One woman's path through doula training, childrearing, and a computer science Ph. D. program

Sunday, February 27, 2011

An amazing Facebook birth

This post is about Amy, a mom that recently had a baby while updating her friends on her 48-hour labor progress in real-time.  As any mom that has gone through labor knows, this is no easy task!  I commend Amy on her unique labor coping strategy of Facebook-ing while in labor.

About Amy

Amy and I go way back:  We first met in middle school and went though tenth grade together, at which point my family and I moved across the US.  Though we have kept in touch, our closeness and level of intimate knowledge of one-another could not have been possible without Facebook.

I found out that Amy was pregnant with her third child when she posted an update saying her first prenatal appointment was coming up soon.... at 38 weeks.  Difficult financial times meant an unfortunate lack of health insurance, which prevented her from seeking prenatal care until fairly late in the pregnancy.  Luckily, all was well with her and her baby. The baby was growing happily and Amy had no risk factors for things like gestational diabetes or pre-eclampsia.  (However, over the next few weeks and prenatal appointments, the doctor was increasingly antsy to get the baby out -- threatening induction and c-section. My opinion? His reasoning was that the baby would be better off in his care than in the womb of a woman that would forego prenatal care.)

Nine days before Amy's due date (T-9), she mentions how difficult it is to be so pregnant:
Well this baby should be due anytime between now and 3 1/2 weeks from now... Wonder when he will want to come. Hard to roll over in bed!

Amy and I talked over Facebook; she told me this is likely her last baby, and her priority for her birth experience is to birth naturally, and especially without Pitocin, a synthetic oxytocin used to speed up labor or increase the strength of labor contractions.  Her second baby was induced with Pitocin, and she had a difficult time with the labor.

Do you have a doula?

Of course, I asked if Amy had hired a doula.

"No," she replied.  "Isn't it kind of late?  I mean, I am almost 39 weeks along."  Then: "Also, I don't think we can afford a doula."

Will you be my friend's doula?
That night I sent out an e-mail to a volunteer doula organization mailing list asking if anyone in her area would be willing to consider a volunteer birth, due between now and three weeks from now.  The next day, I got an e-mail back with the name of a doula, Joanne, residing an hour and a half away from Amy -- which I immediately forwarded along.  Amy called her.  Joanne said yes.

Joanne explained that there were so few women in her general geographic area that a) wanted a natural birth, b) knew what a doula was, and c) were considering hiring one.  Because of this, she was having a hard time meeting the requirements for the number of births attended, for certification through her organization.

Five days before Amy's due date (T-5), Amy feels large, sore, but excited about Joanne:
Feel rested, sore, and still quite preggo. Meeting with a doula in training today. Should be interesting - hopefully she'll be able to help me get the natural birth I want and avoid ALL unnecessary interventions.
Woot I gots me a doula!
Ug. Up at midnight with HORRIBLE heartburn even after 4 chewable heartburn tablets!! I thought heartburn was supposed to ease up when the baby was low but I guess mine likes breaking the rules.
Amy's due date came and went.  The waiting game set in.  Amy's status updates on Facebook became progressively impatient.


For Amy, labor started slowly, over the course of about two weeks.  In the days before Amy's due date, she mentioned light cramping that would eventually lead to contractions that would open her cervix. Her husband, Bill, noticed that the baby had dropped significantly,.

(T-3) Well I could be wrong, but I feel pretty sure that I'm now in prodromal labor. For those not aware of what that means, that's early labor. But no need to get excited. If I'm right it could still be days away. With my first, I had prodromal labor a week before she was born. 
(T-1) Well when I took a bath this morning I felt like the baby wasn't as high. Bill confirmed, I didn't look as "pooched" as I have been so I'm assuming the baby has dropped. And I feel very very very tired. Standing on my feet more than a few minutes is exhausting. 
(T-1) Off to bed. Baby is still cooking but he definitely is lower. And my blood sugar has been awesome even though I haven't changed anything. 115 or less 2 hours after eating every time. Go figure.
On Amy's due date (T+0), Amy laments waddling:

I am Pengo, the amazing pregnant penguin. At least that's how I feel when I walk... *waddle waddle waddle*. I don't remember waddling quite this much before lol! Then again, this baby is low and has been for some time, so maybe that's why.

The day after Amy's due date (T+1), life goes on:

Well the baby didn't move quite as much last night as in several nights past. Still moving, but not so active. Could mean one of two things, and I'm leaning towards the positive - which is that he's resting for the big day. Got a prenatal today anyways and they'll do a non stress test.

Two days past the due date (T+2), Amy mentions how low the baby is:
The waiting game begins. Last night when Bill and I were walking around the pharmacy, I could feel the baby pressing down as I walked. I know it's going to be very soon.

Four days past the due date (T+4), the baby still has not come, and Amy's stress level is rising:
Getting mixed reviews on whether stress induces or hinders labor. Either way, trying to chillax. 
Twelve days past the due date -- that's a week and 5 days! -- Amy updates her friends and assures them that there have been no babies born (T+12):
Ok just posting an update because apparently if I don't people worry. :). Still preggo but I think the cramping may be getting regular. Should be soon!

Early labor

On the thirteenth day after her due date (T+13), the real early labor contractions came.  They were light, and Amy did the right thing: relaxed, ate, drank, and continued her positive attitude.

Been feeling some contractions tonight, close enough together to make me wonder. So I'm up, eating something, watching some tv, keeping hydrated for a bit, to see if it progresses to anything further, or if it's just false labor and my high hopes for baby due on T+14 lol. Will keep this updated.

Well they seem to be regular contractions at least. About every 20-30 minutes, just not near strong enough yet. Regular is good. Going to stay up a bit longer then get some rest. Could just be a T+14 baby yet!

The next morning (T+14), Amy finds the contractions have not developed a pattern (meaning that, if this were labor -- which it was -- it is still early labor):
Baby is still moving and I believe I'm still feeling contractions. Half asleep right now seeing Bill off to work but have felt like two since I woke up. I can only assume they kept going overnight, they're just not strong enough to wake me up or keep me up. Would be funny if he was born at 2 in the afternoon today... You know... 14:00 military time. T+14. Ok anyways we'll see!
By the evening (T+14) the contractions were still present, but not consistent.  By now it was clear that this was the real thing: labor.  Her husband Bill, Amy, and I all joked on her status messages.
Contractions are now averaging about 10-15 minutes apart. May be tonight, maybe tomorrow... Time will tell!

Me 8:21pm
Let's see if you post all the way through labor. E.g., "Pushing. Baby at +2. Crowning eminent."

LOL I don't think my pain tolerance is quite that high lol. Right now I'm at the pain level of noticeable, I breathe through it and manage. I seem to remember it was like this a day before my first was born... The night I slept in the bath tub for 3 hours because I couldn't get rest any other way lol

Bill 10:04pm
Don't tempt her. She'll be in the middle of pushing and posting at the same time. You watch.

Me 10:33pm
I subscribe to this thread. Let the labor/posting commence! ;)

Lol just painful contractions at the moment ten min apart. Give or take. I'd rate it at about 5 right now. Well at least as far as I can remember. It was 6 years ago lol.
At this point, I thought I should ask about her doula.  Given that Joanne lives an hour and a half away, she should probably have been notified by now.  A surprising (for the readers) turn of events is unfolded.  But Amy still kept her positive attitude.
Me 10:36pm
Have you called your doula???

Turns out she won't be able to make it. She told me last night. She is now pregnant herself and has bad morning sickness. Sucks but it's ok. I'm just thrilled I went into labor naturally.

Me 11:10pm
Doesn't she have a back-up? :(

I have no idea. It was free and she was in training so I guess I can't complain too much.

That evening (still T+14), Amy turns in for the night as she normally does.
Going to try and get some sleep. We'll see how that goes.

Active labor

On the 15th day after her due date (Amy is now 2 weeks and one day late) (T+15), in the wee hours of the morning, Amy is awakened by contractions:
Contractions are waking me up. I'm saying they're pain level 6 or 7 right now. I'm not quite ready to rush off to the hospital just yet though.
Nearly three hours pass; Amy decides to go to the hospital.  There, she is admitted, and is delighted to discover she is at 5cm -- active labor.  The current thinking is that hospitals will not admit women under 3cm dilation because the risk of unnecessary (and costly) interventions increases the smaller the dilation upon admittance.
Going to the hospital now. Contractions are pain level 8 lasting a minute or longer and 5 min avg in between

I can only go based on my experience with my first but with her they never got closer than 8 min or so apart during transitive labor. The pain feels similar now just they're closer together. Each pregnancy is different I guess. We'll see how accurate my self assessment is in like 40 minutes

5 cm dilated

My muscles are so tired already
A mere two hours later, Amy enters transition.  This is fantastic progress, and she should be proud (though, at the time, I am sure pride was the last feeling on her emotion stack).
In [transition] phase now. 7 cm.
Half an hour later, during what women frequently consider the most intense part of labor, Amy posts a verbose status update.  She had just talked to her doctor, who requested antibiotics for Group B strep, and asked her to refrain from eating.
Just got done talking to the doctor. I will be able to get pretty much everything I wanted except two things: I need an iv for group b strep but labor is almost over so that's ok. And no eating. They let me drink though

So sleepy
Four hours go by with no dilation progress.  Is this cause for concern?  No.  The cervix has two jobs in the first stage of labor: to dilate, and to efface.  This means it needs to thin out on the bottom.  The muscle gets displaced to the top of the uterus, where it will be used in the second stage of labor for pushing.  Before pushing can begin, the cervix needs to be 10cm dilated and 100% effaced.
100% effaced. 7 cm dilated. Baby at 0 station. Contractions make me feel like I'm going to die


Forty-five minutes later, after dilating 3cm and after just three big pushes, the next status update is one of jubilation (note the exclamation marks).
Baby is born!!! 3:28 pm!!!

Meant to post this earlier but he was 9 lbs 15.5 oz and 21.75" long. He's doing great. Both mom and baby's sugar was great (surprise surprise). He nursed well and fell asleep in my arms.

Facebook baby

Later, in the day after the birth, Amy explained: "I was not confirmed 10 cm when I pushed. I had been measured about 10 minutes earlier, and was still at 9[cm], but I didn't care."  The contractions pushing contractions were too overwhelming.  "Actually, after three hours at 7[cm] I pushed a little through contractions because it made it hurt less."
I pushed on hands and knees -- two pushes for the head then rolled over to my side for one body push.  When I got on my hands and knees I could not help but push.  They kept trying to tell me I'd know to push if I felt like pushing between contractions but that didn't happen. It was an incredible need to push during contractions that did it for me. Bill had a good analogy: He said that when I was squeezing his hand, he had to squeeze back as hard as he could so it wouldn't hurt. I told him that is exactly how I felt about pushing through contractions.
Amy added that the nurses begged her to get on the bed in the traditional supine (on the back) position, knees by her ears, to push.  Loathing this position, she abstained: "I can't."  Pushing, the head was born as she was on her hands and knees.  It was only then she was able to roll onto her side.

Congratulations, Facebook Mom!


There are a few key points to take away here.

The first is that babies do not always come on their due dates.  First babies are usually late; even subsequent babies can be very late.   Amy's baby came over two weeks after her estimated due date.  Due dates are just that: estimates.

Next, labor can start very slowly and progress over the course of weeks.  This does not mean that life stops: Amy showed how to handle a slow-starting labor and the rest of her life.  She did not let pre-labor alter her routine.

Then, the in-labor measurements of effacement and dilation are also estimates.  The way these are measured is largely subjective.  For dilation, the nurse or doctor inserts two fingers into the vagina, spreads them gently, and estimates the distance between them (this is why measurements are frequently preceded by "probably" or "around").  For effacement, the thumb and forefinger lightly pinch the cervix, and the doctor or nurse estimates how thin it is compared to other women's cervixes they have seen.  This is more of an art than a science, and is sometimes not totally correct -- as in Amy's case, in which she began to feel like pushing before the necessary 10cm mark.

Finally, Amy showed that, by listening to her body and under the care of her medical professionals, she could have the strong, empowered birth that she longed for.  Maybe it was not the ideal birth, both from the medical perspective (they wanted the baby out before the 2-week overdue mark, and they wanted her to push supine) and from her own (her doula did not make it, she had to struggle or argue for her body's rights, and she took some serious risks by skipping her prenatal appointments until so late in pregnancy), but it was within the realm of possibilities and, in the end, everyone was healthy, happy, satisfied.

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