Birth Knot: An Unexpected Denver Hospital Birth

Denver Birth Photography

Oh, where to begin. What a wild ride this has been! There are so many things about our labor and birth that I don’t even remember, so Josh would likely write a totally different story, but this is written to the best of my “labor brain” ability. We had a very healthy, uneventful pregnancy. So healthy and uneventful that I spent the last months of my pregnancy installing flooring and chair rail, we went looking at fall colors in the mountains on my due date, and I went hiking at Red Rocks at 41w1d. We absolutely loved doing our prenatal care and classes at an independent birth center near our home. We had a doula, and we were prepped and ready to tackle natural birth whenever this little human decided it was time. Since he was “cooking” longer than 41 weeks, the birth center wanted to do regular non-stress tests to make sure he was still comfy inside and was getting enough food and oxygen since placental function can start to decline after 41 weeks. His first NST was uneventful. Heart tones were great, and we scheduled an appt for a follow up if I didn’t go into labor before then. At our 41w2d appointment, our midwife Laura did some labor encouragement procedures to try and get this kiddo going because after 42w, I would have had to transfer care. We did a membrane sweep and a Foley bulb to try and encourage cervical effacement and dilation. Afterward, they hooked us up to the NST machine again to see how the kiddo handled the procedures, and we listened to heart tones while I drank some juice and ate some chocolate to get him to move for us. Laura was a bit concerned about a few of the patterns, so she removed the Foley bulb thinking the kiddo might have not liked that so much. His heart tone patterns normalized, and after Laura consulted with another midwife, they decided those previous concerning patterns were probably nothing. They sent us home with some herbs and an appointment for the next morning to check on labor progress. Later that evening, I got 2 calls from Laura who couldn’t stop thinking about us.  I was just about to climb into bed as I listened to her messages. Her instinct was telling her that the strange patterns she saw were something to think about more seriously. She had talked to yet another midwife who also made her second guess her previous assessment. She said it was almost all instinct as there was nothing starkly wrong, but she just didn’t want to ignore something that she thought Max might be telling us. If he may have been stressed from the minimal procedures we did, how would he handle labor, she wondered? He might do fine, but he might not. She wanted us to transfer to a hospital-based midwifery practice for an induction. She thought we needed more monitoring just in case, especially considering we were approaching 42 weeks, when risks tend to increase anyway. And given the strange heart tones, she thought we better get our baby here sooner rather than later. This was Tuesday evening, and I was crushed and scared. We had an incredibly healthy, uneventful pregnancy and I had been dreaming about a birth at the birth center with these wonderful midwives I had gotten to know and trust over the course of pregnancy. That they would help us have the natural birth I wanted and help us get our baby here safely and gently. After driving to the birth center to talk to Laura in person and shed some tears together, we got ready to transfer to the hospital and their midwifery team with the reassurance from Laura that we could still have a healthy, safe, natural vaginal birth and to not think that this meant interventions leading to a c-section. 

We made arrangements for our dog Sidney to be cared for since we didn’t know what the days ahead would bring (thank you, Jessie and Ashley, for being rockstar friends and helping us a ton!). We decided not to tell our families at this point since nothing was emergent, and we didn’t want anyone to worry. I was anxious enough about the transfer, and I wanted to be able to just focus on me, Josh, and the baby. We packed our bags and headed to the hospital at 11:30pm Tuesday night to check into their labor and delivery department. We were met by a wonderful nurse who told us she understood that this isn’t where we wanted to be and promised that they would make our birth experience as close to the birth center as they could and to please be reassured that they do safe, natural birth all the time. She was a gem, and while I was still not 100% on board with being there, it was nice to know that they respected our vision for birth and that they would honor that as much as possible. 

When we met with the first midwife of our stay, she discussed starting me on Cytotec to get some cervical ripening going. I would need monitoring for a couple of hours to make sure the kiddo handled it well. We agreed, and started a long, slow induction. I wanted to take it as slow as possible because I didn’t want to rush this kiddo and put him into distress or push my body too quickly and wear myself out. Over the course of Wednesday and Thursday, we did some more doses of Cytotec in the hopes I could start labor on my own with just a little more “push”. I really didn’t want to do more intervention than that, and I had a very big mental hold up with starting Pitocin since I had heard so many stories of Pitocin leading to an epidural leading to a c-section, and I wanted to experience a natural vaginal birth. 

The middle of the night (so Friday early morning), our midwife Tracy and I had a heart-to-heart. Tracy ironically founded the birth center we started care with, and she was actually the midwife we had at our first prenatal when we heard Max’s heartbeat for the first time. I was in tears as she checked me because I just knew we hadn’t made much progress with the Cytotec before she even checked me. She let me cry and rubbed my legs as I made peace with needing to start Pitocin and reassured me that a c-section was not inevitable, our baby would be safe, and he would likely be here within the next 24 hours. I was so tired from being there for days waiting for something to happen, and I was still overwhelmed with coming to terms with our quick change in plans. She knew the kind of experience we had hoped for because she created that experience with the birth center she started. She knew I needed some time to mourn the loss of that experience, and she gave me much more time than I know we would have gotten elsewhere. They took me off the monitors for a couple of hours so I could shower and rest, and she said she’d be back by the end of her shift to start me on the lowest dose of Pitocin they do. I trusted her. She was a homebirth midwife before starting the birth center and recently transferred to this hospital’s midwifery team, at a hospital with one of the lowest c-section rates state-wide and nationally. I knew that if she thought this was the direction we needed to head, that it was the right choice and that she wasn’t rushing me just for the sake of rushing me. 

At around 6am Friday morning, they started me on Pitocin, and we called our doula (who was actually a back-up doula as our doula was sick and her doula partner was out of town, so we had never met her before—another change of plans). She arrived within the half hour. She had me relax in bed as she massaged my legs and feet to help me calm down, and Josh got some music going. He even upgraded us to commercial-free Pandora, so the James Taylor station played straight through my whole labor and birth. I so appreciated them changing the energy in the room. Between Robyn (our doula), Josh and our fabulous midwife Sheila and nurses, I was starting to get excited and my anxiety began to lessen. Our baby would be here soon! Though I had been having moderate contractions since Wednesday morning, by 9:30am Friday, the Pitocin did its trick, and we REALLY got going. They upped my dose just once, and that was all it took. By 10:30, my water broke, which threw me into even more intense contractions, and I got in the tub to work through them. I had such a fabulous team, with the nurses wheeling my monitor and IV into the bathroom, our doula running the shower over my back while I labored, and Josh offering me water and juice between contractions to keep me hydrated and fueled. When I was pregnant, I thought I would really enjoy being in the tub during labor, but I actually felt sort of “trapped” and had a harder time working through contractions trying to maneuver my hugely pregnant body. Moving around the room was much better for me. I vaguely remember some of my favorite songs playing throughout labor, catching a few words of “Blackbird” or “Leather and Lace” or “What a Wonderful World” in between contractions that seemed to be right on top of each other. Really most of what I remember is the intensity of it all and saying multiple times, ‘This is so hard.” “I don’t know if I can do this; it’s so hard.” And everyone around me saying, “I know it’s hard, but you’re doing it. You can do it because you are doing it right now.” Not once was I offered pain medication or an epidural, per our birth plan. I was determined to get through this without any more drugs than we had already had, and I wanted to feel labor and birth. I know this isn’t every woman’s desire, but I needed to feel that intense connection to the experience, especially given our change in plans. I will say that had it been offered, I would have probably taken them up on pain relief at points in my labor since contractions were long and strong with very few breaks. This just goes to show the importance of an amazing support team who believed in me and knew my wishes and did everything they could to help me through those tough moments. At some point when I was laboring, they took me off of the Pitocin, monitors, and my IV because I wouldn’t get out of a hands and knees position, and they couldn’t get the monitors to work right. Josh tells me that a nurse was holding a monitor to my belly for a good half hour because it wouldn’t stay on by itself because I wouldn’t hold still. Bless our amazing team who, instead of making me sit still in bed (there is no WAY I could have tolerated that), trusted that labor was progressing well and that I could keep going without continuous monitoring or more augmentation. That felt amazing to be off the machines and laboring on my own. Mentally, I needed that. 
 

Around 1pm, the midwife wanted to check me. Josh was ticked when he came back in from getting lunch because he didn’t think I was very far along given the limited time lapse and didn’t want it to mess with my head. To our surprise (but not our midwife’s, because their instincts are pretty incredible), I was complete. I went from a mere 1.5cms at 6am to complete at 1pm. Bodies are amazing. She asked if I had the urge to push and I said kind of, and minutes later that “kind of” changed to “holy crap I have to push.” The intensity and primal nature of spontaneous pushing really surprised me. I had heard about your body just taking over, but to experience that was inexplicable. And I was LOUD. I don’t remember when the vocalizations started, but my throat was sore all day Saturday, so I’m sure the whole labor and delivery floor got a lovely “concert” from room 310. I pushed for a good three hours when the midwife asked me what I wanted to do next. I could work for awhile longer to try and get Max past a particularly tricky spot that was holding him up, or they could try a vacuum or forceps. They thought he might be posterior with the tailbone pain I was experiencing. The OB who would do those procedures came right by my head as I labored on my knees, backward in the bed. I distinctly remember her red hair and soft-spoken nature as she talked to me about my options, never once pressuring me and talking to me so gently. I knew I needed some help at that point. I was so, so tired. I kept asking “How many more minutes?” and said something to the effect of, “I could do 2 or 5 minutes, but not 20 minutes.” So logical, laboring Kim was. I decided to consent to forceps after asking Josh what he thought we should do, and the OB used them to turn Max just slightly, removed them after what seemed like mere seconds, and then I pushed him the rest of the way out on my own. He wasn’t posterior, but there was one spot that he just kept ramming into and that little shift in position made all the difference. He was born at 4:30pm at 8lbs 7.5oz, 20.5 inches long. 12 days “late”, but right on time. He was just perfect, as all babies are. The midwife immediately put him to my chest, and it was beyond amazing to have this brand new, mere seconds-old small human in my arms. He was almost completely clean except for a little vernix on his bum. I remember looking over at Josh and saying, “We have a son!” and then said, “Thank you for your sperm!” Because apparently that’s what an exhausted woman who just gave birth says to her husband who obviously had done *so* much more than just be a sperm donor. Sorry, sweetie! 

We spent the next three days in the NICU with Max because he had some low blood sugar issues after birth that they wanted to monitor. Those days were long and exhausting, but he was stable and otherwise very healthy, so our stay was relatively uneventful other than an exhausted, emotional postpartum mama wanting to get.the.hell.outta.there. Being in the NICU with a healthy, full-term baby next door to 25 and 28 week babies who cannot even be touched will give you perspective, though. Fortunately, we got a private room in the NICU and the nurses brought in a pull out bed for us. Other than Josh running out to get us food, we all stayed in that room together until we went home. We did tons of skin-to-skin time (he was either on my or Josh’s chest the entire time we were there) and worked on breastfeeding, determined to get out of there and get home ASAP as we were *so* done with hospitals at that point after 3 days of induction and then 3 days in the NICU. We had also planned to do delayed cord clamping. However, when Max was born and put on my chest, the cord was already drained. It had ruptured at some point during birth because of a velamentous cord insertion, which I had never heard of before. Apparently it only occurs in 1% of singleton pregnancies (more often in multiples) and can sometimes be detected with ultrasound, but ours was normal at our 20 week. It happens when umbilical cord vessels embed themselves into the placenta at the insertion site, preventing that part of the cord from having the protective "jelly" on it, therefore making it prone to rupture. We were told that there is no increased likelihood of this happening with subsequent pregnancies, and it was just a random anomaly. It may have had something to do with Max's low blood sugar after birth, it could have contributed to his worrisome NST at the birth center, and it necessitated a manual placental extraction which was *super* fun (read: painful). The sweet red-headed OB who did the extraction was wonderful, though, and I was still able to take our placenta and have it encapsulated. That experience alone made me grateful that we were at the hospital because it would have been grounds for transfer from the birth center, and I would have had to be separated from Max, which would have been so hard. Things really do seem to happen for a reason.

What an adventure. I fully peed myself multiple times in the days and weeks after his birth, and my tailbone felt like I had biffed it on the ice about 10 times in a row. And, in probably a really twisted way, I was proud of that soreness and incontinence. I often talk about my “small woman syndrome”. I get defensive of my petite frame since people think I’m incapable of even the simplest physical tasks. This multiplied with pregnancy, when the world thinks it’s the authority on a woman’s ability to do anything. I needed to know that this small body could successfully house, nourish and birth that baby. And it did. The empowerment that comes with knowing how capable this body is of doing what I wanted it to do most—creating this new life that we love more than anything and bringing him into the world—is an amazing feeling. Birth plans are often mocked since you can’t really “plan” birth. However, I’m so glad we had one and that our care providers were versed in it and respected our goals. Though I didn’t imagine an induction with forceps in a hospital for my first birth experience, I am glad for the experience. I’m no longer as scared of interventions when used appropriately and know that when you have care providers who respect natural birth, one intervention doesn’t necessarily lead to more and more. And if our next birth doesn’t require an induction, labor will be a walk in the park, right? ;)

Denver Birth Photography
Denver Birth Photography
Denver Birth Photography