Leif Alexander: Part One

Part One: Late, Lazy Leif – our 43 week baby

Leif Alexander
Born at home: February 12, 2011 at 8:53am
Weight: 8lbs, 12ozs
Length: 21 3/8th inches

Leif is named for the Viking explorer “Leif Erickson”, for whose father my husband, Eric, is named. There are several variants on how to pronounce this simple four letter name, and we pronounce it with a long “A”. To help people remember this, we have given Leif the alliteration “Late, Lazy Leif”.

His birth story begins 2 weeks earlier at my 41 week pre-natal appointment. That’s right, 41 weeks. Eric and I stopped using contraception on our wedding night, May 1st. Two weeks later I had a positive home pregnancy test. By every possible calculation – LMP, date of ovulation, date of conception, etc. – his due date fell on January 20/21st.

My midwife is a certified nurse-midwife who has been delivering babies for over 30 years, in the hospital, in stand-alone birthing centers, and at home through her current solo reproductive health practice. I first heard of her several years prior when reading a feature article about the Baltimore birthing industry in the local City Paper, and was impressed by her knowledgeable comments concerning the difficult decision women face when choosing their birth options. When my friend, whom had had two successful homebirths, sent me a list of homebirth CNMs in my area, and Evelyn’s name was on it, I immediately called to schedule an interview. I later found out that Evelyn had delivered four of my friends’ homebirths. It didn’t hurt that her practice was in my childhood home town, just 15 minutes up the road, and across the street from the best family owned pit beef shack in all of Maryland! My husband required me to schedule all my pre-natal appointment in conjunction with lunch time at the shack – but that’s another story.

The biggest factor in my decision to homebirth rather than birth at a birthing center (hospital birth was never an option for my consideration), was Evelyn’s policy regarding post-due inductions. As a licensed acupuncturist who treats right down the street from the only two free-standing birth centers in the Baltimore/Washington corridor, I routinely receive referrals of patients approaching their 42 week mark and facing a medical induction. The centers’ liability insurance requires that they refer a post-term patient to an OB, even if there is no sign of maternal or fetal distress. Don’t get me wrong, I think medical induction is a wonderful thing when necessary, and I have seen it literally save the lives of several patients with serious issues such as pre-eclampsia, etc. But having seen far too many frantic, anxiety-ridden women in my office at the last moment trying to beat the clock based on insurance driven policies, not medical need, I didn’t want to be faced with this unnecessary challenge if it arose.

This was one of the first questions I asked Evelyn during our interview. My husband had been delivered via c-section at 25 days post-due date. And studies indicate that family history of post-due delivery increases the likelihood that my own would be post-due. Evelyn explained in detail what types of monitoring would be done, when it would be done, and what findings would indicate the need to induce. “Babies come when they are ready,” she said. “As long as you and the baby are fine, we can wait as long as you are comfortable.” Her answer sealed the deal for my husband and I. Not only was this the answer we were hoping for, but we felt confident, given her detailed explanation of what would constitute a medical necessity, that she would be vigilant in her attention to the warning signs that a homebirth is no longer appropriate. You see, the “interview” of a CNM is as much a chance for the midwife to interview you and determine that you are a good homebirth candidate as it is a chance for you to decide if this is the right midwife for you.

Now, 41 weeks later on a Friday afternoon, we were facing the exact situation we worried about when making our decision. Bobbi, a birth assistant and doula, gave me my first Non Stress Test (NST) and wrote me a script to have an ultrasound that would check amniotic fluid levels (AFI). It would be the first ultrasound I had had since the 19 week anatomy scan. I scheduled it for Monday morning, and also scheduled an appointment to see Evelyn Monday afternoon.

Monday morning’s scan went well. The technician estimated the weight over 9lbs, and I got a little nervous until I remembered how grossly inaccurate weight estimates are. Though my fundal height was measuring all the way up and under my sternum, my stomach still looked so small that most people guessed I was in the second trimester still. My mother, a retired OBGYN RN, agreed, “There’s no way that is a 9lb. baby.” The appointment with Evelyn that afternoon, however was more problematic.

My AFI put my levels at 6.6 – 5 is considered low, and 3 - 4 is grounds for induction. To make matters worse, Evelyn did an internal exam for the first time and I was completely unfavorable. The baby had begun to descend (-2 station), but my cervix was posterior, tightly closed and not even remotely effaced. She sent me home with instructions to rest, hydrate myself, and increase all the natural cervical ripening agents. I was to receive another ultrasound on Thursday – this time something called a BPP (biophysical profile) to determine Leif’s health.

I left the office in tears. I had been having strong contractions every 10 minutes for several hours at a time since 39 weeks, but contractions apparently were not the problem – it was the cervix. And there are far fewer natural induction methods that address cervical dilation – most serve to increase contractions (I know because I did detailed research into what the biological mechanism in the body is for each “natural” induction method).

I drank water, I rested, I walked around the mall. Being the dead of winter, my mother took me to every mall in a 45 mile radius. Just shy of 42 weeks, the BPP went well – Leif easily received a perfect score (8 out 8), my AFI was now close to 8, I passed another NST with flying colors. Lori, the birth assistant whom was finishing her schooling to become a CNM, told me that by law they were obligated to offer a referral to an OB who would induce at 42 weeks, but it was my choice as nothing on the tests indicated any medical problems so they couldn’t force me. I declined and had a wonderfully relaxing weekend.

On Monday, I received another passing score on the NST, and saw Evelyn for another internal. I spent all weekend receiving cervical ripening treatments from my other care providers (acupuncture, chiropractice, specific herbs and supplements, and nipple stimulation with an electric pump), and it was doing some good. Leif had dropped to -1, my cervix was 50% effaced and a finger tip dilated, but still posterior.

Evelyn’s office was very busy in February, so each time I made an appointment over the past two weeks, the receptionist would slide me into a non-existent appointment slot and joke that it didn’t matter ‘cause I’d go into labor and not need it. The appointment on Thursday, February 10th was when things came to a head. At 42 weeks and 6 days, my NST for the first time did not pass with flying colors. I passed, but in an amount of time that made Bobbi very nervous. I think this was mostly due to the fact that all other NSTs had been in the afternoon – Leif’s active time – and this one was first thing in the morning – his sleeping time.

To further complicate things, my internal exam showed no additional progress, and Leif had positioned himself slightly out of my pelvis in an asynclitic presentation which would stop him from further descending. Evelyn scheduled a BPP for 3pm, and told me to see my chiropractor both before and after the BPP to address the asynclitic presentation, and I was scheduled for another appointment with her the following morning. Eric decided to take the rest of the day off work, and drove me straight to my chiropractor in Odenton. She did a pelvic floor release movement on me that Eric and I had read about on spinningbabies.com, though she was much more skilled at it than our at-home version. We grabbed a quick bite to eat and headed to north Baltimore – the only place that could take me for a BPP on such short notice.

We waited over an hour, and the entire time I had such strong back contractions I could barely sit in the waiting room. My labor had already begun, unbeknownst to me. The technician was friendly and kind, and helped to ease our anxiety. Leif received the first 6 points immediately, but took about 20 minutes to achieve the last 2 points by “practice breathing” – something the tech said was not unusual to have to patiently wait for. This time he measured at about 8 ½ lbs. (our incredible shrinking baby). She showed us his actual sized foot – which was so enormous that I joked we were having a hobbit (my husband is, um, rather hairy). She could see my cervix on the screen and said that it was still very posterior, and not ready to have a baby. But, she assured us, there was no distress and no cause for concern and we should be able to hold out for a few more days.

We sped across town, back to our chiropractor who closes at 6pm to receive the final treatment for the evening. This time, after the pelvic floor release, my back contractions were so intense that I could barely sit still in the car ride home. Though I knew these were contractions, I had been having milder contractions for weeks, so I gave it no mind. They had always stopped after an hour in the weeks before. This time, they never stopped.

Eric’s friends were scheduled to come over that evening to play Dungeons and Dragons (yes, my 29 year old, professional engineer of a husband still plays table top role-playing games – I would too if my job didn’t require me to work in the evenings). Not wanting to be sitting still because of the intensity of the back contractions, I offered to go down the street to the Safeway and KFC to pick up the group’s dinner. I had a craving for mashed potatoes and cole slaw – fast food style – it was to be my last meal that I would be able to taste for the next two days. And I will never let my husband live down that I drove to get him fried chicken when I was in labor, ‘cause I’m that great of a wife!

I returned home and finished my meal around 9pm. By 10pm, the contractions were so strong I knew for sure I was in labor. I could no longer sit on my birthing ball without back spasms, so, not wanting to interrupt the gaming – I went upstairs. About half way up, I had a strong contraction and had to call out to Eric to help me the rest of the way up. I laid down on my bed and listened to a hypnobabies track. By 10:30pm, his friends had left and I lost my mucus plug. We began timing contractions, which were consistently 6 minutes apart, on his phone application and called Evelyn with the news. She cancelled our appointment for the morning, and told us call back if my water broke or if the contractions got to 4 minutes apart. I called my mother and she came over, and we all hunkered down for the evening. It was official – the baby was coming soon.

I texted a few of my friends who were eagerly awaiting some news. My friend Kate responded back around 11:30 reminding me that February 10th was our friend Anne’s birthday, and I better “get on it” cause I had half an hour to go if I was going to still make her birthday. I laughed and tried to get some sleep.