don't know why they can't listen when I tell them which veins tend to not work very well for me. I know which ones collapse and which ones have multiple valves that impede IV insertion. After all, I am a nurse. Shortly afterward I received my first dose of antibiotics in my IV and the pitocin was started. At first the contractions didn't feel much stronger than Braxton Hicks. I watched TV, even called a friend and chatted on the phone. The OB came back into the room around 9:30am and stated that if I could talk on the phone, the contractions weren't strong enough. That's when I decided that having an induction is a lot like being tortured by your brother. "Oh, that doesn't hurt?"

I had asked if I could walk around during labor, because the hospital was supposed to have wireless electronic fetal monitors. But apparently the one in my room was not wireless, and there was only 2 rooms that had the wireless EFM. Oh, and the nurses said they didn't work very well. Translation: "They take too much of our time to keep adjusting them when you move around." Only certain rooms had the wireless EFM, and they were full. Can we say "bait and switch" anyone? So I was stuck in the bed again and I had to have continuous EFM because of the Pitocin.

The nurse that was assigned to me had another patient in labor, and she was having a lot of difficulty attending to both of us. So I ended up with the charge nurse providing most of the nursing care during my labor with S. She was pretty nice though. Around 10:30 am the contractions were more intense and definitely painful. The nurse checked and found that I was 5 cm dilated. I wanted to try something for pain, but not the epidural just yet. Again, the only thing available was Stadol. She gave me a dose around 11 am and it did nothing. I reluctantly asked for an epidural, thinking I had failed again by not being able to cope with the pain. So she called for the anesthesiologist. And we waited. And waited. And I writhed around in the bed in pain. My husband was like "are you all right, you look like your eyes are going to roll back in your head?" I just gasped out "It hurts!" As noon approached I told the nurse that I was having a lot of pain that was not completely going away between contractions. She was in the room running my second dose of antibiotics.

It ended up being a blessing that the anesthesiologist never showed up. My obstetrician came back shortly after I was starting to have pain that didn't stop when the contractions did. He decided to check my progress and his jaw just about hit the floor. He said "You are complete. You have remarkable control for someone who is fully dilated." I guess he expected screaming and swearing. I know I heard some screaming from the last patient that he delivered in the next room. I'm more quiet in transition, just trying to keep it together. But when he said that, it was a ray of hope. I was almost done! I didn't need the epidural now, because I could see the finish line! Suddenly the pain became almost bearable. It wasn't going to take another 8 hours, and I would be able to push well because I wasn't numb.

And before I knew it I was pushing, and the baby was moving down this time. I felt the "ring of fire" and thought it would be easier to push without that sensation. So I asked for a local anesthetic. The doctor injected some lidocaine and the burning went away, except for one spot, near my episiotomy scar. But apparently, there was a tear beginning in a new spot, because when I pointed to where the lidocaine wasn't working, the OB started to say "I can't do anything about that" but then saw that I wasn't talking about the tear he was seeing. Too bad he didn't clue me in at the time, perhaps to suggest repositioning? I was sitting upright on the bed, thinking it was much better than the semi-reclined position I delivered J. in, but unfortunately it also meant that I was sitting on my tailbone. Which I think was the cause of the tear, as it pushed baby's head forward.

The main thing I remember about pushing was people counting to ten. And me feeling like my lungs were going to explode if I didn't take a breath. I started screaming through clenched teeth vocalizing more during pushing to try and get some air that way but when I did that it seemed to make everyone nervous for some reason. They kept trying to get me to quiet down. I tried to ignore them but it wasn't easy to do. And I don't construct sentences very well during that part of labor, I'm lucky just to get a few words out. After about 45 minutes I just decided I had enough of it and pushed with all my might. S. was born at 12:45pm, after approximately 2 hours of active labor. I felt elated, I had given birth without an epidural. Now I knew that I could do it!

I wanted to lift S. up onto my chest as he was born, as I had with J., and my OB reluctantly agreed. But as I grasped my son under his arms and started to lift, the doctor started yelling "Short cord!" He yelled it about 3 times before he got my attention. I was all set to lift S. up close to my face, it took a moment for his words to click. I put the baby on my tummy but I really wanted to look at him more closely, so I said to the OB "Cut it, then" and sort of shrugged. S. looked fine to me, he was breathing and looking around. I had never heard about the benefits of delayed cord clamping so to me, baby was out and breathing, why does he need it? My doctor paused for a moment, as if he were thinking about it, but he never said a word. He clamped and cut and I lifted my son up onto my chest.

I know I held him for a short time but I don't remember anything about looking at S. or talking to him. All I remember is the pain. The tear that the doctor probably knew was happening as I started pushing, now I could feel it. At least I could feel it as the doctor persistently poked and prodded at it as he was trying to decide whether or not to stitch it up. It wasn't a terrible laceration, more like a skin flap but it was a labial tear in a really uncomfortable location. My husband didn't take any pictures of me holding the baby right after birth because he felt like he couldn't avoid exposing things we didn't want in the photo. So I don't even have pictures to remember the moment. I quickly asked for my husband to hold the baby instead because I felt my arms tensing up and I didn't want to squeeze him. My husband would not hold him, I think because he had a longer section of umbilical cord with hemostats attached to it. He was afraid of hurting him, I guess.

So poor little S. was hastily brought to the waiting warmer and basically left alone. Of course my husband was watching over him and taking pictures but the nurse dashed back to my side because at that point she was the only one available to assist the doctor and there was again concern over bleeding. This time both pitocin and methergine were given. I was, again, not particularly aware of the delivery of the placenta, but I strongly suspect some cord traction was used. My husband recalls the time from birth to delivery of the placenta as being approximately 10 minutes.

Soon the bleeding was under control and the nurse began doing the routine newborn procedures as the doctor finished poking and prodding examining me.

7 pounds even and not too happy about it.

I got him back but he was mad! I had wanted to see if he could do the breast crawl and latch on without help, but there was just no way. He wouldn't calm down. Finally about 2 hours after S.'s birth, I got up, sat in the rocking chair with a pillow on my lap and put him to breast myself. He did nurse well for about 5 minutes on one side, then fell into a deep sleep for about 6 hours.

A significant portion of those early hours he spent on the warmer as we were moved to another room and tried to get comfortable. He didn't need the warmer, but the nursing staff was apparently too busy to switch it out for a bassinet. We were in a really tiny room, normally used for patients having gynecological procedures. Again with the bait and switch, as we were offered a "nice clean room." Yeah, one that is half the size. After family and friends came and admired the new baby, I decided I would like to hold him and maybe see if he would nurse again. He slept and slept.

The baby had some difficulty latching on, but nothing like my first baby. S. did NOT have a tongue tie, and the difference was pretty amazing. As for the rest of the short hospital stay, I'll just say it was annoying. They never brought me a dinner tray or a menu, and by the time I actually wanted to eat something it was too late to get one. They wanted to weigh my baby and test his hearing at 1 am. I was ok with a quick trip to the nursery but I ended up walking the halls trying to find a way to get him back. I could see into the nursery but no one was paying attention to me and I couldn't see where my baby was. Finally I had him back but I was up all night. I couldn't get the room dark and I could hear other babies crying nearby. We went home when S. was about 28 hours old. Even having a toddler in the home was better than dealing with the constant influx of every hospital staff member imaginable. Although the initial welcome was a little too exuberant!

Welcome home, S.

S. ended up having a rather sleepy start to life. He nursed enough and had the correct amount of wet and dirty diapers, but he was a very sleepy baby. I took him to the pediatrician at 3 days of age because of the sleepiness and some jaundice was noted but no blood test was done. We went to see a lactation consultant when he was 8 days old. He was just 2 ounces shy of regaining his birth weight. I was diagnosed with breast engorgement, hyperlactation, and plugged ducts. The baby was noted to be jaundiced. We saw the pediatrician the next morning and the baby's bilirubin was 17. We got a bili blanket delivered that afternoon, which brought his level down to 14.6 by day 10. This seemed to make him more wakeful. And a little cranky. Recheck on day 11 was 14.3.

S. would go on to develop other issues, including allergic colitis, low muscle tone, developmental delays, and eventually failure to thrive. He is now a healthy 5 1/2 year old with some mild hypotonia and slight delays in fine and gross motor development. Many of the challenges he experienced could possibly be attributed to his induction prior to term, cord clamping, intrapartum antibiotic use, lack of skin to skin care, and jaundice. My advice to other moms is to educate yourself and carefully consider the use of any interventions in the birth process to get the best health outcome possible for your child. I am thankful to Birth to 3, a very wise holistic IBCLC, and a DAN! naturopathic doctor for the progress S. has made to date. S. is a very sweet and affectionate child that has enriched our lives in many ways. I enjoy hearing him share his thoughts with me each and every day.

From Nurse to Gentle Birth Advocate, Part One, J.'s Birth Story

I feel like I am kind of going backwards here, but since I didn't discuss J.'s birth in detail in the story of his first year of life, I'm going to talk about his birth before I move on to other topics and experiences. I believe that how we birth has a strong influence on infant development, and it is something we need to be mindful of so we can make informed choices in our care.

I would say that I went into my first pregnancy with my expectations for birth colored by past experiences. I had supported a friend during labor and was present at the birth of her daughter. I witnessed several births when I was in nursing school. I heard the stories of other women's births. I had a realistic idea of what a hospital birth entailed, and I didn't see anything wrong with that. I wanted to have an unmedicated birth, but didn't really feel too strongly about it. I was just willing to wait and see how things went. I knew I didn't want a c section, but didn't know much about how commonly used interventions increased the risk of having a surgical birth.

I thought I knew pretty much what I needed to know. I had studied maternal/newborn nursing, I was aware of what the hospital routines were like. I signed up for a childbirth class, mainly so my husband would have some idea of what to expect. The hospital where I was to deliver was about 30 minutes away so I ended up taking the class at a closer hospital, just for convenience sake. It didn't really occur to me that there are different types of childbirth classes, so I didn't do much shopping around.

I did ask my OB a list of questions about his practice style, including c section rates and episiotomy rates, whether he used forceps or vacuum, and how frequently, that sort of thing. I had spent some time working in a newborn special care nursery, and had heard some horror stories about the use of vacuum and forceps, so I really wanted to avoid them. My OB said he did not use vacuum, but just the forceps and he wouldn't do anything that he wouldn't do for his own child. I was satisfied with that answer. I wrote a birth plan and went over it with my OB in the third trimester, he was agreeable to it and included the birth plan in my chart.

As I was nearing the end of my pregnancy, an ultrasound was scheduled. I don't recall the exact indication for the ultrasound, but it sounded pretty routine. The scan was done at 37 weeks and 4 days gestation. The baby's weight was estimated at 8 pounds, 2 ounces. I don't recall anyone mentioning that ultrasound estimates of weight could be off by up to a pound, so I was quite content to let the OB schedule an induction. I was getting very uncomfortable. It felt like that baby's foot was a knife sticking directly into my liver. From what I had heard, 37 weeks was considered full term. I thought, why not get him out while he still fit, right? I was actually rather annoyed that they wouldn't schedule it until he was close to 39 weeks. Not that they didn't do that, but his due date was toward the end of the week and inductions were normally scheduled at the beginning of the week. However, inducing for a suspected large baby does not decrease the risk of c section, nor does it decrease the risk of complications like shoulder dystocia. I never received any information on the risks and benefits of inducing from my obstetrician. I did get a heads up from my pediatrician, but unfortunately I didn't heed his warning.

Now, I had heard enough horror stories about pitocin inductions that I really wanted to avoid one if possible. So after discussing this with my OB, he suggested using cervidil to ripen my cervix. I didn't happen to have heard any cervidil horror stories. I was scheduled to come to the hospital on Tuesday April 9th, at 38 weeks 5 days. News flash! There are cervidil horror stories. This is one of them.

When I arrived at the hospital and got through the admitting process, the nurse put on the belts to measure contractions and the baby's heartbeat. To my surprise, she said that I was contracting at regular intervals. The only thing is, I didn't feel the contractions at all, so I didn't think they were particularly significant. I can't recall the details very well, but I believe I was about 1 cm dilated. The nurse inserted the cervidil, which looked like a little piece of gauze with a string attached. This allowed it to be removed if it caused contractions that were too strong. It didn't really do anything. I spent the day at the hospital and used some natural methods that the nurse suggested to try and get labor going. I walked up and down the halls and bounced on a birthing ball until I was sore and aching all over, but I did not go into labor. At the end of the day, they sent me home, but with the plan for me to return the next morning.

I didn't sleep that night, excited and wondering when I would go into labor and have my son. When I came back the next morning, still not in labor, they repeated the cervidil and after monitoring for a short time, sent me home with instructions . I was supposed to remove it if contractions became too strong. Late that afternoon I started having contractions that were uncomfortable, though not painful at first. They were regular. I decided to keep busy, running a few loads of laundry and making some dinner for my husband and myself. By the time I had the food ready, the contractions were strong enough that I wasn't enthused about the idea of eating. I started to time them around 7pm and they were 2 minutes apart for 1 hour. I called the doctor and received a call back from the OB on call. I asked if I should take out the cervidil because the contractions were so close, but she said no. But she did say to come in.

I arrived at the hospital around 9pm. I was still about 1 cm dilated. The admission was pretty straight forward, but the contractions were really intense so I was a little snappy. I believe there was some bad language involved. My husband commented on that later, but you know, he wasn't the one in labor. There were several painful attempts to get an IV in. I tried walking the halls but the contractions were coming every two minutes and I found it really hard to cope with them. A They were about a minute long so that meant I was contracting 50 percent of the time I was in labor. I learned later that a contraction pattern like this is not typical for early labor, and was almost certainly due to the use of cervidil. I tried getting into the shower but it didn't provide any relief. I thought I was such a wimp for not being able to handle the pain. Around 11 pm the nurse gave me a dose of Stadol in my IV. I felt nice and relaxed, for about a minute until the next contraction hit. After that it did nothing for me.

By 1 am I was about 2cm dilated, which was rather disappointing, and had an epidural placed. I wanted to wait longer but I felt like I couldn't cope with the contractions being so close together. It felt like a bolt of lightning went down my right leg when they put it in, and but it seemed to work. I felt myself jump involuntarily, thank goodness that I wasn't injured! At first one side was better than the other but after rolling onto my side it evened out. The contractions were no longer painful but I had severe heartburn with every single one of them. I tried to chew on ice chips for relief, but it didn't work very well. After the nurse left the room and the lights were turned off, I felt a pop and a warm sensation. I was pretty sure my water had just broken. I used the call button and the nurse came back in. I was correct. She checked the fluid, and got me settled again with dry bedding, then left.

After that, my husband and my only support person went to sleep. I was supposed to try to get some sleep too, but I was wide awake. Who could sleep with fire in their throat every two minutes? The husband was snoring, which irritated me. I threw some ice chips at him and growled at him to stop snoring. This, my friends, is why you hire a doula. Trust me, it's worth it. YOU are worth it. After a while I finally asked for something for the heartburn and was given some medication. At 4 am the nurse checked me, and to her surprise and mine, I was fully dilated. Did I want to push? Sure, I wanted to see the baby, why not? No one suggested that I labor down a little until I felt an urge to push. This mistake would lead to hours of pain and frustration.

There were a few decelerations throughout my labor at various times. I was told to quickly roll onto my left side and I did. I didn't think too much of it at the time, had seen similar scenarios when I was in nursing school. His heart rate did come back up with position change. They may have given me oxygen doing one of the decels, but I don't recall for sure.

Around the time that I was entering the second stage of labor, I started having severe pain very low in my abdomen that I felt through the epidural and which did not stop between contractions. They had been giving IV fluids for hours and I had not been up to use the bathroom. The nurse got 700 cc of urine out of my bladder with a catheter. That took care of the pain for the moment. I'm a little fuzzy on the exact timing, but I did start pushing soon afterward. I would guess that it was sometime around 4:30 to 5am. After about an hour I was in a lot of pain. The contractions hurt. A lot. I asked them accusingly, "What happened to my epidural?" They said it was still going. After 2 hours I said "this isn't working, I want you to use forceps." I wanted that child out, it seriously hurt. It hurt to push and it hurt not to push. They reminded me of my birth plan, that I said I didn't want forceps unless the baby was in distress.

I have to give the doctor credit for something, because he stayed with me from about this point on. Not too many obstetricians will spend more than 2 hours with a woman in the second stage of labor, but he did. He had far more empathy than the nurses or anyone else did. My husband was holding one leg when I pushed, and there was a nurse orienting that was holding the other leg. The only problem was, as soon as a contraction was over and I stopped pushing, they would just let my legs go. I was completely numb so I had to reach out and catch my legs with my hands so that they wouldn't hit the side rail. The doctor noticed this and set up the bed so that I could relax my legs in an elevated position without anyone having to hold them. He told them to help me hold my head up when pushing instead. I know stirrups get a bad rap, but since I was numb from the waist down, the leg supports were actually a huge relief. My neck was soooo tired, and having both neck and leg support for pushing helped tremendously. I didn't feel able to advocate for myself during this stage of labor, it was difficult even to speak. When I needed a sip of water after each push, I gestured toward the cup and made a noise. Why did I feel so helpless? In retrospect, I probably should have had them shut off the epidural and let me get out of the bed to push. I couldn't have imagined it at the time though, it was so painful even with it.

There were some good things that happened in the second stage. The hospital staff were very mindful of my birth plan. I got to see the baby's head with a mirror. I got to touch his head and feel his hair. I was really happy about that. It put me in a better frame of mind and gave me some strength to go on. The doctor that cared for me during the second stage of labor was NOT one of the doctors that has recommended the induction, nor was he involved in the process. My primary doctor went off call at 7 am and his partner came in at the end of this chain of events. In retrospect, I think we were lucky that this happened because he was probably the most supportive of vaginal birth of all the doctors in the group. He certainly had a great deal of patience, and a calm, soft spoken demeanor.

After another hour, the doctor looked at my husband and I and said "I don't think this is going to work." We thought he meant that he would need to do a c section, so when he asked if he could cut an episiotomy, it actually sounded good at that point. I was kind of thinking, if that is all you needed to do, why didn't you suggest that already? So he cut. I think he may have cut mediolateral incisions on both sides, but I'm not sure now. Our son entered the world about 15 minutes later, at 8:45 am.

After J.'s head and shoulders were born, the doctor told me to reach down. I think he realized how hard I had worked for this, and wanted to be sure I got the maximum reward for my efforts. I thought the baby was all the way out, but when I took hold of him under his arms and tried to lift him, I realized that he was only delivered to about his waist! Then he slid out and I lifted him onto my chest. I helped dry him gently with blankets and I talked to him. He looked right into my eyes and he didn't cry at all. My husband was a little worried but I knew the baby was fine. I was blissfully unaware of anything else for a few minutes. I do recall the doctor doing fundal massage and me telling the baby that "the doctor is really hurting me right now." A little mild panic in the room over bleeding and "we would like to give pitocin." Ok. I didn't even notice the birth of the placenta, I never saw it. J. had my complete attention. He was here and he was beautiful!

Of course it was a bit hard to look at him while laying flat on my back. But I didn't really notice that at the time. Wasn't our nurse pretty? She's making me look worse. LOL


I opted to allow the nurse to do his routine newborn care on the warmer while the doctor spent about 20 minutes stitching me up, as the process was rather uncomfortable. I was unaware at this time of the benefits of skin to skin care of the newborn. Interrupting this bonding time immediately after birth effects neurological development, breastfeeding, and the development of gut flora in the newborn. I now wonder how our first hours, days, and weeks and beyond might have been different if J. received uninterrupted skin to skin care in his first hours of life.


J.'s first cries came as he was transferred to the warmer. At the time we believed this was a normal part of newborn care. It never occurred to me that new babies should be cared for differently.

8 pounds, 1.5 ounces.

Dressed with hands covered. Eye ointment blurs vision.

I did feel much better, had a chance to change clothing and now sitting upright so I can see the baby better. J. nursed within an hour of his birth.

J.'s daddy holding him for the first time. My husband looks like someone who has also been up all night. Except for the nice, long nap after my water broke, of course.

It's been a long 8 years since this day. It's hard not to look back and think "What if things had been done differently?" We are sporting a few wrinkles and grey hairs. Can we blame him? ;-) Nah, he's too cute. Let's just blame the doctors. It's more fun.

Happy 8th Birthday, J. We love you!