An announcement: my child will enter the world by springing, fully formed, from my skull.
There is no way IN HELL that I am ever doing what I saw Melissa do.
No. Way.
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My flight landed at 10:15 or so and I headed straight for the hospital, arriving a bit before 11pm. I found Melissa and Derek in the Birth Center that resembled a home - living room and dining room with three huge birthing bedrooms with big double beds and the most gigantic jacuzzi tubs in the bathroom. They had called me when I was driving to tell me that it was slow going and that Melissa wanted me to be prepared for the state she was in (HAHAHAHA - if she had only known... 5 cm dilated was NOTHING compared to what was coming). I am not squeamish and have no issue with doing whatever needs to be done for the people I love, so I was completely unconcerned and found it amusing how often Melissa worried about me during the course of the evening.
Anyway, she was about 5-6cm when I got there, and she was swaying and pacing and holding on to Derek when the contractions came. I was in the bathroom when the first one in my presence occurred, but I heard her bellowing from there. I asked if she had to be taught to bellow like that and she said the midwife had told her to moan like a cow in a field (low tones being more conducive to relaxing the body than high tones, which tense one up). She was doing an admirable job.
They checked her and told her that it might be a good idea to break her water to help move things along a little more quickly (she had been in slow labor for about 9-10 hours at this point). She and Derek talked it over and decided to go for it - mostly she was scared of doing it because they told her the contractions would get more intense and that was scary, but she also realized that the contractions would, in fact, HAVE TO get more intense at some point and, as the midwife said, this might mean fewer contractions overall. She got back in the tub (where she had been earlier) and they broke her water there. Right away they could see that there was some meconium in there (that means the baby pooped inside her) and this meant she couldn't give birth in the water. Fortunately, being smart, she did not have her heart set on any particular place or position for the birth so this was no big deal - it had just been one option. She labored a little longer in the tub and then got out, knowing now that she couldn't stay in indefinitely. Then she labored on the ball for a while and Derek and I really got into a good rhythm of helping her through the contractions - one rubbing her back and one at her front rubbing her shoulders, reminding her to relax and keep her moans low in tone. We made it through the rest of the contraction part this way.
It wasn't very much longer before they said she was 9-10cm and that she might want to think about pushing if the urge came to her. I think it was around midnight. Before the pushing started, I asked the midwife if I had an hour to go check into my hotel and come back. She was unsure, thinking I might but might not. It was possible, she thought, that the baby could come in an hour or shortly thereafter and I might miss it. In reality, he did not come in an hour. Or shortly thereafter.
Eventually she had the hint of an urge so we started trying that out. Wes and others have told me that the pushing phase was a bit of a relief because at least then you are DOING something. It seemed pretty clear to me right away that this was not really a relief phase for Lissa. This was definitely the hardest thing I had ever seen someone do. This was the point at which I became firmly convinced that I was never, ever going to be able to have a baby and that if there wasn't one already growing (hopefully) inside me, I do not know that I would continue trying, knowing that I might have to eventually get it out in this manner. The pain was bad. She was fighting the screams each time she pushed (being told to not make a noise but to hold her breath and put all the energy into the pushing - but the scream would usually escape by the end of the push). But beyond that, she was turning various shades of red and purple with the effort of pushing. It was truly hideous.
More hideous was the fact that the midwife eventually realized that she was not really fully dilated - there was a lip of her cervix still in the way. This means she was basically dilated but one little part of cervix hadn't thinned out yet. So when she pushed, this lip was blocking the baby's head. The midwife said she was going to try holding the lip out of the way so that Melissa could push the baby's head past it and then it would stay out of the way. This was not so easily accomplished, though, because having someone's hand inside you pushing at part of your cervix while having a contraction AND attempting to push out a baby's head HURTS like a motherf*cker.
And so, because Melissa screamed in such a new and different and terrible way when the midwife attempted this, she announced that the other alternative was to wait several more contractions in a different position and made Melissa get up again. I think she had been pushing for a solid hour or so at this point.
It was a little while after this that Melissa really started feeling the urge to push, so there was probably an hour of attempting not to push but riding out the contractions. One sort of unusual thing was that Melissa's contractions were further apart than the average - she would have a good 5 minutes or more in between to rest (the midwife said most/some women have the contractions every 2 minutes or so at that point). This meant some rest, but it also explained why things took a really long time from here on out.
Eventually she started to really push in earnest. This is how things went for quite some time: the midwife and nurse would suggest a position, Melissa would willingly try it, the contraction would come, she would immediately yell that she HATED the new position, the midwife would tell her she just had to try it for one contraction, Melissa would ride it out in the new, hated position, then they would ask if she wanted to change to a new position and Melissa would grudgingly say that she was willing to try it for another one. She stayed in most positions for 3-5 contractions.
She had pushed for nearly 2 hours (I think) with very slow and slight but steady progress (a slightly larger opening appearing each time) and the midwife was off delivering another baby when the nurse realized that the cervix lip STILL wasn't gone! She was, as the nurse announced, "crowning cervix," meaning the cervix was being pushed out of the vagina by the baby's head. The nurse seemed really surprised about this and did the thing they'd tried earlier - held the cervix out of the way (to much screaming) so that his head could get by it. This did work after a couple of pushes and things progressed a bit more quickly after that (though still took a lot more work).
All told, Melissa pushed for about 5 hours off and on, with 2.5-3 of those being the last hours of truly hard and steady work. We both think she would likely have had a c-section if she hadn't been in a birth center attended by a midwife, partly because of what happened next.
After the lip was out of the way, he started to appear a little bit at a time. Each time she would get him the tiniest bit further out but then she would have the 5 minute rest and he would slide back up. So this took a long time. They were listening to his heartbeat after every contraction at this point, and they kept calm (we didn't really know it was a big deal) but his heartrate stayed elevated. I hadn't really known that elevated was a problem (I knew low was bad, but didn't think much about the high end) so I didn't know until we got to the end that they were concerned. Eventually, his head managed to make it out about an inch. The nurse actually pushed on Melissa's stomach to hold his butt down so he couldn't slither back up (he was kicking her through the stomach!) and the midwife kept Melissa pushing tiny pushes throughout her rest period so that he couldn't slide back up either. This worked well, but it really became apparent soon that his head was just too, too big for the space Melissa had to work with. It was then that the midwife told us that she thought Melissa should have an episiotomy, saying that she didn't like to do them ordinarily but that he was really having trouble getting out and telling us that his elevated heartrate meant that he was struggling and really needed to come out as soon as possible. It was rather a no-brainer and I was glad Melissa agreed with no hesitation, saying to just "GET HIM OUT." I watched the episiotomy as I watched all the gory bits - wow, was that gross! She just grabbed some scissors and three snips into Melissa's skin (with an all-new, totally unique scream from Lissa for the occasion) was all it took. The pushes became more productive right away, but what really amazed me was how much hard work the midwife did at this point - she was truly pulling that baby's head out of Melissa with all her might. It looked like she was really mangling his head to do so, but it sprang right back afterward. But seriously - she had a major grip on the kid's head to get him out, which further showed how intensely they thought he needed to get out of her right away.
Once the head was out, the rest of his body sort of slithered out in one push at 5:56am. The head had been the focus for such a very, very, very long time that it was truly shocking to see a whole kid slide out of her. It really seemed impossible and magic even though we had watched hours of work to get him out. Derek and I burst into tears right away, but we were also quickly scared silent by the fact that the NICU nurses/doctors/whatever they were immediately grabbed him and intebated him. The fact that there had been meconium meant that they wanted to suck out his tummy before he even cried, and that was damn scary. We heard them say that the heartrate was good and his color was good, but even from where we were in the bed next to them partially blocked, we could see that his breathing was labored - he was "retracting," meaning that his little tummy sucked in really hard with each breath. Melissa was thankfully out of it at this point, as the midwife was starting to give her painful shots of local anesthesia so she could stitch the episiotomy (more new, different screams of pain for the shots, of which there were several). Derek went over to watch the baby while I watched Melissa get stitched up - pretty cool.
They decided they needed to take the baby to the "transitional nursery" to observe him and be sure his breathing was OK so Derek went with him while I stayed with Melissa. We were a bit calmed by the fact that no one was rushing him out of the room to the NICU or anything - they took their time wrapping him up and they brought him over so Melissa could hold him for a minute. That helped me not be so terrorized. Also very cool - the midwife has started to tug on the cord and massage Melissa's stomach to get out the placenta, and was about to ask her for a little push, but the second the baby was in her arms, the thing just slithered right out - contact with the baby really does make the uterus contract!
Oh, and then the placenta sort of exploded on the bed leaving Lissa in a giant pool of blood. And that was when her mother and sister arrived and wanted to come in and we decided it should wait until they wouldn't see their loved one in a pool of blood after driving for 12 hours. Yeah. Placentas are really, really gross. A big blood sac, really. Amazingly, grossly cool.
They also had to give Melissa a shot of pitocin to try to keep her uterus contracting - this is one of the things that stop the blood flow, and since she had to wait a little while before nursing (which normally helps the contracting) meant they needed to do something to help. Thank god they did, because even the amount of blood Melissa did lose meant that the next day found her fainting and convulsing on the bathroom floor in a pool of her own blood. Lovely. She was found to have low hemoglobin and made to spend another night at the birth center (the baby actually needed to stay for observation, too, as he was found to have some sort of genetic jaundice thing - he wasn't actually showing signs, but it showed in a blood test. Tests the next day showed his bilirubin was fine, though. And he was out of the transitional nursery in about 2 hours and spent the day and night in the room with them, so all was fine relatively quickly).
I left pretty soon after the birth because I could barely keep my eyes open and still had to drive to my hotel. It was 7:15am by the time I called Asia and then Wes and recited the entire story to them so I could clear my head enough to sleep. And then I slept.
I feel like I am not truly doing justice to this story - I am tired, for one, but also there is just no way to really describe how absolutely stunningly horrible the whole thing was. It was amazing in that there didn't seem to be any way that baby's head could have made it through that orifice. But I did not find it amazing in any sort of beautiful touchy feely new agey way. It was downright disgusting, dirty work. WORK. The pain was sort of scary, but the work was far scarier. There is just no way I could ever work that hard. Wes keeps telling me that it is unlikely that I will have to push for 3 hours - most people don't, really. And naturally this whole experience cemented my desire for an epidural - I have no strength or stamina and I really will need to conserve my energy during all those hours of contractions. What I learned from this was that even if I have an epidural, I am still going to have to do the work of pushing the baby out. And that, my friends, scares the crap out of me.
I am sure that this experience will be coming out in more bits all week as I process it. It was absolutely one of the most stunning things I have ever seen and I don't think that I will ever be able to forget it. But while I go on and on about how revolting and scary the whole thing was, let me also say that I will forever forever be grateful to Derek and to Melissa for allowing me to be there for the birth of their son. Melissa has been my best friend for 17 years and this was the kind of thing we used to fantasize about when we were 15 - being there for one another's births. I can't believe that it timed out so that I could actually make it and I am just so happy that I was able to be there to support her. It feels like such a tremendous gift.
