The baby finally came, at 41 weeks and 6 days (whew!–barely dodged the induction!) The birth was not exactly what I expected, and for me it highlighted the difference between being a patient and being a patient who is also a healthcare provider.
The labor was long. 45 hours long. And I felt almost every damn minute of it. Despite my fervent desire for a med-free birth, I ended up getting Pitocin around hour 32 due to extremely slow cervical dilation (although the contractions were 1 minute long and 2 minutes apart almost from the beginning–d’oh). Then I got an epidural 6 or 7 hours later due to the horrendous Pitocin-induced contractions and the fact that I was pretty exhausted. The epidural–despite my reservations–turned out to be really helpful because it allowed me, my partner and the doula to sleep for a few hours and regroup. When it was time to push, the midwife shut off the epidural as we had discussed prior to its placement. Here’s where the “healthcare provider as patient” thing came into play. The feeling came back into my legs pretty quickly, and I could move them well. The midwife told me to lie on my back to push, and that she wanted me to bear down while holding my breath. Unfortunately, both of these things were what I had hoped to avoid in the pushing stage. My birth plan, while generally vague and flexible, read “NO COUNTING DURING PUSHING.” I had really hoped to avoid the classic lie-on-your-back-hold-your-breath-push-and-count-to-ten type of scenario.
I told the midwife that I wanted to push on my hands and knees, like we had discussed prior to the epidural placement. I also told her that I wanted to do non-directed pushing. She was quite dubious about this approach and told me–in so many words, and in a condescending fashion–that she did not think it would work. I told her that was fine, I wanted to try it my way and if it didn’t work out then we could try it her way after a while. While there are consumers of healthcare that are confident enough to decline instructions from their providers during stressful situations, I felt like it was my background as a provider that allowed me to listen to the midwife’s perspective but feel that her advice was not right for the situation. After the discussion, the midwife told me in a doubtful voice that I “could try” pushing, and then left the room. She was gone for an hour, during which time I pushed on hands and knees using short, non-directed pushes. Whaddaya know, after an hour the baby’s head came out…with no midwife in sight! Chaos ensued, with nurses yelling not to push and the midwife running into the room just in time to catch the baby’s body. That part sucked, but I felt pretty smug that my approach turned out to be pretty effective after all.
The other thing that sucked was that there was not one, but two RN’s in the room when the baby crowned, but despite my announcements that I could feel the baby’s head coming out, neither of them were looking at me. They were both looking at the fetal monitor, which they had been futzing with for the entire hour that I had been pushing. This really exemplifies the whole “watch the patient, not the monitor” thing. Once the doula and my partner announced that the baby’s head was out, the RNs started paying attention…but a lot of chaos could have been avoided if they had been listening to me beforehand.
Anyway, the end result of my labor was that I had a vaginal delivery and was able to push the baby out in (almost) exactly the way that I wanted. The Pitocin, epidural and continuous fetal monitoring, while sucky, didn’t ruin my entire birth experience. Although…if I had ignored my intuition and desires in favor of what the midwife wanted during pushing, I’m not sure I would have been able to deliver the baby as easily.
Now I’m at home for an 11-week maternity leave with my beautiful and healthy baby girl, and my new job is to be a human milk machine. Yay!