Madison Aubrey Frost’s Birth Story

(This birth narrative flows from two voices: first my voice and then that of my doula, Teresa Howard, as I have indicated in italics.)

Friday September 6th marked my 41st week of pregnancy, and it began like any other Friday before: as was routine for me, I woke up at 6am and got myself ready for work. Despite the surprised reactions from work associates in the days and weeks prior, I had no intentions of beginning my maternity leave early, as the limited days I would be able to spend with my newborn daughter were far too precious to me to consume before her arrival. That, and I was feeling perfectly fine – upbeat, chipper and very balanced. One word that was used most often throughout my pregnancy by others to describe my demeanor was “mellow,” and that’s exactly how I felt one week post-date. I was driving to the office when I decided to call my mother and let her know I was headed to work, which prompted a phone call en route because she was amazed that I was feeling well enough to go in. During our conversation, I went over what I had planned for the day: although I was going into the office, I had an 11am appointment to see the much-heralded Atlanta-based obstetrician Dr. Brad Bootstaylor at his Emory Hospital practice for a re-check on my amniotic fluid levels (I had seen Dr. Bootstaylor for the same exam the day before) since they were appearing low regardless of my own personal water intake. Now that I was post-dates, I was definitely being more closely monitored by my midwife group, especially too since my blood pressure had been elevated for the past few visits and I was deemed at risk for being preeclamptic.

Although her blood pressure seemed to have stabilized and her biophysical was 8/10 both on Thursday and Friday, her ultrasound had gone from having fluid of an AFI of 4.0cm down to 1.0cm within less than 24 hours. That was an indicator that her placenta was definitely not working as well as we had hoped. It showed some calcification on the ultrasound as well. (This was also evident after the birth in examining the placenta.)

When going over the results from the ultrasound, Dr. Bootstaylor, who at this point was no longer concerned about my blood pressure, did focus in on the continued drop in the amniotic fluid level. “What would be your professional recommendation?” I asked. “I would recommend an induction, but I will pass along these results to the midwives so they can weigh in on what the next step is. You should receive a call from them in about an hour. They may request that you come in today to begin the induction process.” I was somewhat taken back by the fact that I could be admitted to the hospital that same day to be induced, but I understood Dr. Bootstaylor’s recommendation came to me as a medical necessity and that my placenta was aging to the point of losing its functionality. At this point, our baby girl was better-off out than in.

I called Michael to go over the details from the appointment and to give him a head’s up that we could be going into the hospital sooner than we’d thought. He was at a closing about an hour away when I got a phone call at 3:30pm from one of the midwives, Gloria. After explaining in more detail the results from my re-check earlier that morning, she too recommended we move forward with the induction and that I should check into the hospital by 5pm and get settled in a room they had reserved for me. Knowing Michael would want to drive down to Atlanta together and avoid taking two cars, I told her I’d have to wait for my husband to return home so we could leave together, but that I’d do the best I could to arrive as close to 5pm as possible (I knew this wasn’t going to happen). While Michael headed home, I was busily packing the balance of my hospital bag and texting family members the new plan, keeping my brain and body somewhat numb to the fact that I was going in for an induction and was likely going to meet our baby in the next 24 hours. Michael finally got home and together we soon made our way down to Atlanta Medical Center, where we arrived at the desk of the Labor and Delivery ward at 6pm sharp. We were escorted to L&D room # 7, and proceeded to get settled.

I got a text around 7pm stating that they were comfortable in their room. She had met with Carrie (a student midwife) and Anjli (Carrie’s mentor midwife from Intown Midwifery, where we had been receiving our prenatal care). They went over the different options for induction and landed on a low dose of Pitocin.  Her Bishop Score improved to a 9 (2 cm dilated/80% effaced/-2 station and anterior soft cervix.) The odds of this induction being a success had improved greatly! The plan was to start at 2 mil units per minute of Pitocin, not to exceed 4 through the night. The hope is for her to be able to rest and yet have some cervical dilation slowly going on. Anjli gave her some options for sleep medication but they did not put an order in until they figured out what the low dose Pitocin would be like.

The low-dose of Pitocin acted as a kick-start to bring my body into active labor so that as I progressed, I would hopefully be able to go off the Pitocin and allow my body to take over and continue to labor naturally. As the evening wore on, I was finding that I really had to cope and breathe my way through each contraction, which were coming at a regular interval and were somewhat exhaustive. Although not painful, they were very uncomfortable, and I was concerned about not being able to get any rest in advance of what I was sure would be a very physically challenging day ahead of me.

1:20am call from Stephanie. She was really working and vocalizing during the contractions. Upon listening to her, I realized the contractions were only lasting no more than 20 seconds. I knew that meant it was still very early in labor. I also knew that the midwives wanted her to be able to rest during this early phase and she was not going to be able to do so without some sleep assistance. She had sent Michael home to sleep. She called him to return and I suggested she tell the nurse to contact the midwife to come talk to her. In the meantime, not being able to sleep without being concerned about her, I texted Anjli to let her know the situation.

Anjli sent Carrie to check on her.  Anjli felt her body was kicking into labor but it was still early. Carrie found her to be dilated to 3cm now. I told Anjli if she felt that I was needed, to please let me know. She texted me back that Stephanie had opted to get some sleep help. The medication was Nubain. Stephanie told me later it helped so much. It caused her to feel very heavy immediately. She slept through the night, with Michael there with her. He told me she would moan a bit at the peak of a contraction but mostly stayed asleep.

From here, the next portion of the narrative will shift predominantly to my doula’s voice. I was so completely immersed in the realm of “Labor Land” that I seemed to only exist in a world with a capacity of 1 – myself. I moved parallel to everyone else around me. I could hear and communicate with the individuals in my room, but only in limited, one-word responses in between my vocalized moans. My body and mind were drifting. I felt like I was floating, teetering somewhere on the edge of sleep and awakeness.

Her water broke around 6am and woke her. There was a nurse shift change and all the commotion that occurs with that. The next call came at 7:20am from Michael.  Eileen their nurse suggested they call me. Michael told me things were beginning to crank up since her water broke. I hit the shower and headed that way.

The next exam showed she was dilated to 6cm and was effaced 100% and the baby was down to 0 station. It was 8:05am when this exam was done. I arrived at 8:15am. She was on her left side and Anjli, Carrie and Eileen were with her and Michael. Within a few minutes, Jessica Hamilton, my apprentice also arrived.

Around 8:45am she was up to the bathroom. And by 9am she got in the shower which was a fabulous comfort to her. She sat on the birth ball with the shower head spraying on her back. Michael mostly sat with her but Jessica and I took some time being with her as well. I got out my little white lights to provide a bit of ambient light in the bathroom. This was a perfect place for her. They wanted to take labs and make a decision on whether she was still a candidate for a water birth before allowing the pool to be set up. She stayed in the shower until 11:20am.

I remember being in the shower, rotating my hips on the birth ball and enjoying every second of it. The lights were turned off, with the exception of Teresa’s twinkle lights she mentioned above. While in the shower, I was able to keep hot water pulsating against my stomach and back as I pleased to help cope through each contraction. There was also a horizontal stability bar in the shower that I was able to rest my forearms upon and lay my head down. Between contractions, the person that was taking a turn to be with me would give me a sip of ice water or iced apple juice to keep me hydrated. I hadn’t had a solid-food meal since 3:30pm Friday.

The next exam showed she was dilated to 7.5cm and the baby was down to +1 station at 11:40am. She was now in need of back counter-pressure with each contraction. Jessica, Michael and myself provided this help. She also liked a cool cloth covering her face.

By this time I was out of the shower and lying on my left side on the hospital bed, waiting for the opportunity to climb into the tub. I strongly disliked laboring on the bed. The absence of hot water was making me very aware of my discomfort, but I was grateful for the counter-pressure being provided to me. As each contraction mounted, I remember calling out “Counter pressure, please,” and then the relief would come from someone’s hands. I recall Teresa making a candid comment to the room about how polite I was being.

At 1pm it looked like it may be quite a delay in getting the tub in the room. The wait on labs seemed to be the issue – or was it the lack of nursing staff, who knows? But we got her back in the shower for the wait. We also realized she needed to empty her bladder- something she had not been successful doing- even with me adding some peppermint oil to the toilet water and us running the faucet. We wondered if her full bladder may add to her discomfort as well as impinge the baby moving further down. A decision was made to do a straight catheter. And soon after, Carrie enlisted Jessica to help her retrieve a tub despite the nursing staff’s stall. Anjli gave us the go ahead to do so.

I’ll be brief here, but this was the first time I have ever been given a catheter. While it was very uncomfortable, I was happy for the relief it brought.

We soon had the tub filling at 2pm and at 2:20pm she was getting in! You only have to look at a mom’s face for a minute to see the comfort the warm water makes to her labor discomfort. At 3:30pm she was beginning to feel quite pushy. It was mostly just her doula team, Michael and Carrie in the room as Anjli was tied up in another birth and Eileen was out and about. By 4:20pm she was definitely pushing with great determination.

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We had been supporting her with the rebozo (a long, strong, tightly woven scarf) but I found tying it and hanging it from the closed bathroom door seemed to give her new power and Carrie was amazed at the difference it made! Anjli arrived to complete the team around 5:25pm. Stephanie never once asked for any pain medication. She did say a few times she was out of energy but with just a little encouragement, she found her inner warrior and kept working to bring her daughter into the world!

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What helped the most to keep me focused was for a midwife’s hand to point out exactly where I needed to push downward to. I had been laboring in a few different positions in the tub: on my knees leaning my upper body over the side of the tub, kneeling, squatting with the rebozo, and sitting with my legs up at 90 degree angles being supported on either side by Michael and Jessica. This last position made the biggest difference, and as I pushed I remember I kept requesting progress updates. Whenever I could feel a contraction coming, I would call out “Pressure,” and Carrie’s hands would be right there to guide me along. Towards the very end, or the “home stretch” as someone called it, I started returning to the reality that my labor support staff existed in, leaving behind the stupor I had been drifting in before. With another determined push, Carrie told me that the baby’s head was “right there” and that she could feel hair on the top of her head. After a few more pushes, she was crowning. All this was very encouraging to me! Before gaining a second wind, I looked out in front of me at all the smiling women surrounding the tub: Jessica, the same kind nurse who had been with Michael and myself the previous night, who had then returned to our side to see this journey to the end. Anjli the wonderful midwife. Carrie the fabulous student midwife. Eileen the nurse who was very skilled at locating the baby’s heartbeat on the fetal monitor. Jessica the fantastic apprentice doula. And Teresa, my nurturing doula. Michael, who had been such an integral part of the labor team and a strong support for me, was behind me whispering words of encouragement and kissing the back of my head. The only times I winced a bit was when Madison’s head was coming through, followed by her shoulders. After that, she simply slid right out and was placed directly on my chest. I recall exclaiming a few times how pretty she was. All grey and slippery with an infant’s newness, she saw the strange world before her with eyes wide open. As her little body was covered with a receiving blanket, Michael and I took in the moment and were lost and in awe of what we had just accomplished. Although I kept repeating that it was by far the most physically challenging thing I had ever done in my life, we brought our baby girl into the world together as an unbreakable unit. Teresa would later tell us that she adores our synchronicity, and I believe we are stronger together as a couple after having gone through such an incredible journey.

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At 6:58pm, Stephanie gave birth over an intact perineum in spite of a compound presentation of having her hand up by her face! Her baby girl has fabulous APGARs of 9.9! She had a bit of a coned head from being in the birth canal a while as her mom maneuvered her out gently. She went to her dad’s chest, skin to skin with warm blankets until we had Stephanie settled into the bed. The midwives gave her a lesson on placenta 101 showing her the first place that she had lived.

After an hour of being with her mom, practicing some initial breastfeeding, the nursery staff nurse arrived to get some statistics. This baby girl weighed in at 7 pounds 6 ounces and was 20 inches long. Madison Aubrey is beautiful! She has a head full of dark hair and her long lashes to match her mom!

I was delighted to be a part of this beautiful labor of love! – Teresa Howard, doula