The pregnancy was smooth and all was on track. Then, in the last few weeks before my due date, the baby seemed to be having trouble getting consistently into position. For quite a while, she was transverse, lying sideways across my belly. When my doula came by for a prenatal visit, she checked and said, oh good- now she’s head down. Phew! But then at my next midwife appointment, her head had moved way off to the left. The midwife was also able to feel that I had more than the normal amount of amniotic fluid. My belly felt juicy.
I was sent in for an ultrasound at 38 weeks to confirm the baby’s position. Her head was on my cervix, but way over to the left. Her shoulder was in my pelvic cavity. I had no idea that the cervix and the pelvic cavity could be in different places. The doctor actually asked me if I had more than one cervix, which I found to be a bewildering question- is that a thing? As far as I know, I only have one. They also confirmed that I had too much fluid. The midwives said they would consult with Maternal Fetal Medicine at UIC to see if I could get Level II Ultrasound.
I wasn’t worried- my doula said that she had never seen a baby not correct its position in labor if it was already somewhat head down. I knew that too much fluid was associated with some serious problems like diabetes and genetic abnormalities, but the testing I’d done had ruled out all of them. So, I went along, finishing up at work and making use of my remaining days to organize and prep for baby.
About ten days after my ultrasound and five days before my due date, one of the midwives (named Katy- they are almost all named Katy) called me, out of the blue at noon on a Saturday. MFM at UIC was saying that, given my risk factors, it wouldn’t be worth it to do an ultrasound at that point- they recommended induction. The midwives then contacted MFM at Northwestern, and they said the same thing. My risk factors were: too much fluid, advanced maternal age, a big baby (she measured almost 9 pounds at 38 weeks), and IVF.
None of these risk factors were considered risky by themselves, but, combined, the MFMs felt that the risk of waiting was putting the baby in jeopardy. The midwife recommended inducing not necessarily in the next hour but “today or tomorrow,” which was a shock, considering that my first baby was two weeks late and I was not mentally (or otherwise) prepared to go early. I got off the phone, cried, talked to my parents, called my doula. While I could have opted to delay induction, I knew that my anxiety would be overwhelming if I went against the recommendation of two MFM departments and my midwives. I knew that I could weather an induction (my first baby, Evan, was also successfully induced) and I knew that my baby would be safely delivered one way or another in the hospital. I called the midwife back to say OK, and she scheduled me for 8am the following morning.
This gave me mere hours to do the last of my mental and logistical prep. I’d already spent the morning de-cluttering my bedroom—it felt good to at least have a ready landing pad. I sent my dad to the store for labor snacks, read up on pain management, wrote a letter to my baby, cried, meditated. I went to my sister’s for dinner and had a glass of wine. I was on edge, more nervous than I expected. It’s a huge endeavor to have in your immediate future. In a way, the first time is scariest because it’s unknown, but the second time is also scary because it’s (at least somewhat) known.
I went to bed with Evan at 8pm, as usual, knowing that the next time I read him bedtime stories, our baby would be on the outside. I felt so nostalgic about our 3.5 years as a family of two coming to an end. Evan was nothing but excited to meet his baby sister.
Somehow, I slept. I woke up, as usual, two times to pee, and it took a little longer to go back to sleep but I did it. I got up at 6:30am and showered, shaving my legs for the first time in months (not even sure how or why that seemed important). Then I hurriedly packed, throwing baby clothes in a variety of sizes, battery-operated candles, toiletries, and snacks into bags, while trying to get through a breakfast of eggs, toast, bone broth. I said goodbye to Evan–he was brave and I was brave. My sister Diana picked me up and we drove to the hospital.
“I’m here to have a baby!” I said to the guy at the info desk. He directed us to the elevator to the 6th floor and said, “God bless.” From my labor room, I had a gorgeous view of the Chicago skyline, 8 miles east. A perfect mirror image of the east-facing view I had of the San Francisco skyline in 2014 for Evan’s birth.
I was put in a gown, set up with an IV (which took at least an hour by itself), and then we spent a lot of time talking through my induction plan. First, we decided to put a Cook’s catheter to ripen my cervix. This happened around 1pm. At four centimeters of dilation, it would fall out by itself. Great. Minimal discomfort. They started me on level 1 of Pitocin. They checked the baby’s position and her head was still to the left.
The midwife consulted with two OBs about whether we could safely turn the baby to get her head down (a version), and it was determined that this would be extremely unsafe. The abundance of fluid could cause more than usual pressure on the placenta and cause an abruption- so, this wasn’t an option.
The attending doctor, Dr. Morgan Madison, one of many super-talented women in this story, came in to chat with me- I happened to be on the phone with my amazing doula, Victoria, so I put the phone on speaker. Dr. Madison was young and beautiful, hair shaved on one side. A cool doctor and also confident and competent. She wanted to discuss how the baby’s position could result in a C-section. She told me I should stop, as of this precise moment, eating and drinking anything in case a C-section became necessary. Of course, I became instantly parched. The minute she left the room, my sister (trained as a doula) and Victoria both encouraged me to keep eating and drinking. Thank goodness- I can’t imagine how I would have gotten through 24 more hours without it.
My mom arrived, as did my doula Victoria (in a jacket that said “I’m the Doula!” and a shirt that said “I believe in your ability to birth your baby”) and my sister went home. My midwife Amy, whom I’d never met at checkups because she just does weekends on-call, was another super-talented woman who was thoughtful and quirky and has practiced midwifery all over the world. She had distracting dangly earrings, a messy bun, and used surprising metaphors like “this baby is monkeybars!” In the early afternoon, she checked the baby’s position. She was able to nudge the baby’s head manually into a fully down position. Yay! They put on a belly binder. It seemed like maybe we dodged a bullet.
For so many hours, we were waiting for my cervix to ripen and just killing a lot of time sitting around drinking coconut water and eating snacks. We did lots of reminiscing about our babies’ births. The afternoon turned into evening. The nurse came in every two seconds to adjust my monitors- one for the baby’s heartbeat and one for contractions. The contractions looked nice on the monitor but I couldn’t feel them at all. I tried to rest for what was to come.
Around 7pm, Amy came back and checked the baby’s position- she was still head down (vertex) but high. I was on my left side, trying to keep the baby in position (as if I could really control it). Two nurses came in around 9:30pm and struggled to find heart tones. I moved to my right side, and they found the heartbeat in a surprising place because she had changed position again. I could feel the baby changing position a lot.
Later on, Dr. Madison sent the message that we should discontinue the Pitocin because it is contraindicated for a transverse baby. Now the baby was sort of hanging like a rag doll with her back at the top and her limbs hanging down. Our conclusion was that the abundance of fluid was making it impossible for the baby to get her head reliably in position for a vaginal birth.
Close to midnight, we had a powwow: Dr. Madison, Amy, Victoria, the nurse Krystal, my mom, and me. The situation was not something any of them had seen before so it required a more creative brainstorming session, and, incredibly, they were willing to include us in that. They said, “We’re just going to talk this through right here.” I still can’t believe how much effort they put into giving me my best shot at a vaginal delivery.
The problem was too much fluid, which was not only keeping baby from getting into position but it would make contractions less productive (like pushing a rope). If we broke the amniotic bag, there would be a higher than normal risk of cord prolapse due to the additional pressure, meaning that with the rush of fluids come out, the cord would come down the birth canal before the head, potentially cutting off the baby’s oxygen. So, Victoria, my doula, voiced her brilliant idea of just doing a tiny pin prick with a pudenal block needle and guiding the baby’s head into position carefully with the hand. The team got really enthusiastic about this. They left the room for a while (I think it took them a long time to find the right needle) and came back with the full plan.
They would prep me for a C-section in case there was a cord prolapse so they could have the baby out before the 10-minute mark when oxygen supply would be depleted. They took out the Cook’s catheter and discovered that I was already seven centimeters dilated! For some reason it hadn’t fallen out! I had no idea that you could get to 7 cm dilation with no discernible contractions…
At 1am, they put me on a gurney (in case I needed to be rushed to the OR), shaved my incision line, wiped my body with chlorahexadrine. They put my head a little lower than my feet so that gravity would help keep the cord in. And then they started the procedure.
I remember feeling really focused and all my emotions were put aside as we carried out the plan. Amy did the pinprick. The fluid started dribbling out and Dr. Madison started pushing on the top of my belly (fundus) really hard to get the baby to descend. Amy guided the baby’s head with her hand. The fluid came out so gradually that she did another pinprick, and eventually used the more typical crochet hook. I was doing deep breathing as this position was so uncomfortable (plus I was already stiff from trying to hold myself in a left-lying position leading up to the procedure). As pockets of fluid were released, the baby descended. Dr. Madison had her full weight on my body and she was really strong. They kept apologizing to me. I kept thinking- we’re gearing up for a birth, I’m not expecting to be comfortable! After about an hour of this, the baby’s head was at -3 station and I was allowed to sit up which was a huge relief. It worked! They put the belly binder on tight.
The team was celebratory and now all I had to do was “pit this baby out!” (They apologized to me for this expression.) I was so grateful to Victoria for her contribution to our brainstorming sesh.
The nurse was soooo conservative with the pit. She kept saying that I had to show a clear pattern of contractions (rather than “artifacts” which were disorganized and choppy) before she would turn it up. I had spent the whole day at level 2. She turned it up to 3 around 2am, 4 at around 3:30am, and eventually I went to sleep. They also put a monitor on the baby’s head to track her heartbeat (rather than chasing it with the monitor on the outside) and they inserted another sensor to track contractions (which was supposed to sit next to the baby’s face but ultimately floated away and didn’t work). I had at least five cords to manage every time I went to the bathroom (which was a lot, since I’d been pounding coconut water all day).
While I was sleeping, the nurse finally turned the pit up to 5, 6, and 7- and by the time I woke up, I was having real contractions. I burst into tears knowing that the baby would be on her way soon- a big release. My sister Diana arrived again, and my doula Heather (who is also an experienced midwife) came to relieve Victoria. The midwife Annette, whom I had met at checkups and resembled Amy, came to relieve Amy. (Before leaving, Amy called this an “epic” birth, and she didn’t even get to see how it ended…)
From this point, labor progressed normally, although the baby was always described as “high.” At some point, I was determined to be 7.5 cm, which only added .5 cm to where I’d been many hours before. At first I couldn’t remember how to vocalize contractions but when they got stronger they vocalized themselves. As the contractions got stronger, I felt strong too, keeping my voice low, changing positions, staying focused. My labor team was awesome even though I don’t really know who was doing what as I retreated behind my closed eyes. It was comforting to know that I had Heather as well as my mom and sister, soothing me with voices, hands, sips of coconut water, and sometimes just an empathetic “I know…”
I started feeling back labor and wondered if she was “sunny side up” (posterior)- but I didn’t ask, and no one told me. Eventually, I couldn’t find a good resting position, pain was carrying through the spaces between contractions, and I felt really hesitant to change position or try something new. I tried the ball, a birthing stool, draping myself over the top of the raised bed, hands and knees, even runners lunge and side-lying (which was really intense but provided the best rest in between contractions). I started wanting to push but the cervix wasn’t totally effaced. In retrospect, I was having a premature urge to push due to a posterior baby.
Eventually, I was ready for full-on pushing and it did not feel anything like Evan’s birth. With him, I was harnessing the power of a train moving through my body and getting this huge forward motion, and I was feeling triumphant. This time, it was not smooth sailing. It felt like the transition didn’t quite happen and it was a mix of active labor contractions with some pushing at the end of each- it didn’t feel like I was in the flow. I was constantly wondering if I could do it and trying to be brave.
My team was cheering me on but they were also quiet sometimes. I pushed as hard as I could, waiting for their feedback, even having a passing thought about my poor (pre-existing) hemorrhoids. I wanted to get into easier positions but Heather kept me in the harder ones, which probably (thankfully) kept the whole pushing stage from going even longer. I wanted to get on my back, which is how I birthed Evan, but everyone felt that would slow things down, so at the end, after about two hours of pushing, I was in a partial side-lying position, gripping the railing so tightly that my arms were sore for days. I got her head partway out and my sister asked if I wanted to feel it and I said NO. I just wanted to get her out. A few more pushes and then that nothing-else-like-it sensation of her body coming out of mine, and she was here!
She looked just like Evan as a newborn to me, super healthy with an Apgar score of 9- she cried right away. I was very relieved but the pain didn’t stop; now they were massaging my belly to get my placenta to come out. I looked up and saw my mom and sister with tears in their eyes. I was trying to put her on the nipple and they were pushing on my belly and then I was cutting the cord (which took 5 cuts!) and then some negative-energy doctors came by to say that my placenta wasn’t coming out and they needed to reach in to try to detach it (and they mentioned that this was among the most painful things they do to anyone at the hospital). They put Fentanyl in my IV, felt around, determined it would not come out, and shipped me to the operating room to go under general anesthesia so they could get the placenta out. I handed the baby to my family and was rushed to the OR.
With the Fentanyl, I was confused and panicking- I had thought my doula was coming with me, I couldn’t recognize any of the doctors and nurses with their masks on… Eventually a nurse with an accent was putting a mask over my face and I told myself it was time to surrender.
While I was under (for about an hour), they removed my placenta successfully and I hemorrhaged even worse than I did with Evan (1600 ml vs. 1500 ml last time), and I was given a blood transfusion. When I woke up I was so disoriented- eventually I talked the nurse into bringing my mom, the baby, and my glasses into the recovery room.
Once they arrived, I felt huge relief and was completely fine again. If my mom is here, the baby is here, we’re all OK- I’m good. My baby girl started nursing and they wheeled us to our little postpartum room where we spent the next couple of days in the love nest together.
It was while I was in labor that her name solidified in my mind: Chloe. She is a “tender green shoot” and a fertility goddess, a sweet girl with an edge. After a birth of so many twists and turns, her first week of life has been absolutely smooth as she’s nailed all her metrics, mastered nursing, and squeaks and coos. I’ll be forever grateful to the incredible team who guided us through some raging storms to emerge on the other side where the clouds finally parted and life is nothing but sunshine. ❤