As many of you have noticed I’m back full time in the office this past week.  Courtney and I wanted to thank everyone for their kind words and well-wishes on the birth of our daughter Pippa.  Both mom and baby (and even dad) are doing great!  I wanted to take a few minutes to share our birth experience with everyone as we had some unique events happen that may provide interesting and instructive.

As you probably expected Courtney and I very strongly wanted to have a natural birth with minimal to no medical intervention.  We choose this route for a number of reasons.  First and foremost is that we believe that it is the healthiest for the baby.  Vaginal delivery without medical, as nature intended, confers advantages to the baby in physical development, ease of birth, immune system development, and more.  Furthermore, while obviously a more painful experience, the mother’s recovery is much faster and easy (Courtney was back in the gym working out within two weeks of delivery!).  Finally, without medications the body is able to go through labor as it was designed, the stages happen as they should, lessening the chances for complications.

Knowing that we wanted to have a natural birth from the beginning we tried prepare for it and surround ourselves with resources to make it happen.  Courtney began incorporating specific exercises into her workouts, we interviewed and hired a doula for support while we were laboring both at home and in the hospital, we took an amazing Bradley Method of Childbirth class from Juli Walter, an amazing doula, coach, lactation consultant and teacher (as well as Dr. M’s doula, find her online at www.juliwalter.com)   One mistake we made in the beginning was not talking about our desire for a natural birth upfront with our OB/Gyn.  Courtney had been with a practice at Northwestern for a while and really liked the doctor that she regularly saw.  Unfortunately, as we moved through the process and met with other Dr.’s in the practice we came to the realizations that they wouldn’t really support our wishes.  It’s not that they were bad people or bad doctors, it’s just that natural birth wasn’t something that they regularly did and weren’t really set up for.  In fact, at Northwestern, 95% of all births have epidurals or are C-section.  It’s not impossible, Dr. M had both of his there naturally, it’s just not something they do much of.  So at 32 weeks we decided to switch to a midwife group at Evanston Hospital that came highly recommended for their focus on natural birthing.

Other than switching providers the pregnancy was completely uneventful (other than some bad morning sickness weeks 9-12) up until week 37.  On the Monday of that week Courtney went in for a regular visit.  At that visit the midwife was unable to feel the head of the baby (ultimately we found out that it was due to it already beginning to descend into the pelvis).  Because of this she wanted an ultrasound performed to check the positioning.  We returned to the hospital the following day for the ultrasound.  We would have done it in the office but their machine was out of order.  At the hospital, against our midwives’ wishes, the ultrasound tech performed not only a position check (it was head down), but a sizing exam of the baby.

Note:  If we had known at the time that this was going to be done we would have refused it.  Size measurements off of an ultrasound in late term pregnancy are notoriously inaccurate.
After the exam the staff doctor for the hospital came in (head of OB/Gyn).  He explained that they performed a sizing of the baby and it showed in the less than 10% in weight for its age (it measure 5.5 lbs).  He recommended that we induce labor at that time.  We asked him if there were any signs that the baby was in danger, or of any other problems other than simply measuring small.  He said that there wasn’t – the amniotic fluids levels were good, the cord looked good, the heartbeat and movements were strong, and the ultrasound showed no other abnormalities.    His philosophy was that because the baby can live outside of the womb at 37 weeks, we might as well go ahead and take it out and then we can feed it to bring the weight up.  We refused in order to speak with our midwives.

Note:  If the previous paragraph seems ridiculous, it’s because, especially looking back, it is.  Basically, that Dr.  looked at a chart on the wall, and without the baby being in any evident danger, recommended a major intervention, solely because the baby was “below average.”  Guess what:  someone has to be.  It makes me especially frustrated for two reasons:  #1:  as mentioned, ultrasound measurements can be off by up to 1.5 -2 lbs.  Typically we hears stories of C-sections occurring because the baby is “too big”, and then it comes out at 7-8 lbs perfectively deliverable.  Ours just happened to be the opposite.  #2: that late in development babies tend to gain 1/4 to 1/2 lb per week.  If we went to term that would have put Pippa at between 6.5 and 7 lbs (she was born at 6 lbs 12oz).

The following day my wife left work to drive to meet with our midwife to go over the previous day’s events and was rear-ended.  After speaking with the police, on advice of our midwife, she went to the hospital where she underwent about 8 hours of testing.  Our nerves, from both the accident and the doctor the day before, were the only things that were damaged.  We had a long discussion with our midwife and decided that, instead of jumping into inducing the baby, we would wait and see and monitor it weekly to make sure that everything was ok.

The next few weeks flew by.  We had regular appointments at which the baby showed no signs of any issues.  At 39 weeks we did discover that the baby was in a posterior position – sometimes called “sunny-side up”.  With a combination of specific exercises and an adjusting technique called Webster, designed to address issues in pregnant women, the baby turned with no problem and we were ready to go.

We were due on May 23 (only 5% of babies actually come on their due date).  The Friday after that Courtney began having mild – moderate contractions at work.  This was it!  She decided to call me and go ahead and come home from work!  Many of you saw me rush out of the clinic!  We called my parents and they flew in from Kansas, her mom was already here from Arizona, and then everything stopped.  We ended up having an enjoyable Memorial Day weekday with family.

On Wednesday the first Courtney woke up having contraction at approximately 4:30 in the morning.  She went back to sleep and woke me up at 6:30.  These were different.  We started monitoring them and went about our day.  We took our mom’s to breakfast and took a lot of walks.  The contractions were consistent, but were never closer than 7-10 minutes apart.

Note:  It was important to us to wait as long as possible before going to the hospital.  In many hospitals from the moment you check in you are on a clock.  If you don’t progress according to the “average” then you are labeled “failure to progress” and encouraged to have interventions performed – in many cases leading to a c-section that could have been avoided.  Because we know that every birth is different, and even though we knew our midwife was on the same page as us, we wanted to labor as long as possible at home – ideally until the contractions were 2-3 minutes apart, lasting 1 minute, for a solid hour.

At about 4:30 pm the contractions began to lessen and Courtney wasn’t feeling the baby move as much.  We were contemplating calling the midwife when our phone ran – it was her!  She had gotten a phone call from the doctor who runs her practice – the Dr. who encouraged us to induce at 37 weeks had noticed that we had been at the hospital for an ultrasound (again we were unable to do it at the office because of memorial day weekend) and was mad that we hadn’t been induced as per his recommendation.

Note:  When you are post-due our practice asked that you had weekly fluid checks (by ultrasound) and non-stress tests on the baby.  We were ok with these because they were a trade-off for not having to induce labor unless it went really over (more than 2.5 weeks).  When we went to the hospital for the fluid check the ultrasound tech, against the specific orders of our midwife, informed us they were going to do a sizing check.  As this was exact thing that caused us stress at 37 weeks, and due to the fact that we knew everything was fine with the baby, we refused.

We couldn’t rid of this Dr!  It was really frustrating to us that he kept butting in to our case.  If we had wanted to experience a typically medical birth, we would have stayed with our initial practice.  We later found out through our midwife that he is notorious in the hospital for early inducements and, not coincidentally,  has an atypically high c-section rate for Evanston Hospital.

After speaking with the midwife we decided to run up to the hospital to have the baby monitored (with the assurance that we could leave if the everything looked fine).  We arrived at 4:30 pm and monitored until 5:30 – the baby looked great and at that point the contractions were mild and 13 minutes apart.  The midwife went ahead and did a check and we discovered that we were already over 6 cm dilated!  The baby was already trying to pass through the cervix but was being held back by the bag of water.  She felt that if we ruptured it that labor would go ahead and start.  At 6:15 we went ahead and had her rupture the bag, we then went for a 20 minute walk outside of the hospital.  After we came back in we were walking in the lobby when I saw a look on Courtney’s face that I had never seen before.  She started having very, very intense contractions almost on top of one another.  At that point she started progressing very quickly – in the next hour and a half she progressed to 10 cm.  We moved her around a lot – she labored in the tub, on a ball, standing, lying – just about every position imaginable.  She started to push around 8:15 and Pippa was born at 9:39 pm.

Note:  the body is an amazing thing – this just confirmed it for me.  As I mention, Courtney was completely medication free.  She’ll be the first to admit that it wasn’t easy and that she didn’t know if she could do.  About halfway through she started to ask for something for the pain.  We had discussed this situation and I started to do all the things we talked about to take her mind off of it:   we focused just getting through the next few contractions, shifting positions, getting checked, talking about how great the baby was doing, encouraging her, etc.  Finally, a little after 8 she grabbed my arm and said something like:  “please, Jeremy, I know we talked about it but I really really need something – I can’t do this.”  My heart was breaking, I didn’t want to force her to go through this.  Our midwife was great – she stepped in and basically said:  “No, it’s too late, you have to do this, now”.  And amazingly she was right:  at moment Courtney transitioned from contractions to pushing and the pain changed and decreased.  This just re-enforces everything about health and wellness to me.  The body knew what it was doing – it pushed Courtney right to her breaking point, took her as far as she could go, and then at that moment when she thought she was done, backed the pain off and had her channel her energy into  pushing.  It was miraculous and I know that, while every women is different and has a different experience, the body will do what is right for her.

I know this was long and I want to thank all of you for getting through it.  It was a very special experience for us and I would trade any part of it, even the Dr. who just wouldn’t go away.  I got to experience something 1st hand that I had been talking to patients about for years.  I was able to see how couples who want a natural birth are pushed (and scared) off track, and I am grateful that our faith in the body was there to keep us on the path that we wanted.  And in the end I am left with a perfect, beautiful little girl whom I love so much that I can’t even put it into words.

Thanks again everyone for your kinds words and thoughts!

Dr. A