First and foremost, I'd like to thank my beautiful friend and colleague, Dr. Katie, for her generosity and vulnerability in sharing such an intimate experience. On June 21, 2021, she and her husband welcomed the birth of their second child, Remy Rhodes Usher. We wanted to take this time to write out her birth story and share her reasons behind her birth choices. It is important to note this is not meant to persuade anyone or to say this is the best option for everyone. It is only meant to shed light on another option for families who are seeking a natural birth and who would otherwise not have considered birth outside of the hospital. The rest of the blog will be written in first person by Dr. Katie.
“Remy’s due date was Wednesday, June 23. With his older sister coming 6 days early and this being a second birth, I was anticipating going into labor much sooner than the 21st. One small piece of advice for second or third time moms. Remember that each baby, pregnancy and birth is different. Things can be similar, but can also be strikingly different so it is best to not have any expectations (which is easier said than done). My contractions had been coming and going for almost a week, but started to become much more consistent when I woke up on Monday the 21st. I texted my husband and told him to clear the rest of his day and to come home. At that point, they felt more like period cramps so I told him we would drop off our daughter with the babysitter, stop and get coffee, and come home and relax until things started to pick up. By the time we were all ready to go around 9:30am, we decided it was best for me to stay home, as they were already starting to get closer together during that 30 min - 1 hour timeframe. With my contractions lasting 45 seconds to one minute, they were coming every 3-4 minutes but were still very manageable in intensity. I was able to finish cleaning up the house but would have to sit down for each contraction.
At around 10:30am, I made myself an epsom salt bath and waited for my husband to get home. Once he arrived, he set up Hulu in the bathroom with me and stayed on the outside of the tub while we watched an episode of “Zoey’s Extraordinary Playlist”. The water and the show helped so much distracting me from the pain of the contractions.. I got out of the tub around 11:30 when the water started to get cold. Each contraction felt like it was getting more intense and harder for me to talk through, so I had Ryan call the midwives and the doula. The birth team arrived between 12:30-1:00pm. I asked Tammy, my midwife, to do a cervical check when she got there. Under other circumstances, I preferred not to be checked, as cervical dilation is not linear and does not correlate to a specific timeframe of when your baby will be born. In this case, I wanted to know because I hadn’t lost my mucous plug or had my water break, but I felt like I was pretty far along in labor based on the intensity of my contractions. This also felt different than my first labor in a good way - I felt like I had more control and was handling the pain much better this time around. I had prepared with a hypnosis course this pregnancy and couldn’t tell if that work was paying off or if I just wasn’t as far into labor as I had thought. Tammy checked me and found that my cervix was pushed posteriorly to the baby’s head and I wasn’t dilated at all. She was able to adjust my cervix into the correct position, and I dilated from 0-6 centimeters in the middle of her exam, which was in a matter of minutes.
Time is warped when you are in labor, but I am guessing it was around 1:15pm when I decided to get into the birthing pool. My midwife and birth assistant stood back while my husband and doula coached me through each contraction. My husband would remind me about my breathing and my doula would speak calming affirmations over me and apply pressure to parts of my pelvis to help increase the pelvic outlet for the baby to transition down. My main focus was to stay as relaxed as possible through each contraction, focusing on a full inhale and long exhale. I went through most of my active labor on all 4’s, sometimes going into a modified child’s pose, keeping my feet wider than my knees. (The internal rotation opens your pelvic outlet). The amazing part of this whole process was being able to feel the baby adjust position and move in between each contraction. We were both active participants in this process and I knew he was doing his part in descending with each contraction.
When I started to feel the urge to push, which basically feels like the urge to poop for those who haven’t gone through labor, I continued to focus on my breathing but would add in a little downward pressure or pushing on the exhale of each contraction. I also moved into a reclined half kneeling position to open the pelvis. Instinctually, and with my prior knowledge of pelvic floor muscles and pushing mechanics, I decided not to force pushing outside of my contractions, as I wanted to allow my pelvic floor to stretch as much as possible and reduce my risk of perineal tearing. This definitely prolonged the pushing phase because I wasn’t putting a lot of force into the pushing, but it felt more natural and manageable to me. It also seemed to be effective at reducing the baby’s stress, as each time the midwife checked the baby’s heart rate during the pushing phase, he seemed to be unfazed by the pressure. Again, time is warped during labor, but my guess is somewhere around 20-30 minutes after the start of the pushing phase, Remy’s head emerged. My water appeared to have broken right as he was coming out. Once his head was out, my midwife noticed something seemed a little off so she told me if I couldn’t get the rest of him out quickly, we would have to transfer out of the tub to finish delivering him. I had no intention of getting out of the tub with a baby’s head between my legs, so I bridged up, screamed and pushed as hard as I could, and got the rest of his body out on that contraction. The cord was wrapped around his neck, but she was able to untangle it very quickly before he came out from the water. The beautiful thing about water births is babies don’t take their first breath until they reach air. Under the water, it is like they are still in utero and are getting their oxygen from the placenta. I forgot to ask, but I don’t know if this scenario would have been much scarier or dangerous if we hadn’t been in the water. He was born at 3:50pm, about 6 hours after what felt like the start of consistent contractions and about 3 hours after my midwife adjusted the cervix. Between the hypnobreathing and the water, my pain stayed mostly manageable. There were definitely moments where I felt out of control, but luckily the time between contractions started to lengthen as labor progressed and contraction intensity increased.
While this did feel like an idyllic birth and the birth I planned and hoped for, I did have some postpartum complications. Once we transferred to the bed, I delivered the placenta and enjoyed the golden hour with my husband, Ryan, and newborn. He latched well and started nursing, the birth team gave me some food and orange juice. Ryan cut the cord once the placenta was delivered and the midwives started the newborn exam. Remy was 9.04 pounds, and I had no tearing! (A pelvic floor therapist’s dream). However, when I tried to get out of bed to go pee, which is very important postpartum for health of the bladder and uterus, my blood pressure dropped to 80/50 mmHg and I started seeing double. This happened after the birth of my daughter but we were all so surprised that it happened again with how smoothly things had gone up until that point. They laid me back down, and the situation didn’t feel like it was improving for me, as I started feeling spasming of my diaphragm and difficulty focusing and breathing. The midwives quickly set me up with IV fluids and a shot of pitocin to stop my bleeding. While that did help me feel better laying down, they tried a few times over several hours to sit me back up and I wasn’t able to do it without being symptomatic. Thus began my 36 hour stint of being on bedrest and my husband having to use a bedpan for me to pee. Postpartum is humbling to say the least, ladies!
Now that we discussed Remy’s birth story, I want to quickly go over some of my reasons behind choosing a homebirth for my family.
1. Control
While some people have commented on how “brave” or “crazy” I was to have a homebirth with my first birth, the reality was it wasn’t my first. Ryan and I had a miscarriage in 2017 which landed us in the hospital. At the time, I was actually working in the hospital as a PT but had never been a patient myself. My experience was not a good one. People walking in unannounced, performing procedures on me while I was heavily dosed with pain meds which made me feel high and out of control. While it was a short stint, it made an impression on me and made me realize that I wouldn’t have the power to refuse what I didn’t want. When we got pregnant in 2018 with our daughter, I started to do a lot of research on my options and felt most comfortable with homebirth.
In this scenario, my birth team members are guests in my home. I am not a number to them or the most recent admission. They respect our wishes. While they are there to keep the baby and I safe, they aren’t altering the environment. We control the lighting, the music, the smells, what we eat, who is coming and going, etc. There are so many variables we CAN control during birth if you are given the choice and autonomy to do so.
2. Safety:
This is such a personal situation. As mentioned above, I actually felt safer at home than I did in the hospital. I know that isn’t the case for many or most and I totally respect that. I also knew that we were 5 minutes from the hospital if, God forbid, something went wrong which caused need for transfer.
When well-meaning family members or friends would make comments to me about feeling safe out of the hospital, I would politely nod and respond with something along the lines of -
“Birth is not a disease. It is a normal part of life that we have been doing for thousands of years, and we’ve only been delivering in hospitals in the last 150 years or so.”
The World Health Organization recommends a C-section rate of around 10%, but the current rate in the US is around 30%. That means close to 20% of births are unnecessarily ending in CS due to factors being associated with the hospital (unnecessary inductions, interventions, stress, etc).
The US has one of the highest infant and maternal mortality rates as a first world country, despite us spending significantly more in healthcare. Increased intervention and money doesn’t necessarily lead to improved outcomes.
3. Providers:
Midwives work very differently than traditional obstetricians. Midwives spend close to an hour with their patients for all prenatal visits. They are used to seeing normal physiologic births and do their best to limit interventions unless truly needed. They also put the responsibility back on the patient to do their part in preparing for the birthing process. They give resources for birth education courses, discuss the importance of proper nutrition, hydration and exercise for the health of the baby and mother. They want to prevent problems before they become problems during labor.
4. Nervous system regulation:
This is the part that I nerd out on as a PT. Our bodies are regulated by our autonomic nervous system. This is an awesome, primitive design which works to keep us safe. For simplicity’s sake, it’s just important to know our sympathetic nervous system is our “fight or flight” response, or what is involved more when we are stressed. Our parasympathetic system is our “rest and digest” part of the nervous system which is more active when we are resting or sleeping. Our body’s are meant to give birth in similar situations of having sex or going to the bathroom, meaning calm, quiet, safe environments.
If you are in a brightly lit room, or you have random people walking in and out of your room, or are unknowingly stressed or taxed more than you realize, your body is going to have a hard time progressing in labor. Our body’s physiology is wiser than we realize and will stall to keep us “safe.” It’s similar to the inability to orgasm if your mind is in a million places or you're stressed that your baby is about to wake up. I wanted to make sure I optimized my body’s physiology and was able to stay calm and relaxed in my environment.
5. Baby’s first experience of the world:
We don’t often realize this, but baby’s are active participants in birth, or they can be. We also think that because they won’t remember these experiences, that they don’t matter. Research is showing the opposite, however. While their conscious brains will not remember how they came into the world, birth trauma experts describe how their subconscious is imprinted with this experience and can influence if they see the world as a safe or dangerous place. I, of course, do believe there are so many variables at play and these impressions can be outweighed by the million other things that can go right with a child’s development. My goal, in learning this information, was to optimize the chance of bringing my baby into the world in a safe and gentle manner.
As with anything in life, there will always be unknowns with birth. There will always be things you can plan for and things that will surprise you. The best we can do is prepare ourselves as much as possible, and then let go of any expectations. My role as pelvic floor PT is to support you in whatever situation you choose to be the best for your family. What was right for me does not mean it would be right for you, although it may be. My goal in sharing my story is to point out that you do have options if you realize them.
Healthy Happy labor and deliveries (however you chose to do so),
Dr. Carly & Dr. Katie
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