Amelia Eris Ray Van Brink
Born November 13, 2001, 9:14am
Weight: 4lbs 13oz
Length: 18"

After a healthy and normal pregnancy up to this point, with a home birth planned and seeming likely, my waters broke on Thursday, November 8, at 33 weeks 4 days. I wasn't even sure that's what had happened; I was out, and I went home and went to bed convinced that I was having a loss of bladder control. I'd read so many stories of women who'd gone rushing to the doctor or hospital, sure their waters had broken, only to be sent home embarrased...

Well, there was a steady trickle all night, and in the morning I called my midwife, who sadly said that yeah, it sounded like my membranes had ruptured. I met her at her office, where she took one look and was certain, and off I went to the hospital. Exactly the place I had *not* wanted to be. But it's where I needed to be.

The OB on call did a sterile speculum exam, verified that my membranes had ruptured, tried to get a sample of the fluid to have tested for fetal lung maturity, and said I was 1cm dilated (no way to know if that meant anything). She couldn't get enough amniotic fluid for them to test, so we decided that rather than do an amniocentesis we'd just go ahead and administer steroids to me to mature the baby's lungs. She also did a quick ultrasound to verify that the baby was head down and presumably to check for other issues which might have been missed in the past. I spent the weekend on bedrest (though I was allowed up to use the bathroom, woohoo!), getting antibiotics every six hours, a steroid shot friday and saturday nights, and having nurses come in about every four hours to do fetal heart rate and contraction monitoring (I made them use the thin belts they had to keep putting on, because the big bellysock that would stay on me and make their jobs easier made my back hurt). The erythromycin was the worst; it made me nauseous the first time, so after that it was given mixed with about half a liter of lactated ringers solution. This becomes relevant later in the story. It still sucked because various nurses had various difficult times doing the mixture and if they got it wrong it BURNED going into my IV (a heplock site, so if i wasn't getting antibiotics I wasn't tied to the pole).

I was having minor contractions on and off through the weekend, but few that I would classify as any more than the Braxton Hicks ("practice") contractions I'd been feeling for weeks. A few of the weekend's contractions felt like they were *doing* something, but they never got down into any sort of rhythm, and didn't hurt. James was spending his days with me and his nights in our camper in the parking lot of the hospital with the dogs.

Monday evening, I asked my parents to please get me some slippers. I think I felt I'd be needing them soon. And around 10pm I asked James NOT to go to the camper. By eleven, I was feeling some more serious contractions, every ten minutes. I told the nurse about them, and as I recall she ran a strip which showed them as being not very strong. I told her I didn't like being hooked to the monitor, and mentioned that I was feeling like my body was telling me to go with these contractions, and that was the last I saw of her until morning.

So, all night I had contractions about 10 minute apart. I'd lie down, fall asleep, then wake up with a contraction. Ow! These were definitely more real than any I'd felt before, but they were still spaced well apart. The nurse had said to call if they started coming closer than 10 minutes. About every other one, after sitting up and dealing with it, I'd go to the bathroom and pee... it seems that lying in bed for a weekend getting filled up with water (that lactated ringers solution!) makes for a VERY full bladder, and a full bladder makes for... well, *interesting* contractions pain. I had also been constipated all weekend, and that was finally clearing (thankfully, gently). James was sleeping with me on the tiny hospital bed... well, I was sleeping very soundly for about 9 minutes at a time, and he was just pretty much stuck awake all night. At some point during the night I was in the bathroom alone and I meditated on things briefly. I realized that it was OK- the baby was about 5lbs and was going to come out screaming. Everything would be fine.

By around 6am the contractions were definitely more intense and I'd sit on the toilet and pee, then sometimes just wait there for the next one. I *really* wanted to hold out until 8am, when the oncall OB changed from one I didn't really like (and had heard was a bit csection happy) to the one who'd checked me in on Friday, who I did like), but around 7:10am the every ten minute contractions became every three minutes, and at 7:20am I pulled the nurse call in the bathroom.

The nurse came in, saw me on the toilet, and I told her my contractions were three minutes apart. Oh, my! She asked, in a slight panic, if I was straining, and told me to please NOT strain. I assured her I wasn't. I promised I wouldn't strain, and I wouldn't give birth on the toilet (I knew I was just saying that to make her feel good, though... if I was going to get the urge to push and that's where I was and that's what felt good, well darn if I wasn't going to just do that! Didn't work out that way, anyway). I heard her go out into the hall and tell someone else and heard the other person say, "she's what?!" and then all hell seemed to break loose around me. I'd been in a small room on the L&D wing, one which is generally used for people in my situation- just waiting around bored hoping not to go into labor. It didn't have any of the actual delivery accouterments and didn't have much room in it, but there they were, wheeling my regular hospital bed out and were going to bring a delivery bed in. They finally convinced me to get off the toilet, and I came out, had a contraction, dropped to all fours on the floor and rode it out, saw they hadn't pulled the new bed in yet and just stayed there. James called our midwife to let her know that it seemed like we were going to be having the baby (she had promised to come and be with us for the birth, though she wouldn't be able to be there in any official capacity), and she asked to talk to me (this is how they gauge what point a laboring woman is at- they talk to her and listen to her voice), so i took the cell phone and talked to her while I was down there on the floor. She sounded like she'd be on her way pretty soon.

The nurses finally figured out that they had a better room available and maybe I could get there, so I walked two doors over and headed straight for the bathroom- they'd promised that if I was willing to change rooms then I could go to the toilet there. I needed to pee again! They got everything set up and a nurse came in and convinced me that the labor bed would feel as good as the toilet- it had a nice notch that i could sit on that would be a lot like a toilet seat. Yeah. I'd guess it was a bit before 8am by this time. I moved to the bed, which really wasn't too bad, though the notch was NOTHING like a toilet seat. I found myself mostly squatting at the very end of the dropped down portion of the bed for working through contractions and then folding myself over on all fours against the upright back of the bed to rest between them. A nurse got me to sit back for a moment so she could check me, and said she believed I was complete. They were still waiting for a doctor to show up. I was very relieved to hear that I had dilated so far, but had no particular urge to push, so I just continued to ride out the contractions. At some point Kate, my midwife, arrived, as did the pre-8am OB (the one I didn't like), who also checked me, agreed I was complete, and told Kate she could put on ONE sterile glove ("don't catch this baby."). They argued a little about something, while I was there dealing with a contractions... I remember calmly looking at them and asking them to mellow out, but I'm told what I did was growl this suggestion. They looked a little chagrined. Kate put on her one glove.

In the course of this, I gathered that the other OB had arrived, and that yet a third was also outside ready if needed. I'm not sure why I had three OBs fighting over my delivery, but there it was. The good one eventually ended up in there. It wasn't long before I was ready to push and Kate was suggesting that I should. Kate was really the person who held the whole thing together for me. James was there and was very supportive, and Kate was giving gentle and useful suggestions. I don't think anyone liked that I was perching on the very edge of the bed to ride the contractions or then to push, but what were they going to do? A nurse got a fetal heart rate monitor on me, which didn't bother me so it got to stay. I'd spent the weekend listening to my baby's steady heartrate, so when it told me that the heartrate was dropping when i'd curl up into a ball between contractions I didn't really need anyone else telling me I should change positions. i ended up leaning back against the bed, which worked nicely. When a contraction would come again, I'd pull myself up with the squatting bar which had been installed onto the bed at some point, so I ended up pushing in a semisitting/semisquatting position. The cutout on the delivery bed really was a good thing and I didn't feel like the bed was pushing me in a wrong way. One thing about all of this... I really didn't like pushing at all. It was no fun. It hurt each time, and then the pain would subside as the baby's head moved back up. Kate was helping me to know when my pushes were effective (using that one sterile gloved hand), but that didn't make me like it more. I suggested to James that he could take over now. I also tried to convince my body skip contractions, just as I'd done over night ("Come on. Let's just make the next one be in twenty minutes so I can sleep a little longer"). Never worked. I don't know how close my contractions were at this point, but close enough to start really pissing me off. But, what was I to do? So I pushed. At some point, the pain would stop going away after a contraction- the baby's head wasn't moving back up. Someone realized there was a mirror hiding in the room and moved it to where I could watch, and I could see that there was a bit of thing down there that wasn't me. Oh! It's not going away. That was what I needed to really motivate me to finish the job.

The room was filled with women. Me, Kate, my friend and doula Sara (who arrived about four minutes before the baby did), the OB, the labor and delivery nurse (maybe two?), the NICU nurse, and the pediatrician. And James. Once I saw the baby's crown and that it wasn't going to go back up and stay there, I gave a couple of pushes and watched the baby's head come out. I'm told the OB moved a loosely wrapped cord from around its neck and they briefly suctioned with a bulb, while I gave another push and out came the body (I *felt* it... it felt completely weird and much different than the head) and someone very small screamed.

Kate had talked to the OB, who knew we wanted a delayed cord cut, which is especially good for premature babies (get them all the blood they have available). The baby was lifted up and put on my belly, and a few moments later James was surprised to be asked if he wanted to cut the cord. It had stopped pulsing and someone clamped it and showed James where to cut and he did. He also looked and saw that it was a girl (I'd thought it had been in a brief glimpse I had when she was put on my belly, but his was the first pronouncement of it). I don't quite remember the order of operations after this, but I think the baby was taken over to the warmer at this point for a brief examination by the pediatrician, and James stayed with the baby for that, while I pushed the placenta out. I was also bleeding a bit, and a bag of pitocin was hooked up to my heplock, and the OB injected some lidocaine and stiched up a small interior tear. The baby was then brought back to me and put on my chest. I growled away some hands trying to clean her up and she was left alone with just a blanket on her. Kate helped me help the baby latch onto my breast, as the baby was clearly rooting around trying to do so, and convinced the NICU nurses to leave her with me for a while, since she was clearly stable. I remember her making deals- "a half hour more," "fifteen minutes," "ok." "We need to check her blood sugar. I guess we could do that while she's on mom's chest." Eventually they took their heel stick and measure her sugars, which were a little low, and weren't having any of the suggestion that they could put an IV in in the delivery room. The baby had been with me for an hour after she was born and was getting sleepy. I let her go, with James.

The rest of the story isn't really birth story, so I'll summarize. Amelia (whose name we chose after a day or two) spent 18 days in the NICU (the hardest day was Thursday, the day I was discharged and for the first time since conception I found myself not in the same building as my baby). She was very healthy and suffered no illnesses or problems, just needed to grow a bit so she'd have enough energy to eat on her own. She was never given any oxygen or breathing assistance. She came home with us on December 1.

One of the odd things about my labor is that, because I never *wanted* to be in labor, I didn't do any of the things I thought I would do, like walking, or getting into water, or any of that "visualize a flower opening" sort of stuff. I just dealt with what I had, sometimes by using the focused awareness techniques I'd learned, sometimes by just using breath awareness ("breathing in... breathing out... breathing in now..."), and sometimes by just adjusting my position to whatever felt best. My early labor was spent lying in bed hoping I wasn't headed for labor just yet, which is much different than the walks around my neighboorhood and such that I had been envisioning for early labor. My OB never once suggested that we should encourage labor to start, though if I'd managed to lie there until the baby was past 35 or 36 weeks I imagine the risks of the ruptured membrane would outweigh those of delivery.

But considering all of the circumstances, I don't think I could have asked for a better birth experience. My wishes were fairly well respected, and I wasn't railroaded into anything I didn't want or agree would be good. I was unmedicated, and we managed to labor primarily alone, and most important of all, I was able to keep the baby with me for a long time after she was born, and was able to have her latch on and begin breastfeeding (well, I don't know if "feeding" is the word, but she got to make the attempts and get my systems going) immediately. I have to credit my midwife for nearly all of the things which went well, though; she was the best support person I could have asked for given the hospital delivery of my premature baby.


On November 11, 2002, I wrote a rambling bit of my NICU Story.