Jasmine’s Story: What Are the Limits of Normal Birth?

Carol Gray and Beth Yohalem-Ilsley*Note: I co-wrote this article with Beth Yohalem-Ilsley, MS LAc. It was previously published in Midwifery Today in 2005

Introduction
What is a “normal” birth? This birth story is written from the perspective of both the attending midwife and the new mother. We are sharing our stories in order to reexamine the definition of healthy birth.

Carol’s Story
Medically managed births are constricting the boundaries of what is considered normal. A growing number of labors in America are augmented with Pitocin. Labors that take longer than 11-16 hours are increasingly seen as pathological. How can we recognize the unusual, but normal when it happens less frequently? How can we safeguard different, yet ordinary births so they can unfold in ways that are right for each mother and baby? How can we ensure that mothers are allowed to open the doors for themselves?

I was one of Beth’s three attending midwives. Beth began having mild contractions on Thursday night. Silke, one of my midwife partners, visited Beth on Friday morning. She was in early labor and doing well.

By Friday evening Beth needed some support. Silke and I were the first to arrive. Throughout the night Beth’s labor looked active…at times. She had bloody show when her contractions were strong. She was able to rest when things slowed down. She climbed in and out of the tub. She paced around the living room. She squatted. She walked upstairs. She walked downstairs. She ate. She drank. She emptied her bladder. She sat in a chair and cried. Beth’s husband, Justin, provided continuous, attentive support for her. He showed complete faith in the process. Beth’s baby was occiput anterior. The fetal heart tones sounded great.

Saturday morning Beth’s labor continued. Patrice, the third midwife, arrived. Even though Beth had been having contractions for 36 hours, it was easy for us to relax and wait. Beth was still strong and enthusiastic. Her baby sounded great.

Saturday afternoon we gave Beth a homeopathic remedy to help move things along. Labor picked up and then died down. Beth got frustrated. She and her husband are both acupuncturists. As her husband gave her a treatment to strengthen her labor, Beth complained that she hated acupuncture. Four hours later, she agreed to and complained about another acupuncture treatment. Four hours after that, they did it again.

When there was time for my thoughts to drift I begin to think about Pitocin and the hospital. The little angel on my right shoulder said, “Things seem normal.”

The little devil on my left shoulder said, “It has been more than 48 hours since Beth’s contractions began. Maybe she can’t do it.” It’s tempting to imagine a magic remedy to speed things along when mothers and babies take their time and we get tired. The devil said, “Wouldn’t it be nice to get the baby born so we could all go home and get some rest?”

We all kept going.

Late Saturday night Beth was feeling a little pushy so we decided to do a vaginal exam. She was 7cm and 80% effaced. We congratulated her on her progress and gave her some herbs to stimulate stronger contractions.

Beth labored into the darkness of the third night supported by Justin, the midwives and her friend, Sandy. During the next 12 hours she climbed in and out of the tub. She walked upstairs. She walked downstairs. She took a shower. She slept between contractions. She got on her hands and knees. She sat on the birth ball. She lay on her left side. She lay on her right side. We did hip squeezes. We did nothing. She tried pushing a little. She tried not pushing. She pooped. She peed. She ate. She drank. We gave her another homeopathic remedy.

When I had time alone I wondered about what might be “wrong”. Was I really sure of the baby’s position? Did Beth have an unresolved emotional issue affecting the process? Did I have one? Did her baby want a different astrological sign? What was the problem? Could we fix it? Should we fix it?

We all kept going.

Late Sunday morning, 63 hours after the onset of contractions, we did our second vaginal exam. Beth was 7cm, but could stretch to complete. The baby was at -1 to 0 station. There was subtle progress. The baby’s head was molding. It was hard to feel the sutures. We gave her more herbs and for the next several hours we continued doing what we had been doing for the previous three days. Remarkably, Beth had energy and her baby sounded great.

Beth told me Sunday afternoon she had decided that if the baby didn’t arrive by Monday morning she would consider going to the hospital. I don’t ever remember a mother saying that she would consider going to the hospital in 12 or more hours if things didn’t progress. It’s usually an in-the-moment thing when we throw in the towel. Beth had an amazing willingness to accept the process, whatever it was.

On and on she went. Beth and Justin tried sexual stimulation. We tried a homeopathic remedy. Beth sat on the toilet. She sat on the birth ball. She ate. She drank. We tried more herbs.

72 hours into the labor we did our third vaginal exam. Beth was almost complete. She had a soft, moveable lip, but her contractions had died down. We tried another homeopathic remedy. We tried nipple stimulation. Beth walked up and down the stairs.

Three hours later her membranes ruptured and Beth was pushing, but the contractions were 6-10 minutes apart and getting milder. We began to firmly massage her belly to stimulate strong contractions. Amazingly, it worked. Every few minutes we would work up another contraction and Beth would push. A few hours passed. Beth would tell us when it was time for another contraction and we would massage one up for her.

While I sat on the couch having conversations with the doubting devil, Silke was on the front porch praying and calling her mother. Patrice put her necklace with the powerful stones around Beth’s neck.

Beth pushed through the fourth night. She pushed on her left side. She pushed on her right side. She pushed semi-reclining. Beth pushed on her hands and knees. She pushed on the toilet. She pushed in the bath tub and she pushed while walking. We gave her another homeopathic remedy. Her baby sounded great and slowly she made progress.

As the baby descended we checked Beth more frequently. The baby was military and asynclitic – not great. In spite of this Beth was making progress. It felt like there was enough room. Beth’s husband also checked the baby’s position. We all agreed that this baby could pass. We tried to flex the baby’s head, but she wouldn’t budge. She seemed determined to continue her slow descent in her chosen position.

The sun came up Monday morning and Beth was still pushing. Her friend, Sandy had to leave. Everything worked slowly and nothing worked quickly. Beth was unable to pee so we catheterized her. We gave her another homeopathic remedy. Her baby continued to sound great.

After 15 hours of pushing – 90 hours after the onset of contractions – a tired and joyful Beth gave birth in McRoberts position to Jasmine, a meconium and blood-coated 8 lb 6 oz baby girl. Patrice maneuvered Jasmine through her nuchal cord. Her Apgars were 8 and 10. She had a caput over her left parietal. Jasmine looked a little like a mustard and ketchup-coated Gumby with big, bright eyes. We all wept and took a dose of Rescue Remedy. The placenta was born without incident, there was no excessive blood loss and Beth got a tiny tear that needed no repair. A normal birth, right?

While this birth was very hands-off by American medical standards, we used more interventions than usual. Beth had three big acupuncture treatments. We catheterized her. We gave many doses of herbs and homeopathic remedies. We hardly ever do vaginal exams in labor. Yet, after this birth we had to throw away a mountain of used gloves that lay on the floor next to the bed where Jasmine was born. Did any of our interventions make a difference? Maybe. Could we have done less? Probably.

At first I was sure that Jasmine’s birth was one of the most unusual births ever. I spent a few days in the aftermath thinking and doing research – trying to figure things out. I really wanted to know what went wrong. I tried to come up with ways in which we might have been more helpful. Then I realized that while amazing, this birth was simply normal and nothing more was required. Beth already had everything she needed to get her baby born in her own best way.

Beth’s Story
My daughter is nursing as I write this. She is healthy, strong, vibrant and perfect in every way. She had a long, arduous journey out of my body and into the world. We tallied 85 hours from start to finish-all of it at home with the support of my midwives, my husband and a very dear friend.

When I tell people about my labor, they act as if I’m either crazy or some kind of goddess. Maybe I’m neither. Maybe I’m both. I was determined to experience natural childbirth. I wanted to know and feel what it is like to bring another human being into the world. I wanted to be awake. I wanted to be in a warm, nurturing, familiar environment – my home. I was never in danger. My baby was not in danger. It just took a long time.

My contractions were infrequent for most of my labor. They ranged from 5 to 20 minutes apart. I rested in between. I drank electrolytes, used the tub, walked the stairs, walked outside, squatted, knelt, moved my hips, shuffled my feet, sat in my favorite green chair, yodeled, screamed, cried, chatted, laughed and danced. I took tinctures and vomited. I took tinctures and didn’t vomit. I took homeopathics. I had acupuncture, massage and manipulation. I wore a healing crystal around my neck. I meditated. I prayed. I chanted. I peed, I bled, and I discharged all kinds of things all over my house. I marked my territory like an animal. I was an animal.

The sun rose. The sun set. This was my marker of time. Occasionally I was frustrated. At one point during day 2 or 3. I considered going to the hospital to make things go faster. But when I realized what would be done in the hospital to speed things up, I chose to continue what I was doing. My baby’s heart rate was normal, my pulses were strong and my energy was fine. I was- we were- up for the journey.

When I look back on things, the birth doesn’t seem so long or difficult. I remember some painful parts. I remember 15 hours of pushing. There were breaks. I even slept between contractions. I remember finally feeling the ring of fire- the crowning of my daughter’s head. I welcomed the pain because I knew it was almost over. I remember my husband yelling, “I can see her head! I can see her ear! I can see her face! You’re doing it!” I was doing it!

Even though I didn’t tear, my body was exhausted. My baby had a long and bumpy ride. She had been stuck behind my pubic bone for a long time, finally working her way free after a sacral and coccyx adjustment by my husband. She came out bruised and cone-headed, wide-eyed and fishlike. We stared at each other, so glad to finally meet. I remember her big wide eyes and her slippery body. I didn’t notice that she was stained yellow.

My baby’s first taste in life was homeopathic arnica. Among her first touches were craniosacral therapy manipulations. Within a day her head was perfectly round and within a few more, the bruises were completely healed.

Some say I was mismanaged. I would say I wasn’t managed at all. I was supported through a journey that was uniquely mine and Jasmine’s. I chose to follow it as it as it was given to us.

Jasmine is a strong, happy baby. I remind myself as I am resuming physical activities and re-entering my regular life that I labored for 85 hours. I wouldn’t change a thing.

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