Sunday, August 24, 2014

Birth Lessons

In the months prior to conceiving, my wife began “preparing her vessel” as she liked to put it.  She was regimenting her diet, working out regularly, and seeing an acupuncturist.  It was important to her that she have an unmedicated natural delivery, and after much careful thought, we agreed that birthing at home was the most appropriate setting.  Home birth requires a high degree of preparation mentally and physically, and we were both fully committed to the cause, devouring as much reading material as possible, taking birth classes, watching birth videos and lectures, doing birth specific exercises, eating organic and being nutritionally mindful, etc.  So by the time labor was upon us, we were ready.

The first initial contractions began late evening on August 14th.  They were inconsistent and intermittent, so I figured real labor wouldn’t begin until the following afternoon.  I was in the middle of re-formatting my studio, a process that had been underway for weeks, and I had been working the entire day - now knowing that labor was around the corner, I decided to put in some extra work that night to cover a little more ground before the birth put everything on hiatus.  Close to midnight, labor started picking up and by 3 AM it was in full swing.  With only 2 hours of sleep under my belt, I woke up and started timing the contractions over the next hour…they averaged 57 seconds long, every 4:30.  It’s going down, folks.

Lesson #1:  Whatever work related projects, fitness routine, family drama, or other activities that you’ve got going on, none of it deserves your attention once the initial labor contractions begin.  If contractions could talk, their onset would translate to: “hey asshole, drop your bullshit, get focused, and get some rest…you’re gonna need it”.

At around 6AM the doula arrived.  I feed the cats, make breakfast, and set up a birth pool that we had rented.  We then proceed to work like seasoned masseuses, utilizing various massage techniques during and in between contractions, along with frequent words of encouragement, while Heather is vocalizing with every contraction and attaining full-body relaxation.  At 11:45 AM, the midwives arrive and do an internal exam to establish where things are.  My wife requests that they not tell her how dilated she is, and I agree - what’s the point in knowing - let’s just keep working.  

1 PM brings a surprise power outage to the neighborhood, something that hasn’t happened since Superstorm Sandy in 2012 (at least on this particular day it was cool and sunny).  As we’re all scratching our heads trying to figure out how to heat up water with no electricity, my wife blurts out in between contractions “hook up the new propane tank and boil water on the grill”.  Ingenious!

By 3 PM the power was back online - yes!  4:10 PM, the midwives do another internal evaluation and simply report “you’re making progress”.  The work continues…in the pool, on the bed, on the toilet, in the shower, lying down, sitting up…drinking, snacking, peeing regularly.  

8:25 PM, another internal evaluation.  “You’re at the same place you were last check”.  Really?  Whatever, back to work.  Labor outside, labor inside, from this position to that position.  Soon my wife starts reaching a point where she expresses doubt about whether or not she can really do this, an expected signpost during Stage 1 of labor - this is encouraging, and we in turn continue to encourage her.  She eventually vomits (twice), and while ostensibly a terrible occurrence, in truth it is another good indication of progress.  

10:15 PM, another evaluation…no change.  The mood now shifts considerably, and the midwives raise the prospect of transporting to the hospital.  I’m completely blindsided by this.  Ok, what’s the story here, where are we at?  “She was 4 cm at noon, and she’s been 7 cm since 4 PM, and the baby has not dropped at all”.

They breakdown the situation further, explaining the holdup is resulting from the position of the baby.  Although head down, it’s not the traditional vertex position…it’s occiput posterior (OP).  Normally at around 7 cm the baby’s head will have made contact with the cervix, and the resulting pressure, in conjunction with the contractions themselves, dilate the cervix the rest of the way.  In our case, the OP presentation was preventing the baby’s head from being able to engage the cervix, thereby stalling progress, and the all-forward nature of how Heather was carrying (you couldn’t tell she was pregnant from behind) was not helping matters.

Lesson # 2:  Some things are simply out of your control.  In the case of birth, nothing can mandate the presentation of a baby - you can take steps during pregnancy to encourage optimal positioning (which we did), but you cannot guarantee what the presentation will be the day labor begins.  All you can do is play the cards you’re dealt as best you can.  Such is life.

The midwives decide to administer IV fluids in order to help boost her energy levels (she wasn’t able to eat by this point), and they communicate in no uncertain terms that we’re approaching a crossroads - it’s time to dig deep or transport.  My wife rises to the occasion.  We work for another 4 hours, utilizing specific positions and rebozo techniques to counteract the OP presentation, along with aroma therapy, acupressure points, nipple stimulation, and herbal remedies that had been exploited on and off throughout labor.  A caravan develops as Heather walks throughout the house, with the doula in front of her, me behind her, and the midwife’s assistant holding up the IV fluids on a broom stick leading the parade - surely a peculiar sight to see out of context - when a contraction came, we all paused and Heather would lean back onto my lap as a midwife deftly placed a chair under my legs.  

Her “shelf” was dropping (the high point of the baby in the abdomen) and amniotic fluid had released (suggestive of a break high in the amniotic sac, as opposed to a traditional rupture)…both very encouraging.  Her vocalizations took on a new caliber of intensity, as her contractions got even longer and harder - she was deep in the labor zone, as were we all.  She began reciting affirmations, along with everyone else.  “I can do this”  /  “You can do this”  /  “Welcome it”  /  “I welcome it”  /  “You’re body won’t give you anything you can’t handle”  /  “My body and baby know how to birth”  /  “The pain will lead you to the baby”  /  “Follow the pain to the baby”.  Whatever heights were reached before, we were now in uncharted terrain.  My wife got to a place she didn’t think she could get to, and she continued charging ahead.  The atmosphere was electric, and we all felt that we had turned the corner.

At 2 AM, the midwives do another evaluation….7 cm, no change.  The devastation and disappointment was palpable.  I can tell from everyone’s facial expressions that it’s game over, but I can’t accept it.  I insist Heather can still do this, but my wife is protesting.  They clear the room, and I tell Heather, “I don’t care that you’re still 7 cm - no woman dilates on a set schedule - you could be at 10 cm in the next 30 minutes for all we know - and we have been seeing other indications of progress - you are so close, you can do this”.  “Zack, you don’t understand, I can’t do this anymore”.  “Yes, you can”.  

The midwives return and explain that Heather’s degree of exhaustion has gone too far, that her uterus has become too fatigued, and that in their medical opinion it is time to transport.  I recognize that I’m the only one who thinks continuing is an option, and it angers me - I’m angry that they are giving up on her, I’m angry that I am failing my wife in not being able to convince everyone (including her) that she can still do this, and I’m angry that on some level I too know it’s time to transport.  Of course, contractions are still coming, and as I’m anxiously trying to figure out some way to salvage this, my wife’s vocalizations take on yet another caliber of intensity, only this time the sound she’s making is of a very different nature, and it goes right through me.  Some vocalizations signify working your body to the brink of its capacity, and some vocalizations signify working your body beyond the brink of its capacity.  In that instant, it became clear to me that my wife was no longer laboring, she was being tortured.  

“Ok, we’re going” I declare.

Lesson # 3:  There’s what you want your birth to be, and there’s how it actually goes.  Unfortunately these two things don’t always match.  It’s imperative to never let one’s attachments and desires, however important and cherished they may be, get in the way of making objective assessments.

Now, there are 2 hospitals we can transport to.  One is 20 minutes away, and the other 40 minutes, but the further hospital is the preferred choice of the midwives in a non-emergency.  There is no fetal distress whatsoever, so it’s up to Heather.  She opts for the preferred hospital 40 minutes away.  The midwives call in advance, and begin packing their stuff.  I’m secretly hoping that by the time we get Heather into the car or to the hospital, she will have completed transition and we’ll birth this baby in the car.  Heather begins apologizing to me and everyone, for which we all admonish her, while I mask my grief that this is really happening…I don’t want her to know how upset I am, because as the midwives explain, there’s still a lot of work ahead - this baby still needs to be born, and the top priority now is having a vaginal birth at the hospital.  Off we go.

Driving at 3 AM through winding country roads while your wife is laboring in the backseat is not something I recommend doing while sleep deprived and exhausted…but with adrenaline pumping, you’d be surprised at how efficiently you can accomplish this.  Oh, hello deer - hitting you is the last thing I need right now.  My wife was miraculously silent during the entire drive, apparently summoning the will from not wanting to cause me to panic, while I too was miraculously silent for not wanting to cause my wife any additional distress…if we’d been in separate vehicles, I would have been weeping.

It’s close to 4 AM as we arrive at the hospital.  Quick pee outside in front of the ER entrance (my wife, not me) and we proceed inside.  Heather continues to apologize to everyone, and a nurse tells her reassuringly “hey, you got to 7 cm all on your own, you should be proud of yourself”.  All I’m thinking is “fuck you, lady”.  The hospital midwife on call assesses dilation at 8 cm.  The anesthesiologist eventually arrives around 5 AM to administer an epidural just as Heather vomits for a 3rd time, at which point they also start her on a conservative drip of Pitocin.  Basically, although her uterus was still contracting regularly, it was now so fatigued that the contractions were believed to be too ineffective to dilate her cervix the rest of the way…so the plan was for the epidural to allow her to go to sleep in order for her body to rest, while the Pitocin beefed up the contractions in the meantime without her being aware of them.  The birth team disperses, and Heather and I try to get some sleep.

Lesson #  4:  The amount of routine unnecessary medication and intervention during labor is disturbing - from induction to epidurals to episiotomy to cesarian - such measures should always be a last resort, yet too often they are utilized out of convenience, ignorance, habit, or paranoia.  However, when there is a true medicinal purpose, intervention can be a truly beautiful thing.  Never stubbornly refuse an intervention for the sake of principle alone - if you genuinely need help, accept it.

A couple of hours later, the hospital midwife checks her dilation.  No change.  “We’re gonna up the Pitocin a little bit and give it another hour”.  One hour later, no change.  “We’re gonna up it a little more and give it more time”.  Another hour later, no change.  My wife is starting to panic, but I remind her that the baby isn’t in any distress, and it’s simply a question of giving her body the time it needs, to which the hospital midwife responds “well I don’t want to say we have all the time in the world - this is a really protracted labor, and if we don’t see progress relatively soon, we’re going to have to start having a very different conversation”.  You’ve gotta be fucking kidding me.  “But we’re gonna up the Pitocin a little bit more and see what happens”.

30 minutes later, our birth team walks back into the room like knights in shining armor.  At the next check, Heather was 9.5 cm _ [cue angelic choir] _ and before we knew it she was feeling the urge to push (by which point the epidural had worn off).  And push she did, with a fervor and intensity that belied she had been in active labor for over 30 hours.  After another gauntlet of birthing postures to facilitate the baby’s positioning, finally at 11:24 AM on August 16th, Scarlet Sage Hemsey was born.  The sense of triumph that pervaded all of our spirits in this moment was extraordinary…it felt like snatching victory from the jaws of defeat.

Lesson # 5:  Throughout our stay at the hospital, I was thinking about all the time and energy that we had put into birthing at home, all of our efforts during the last 9 months of pregnancy (and prior), and the 30 hours of laboring we had just completed before transporting - this tremendous investment, and it was all for nothing.  But the truth is that our investment had in fact paid off, just not in the way we had expected it to.  The hospital was on the verge of doing a cesarian section when Heather finally dilated to 10 cm, so if Heather had not already been birthing at home for those 30 hours, or if she had decided to birth at the hospital from the outset, C-section would have been a certainty.  In the end, home birth is what made vaginal birth possible.

Lesson # 6:  The more learning and preparation you do in advance of labor, the more confident you will be when it’s underway.  However, there is a potential pitfall for expecting parents who know all the intricacies of birth, what to expect, and have a clear vision of what lies ahead…and that is if / when labor strays from how it was imagined to be, it can be extremely scary and disconcerting, and very difficult to let go of prior expectations and accept what you’re presented with.  You can do all the reading in the world, but none of it will allow you to truly anticipate what labor will feel like or how your particular labor will unfold.  So know what to expect, but don’t have any expectations.

Lesson # 7:  Hindsight is not always 20/20.  If I could go back in time, there are a variety of things I would try in an effort to change the outcome…maybe if we had spent more time in these birthing positions instead of those, Heather would have progressed faster…maybe if Heather listened to music, she could have focused or relaxed more…maybe if I had made more fresh fruit juice (perhaps 6 glasses instead of the 2 that I did), she would have had more energy…maybe if I called her acupuncturist for a home visit during labor, she would have been able to do something to affect the baby’s position and/or Heather’s stamina…or maybe we could have driven over bumpy roads and bounced that stubborn baby downwards.  But the reality is there’s no way to know if any such alterations would have affected the outcome (and if they did, whether for better or worse).  In navigating labor, all you can do is make your best on-the-fly judgement each step along the way.

Lesson # 8:  Initially looking back, I thought maybe I was wrong to have championed my wife onwards at 10PM when the prospect of transport was first raised.  Perhaps she endured 4 more hours of pain unnecessarily.  However, in truth, I think it would have been a disservice to her to have done otherwise.  Even though our rallying ultimately did not affect the outcome with respect to transporting, I believe it was extremely valuable to my wife’s psyche  to have been able to summon the willpower and determination that she did during those last hours at home, and I truly feel that her birth experience would have been diminished without it.  While we should absolutely seek to protect the well being of our loved ones, we should never doubt their resolve.  I believed in my wife then, and I still believe in her now.

I remember thinking to myself at one point during labor, “who would ever want to be a midwife or a doula?  This is so exhausting”.  But when it was all said and done, I understood.  My deepest gratitude to Susan Schmidt, Cathy Gallagher, Nancy McDaid, and Julie Hartman.  I am forever in your debt.




12 comments:

  1. Hey I have mixed feelings about your blog post...

    Does heather agree that recognition of her own physical and mental strength that came from delaying the trip to the hospital was worth it? Also- why was home birth so important to you guys? Why was vaginal birth so important? I assume (and especially knowing you two) there's well intentioned and logical reasons for your choices. I think it struck a chord bc lately I've been feeling some type of way about people's choices when it comes to just this kind of thing... I find it odd that we as a society feel it's important to "go all natural" for big time life events yet are perfectly content to utilize all the latest technology from microwaves to computers for the mundane daily tasks.. Now I know you guys in particular live a green lifestyle in general and are for sure way more "natural" in your day to day than others- but still- your very career is built on modern technology and it's not like you're going without an oven or a microwave or telephones bc we as humans weren't meant to take advantage of such things.

    I think I wouldn't feel so put off if I hadn't read how angry you were about "giving up " and going to the hospital. I mean- home birth is a personal choice but when it looked like it just wasn't in the cards it wasn't like, "oh well-plan b", it seemed like you actually turned up your nose to hospital births and traditional pain meds, etc... As if they are sub-par. So yea I guess my question is- was heather right with you (even if it was somewhat veiled by pain and fatigue) or does she remember truly wanting to change course and having to be convinced to continue on at home? Looking back does she regret not going sooner?

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    1. Yes, Heather does agree about persevering until 2 AM, because she has no doubt that she truly gave it her all…had she transported at 10 PM, she would have looked back feeling that she “gave up” too soon. She has no regrets whatsoever.

      You seem to be under the assumption that our desire for home birth stems from some kind of green hug-a-tree holistic fad. It is nothing of the sort, and in no way related to any stance on technology, or western medicine overall. In terms of why home birth / vaginal birth was important to us, I had decided not to address this in the article because I didn’t want it to be perceived as pro-home-birth or anti-hospital-birth. Home birth happened to be what was important to us, but if someone else prefers to birth via cesarian section, so be it. There is no judgement on our part as to how anyone chooses to birth. That being said, there certainly are a variety of reasons as to why we chose to birth at home.

      To start with, we knew we wanted a vaginal delivery - aside from the fact that this is what the body is designed to do, developmentally speaking there are microbiota within the vagina that the baby picks up as it is being birthed, which are important to its health. Vaginal birth also allows for immediate skin-to-skin contact between baby and mother (which has physiological and bonding benefits) and for the umbilical cord to be left intact upon birth, which in turn allows it to fully pulsate before being cut (which introduces additional antibodies and blood supply to the newborn). Recovery time from a vaginal birth is significantly quicker than a C-section (which after all, is major abdominal surgery), and even quicker if unmedicated (could be up and out the door within a few hours), and recovery from cesarian birth is far more painful. C-section also leads to increased risk of infection, increased risk of hemorrhage / hysterectomy, risk of accidental fetal laceration (yes, this can happen), not to mention increased risk of maternal death (yes, although rare, this still happens even today), among other things.

      Now, if given a choice between C-section and fetal demise, sign me up for the C-section. No question. It is remarkable that this procedure can save babies who otherwise would not have survived labor. In fact, Heather was born via cesarian, and she turned out fine (well, mostly fine). But intentionally seeking out a C-section without any medical necessity is another matter, and not something that we would consider in light of the above information.

      So the next question is whether to have a medicated or unmedicated birth. Medication during labor has an effect on the body’s natural production of hormones / chemicals, which is to tinker with a biological process that has been fine tuned over the course of however many thousands of years. Synthetic chemicals such as Pitocin, which are used to induce labor or expedite it, have the effect of increasing the intensity or frequency of contractions (which are naturally quite intense to begin with). This can lead to fetal distress as a result of reduced oxygen due to the incessant / extreme contracting, or increased pain too intense to cope with (if the artificial and natural contractions coincide) necessitating an epidural. Pitocin also leads to increased incidence of postpartum hemorrhage. With an epidural comes no sensation (rendering the laboring woman unable to work with her body during Stage 1, which has the potential to prolong it) and a new set of risks (including increased chance of delivery via forceps / vacuum extraction / C-section, risk of long term backache, risk of spinal headache with improper placement by anesthesiologist, and most frighteningly, albeit very rare, permanent paralysis). Of course, any medication given to the mother unavoidably passes to the baby as well (and a proper dosage for the mother is an exorbitant dosage for the baby).

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    2. Again, to be clear, medication is a remarkable tool when truly needed, and plenty of healthy babies have been born involving the use of Pitocin, epidurals, and the like. And as noted in my account, when it seemed truly appropriate, we utilized them (fortunately in a restrained and conservative fashion, and only at the tail end of Stage 1). But intentionally seeking out medication without actual necessity is another matter, and not something we were inclined to do. This should not be taken to mean that Heather wanted to suffer through the agony of labor like some kind of martyr - rather, she simply wanted to avoid unnecessary risk to her and her baby, and additionally, she intended to utilize proper labor technique to minimize the pain involved.

      So once you know you want an unmedicated vaginal delivery, the final question is where to have it. Western hospitals are notorious for unnecessary interventions involving C-section and/or episiotomy, and they view the routine use of drugs during labor as normal and inconsequential. Not to mention, hospitals are cesspools for undesirable germs and bacteria (in contrast to your home, which has bacteria you actually want your baby to be exposed to). Additionally, many hospitals limit the mobility of the laboring mother, as well as her consumption of food / drink, and place arbitrary time limits on birth. Generally speaking, there is an important philosophical consideration with respect to how hospitals view birth - often as a condition in need of fixing. Also consider that obstetricians are not trained for natural childbirth, they are trained for labors with complications, and this is the skill set that they bring to the table. Midwives, in contrast, are experts in natural labor (and I use the term “expert” intentionally, alluding to the fact that they are adept in a variety of methods / techniques to facilitate natural delivery). Now, some hospital do use midwives, but hospital midwives are ultimately beholden to hospital procedure and protocol, which can create a conflict in their professional responsibilities. One last thing to consider is that relaxation is a critical component of birthing - the more relaxed a laboring woman, the more efficient the labor - where are you going to be the most relaxed, in your home or at a hospital?

      Keep in mind that all of the above is by no means exhaustive of all the variables, components, and research there is to sift through and consider - but it should be sufficient to demonstrate that it is very reasonable for some to find home birth compelling. So it’s not a question of hospital birth being subpar - it’s a question of it not being what we wanted. It’s one thing to have a preference when ordering food at a diner - if you’re scrambled eggs get fucked up, it’s not the end of the world - it’s another thing to have a preference for how you want your child to be birthed into the world - if it doesn’t go exactly as you intend, it can be quite traumatic. Moreover, I was not upping my nose at hospitals or pain medication - rather, I was lamenting the fact that the birth experience we had worked so long and so hard for was slipping out of our grasp. And make no mistake, if Heather truly didn’t want to continue, there is nothing I could have said or done that would have changed that (which is why we ended up transporting at 2 AM). To the extent that any of my commentary on the matter came across as me pushing her to do something against her will, that was not my intention, and I assure you was not the case by any means - I was encouraging her to do what I knew she wanted to do, and what I knew she was capable of doing.

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  2. Hello Zack, I love reading your blogs, you really are a genius in both your life and in your music. I've been listening to all of your songs on Youtube for months (maybe even years?) now, and I can't get enough of it. I would have to say "Don't Get In My Way" is my favorite song, but I can't say I've found one I disliked.

    I just have two questions for you, do you do your own vocals? And also do you have any plans for a future album? Thanks!

    And congratulations on the baby!

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    1. Thank you! Yes, I do my own vocals, and yes, it is my intention to make another album in the future...however, as you can deduce from the above, I will be a bit preoccupied for some time, so it's going to be a while!

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  3. I experienced many emotions as I read this post. Many ups and downs, many yes and no’s, many why and when and at the end of it all was a wonderful gift little Scarlet Sage.

    An amazing journey!

    Congratulations to the Family and a BIG welcome to a wonderful little girl!
    Love Laura

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  4. Congratulations on the baby!

    It sounds like you had an incredibly life changing experience the way you and your wife decided to give birth. Thank you for sharing your experience and all the information on home birthing. I had no idea that was still an option in todays world, let alone how positive it is.

    I commend you for you and wives determination and you guys holding on until the very end.

    There was a point in your post where I think you hit genius, when you said...

    "Never stubbornly refuse an intervention for the sake of principle alone."

    For me, that is the pinnacle lesson being taught here. I suffer from this stubborn pride that never lets up despite failure imminently approaching, which could be avoided with assistance from those who offer.

    Sometimes we need to step aside and let those that know more, have more, do more.

    Love the post man. Many your family spend countless fruitful years together.

    Now do me a favor... for the love of God... make "Mind Heist 2" already!

    (just planting a little seed)

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    1. Very funny, but as far as "Mind Heist" is concerned...been there done that. :)

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    2. I just love the arrangement in Mind Heist, honestly. I've made a couple of songs trying to mimic what you did in Mind Heist. my mastering is what needs work at this point. Doing everything from my dungeon. Solo. But seeing improvement none-the-less.

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  5. Congratulations on the new baby! Sounds like a tremendously difficult experience for you both but I'm sure extremely rewarding by the end.

    Just as a side note, I recently discovered your music - I'd heard a lot before in trailers but never knew the composer - and I just gotta say.. wow. Absolutely incredible. I heard 'The Way' first and after listening to every other song you've made, it's still my favourite (closely followed by 'Vengeance'). I don't think I've ever felt so moved by music in my life. And just when I think a song's over, BOOM and my mind is fucking blown again. Music has always had the power to send a person's mind to different places and to bring out strong emotions in people but I never knew one single song could be so beautiful, chilling, epic and emotional all at once. Gah. No words do it justice.

    I bow down to you, sir, you are God.

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    1. Difficult and challenging for sure, but most certainly rewarding and a positive experience overall. I appreciate the kind words on the music - now please stop bowing. :)

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