A Lesson on Birth Plans: The Birth of Mabel

I had a beautiful birth plan. Literally. My friend is a creative director at a local ad agency and created a visual birth plan for his baby born seven weeks prior to ours. He lent me the template. When I turned it into my midwife during a third trimester appointment, she asked if she could show the whole staff. Every nurse ended up gawking at it throughout our hospital stay. Lesson: no matter how beautiful your birth plan is, be fully prepared to throw it all out the window.

I was really pregnant–41 weeks and 6 days, to be exact­­–when I found out I had low amniotic fluid levels and would need to start a hospital induction that evening. I had tried everything to get this baby out of me before the looming 42-week deadline of having the birth center birth we had planned for throughout the entire pregnancy. Walking. Attempted membrane sweep. Eggplant. Acupuncture. Castor oil. I had read all of Ina May’s books. I had picked the room with the couch at the St. Paul Minnesota Birth Center. I had bought an abstract painting of waves to help visualize as I labored naturally through contractions. A hospital induction was not in my beautiful birth plan.

I was admitted Saturday evening to the hospital, and a cervical check proved what we already expected: 1 cm, 40% effaced. Cervidil was placed for the overnight hours, and we settled in with hours of Olympic swimming on the TV.

The Cervidil was removed first thing Sunday morning and showed pretty much zero progress. We switched tactics and began the first of four doses of Cytotec. 10 hours later, my Bishop Score was still barely at a 4 with non-progressing, mild contractions happening about every 4 minutes. At midnight, I had my first Cook balloon catheter inserted with 40 cc’s of fluid on either side.

My third day brought the arrival of my third midwife, and we started the day hopeful as noticeable contractions from the balloon were about 4-5 minutes apart. They inserted an IV for the first time and started Pitocin at 8 am. The Cook balloon was removed in the early afternoon, and I was sure we’d get the good news that my cervix was on its way to laboring. And, there was pretty much no change since the last check.

Welcome to my first utter and complete breakdown. We had already called our doula, Jill, before the check to come in and give us a break from, well, ourselves. It’d been a long three days. A trying three days. And, we still felt no closer to meeting our baby than when we received news we’d needed to induce a full 72 hours prior. Jill motivated me to get up and back walking around the labor and delivery ward again. The laps were monotonous, the scenery unchanging over the course of the days, but she offered a fresh optimism that we needed.

After 11 hours, they turned off the Pitocin. It had done us no good. But, we got the green light to go on a walk. Outside the hospital walls. It was Monday. I hadn’t left the hospital walls since Saturday. It was a dream.

I came back to our room refreshed and ready to tackle the next set of meds. We started Cytotec round 2, but had to stop at two doses, as my contractions were coming too quickly, piling up on each other, while not progressing my labor. My cervix had softened some, effaced 60%, and dilated to 1.5 cm, or, as the nurse described, “one and a wiggle.” I slept until morning.

Welcome midwife number 4. Before she even got to the hospital, she told me to go on a walk. A long one. Outside. It was hot. Humidity hung in the air. And, I felt alive. I had never met Mary-Signe. She normally worked with the Minneapolis midwife team. She stopped all interventions. She told me to breathe. She wanted to send us home. Regroup. Sleep in our bed. Pet our animals. She ordered a Biophysical Profile ultrasound to check fluid levels and baby’s movement. Rather inevitably, I failed. My fluid levels had not magically rebounded despite drinking about 3 gallons of water prior to the ultrasound.

She said, okay. You have three options. Another Cook catheter, Cook and Pitocin, or break my waters. As breaking my waters started a 24-hour clock, I chose to move ahead with another balloon catheter and go from there. She assured me: we will get you into labor. It’s Tuesday. Not a single person had mentioned a C-Section. Baby was a rockstar, being continuously monitored without issues from the time of admittance.

Mary-Signe held to her promise. By that afternoon, I had contractions coming every 5-7 minutes apart, having to pause and breathe through many of them. Pitocin was restarted at 3 pm. Jo, a traveling nurse from Iowa, started her shift. She looked at me and said sternly, “I’m not like those other nurses. I’m not scared of Pitocin.” By 4 pm, contractions were 3 minutes apart. Jo was attentive, adjusting the Pitocin down when they got too close, up when we needed to advance labor. That evening, Lennon and I played hangman to distract me through the early labor that had finally arrived.

We went to sleep in preparation for the real deal. Finally. We knew it was coming. At 2 am on Wednesday, I was awoken by strong contractions. Lennon began to apply counter-pressure and help me with different positions to stay comfortable. I ate chunks of cantaloupe and watermelon. We let Jill know that we’d need her here soon. Around 5 am, at the end of her shift, Mary-Signe broke my waters. With such low fluid levels, we weren’t surprised when nothing really came out. But, it was time. I was in labor.

Midwives had come full circle, and Katie was on call for the second time throughout our long journey. I also had a new nurse, Mary. Mary was probably 60, and immediately came in and took charge. She cleaned up the room. She got me drinks. She was omnipresent but unobtrusive. She was the motherly figure I needed when things got really hard. She held my hand when I cried. Days later, she stopped by our postpartum room to meet our baby.

According to my beautiful birth plan, I wanted to spend as much time in the water as possible. Though I wouldn’t be able to birth in water, I was still expecting to spend much of my labor in the tub. Except I f*ing hated it. I couldn’t get comfortable, and I’d spend so much time looking for a comfortable position that I wouldn’t be ready when the next contraction came. I loved the shower, though. Leaning on the shower wall, the stream of hot water hitting my back. Jill filled the room with a mist of lavender essential oil, and Lennon brought in my portable speaker with my preset labor playlist. It was the only place I was able to find the rhythm that I thought would come so naturally to me in labor.

Things got hard. It hurt. And sometimes felt constant. I had to pee and couldn’t. Baby was still not engaging, her back facing my right side, and we had to get her to turn. My contractions were starting to couple, indicative of malposition. I was tired. I said I wanted to lie down. They warned me it could be more intense. They placed the peanut ball, a yoga ball shaped like a peanut, between my knees to open by hips and encourage the baby around into position. During the first contraction, I kicked the ball across the room and scrambled to change positions to bend over the bed. I got back in the shower. I cried. I looked at Jill and told her I felt defeated. That was all I needed to say to spring Katie into action. “You have options,” she reminded me. In my head, I was already coming to terms with what I thought I’d never do, but couldn’t bring myself to say it aloud yet.

They brought out the nitrous oxide, and got me back on the bed with the peanut ball. Katie knew we had to get her down and in position, or else labor would stall. The first contraction with the nitrous was not as I expected. Everyone sounded very far away. It still hurt. But, it allowed my mind to wander. And, it wandered to: if this is all nitrous does, this is not enough. I made it through half a dozen contractions with the peanut ball, until I couldn’t do any more. Katie quickly moved me to sit backwards on the toilet with my foot up on a stool. More hip opening. More turning. More progress. I labored there for awhile. Katie set up what she called “the towtruck.” I hung from the labor bar with all of my weight at the end of the bed, sitting on a low seat between contractions. I felt her descending with each contraction. I made it through 3 or 4 until I just couldn’t do it anymore.

I asked for a cervical check. If I wasn’t extremely close, I knew what the next step had to be for me. I was 6 cm and zero station. They cheered. I cried. Katie looked at me, “Do you want an epidural?” “Will the baby be okay? Have I done enough to make it okay?” “Yes,” she said, looking me right in the eyes. “It is the perfect time for an epidural. You have done an awesome job.”

They stopped the Pitocin. I laughed. And cried. And breathed a sigh of relief. And joked that I was eating cantaloupe, and my safe word for the epidural was cantaloupe. But, I never had to even say it. Half an hour later, the epidural was in place. But, an hour later, my left side and abdomen still weren’t numb. He adjusted it. No change. His shift was over for the day. My IV line needed to be replaced in my hand. I was shaking uncontrollably. I still hadn’t peed. My contractions were non-existent, Katie urgently said that we needed to restart Pitocin. Now. I was having an anxiety attack. Mary stroked my hair. Jill fed me honey sticks. Lennon held my hand. A new anesthesiologist came in. “I was told I needed to come in with a joke. What do you get when the Pillsbury doughboy bends over? Doughnuts.”

The epidural worked immediately. The catheter was finally placed. And, I slept. Wrapped around the peanut ball, I slept. Contentedly. I sipped apple juice and 7-UP. Honey sticks to give me energy. The contractions eventually picked back up as I dozed. I started needing to breathe through them. And was beginning to feel immense pressure during each one. I was dilated to 9 with just a lip. “Just let us know when the pressure is constant; it’ll still be awhile,” our new nurse Annette said. “Probably 3 or 4 hours before you’ll be ready to push,” Katie added. 45 minutes later, I let Annette know that it seemed like my body was ready to push. I was breathing through each contraction, holding back the urge to push with everything I had. She called Katie. Katie did a quick exam and said, “Oh, yes! You can feel free to push the next contraction!” The nurse Annette worked quickly. She and Katie were in sync like they birthed babies together every day. As far as I know, they’d never worked together before.

I grabbed my legs and quickly got the hang of how and where to push. It was so satisfying. It was so hard. It was so amazing. The baby’s heart rate dropped. They quickly moved me to my side and had me hold through a couple of contractions with an oxygen mask on. They placed an internal monitor on her head in utero. I pushed on my side for a few more contractions. With baby’s heart rate back safe and sound, I returned to my back and used a sheet wrapped over the bar to push. She was crowning. I felt the burning. The pressure. I felt her face as it emerged from my body. One more push and her head was out. One more push and her body was out. My baby. Our baby Mabel was born after four days of induction and just 40 minutes of pushing. And, she was perfect. She was pink. And crying. And placed immediately on my chest to the overwhelming joy and excitement that the last four days had led us to. The last ten months. The last five years of our marriage. It had all come to this overwhelming, thrilling moment.

They had called the NICU team, as they were concerned about meconium aspiration. The team arrived late, and she was already on my chest when they arrived. I will always remember the face of the man at the front of the team, as he looked at me and the baby and said, “Oh. Well. Congratulations!” as he turned and walked out of the room. Mabel Alles Manthe was born at 8:55 PM at 42 weeks and 3 days gestation. 7 pounds, 2 ounces. 19 ¼ inches long. She had no signs of being overdue. My placenta wasn’t calcified. Her fingernails weren’t long. She scored a 9 on the APGAR. They thought she was a 10, but her feet were a tiny bit purple. I just bake my babies a little bit longer.

They ran the Pitocin full bore, concerned about hemorrhaging after all my body and my uterus had been subjected to over the course of our hospital stay. There was no hemorrhaging. I had minor tearing, just barely a 2nd degree.

She was here. And, it was fantastic.

All of the women that we worked with over the course of our hospital stay were amazed by our positivity throughout the induction process: nurses, midwives, our doula. And my response is always the same: what else could we do? A cesarean simply wasn’t an option for me. As long as Mabel was safe, I was determined to have a vaginal birth. So, that’s all we had. We knew I had to go into labor. No matter how long that took. We knew we had each other. So, we watched the Olympics. I danced alone in my hospital room to Tedeschi Trucks as Lennon got us a second round of clean clothes from our house. We played cribbage. Watched Netflix. Walked circles around the ward. Stared endlessly at our baby’s heart rate on the monitor.

Sometimes, your beautiful birth plan is thrown out the window due to things within and outside of your control. And you get through four days of induction at over 42 weeks and realize it was all meant to happen the way it did. And it’s good. And okay. And filled with love. And support. And the best birth team our new family of three could ask for.

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~ Stephanie M.


We love birth stories! If you would like to share your story on the blog, please email karen@theminnesotabirthcenter.com.

 

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