BIRTH STORY: Solstice, Bluegrass and Moonlight

(by Laura Gilkey, about the birth of Benjamin Wilson, born 12.22.07)

(December 22, 2007) It is 3:30 am, and I believe this solstice day may be your birthday! What a time for rebirth!

I was in Banyan’s room singing him to sleep when I felt a lot of wetness between my legs. I went to the bathroom and found I had lost my mucous plug, and since then I’ve had more show and some trickling water. I nested for a moment, emptying the dishwasher and folding laundry, then laid down with Papa and tried to rest. I’m awake now timing your squeezes…not quite time to let Harmony know yet. I’ll go back to bed and try to get as much sleep as possible. Who will you be? My eyes will know you!

It’s 9:30 am and my contractions have slowed to about once every 20 minutes, but super intense and short at each interval. Sweet Harmony is at a birth right now and will come and check things out on her way home. Banyan just woke up and gave me a big hug and whispered “happy birthday” to my belly. I LOVE YOU!

(December 26, 27 & 28, 2007) While it is still fresh in my madly-in-love mind, let me tell you the rest of the story of your birthday.

After speaking to Harmony Saturday morning, I decided to go ahead and make the kimbly, or ‘groaning cake,’ that I had read about in midwifery books. The story is that if a woman bakes this cake during labor, her pains will be short, and prosperity will come to the family. The scent of the cake baking throughout the home brings strength to the mother. The cake was beautiful and smelled of winter spices.

I stayed in a creating sort of space, brewing tea and preparing food for the day. We relaxed and played together throughout the morning. I wasn’t sure whether I was really in the thick of labor or not, because the contractions had slowed so much; so Papa and Banyan watched a mid-day movie and I took a glorious nap, waking only every half-hour or so for a contraction.

I was just waking up and planning to go in the kitchen and bake a blackberry crisp when Harmony arrived at our house, around 2:30 pm. We chatted, she told us about the birth she attended that morning, it was all very relaxed and casual. She decided to give me an impromptu prenatal checkup to see how we should proceed, expecting to go home and have us call her when things really progressed. I don’t think I’ll ever forget the look on her face when she said, “I want to be sure what I’m feeling here before I say anything….um, Laura? YOU ARE 8cm DILATED!” I felt elated, giddy, silly, and proud. I felt like Wonder Woman and like a little kid at the same time. We decided we’d better call Aunt Sarah and Mimi, and hope they made it in time, and Harmony decided she’d better not go anywhere! I told Harmony I didn’t know what to do with myself! She said, “if you were going to bake a blackberry crisp, go bake a blackberry crisp!” So I did, and the laughing and the baking and the happy day continued, right into the evening.

Aunt Gana arrived, Aunt Sarah arrived, and then Mimi arrived, and right on cue, my contractions started getting closer together. I stuck the chicken I had brined in the oven so my labor team would have something to eat for dinner. I was in a place of ecstasy, so happy I couldn’t stop smiling. Everyone was! At one point we all were sitting on the floor in Banyan’s room taking turns reading him stories. I was sitting on the birthing ball through those contractions, just happy to be in the room with everyone and not feeling reclusive at all, the way I remember feeling in labor with Banyan. I’d just have a contraction, open up, and it would be over, and I don’t think I ever stopped smiling! Banyan looked so beautiful to me as I was preparing to bring you into the world. He was absorbing the happiness of everyone around him.

As the evening progressed and my contractions became stronger and closer together, we put on some bluegrass music and started to move. With each contraction I would lean against Papa and have him press his strong hands into my back. Mimi made a salad and Harmony colored a mandala at the dining room table. We were still laughing, telling stories, and just busily creating our birthing space. Harmony called Jodi, our birth assistant, who arrived around 7:00. She was just lovely. She felt right at home in our space and said so, making me feel proud of my cozy nest. She was the last piece in the perfect group of attendants, waiting for you.

We continued dancing right on through the contractions. Everyone ate dinner while Papa and I danced our labor dance. Things began to intensify yet again, and at around 8:30 we decided to take a moonlight walk. What a great idea that was. All of us went, even Banyan, the lightkeeper, who thought it was terrific fun. It was the most gorgeous winter solstice night, two away from a full moon, cool and crisp and clear. I looked at that moon and those bright stars and felt surrounded by the energy and wisdom of the universe. I felt like a miracle.When our walk was over, things changed in my body. My amazing birth team sensed that and even as I walked in the house, the bluegrass had been turned off, the lights turned down, and the mood much calmer. I needed all of those things to have happened and I didn’t even know it, much less voice it. I was only in the house a few minutes and a few contractions before I decided it was time to get into the birth pool. Harmony and Jodi filled the pool; Banyan helped, then went with Aunt Sarah to his room to read stories. I was a bit saddened by this. I really wanted him to see your birth, but I knew he was exhausted and would fall into the rhythm that was right for him. And of course, everything happens for a reason. I just missed him a little.

When the pool was full I took off my clothes and got in. The water felt amazing. The birth altar which had been set up since my Blessingway was alive with candlelight, and I chose an angle to labor that would allow me to look right at all of those symbols of support. Papa knelt right beside me, giving me that same strength that he had given me through Banyan’s birth, the strength that was the most important element of my birthing ability. I enjoyed very much the time we had alone together in that small space, while the rest of the birth team waited to come and watch your arrival. Kissing him felt so good, I didn’t want to stop doing it. I was still riding a wave of ecstasy I couldn’t believe.

I had several contractions in the pool before my water broke. I kept feeling an urge to push, and kept feeling to see if your head was within reach, even though I knew it wasn’t time yet. Now I know that feeling was because of the bag of waters bulging in front of you. Suddenly, with one strong contraction it was like a cannon shot out of my body, making everyone in the room jump. It burst forth in huge white ripples through the water. Harmony said in her sweet voice, “the next contraction is going to feel a little different.” I braced myself. I was given one contraction to prepare, one final moment of ecstasy.

Then came the next contraction, and I felt my body being tunneled down by a freight train, ripping through me faster than I felt ready for. I remember asking my body out loud to “slow down.” You crowned immediately and stayed that way for four or five minutes. I felt your sweet head and heard everyone say they could see your nose, your ear. With one more contraction your head was out. Papa was behind me and I knew he wanted to catch you, but he stayed by my side, because Harmony needed to work her magic. She spoke those unbelievable words I had never expected to hear again: “Laura, you need to get out of the tub now.”

I gathered the strength to stand up and held onto Papa with everything I had. That is when I felt a bit of fear. I knew it would be over soon and you would be in my arms; it was this singular thought that gave me comfort. This cannot possibly last more than a few moments. Breathe. Breathe. Breathe. But I know on the outside I was screaming. What I didn’t know then was that you had shoulder dystocia, where your little shoulder was stuck behind my pelvic bone. It had caused the cord to be wrapped around your body like a harness, and Harmony couldn’t free your shoulder or the cord with me in the tub. So I stood, clinging to Papa, trying with all my might not to bite him as I pushed your body out with Harmony’s hands inside me, tumbling you over so the cord would free you. And there you were, my little bird, on the floor beneath me, with Harmony above you giving you oxygen. I felt helpless at that point because I couldn’t hold you, I couldn’t turn my body around without pulling on our cord and Harmony needed to be with you. She abandoned the oxygen mask and knelt down to you, giving you a breath of her life and speaking sweet welcoming words into your heart. I saw that you were a boy and announced it joyously, then said to you as closely as our still-joined bodies would allow, “we’re not going anywhere. This is our home.” And we didn’t. You breathed, you cried, we cried, and just like that, our family became a foursome.Harmony suggested we move into bed. I found it a difficult task, but you were in my arms at last and my liquid insides didn’t seem to matter much. Because of the crazy push through the birth canal and the extra oxygen you needed, Harmony really wanted you nursing well right away. It took you a while to get the hang of it. It finally happened after I delivered your placenta, which we left you attached to as long as possible; then Papa cut the cord and you were free, your own little bird. Everyone was at the foot of the bed checking out the placenta and making prints of it (that turned out beautifully) when you latched on perfectly and never looked back.

While I was pregnant with you, I was unsure of your gender. But when I was in labor, especially as you were traveling through me, I was picturing you: a boy, clear as day. And the second I saw your face, I knew your name. Benjamin. Once you were free of the placenta, Harmony measured and weighed you, and you took after your big brother and tipped the scale at ten pounds even, 22 and a half inches long. I wanted to get into a nice herbal bath (even though I didn’t tear, my bottom half was rather sore!) so Papa proudly carried you into the living room to announce your name, your weight and your length to Grammy and Papu under the twinkling lights of the Christmas tree.

After getting dressed we snuggled down together in bed, nursing, smiling, and drifting into a blissful sleep. While everyone was still sleeping, Banyan woke up at about 5 am. He sleepily crawled into bed with us and said hello to you for the first time. It was beautiful to watch him look at your face for the first time, kiss your sweet blond hair, clutch your tiny fingers.

Welcome, little bird. Thank you for choosing me to give you the grand tour!*edited to add: Re-reading this story makes it even more clear to me why I have chosen to advocate for choices in childbirth so passionately. Because of the midwives' model of care, I was able to have the most supportive labor team and most comfortable setting imaginable. Thank you Michael, Harmony, Jodi, Mama, Sarah, Gana, Kathy and Mic for your unbelievable support.

Born in Sarasota Post in Midwifery Today

I was honored to receive the winter quarterly issue of Midwifery Today and find a Born in Sarasota post in their Networking section! Managing Editor Teri Myers saw the post immediately following Florida's 2nd national ranking in c-section rates, and asked me to resubmit it for the magazine's audience. The article follows in its entirety.

Florida Ranks 2nd Nationally for C-Sections

A June 8, 2009 article in the South Florida Sun-Sentinel reveals that the most recent Florida Agency for Health Care Administration data, from July 2007 through June 2008, shows Florida ranking second in cesarean section rates, just behind New Jersey. Florida rates are now 39%, far exceeding the national average of 31.8%. According to the researchers’ data from 2007, Sarasota County ranks 4th of all reporting counties in Florida, delivering over 41% of our babies surgically. The consumer data from the same year puts this number at an even higher 44%, almost tripling the World Health Organization’s recommended 15%.

In sharp contrast, the most recently available Licensed Midwives Annual Report, collected from 34 practicing Florida Licensed Midwives in 2006, reveals a C-section rate of just 6.3% (92 surgeries out of 1454 births).

Something isn't adding up.

The Sun-Sentinel article, like many other writings on the subject, cites "medical malpractice fears" as a big part of the problem. "Obstetricians and hospitals in litigious South Florida order C-sections for any irregularity before or during labor," doctors and researchers said. "Doctors contend they are under pressure to deliver surgically. If they don't and something goes wrong, they are sued." Yet based on my own research, I have yet to discover a single medical malpractice suit awarded to a client of a Florida Licensed Midwife.

So midwives aren't getting sued, yet they aren't performing the high volume of C-sections that many obstetricians credit as their saving grace from malpractice litigation. What is at the root of this anomaly?

I understand that the current C-section rates take into account those high-risk women and pregnancies that actually require them, and once again, I cannot extend enough gratitude to the obstetricians that skillfully and appropriately perform this surgery. Yet according to the World Health Organization, as well as recent research supporting its recommendation, the best outcomes for mothers and babies are congruent with cesarean section rates of 5% to 10%. High-risk hospitals (such as Sarasota Memorial, the only provider of obstetrical services and Level III neonatal intensive care in Sarasota County) have the best outcomes with C-section rates of 15% or less. The combined evidence I've seen over the last five years, including the most recent issue of Obstetrics and Gynecology, indicates that cesarean rates above 15% are simply medically irresponsible, and are directly contributing to the high maternal mortality rates in our country (1 in 4800).

According to research from the Childbirth Connection, the following seven evidence-based factors are contributing to the rising C-section rates in America:

1. Low priority of enhancing women’s own abilities to give birth.
2. Side effects of common labor interventions
3. Refusal to offer the informed choice of vaginal birth.
4. Casual attitudes about surgery and C-sections in particular.
5. Limited awareness of harms that are more likely with C-sections.
6. Providers’ fears of malpractice claims and lawsuits.
7. Incentives to practice in a manner that is efficient for providers.

It seems to me that perhaps the root of the malpractice anomaly lies within the patient's basic rights to informed consent and refusal. An excerpt from The Florida Patient's Bill of Rights:

"A patient has the right to be given by his or her health care provider information concerning diagnosis, planned course of treatment, alternatives, risks, and prognosis, unless it is medically inadvisable or impossible to give this information to the patient, in which case the information must be given to the patient's guardian or a person designated as the patient's representative. A patient has the right to refuse this information.

"A patient has the right to refuse any treatment based on information required by this paragraph, except as otherwise provided by law."

Improving American birth culture and reducing egregious C-section rates absolutely must be the result of a combined effort among legislators, policy makers, public health officials, hospitals, maternity care providers, and us, the consumers, who have the right and responsibility to the best evidence and information about our maternity care choices.