Baby Four: a birth story

The time it has taken me to write this story is a perfect reflection of life in transition to four littles. And yes, even at 18 whole months since she was born, we are still transitioning. Quite the transition it has been…

Are we having anymore kids?

Our fourth babe’s birth story truly begins back in November of 2022. I began to feel this sense of urgency to decide if we were going to have another baby or not.

You see, from our very first baby born in March 2016 up until this point, fertility was really out of our control. Each of our three pregnancies were… miraculous, to say the least. We spent years hoping and praying for one, and when that prayer was answered, we hoped and prayed for the next and the next, never really settling on a final family number, just really, really grateful to have the opportunities to grow.

But… three kids proved to be a lot for us. A lot of laughter, a lot of joy, a lot of growth and a lot of challenge. So, you could say we had a bit more pause after baby number three than the other two. In November 2022, our third baby chick had just passed the 18 month mark (the time when I would typically become pregnant again)… and that’s when (and probably why) that imminence to pick a direction kept creeping in.

But I couldn’t place it. Why did it feel like an urgency to make a decision, like it was now or never? I couldn’t even decide for myself. Pregnancy and newborn life is my sweet spot, it’s where I feel most like myself, so of course, I wanted to be back there. But the day-to-day of our life was a mess, a super chaotic (yes, also, beautiful) mess. How would it even work? Could it even work?

Unintentionally, I kind of sort of hijacked our one and only date night of the century and made it all about… a baby (well, a baby and some delish fire oven pizza). I wanted to know how Jake felt, and to be honest, I think we were on two different pages of the same untitled book. That date night ended with even less clarity about growing our family than it started.

So we tabled it.

For a couple weeks anyway. And then something just wasn’t right. I was sick. And tired. And late. A couple cheap (and secret) pregnancy tests later revealed… that whole urgency to make a decision, the hijacked date night conversation… the decision had already been made, we just didn’t know it at the time.

And so I did what any mom of (about to be) four kiddos does. I sent a picture of the pregnancy test to my husband at work. My husband who had no idea that pregnancy was even in the ballpark this month. He was a bit surprised.

And so was I.

But my goodness… for me, there is nothing like the privilege of being pregnant.

Planning another vba2c

By the grace of God, baby number four followed mostly in her big siblings’ footsteps. Pregnancy was sweet and normal and exciting. Nausea never let up, not for one day in a whole 40 weeks, but it was manageable.

I was planning my second vaginal birth after two cesareans (2VBA2C) and was now deemed “advanced maternal age,” which sometimes makes a girl feel like the cards are stacked against her. Add in three post-date gestations (42, 42 and 41 weeks), and I was cause for all kinds of monitoring.

But hiring a great doula, becoming one myself and changing providers helped me feel like I was in the driver’s seat of my own experience. And the support from Jake every inch of the way, well.. that’s always been invaluable.

Sweet baby girl was “due” on August 7. I was mostly planning a late August baby, but my 40-week appointment on August 10 changed the tides.

My first stop of the appointment was ultrasound to test baby’s biophysical profile or BPP (checking her heart rate, breathing, movement, muscle tone and fluid). Well, this baby… she slept through the entire thing. And I didn’t realize that was a very big problem until I had moved to my second stop of the appointment, the non-stress test (NST). I had just gotten hooked up to the monitors and settled in for a little nap when two medical assistants busted into the room, unhooked the monitors, shut off the machine and announced, “You’re having your baby today!”

They were half panicked and half expecting me to be elated.

I was not.

I was scared and angry and confused. And I was alone.

I was scrambling to ask as many questions as I could before they practically shoved me out the door to labor & delivery. They told me that my baby “failed” the BPP with a 4/10 score and so Maternal Fetal Medicine (who as far as I knew at the time is like Big Brother for pregnant people) advised “immediate delivery.” I begged to continue the NST, to get another BPP, to at least meet with a midwife.

Because they couldn’t seem to answer many of my questions and could likely sense the desperation in my tears, they were able to squeeze me in with a midwife.

Meanwhile, my phone was on low-power mode because I never charge it. And my husband was at home trying to de-code my texts and understand the little that I could convey to him over three rambunctious kiddos asking for him for snacks.

Of course, the midwife with availability that day was not a midwife I had met up until that point. I had no idea if she knew my previous birth history, my strong desire for a 2VBA2C or if she would even care.

As it turned out, she did. She cared a lot. She hugged me, she let me cry, she prayed with me… and she was really honest with me about the unknowns of the result we got as well as what could happen if we ignored it. But she also agreed that with an “unfavorable cervix,” at an advanced maternal age with two prior cesareans and a baby past her due date… all signs were pointing to a repeat c-section by hospital standards.

Cue more crying.

What she didn’t seem to think was necessary was the “immediate delivery” part. She told me to go home, hug my kids, eat some dinner and then head for the hospital.

So, home I went. I called my doula on the way, which always felt like a comfort. And I sorted through so many questions and possibilities and options in my head… but the sorting felt more like a jumbled mess.

Not one ounce of me thought I’d get that result and have to make a decision about how to have a baby when my body was clearly not ready for labor. But I promised myself (and my therapist) that more than having another vaginal birth, I wanted to be connected to my intuition. I wanted to feel like my choices were informed and my mind was clear about what I wanted.

So, we made one decision at a time. We weighed all of the options, and we decided to head back to the hospital that night. We started the childcare train for our kiddos, ate some dinner, put them to bed and drove back downtown.

It was 9pm.

Triage decisions

Triage was pretty quiet. I know because we sat there for a long time. I adamantly refused the hospital gown (and anything else that made me feel like a patient), and we waited for someone to come talk to us. We had a lot of questions like what does a “failed” BPP really mean, could we repeat the BPP, what if we do nothing, what induction options do I have. And the longer we sat there, the more questions we had.

One of the midwives from my provider group (another one I hadn’t met yet) came to talk with us, and that conversation left us feeling somewhat confused but ultimately like there was only one option: c-section. From what the midwife told us, another BPP wouldn’t matter because there’s no definite correlation between a failure and an outcome. One failed BPP means something could be off somewhere even if you pass the next one. She also explained that it didn’t seem possible to place a Foley because I wasn’t dilated enough, but I could potentially start a pitocin drip. She said the OB on call would be around to answer any additional questions we had and help us determine next steps.

We spent the next few hours going over pros and cons, what ifs and how comes. We called our doula and talked through options, ideas, alternatives and mostly just reassurance that sometimes things just happen this way.

And we decided on a c-section. We didn’t feel comfortable going home and doing nothing, and I wasn’t interested in a pitocin induction (been-there-done-that a few births ago, and I swore I would never do it again).

I cried (a lot) — it was a grief over not getting what I wanted, feeling like I had no other options, thinking about recovering from a major surgery with four littles and so much more. But it felt like the only thing to do.

A knight in blue scrubs

Around 1am that on-call OB finally made his way in. I was tired, emotional, disappointed and a bit irritated that I was meeting yet another provider I had never met (especially an OB when I was “supposed” to be under midwifery care).

This OB sat with us and apologized profusely for being so late. He basically read my chart and birth preferences word-for-word from memory and listened to our questions and concerns. And then do you know what he said?

“I think you’re a good candidate for another VBA2C. I think I can place a Foley.”

Well, that was unexpected.

I was shocked. We were shocked. And elated. And totally shocked.

I made it very clear that I was not signing myself up for any other interventions. I wanted to try the Foley and take every other decision one at a time.

He agreed that was a good plan and said he’d meet us upstairs in Labor & Delivery.

Let the labor begin

As he promised, Dr. Dood met us upstairs and easily placed a Foley with less than one centimeter of dilation. And while I was pretty nervous about the pain, it felt like nothing more than a cervical exam.

We rested for a couple of hours, until about 7am, and the Foley fell out around 9:15am. The midwife who met me in the office the day before (who held space for all of my surprised, big feelings) was on call, and I was so, so grateful to see her walk in the room. She suggested breaking my water and placing an IUPC, and I agreed. Looking back now, I’m not entirely sure why I so quickly agreed — AROM (artificial rupture of membranes) is a type of intervention that isn’t necessary, and I don’t even remember why she suggested it. Likewise, an IUPC (intrauterine pressure catheter) is also unnecessary, a type of monitoring used to measure the efficiency of contractions, which I hadn’t really been having anyway.

But… I think I just felt such a connection to this midwife, like she understood my goals and like I could trust her. I told myself I would make one decision at a time, and this just felt like the next right step in an effort to avoid the major interventions I truly did not want.

As soon as she left the room, after telling me it was time to get my “twerk” on, I started a movement circuit. I wasn’t having contractions so every fifteen minutes I tried something different — open knee chest position, side lying release, stool stepping, figure eights on the birth ball, knee raises, lunges and squats. After a couple hours, I added in manual nipple stimulation while sitting backwards on the toilet.

All day long I was trying to grab little bites of food and stay super hydrated, knowing that I would likely be in for a marathon.

Finally, mild contractions started around 1pm.

My midwife did a cervical exam around 3pm. I was 4-5cm inside and about 7cm outside. Again, this is another thing that the doula in me thinks back on with a “huh?” But in the moment, I just remember feeling confident and ok with it.

And that’s the really important thing.

I took some time for rest (it’s a delicate balance in a labor like this… you can very easily wear yourself out by trying to move and groove your body into active labor). A few more hours passed and a bit more progression later, at 5pm I was around an actual 7cm and 50% effaced. Contractions were starting to grow in intensity and were about 3-4 minutes apart — good progress. I added in more nipple stimulation, and while the intensity of contractions stuck around, they slowed down a bit.

A doula’s energy

The next few hours were kind of a blur… probably because active labor was finally kicking in. I remember being in a hands and knees position on the bed and telling Jake I was ready for our doula to come. It felt like two seconds later that she walked in. It was 8:30pm.

The energy immediately shifted.

I think we were doing all the “right” things, and my (then very, very green) doula brain was doing all the things that I thought were helpful, but I’m telling you… my doula changed the space and the feel and the entire vibe.

She walked in with the calmest, sweetest, most attentive demeanor. She changed the lighting and moved the furniture around, making the entire room feel more safe and warm.

We did all the things under her recommendation — countless position changes, massages (I’m telling you… there is POWER in a good foot massage during labor) and the tub.

I labored in the tub for a long time. It felt like a distraction both physically and mentally. And thinking back to it now, I don’t remember too much about those hours from late evening to the middle of the night… I don’t think I was a very nice person, but I don’t think I got super ugly until about 2am.

I got out of the tub and just felt.. desperate. Although I couldn’t imagine a better support system, I felt alone. I felt like I needed someone to make it end. I remember begging someone to tell me it was almost over. The intensity, the pressure both felt so, so insurmountable.

I was waffling back and forth between wanting a cervical check and not wanting one. I felt like it had to be time, but I was terrified that I didn’t make enough change to actually push this baby out yet. I decided to have my midwife check, and as soon as I heard her say “7cm,” I probably screamed and cried and then demanded an epidural. Definitely not part of my original plan.

It was about 2:10am.

As I waited for the epidural… deep in the trenches of a painful labor feeling completely void of coping skills, afraid of how long the labor would continue and embarrassed that I opted for an epidural, my midwife started twisting and turning me into all kinds of odd (and HIGHLY uncomfortable) positions. She had me “practice” the sitting up / hunched over position I’d need to be in for the epidural placement among other very odd positions that were extremely difficult to achieve.

I’m going to push

In comes the anesthesiologist, and I was frantic and straining. I was sitting in that epidural position and the exact second he started placing the epidural… the pushing pressure emerged.

It’s the kind of pressure you couldn’t stop if you tried with all your might. And as I looked around at my husband and doula, tears in their eyes watching me howl, I felt like no one could hear me. I knew I had to stay still as a gigantic needle was in my back, but I was pushing a baby out, and no one said a word. Or maybe I just couldn’t hear them.

My body instinctively pushed about three times during the epidural placement. As soon as it was over, I laid back, pushed two more times, and my sweet and perfectly healthy babe was born.

It was 2:32am.

I held my babe as my midwife stitched up minor tearing. And I was in complete disbelief. My tiny baby girl, who’s health just 24 hours prior we were in the dark about, was perfect.

Labor can be like that

It is a wild, wild thing to believe that there were just minutes in between 7cm and pulling my baby to my chest. But it really happened.

Labor can be like that.

And it took me walking through this experience of surprise information, processing options, making peace and changing course and making one single decision at a time on the road to a birth that looks as much like I hoped as possible. A birth where I felt in charge of my experience the entire time. Not in control, but in the driver’s seat of every decision.

This birth experience was so different from my other three (and nothing I would have planned) but absolutely necessary to my understanding of birth and my ability to support other mamas.

We make these birth plans and have these birthing preferences, but this birth taught me the importance of leaning into the birth process rather than forcing my birth plans.

It is a lesson I will hold so closely for so many reasons. Regardless of how many more babies I do or do not have, I’ll hold this lesson closely through motherhood, through my birthwork journey, for every family member, friend and client I am privileged enough to support and for me, as I grow…. I’ll remember that plans are good, but preferences are better.

Flexibility and faith, manifesting into freedom, are the very best tools of birth, mothering and living a full and grateful life.