Placentadendron

An update on the placenta situation (this is long in coming). About 6 weeks ago we buried the placenta under the Rhododendron in front of our house. A few professionals agreed that there would be nothing left of a cremated placenta, so this was the next best thing.

Dave dug the hole, I examined the placenta (fresh is much better than preserved) and Lazadae and I buried it.

No ceremony.

It's nice to have a place to go to look at it. And I always look forward to seeing the rhodie's pick flowers in the spring. It's outside my office and I thought it would be the tree I stared out as I pushed my baby out. So it seems like a perfect place.

Our Birth Story - Day 3, Part 6

Friday, April 1, 4 - 6 a.m.

From the bathroom I walked to the kitchen where the midwives were talking to tell them we had to transport. Kim mentioned that she's only ever seen that much meconium in a frank breech baby. Still, that statement wasn't enough to pull us from the idea that the baby was head-down.

I asked what their plan was anyway, just to see. They said they were willing to stay for another hour, do a cervical check and talk after that. What I didn't want to happen was to get to the hospital and find out that the baby was close and I was ready to push. I wanted Kim to do the second check, but seeing as Laurie had done the first, we agreed it was best for Laurie to do the second since she could refer back to what she previously felt.

I don't remember anything about the second check but Dave does.

We returned to the bedroom for the second check, resuming the positions we'd occupied three hours earlier. Laurie spent maybe half the time inside of Courtney as she did during the first check, and her prognosis came quickly once she removed her hand. It felt to her that the constriction ring hadn't softened at all, and perhaps had even grown tighter. Even though the midwives were still comfortable giving it another hour, neither Courtney or I saw the point in waiting, and decided it was time to go to the hospital. I was still hopeful that she would have a vaginal birth. Courtney hadn't yet communicated that she suspected we were heading to the OR, but based on how quickly she deflated and withdrew, I should have known she already knew the outcome.

(During a postpartum visit after the birth, Laurie communicated that she thought my cervix had swollen to one-centimeter. Chances are, she was feeling the baby's rectum. However, since no one suspected that the baby was actually breech, we didn't consider this possibility in the moment.)

The next half-hour was a flurry of movement, anxiety and worry. Kim started helping me pack, asking what essentials I wanted. She didn't know where we kept our bags and I told her to ask Dave. The dogs, meanwhile, were tapped into our energy and were responding in their own ways: Satchel watching intently, Maji pacing, trembling and hiding.

I wanted my hoodie, and at one point had everyone looking for it. I told Dave to pack a laptop and he refused. In his mind we'd be home later in the day or evening. I knew better. I wanted Kim to grab a specific baby blanket in the event I'd want something nice in the hospital - there I was in the midst of everything falling apart, and I wanted to be sure I had this one very comfortable looking blanket for the baby, which seemed to me to be an extension of a special love I was no longer able to provide because of how the birth was unfolding.

The worst part of it all was that my contractions continued, but now I was faced with the fact that this horribly painful back labor was all for not.

Dave bounced from room to room looking for things, trying to find bags. He also called Lynette to come for the dogs.

I fell into the place where I hated everything - a dark, unfortunate place I hate visiting. But there I was, suddenly and completely at a loss, unsure how to help and pissed off at what was happening. I grabbed backpacks and started jamming things into them. Courtney wanted to pack a laptop and I refused - what was the point? Everything we'd planned was falling apart, and the house itself seemed to be spinning.

At some point I put Maji in her crate then brought her back out. Everyone was pacing and the dogs were getting in the way. I called Lynette who answered half-asleep and told her what was happening. I pictured her springing up in bed as she said she'd be at the house in 30 minutes for the pups. Knowing she was there to help was a brief glimmer in an otherwise depressing and disheartening span of time.

The midwives asked who I wanted to go to the hospital with us while the other stayed behind. I asked for Kim to go, and asked Laurie to stay back until Lynette showed up. Just knowing the dogs wouldn't be alone for even a second was a huge relief.

Kim walked me to the Zada. It was 4:30 now, we were out in the middle of my street in the dark, and I started to have a contraction. During the contraction I said to Kim that I could never have kids again - this was my second pregnancy, and, in my mind, the second one that I'd messed up (the first being the miscarriage, which had happened almost exactly a year earlier).

During the car ride I said aloud that the baby would be born in the OR. I smelled meconium; I'd never attended a birth with this much. We still thought the baby was head-down, and for the first time I thought something must be wrong, though didn't share this with Dave.

I made one unsuccessful stab at conversation, then drove slowly and silently to nearby Emanuel Hospital, where the midwives had called ahead. There would be a nurse midwife waiting for us, which was comforting, though my comfort didn't seem to matter. Courtney had at least one contraction during the ride, and by now was pissed off at the simple fact that she was still contracting. I still held out hope that she'd have a vaginal birth, but she was convinced otherwise.

I followed behind Kim through the maze of hospital parking lot construction. She wound up going to the wrong garage, which caused us to have to back up and try a new spot. We parked near the emergency room and were soon walking through a temporary plywood corridor, itself more distressing and maze-like than even the parking lot had been. We had no barings or idea where we were, which seemed fitting for the experience. Finally we popped out to a front desk area and were soon ushered into one of the hospital's birthing rooms.

Kim pushed me in the wheelchair. I wanted to tell how fun it was riding in a wheelchair, but I didn't allow myself to communicate at all. I had a contraction and had to get up from the wheelchair before we got in an elevator. In the birthing room, all I wanted was an epidural. Before that, I had to have an IV inserted and needed to receive a full bag of fluid.

The hospital staff wanted a urine sample. In the bathroom, I noticed that the amount of meconium had literally quadrupled since we left the house. I was too scared to tell this to anyone.

Everyone at the hospital was incredibly kind, acknowledged my midwifery backround, and shared that they knew I didn't want to be there and were sorry I had to be

. I never had to get in the bed, but instead stood at the side, unable to deal with the contractions as well as the fact that I was still contracting.

When it came to signing waivers, I knew I didn't want the baby to receive the Hep B vaccine, Vit. K injection or eye ointment. I verbalized this, then asked for Do Not Consent forms to sign because I didn't trust that my verbal request would be honored. I asked twice, which was the only time I had to ask anything more than once.

Next came the IV. The nurse said, "Let's try to get the IV in," which concerned me because every time I've ever heard anyone say "Let's try" with regards to giving an IV, they've failed. I looked at Kim, who saw my distress and came over to hold my hand. The nurse did fine, and the IV began to flow.

I still wanted my epidural. I knew I was going to have a c-section, but was the only person in the room who was expecting it. Everyone else stayed positive about a vaginal birth. This made me feel like they stupid and that I was merely placating them when I went along with their positive thinking.

I continued to manage my contractions standing at the edge of the bed or sitting on a birth ball. I felt very angry and also imagined that I was acting meanly and loudly. Apparently this wasn't true, as the nurse midwife, during a postpartum visit a few weeks later, would tell me she thought I handled the situation gracefully, all things considered. In the moment, it seemed like I was yelling at everyone, and was even yelling at the IV itself for dripping too slowly, thereby delaying the epidural. At one point, Kim literally squeezed the liquid (when no one was looking) to speed the drip. That made me smile.

The hospital staff was questioning the midwives about my history, and wanted to check on my GBS results. I was grateful that I'd chosen to test for GBS - elsewise I would have been hooked up to the IV antibiotics even longer than I was, and the baby, once she arrived, would most likely be held for observation.

When Laurie comes in, the first thing I asked was about the dogs - other than that, I kept my focus either on Kim or Liz, the latter of whom was growing concerned about the fetal decels she was seeing on the monitor after every contraction. I know now that Dave was nearby, but I have no recollection of acknowledging him or even seeing him in the room. Liz, who looked like an angel at this point - big bright eyes and blonde hair - continued to voice her concern, made a print out and left to consult with the physician on staff. In a few minutes they both came into the room to try to delicately break the news that I might be headed toward a cesarean.

After another couple of contractions Liz left again. This time, when she and the physician returned, they were more matter-of-fact. The baby would indeed be born in the OR, which I'd secretly known for at least the past two hours.

All sense of overwhelment had gone away for me at this point. There was a strange calming factor to the birthing room - perhaps it was the resignation we were all feeling that, for all intents and purposes, the labor would be over soon, as Courtney was about to head in for surgery. The attending physician began to explain what was happening in great detail and I abruptly cut him off and said I didn't care, I trusted what he was saying and just wanted the process to get started. Later, with Courtney out of the room, I finally broke down to the midwives, but for the time I'd slipped into a hyper-focus mode where I wanted the hospital staff to take over.

If I wasn't out of my body prior to all of this, I was definitely gone by now. Someone presented a consent form for the cesaraen - I scrawled my name.

Our Birth Story - Day 3, Part 5

Thursday, March 31, 5 p.m. - Friday, April 1, 4 a.m.

Both midwives arrived around 5 o'clock. Because of my earlier performance anxiety, they kept to themselves in the kitchen, knitting and talking, while I continued to labor in the pool with Dave supporting my back.

After a series of very intense contractions, Laurie asked how I was doing, then said, "It sounds pretty intense." I replied, "It's not pain, it's just what's happening," a quote that Dave actually recorded as I was talking. (Eventually we're going to include audio of a couple of contractions.)

Several hours went by, and even as they were happening it seemed like a blur. This I know: at one point, Laurie took Maji for a walk, while Kim, around that same time, asked me to get out of the pool. The water was too warm, and she was concerned that the heat was causing my blood pressure to run too high. Also, when both midwives were around again, I told them that it felt like the baby was "spiraling."

As night came on, Dave decided to get some sleep - actually, he literally fell down on the couch and stayed there for three hours. Kim went upstairs for the first sleep shift, while Laurie and I labored throughout a few spots in the house: the kitchen on the medicine ball (Laurie made me a snack of turkey breast and cheese with crackers); we moved to the bathroom, where I held onto the sink during contractions; then she suggested I take a hot shower - I labored in the shower for a few contractions.

I stepped out of the shower and told Laurie that nothing was changing. It was after midnight, and I'd been laboring for 50 hours by now. As a birth attendant, I knew that whenever a laboring mom would look into my eyes, saymy name and tell me she's in pain, it can be absolutely heart wrenching. I could see that same look in Laurie's eyes when I addressed her and asked why nothing was happening.

For the first time I was offered a cervical check. I agreed. I thought it would be good to confirm my suspicion that I was around 6 or 7 centimeters dilated. At the same time I was scared. I'd have to lie on my back, which, coupled with the back labor I'd been experiencing the entire time, seemed like a position that would be impossible to bear.

I woke up Dave to tell him I needed his help. We placed a heating pad on the bed, and I waited until the last minute to lie on my back to be checked.

I told Laurie that I wasn't sure whether or not I wanted to know my dilation, and instructed her to do her check without telling me what was going on.

Excruciating isn't quite the word to describe what it's like to be on your back while you're having back labor. I couldn't let Laurie stay in me too long, but I could tell by the amount of time she was staying in there, along with the look on her face, that something wasn't quite right.

I made her remove her fingers, as a contraction was coming. I tried to catch a glimpse of her gloves to see how much blood was on her hand; like a good midwife, she kept her fingers curled and away from my line of vision.

After the contraction, I asked her to tell me what was going on. It took her a few seconds to formulate her thoughts. I don't remember exactly how the words came out of her mouth, but I do remember hearing the following: constriction ring, three centimeters, head down, everything soft and melted except the ring.

I didn't have prior field experience with the constriction ring, but I did remember in that moment the exact paragraph in the textbook that talked about it, and I remember having thought while I was reading, "That would be horrible to have." (Picture a constriction ring like the rubber band around a head of broccoli - a tight band of cervix that won't dilate.)

I was devastated. I couldn't imagine how I'd labored for 50+ hours only to be at 3-centimeters. I didn't know and couldn't fathom why my body was failing. Simply put, I plummeted.

Courtney's such an amazing trooper, and perhaps the hardest worker I've ever met. I've felt this way long before I got to witness her in labor. Knowing her as I do, I also know how hard and fast she can fall. In light of Laurie's check, Courtney was falling.

Up to now, I would describe my role in the labor as having been one of physical and emotional support without doing too much in way of cheering her on. Complimenting her, cooing her, stroking her...yes, all of those things, but picking her up and trying to keep her from falling to pieces wasn't something I'd had to tap into.

During the last couple of months of pregnancy, I learned -- with Courtney's help, of course -- that the best way to get an answer out of her, to get her to move, to get her to decide on the mundane (what are you hungry for? what would you like to drink?) was simply to "tell her" what was happening and what I was about to cook/prepare/bring her. Again, I learned this with her help, after hearing time and again that she couldn't think, couldn't deal with questions, couldn't make decisions and simply needed someone to do things for and bring things to her.

All of that was floating around in my mind as she started to slip into her despair mode. I said, "There's no way I can do anything else but to tell her how this is going to go and what she needs to do while reminding her that everything is OK." The three-hour nap I just woke from was definitely helpful in having this type of clarity at this stage in the game.

So for the first time, I slipped into what you might call "Coach" mode. My language was clear and supportive in an effort to shake her free from the trap she was quickly falling into, the one that said, "I can't do this anymore."

I'd seen her run a marathon and change her career not once but twice in our time together. I knew in that moment what I always know about Courtney - that she is capable of anything as long as she can stay out of her own way.

While Dave was talking to me, I was running through the list of reasons why I would have a constriction ring, and none of them matched my situation. A DNC, for instance, or any kind of cervical trauma...none of which I'd had. I was thinking about my miscarriage, and wondered how my cervix had played into the eight weeks it took to complete. I was trying to figure out how I could get through this, and said out loud that I had about 24-hours -- one full day -- in me before I became too tired, too dehydrated, and finally reached the point of breaking.

During this time Laurie went upstairs to wake Kim and come up with a plan. Laurie then stayed upstairs to sleep and Kim came down.

The plan included trying homeopathics and a specific new position for dealing with contractions and getting the baby to drop.

They weren't sure what homeopathic to use; I suggested gelsinium (yellow jasmine), which was something I had used successfully with other moms.

They double-checked their references and agreed it was the one to use.

I moved my laboring back to the Huxstable chair. Between contractions I sat and fell asleep; during each contraction I stood then squatted facing the chair, my backside landing in Kim's arms. The idea was to dig deep and sink into each contraction, even as each one became harder than the last, and I kept thinking that each would be the last one I'd be able to do.

After about five such contractions Kim tired, and Dave took over. He made it through three or four contractions, dropping in a squatting position to allow me to go as low as possible, before he had Kim bring out the medicine ball to support his own movement. He and I continued for well over an hour, even though, days and weeks later, I would recall that we did this for close to four hours.

For me, this was the not only the most intense work that I'd done during the labor, but it also seemed like the most intense work Courtney had done. With each contraction I pictured the baby moving closer and closer to our shared goal. Everything seemed and felt right and completely in synch.

We found our way into a rhythm where both of us felt my body opening, the contractions getting stronger and the baby moving down. We both felt encouraged and happy at the progress, and knew things were headed in a good direction. I even started seeing what we all thought was bloody show.

With each contraction, the stain of the bloody show continued to increase. Kim finally got out a flashlight to double check, and said to me somberly, "That's not bloody show." I didn't want to believe it, and told her it couldn't be anything else but bloody show. If it wasn't bloody show, it could only be meconium - after 50+ hours of labor, and with my water having been broken the entire time, I knew that any meconium was a sure sign of distress. At this point, Dave spoke up and asked Kim what our options were - I knew what he was referring to, and I wouldn't let them have that conversation. Kim agreed with me.

(One thing I didn't know, because I'd asked the midwives to keep it from me, was that by now, my bloodpressure had risen to the point where, with a few points more, they'd be required to transport me to the hospital. On top of that, the baby's heart rate was rising.)

Kim went upstairs to wake Laurie and come up with a new plan. I went to the bathroom, and when I wiped myself the amount of meconium scared me. I knew it was bad, and I knew then that my baby would be born in the operating room.