Season 1 / Episode 02 / Birth

Labour Day

This is the story of how birthing a child is so different and unique for every one of us. It’s certainly a trip, but no holiday.

Two parts, one conversation

Part 1 The Moms

Labour Day, with the moms

paula’s story

As you know, I have two little girls, Maya, who is three and Maddie, who is one and let me tell you that my birth stories for each were so different. I remember it being a Friday afternoon, five days past my due date, and induction was set for the following Monday. I'm washing the dishes in my NEW kitchen sink, the guy is still there doing the finishing touches, and suddenly, I feel a small liquid drizzling down my leg. For a split second, I wondered: did I pee myself? Nope! not incontinente yet! This is the day! Right away, I went upstairs to pee, screamed Matt’s name, and told him this is it; we must go to the hospital. My carry-on suitcase was packed, and I distinctly remember walking down my staircase thinking, " Next time I see this hallway, it will be with a brand new baby girl," as if I was going to purchase a new pair of shoes. The excitement was comparable to knowing a new addition was coming and that I would be taking something home soon; little did I know that a baby girl is not a something but rather a life-changing someone.

We got to the hospital, and they gave me a gown and attached all these wires to my belly. I'm thinking at this point, this is not bad at all. A couple of hours in, they informed me that things were not progressing as they would have liked. Maya's heart rate fluctuated, so they decided to induce me with Petocin to get the contractions coming and get this delivery moving. The contractions came and went, and I remember thinking, this is quite manageable actually; I'm going to ask for the epidural and easy breezy lemon squeezy, push push out!

Contractions started getting closer and a lot more painful; I remember standing up and hitting the wall every time I felt one coming. Finally, the epidural, ah relief! I couldn't feel any contractions anymore; I was lying in my hospital bed, ready to sleep. Doctors were coming and going all night, checking me to see how dilated I was; I had time for three doctors to start and finish their shifts before I was told to start pushing. And then the pushing, I think I pushed for about 2 hours and baby Maya finally came out.

When Maddie was born, I knew what to expect from Maya’s birth, so the feeling was slightly different going into labour. Also, I was almost 42 weeks and had to be induced because that little girl did not want to come out. I clearly remember two things. After getting the epidural, my legs felt like logs; I couldn’t lift one at all. What did that result in? Uncontrollable bowel movements, to put it lightly, and the satisfying feeling of water gushing out of me, which I now know to be amniotic fluid. Since this was my second birth in two years, my cervix remembered what it had to do. I pushed for maybe thirty minutes, and to my surprise, my OB told me to grab Maddie and pull her out! I was like, you want me to do what? I'm not a Kardashian! I was terrified that I would grab her by the neck and her head would fall off; I couldn’t see a thing! But things were going so fast that I did as I was told and pulled her out of me and onto my chest; I immediately started crying with relief and pure love. What a trip!

francesca’s story

Francesca begins by reminding us that her daughter, Tessa, was born in April 2020, one month after the pandemic started. This meant that hospitals were on high alert, and the specific one where Francesca was going to give birth had already advised her that she was the only one who could enter when the time came. That moment did come; at two in the morning, at her house, Francesca felt her water break, and off they went to the hospital, where her husband Mike graciously dropped her off, hospital bag in hand.

“Bye…i’ll call you when i’m done…”

Knowing she would have to give birth to her daughter all by herself, with no husband and no support whatsoever, Francesca knew it would be difficult, and considering herself to be a strong person, she thought she could handle it. She didn’t expect the unexpected series of events that she had no idea was about to happen.

Thankfully, at the nurse’s shift change, Francesca was introduced to a delightful young nurse who made a point to check in on her every hour or so to see how she was doing. Although Francesca appreciated the gesture, she still felt the void of not having Mike there with her. At around 8cm dilated, Francesca, now awake for over 24 hours, is being told that she has stopped progressing and was given medications to help move her along, which did not end up taking effect. At the following shift change, the doctors came in and told Francesca that they were recommending a C-section, and as they started explaining all the risks and implications, she stopped them right there.

“please tell him everything you’re telling me; I’M too tired…”

She put Mike on FaceTime with the doctor and asked her to explain everything involving the C-section because, at this point, Francesca hadn’t slept in over 30 hours, she was loopy from all the medication, and in no state to consent to any legalities. After she hung up the phone, the doctor took Francesca down to the operating room, where she began the surgery, and finally, Tessa was born. At this moment, Francesca was introduced to her newborn daughter and had her on her chest for skin-to-skin contact, and all of a sudden, she called out for someone to remove Tessa from her body as she felt cold, shaky and nauseous. The reason was that she had lost so much blood during her 20-plus hours of labour that she threw up in the operating room. She was finally brought to the ICU to recover, and Tessa was brought to the nursery, where she was taken care of. The first night spent at the hospital with a newborn is already challenging enough, but doing it by yourself after having had open abdomen surgery brings a whole new meaning to the world challenge. But Francesca, being as tough as she is, was walking within two hours, getting up to feed Tessa on her own with the one goal of getting out of there and going home.

“they let him come up! After all that, they let him up!…”

When she was discharged, Mike went up to the hospital room to get Francesca and Tessa and to our shock, they let him up in the hospital room only then! Why? Because after a C-Section, Francesca was not allowed to carry the car seat. They bundled her up and left as fast as possible.

Vanessa’s Story

Similarly to Francesca, Vanessa also had an unplanned C-section with her first daughter, Emma. Her story starts a little differently as she shares something Dom had told her about her birthing story that stuck with her. Dom was one of the first among us to give birth, and she shared with Vanessa that when she started feeling contractions, she went to the hospital, and they sent her back as she wasn’t far along enough. Vanessa remembered that as her contractions began, she told herself she would not get sent home. Her mindset was to wait until she couldn’t take it anymore before going anywhere. About 24 hours into having contractions, Vanessa remembers squatting in her apartment and screaming every time a contraction came and went.

“i can only describe this as ANIMAL-LIKE…i felt really animalistic…”

Chris, her husband, made the call to the hospital as the contractions were getting closer together and more intense, and the nurse suggested they come in right away, hearing Vanessa scream on the other end of the phone. When they arrived at the hospital, Vanessa was already 8cm dilated, which is quite far along and almost too far for an epidural. She was then asked if she wanted the epidural as she was still within the limit of receiving it and thought that she had suffered enough, so she accepted and got it. As soon as the epidural made its way into her body, her labour stopped progressing. More than 24 hours later, and not moving along much at all, Vanessa was also given Petocin to accelerate the labour and get her baby out. Unfortunately, Emma did not react well to the hormone, and her heart rate was decelerating, which led to a rush of doctors and nurses into her hospital room, telling Vanessa they had to perform a C-section right away. There was no asking for consent; this was, and felt like an emergency situation.

“Sure, i mean whatever we have got to do…”

Vanessa barely remembers the surgery, as it all happened so fast, but she does remember feeling like she had done all this work and just wanted the satisfaction of giving birth. She says she felt as if she got robbed of the experience of having a vaginal birth after having gone through all those contractions for such a long time. After the operation, she wasn’t even given the opportunity to have skin-to-skin contact with Emma as she started convulsing, and Emma needed to be given to Chris, who then took off his shirt and performed skin-to-skin. The following six hours were a blur; she could have been asleep, but she claims that she has no recollection of the moments during or after her surgery. They kept Vanessa and her new family at the hospital for about four days; there were no explanations or red flags, maybe because of all the trauma her body had undergone. She tells us that she felt a certain comfort at the hospital, a certain ease as she didn’t experience difficulty breastfeeding and if there was an issue, the staff was always around to help.

“now we are going out into the real world. CAN we really do this?…”

In retrospect, Vanessa shares that she would have probably appreciated if someone had advised her in the 24 hours that she was at the hospital labouring that a C-section could be a possibility so she could at least mentally prepare herself for the event had the words event been uttered to her prior.

Her second pregnancy went entirely differently, even if it still was a C-section, but it was a planned one, and she explains that she felt more prepared going into it, which allowed her also to feel more present. Although she was given the option to have a vaginal birth this time around, she was told that Alice, her second daughter, was measuring small in the wound and that she might have to undergo another C-section if the placenta wasn’t doing its job at feeding her properly. Vanessa went through some time with extra rest, increasing her food portions, and doing everything she could to increase her baby’s weight. During her last ultrasound, the healthcare professionals had recommended a planned C-section as she was still measuring relatively small. When Alice finally made her debut, Vanessa distinctly remembers screaming: “What’s the weight?” her husband responded: “We got a 6-pounder!” Filled with relief, Vanessa knew at that moment that everything was going to be okay and everything was indeed OK.

Alix’s Story

Alix begins her story by sharing that she was induced for all three of her pregnancies because she developed diabetes when she got pregnant all three times. Her first two deliveries were very similar and sounded like your textbook induction labour. The third time, she specifies, was different. She remembers the nurse repeating to her that this delivery is going to be different over and over again. Wondering what she was talking about, Alix was reclassified as being about 2cm dilated and thought this would be a long day. And again, the nurse repeated to her, this time is going to be different; you’re going to be 2cm, and then you’re going to be 10cm, and it’s going to happen immediately. After receiving the epidural, four or five hours have gone by, and Alix is on her side resting, chilling, thinking she was maybe 3cm now, maybe 4cm. All of a sudden, she felt a contraction and asked the nurse if she lowered the epidural dose. Immediately, the nurse reacted and told her to open her legs and start pushing. Alix, still on her side, not even having had the time to turn onto her back, started pushing with about five doctors around her.

“it went from 2cm, chilling resting to it’s coming, the baby’s coming!!!..”

Telling the story now, Alix finds it very funny how fast things progressed with her third delivery, almost a shocking amount of time, and what a surprise it was as it was so different from the first two.

moral of the story: labour isn’t always as simple as signed, sealed, delivered.

Part 2 The Specialist Responds

Labour Day, with Tanya Hobbs

Tanya Hobbs

Tanya Hobbs, RN, BScN, PNC(C)

Certified Perinatal Nurse, Birth Coach & Founder of The MTL Birth Co.

In this podcast, Tanya focuses on labour and delivery from the perspectives and experiences of Francesca's traumatic birthing experience during COVID-19, Vanessa’s unplanned C-Section and Alix’s extremely fast delivery.

understanding laboUr

Tanya starts by explaining that pregnant women can expect to go into labour or have their water break around 37 weeks. The rarity of water breaking naturally, which helped Francesca know when to go to the hospital, is quite high and does not happen often. Medical induction may be required for women past their due date or other medical reasons. Contractions and water breaking are the two main scenarios signalling labour, but the intensity and timing of contractions can vary greatly. Knowing when to go to the hospital during labour is crucial to ensure optimal outcomes.

Reconsidering the 511 Rule

The general guidelines for labour contractions for low-risk, first-time mom pregnancies are as follows: contractions start slowly, feeling like period cramps, and progressively become more intense with longer intervals between breaks. Contractions should be 5 minutes apart, one minute long, and have occurred for at least an hour before going to the hospital. However, Tanya mentions that the 511 rule may not be ideal for first-time mothers. Why?

Listening to your body and instincts is important rather than strictly following the 5-1-1 rule. Contractions should be painful, regular, and progressively stronger, lasting at least an hour or two before going to the hospital. It's crucial to trust your body's signals and not solely rely on the numbers.

Labour Induction

Francesca, Vanessa and Alix were all given something called Pitocin at one point during each of their labours. What is Pitocin? Tanya explains that it’s a synthetic form of oxytocin, the hormone that moves labour along, and is also referred to as the “love hormone.” Although Pitocin is given in most cases, the natural oxytocin released from the brain during labour has the added benefit of natural pain relief, while synthetic oxytocin does not. The primary reason for using Pitocin in labour induction is to increase the strength and frequency of contractions to progress the labour, as well as to avoid potential complications such as fever and infection due to pre-labour rupture of membranes.

Pain Management

As Tanya dives deeper into the subject matter, she explains that oxytocin and endorphins during labour are natural hormones that help a woman's body cope with pain. The synthetic version of oxytocin, Pitocin, contrary to what is thought, may, in some cases, cause more intense contractions and potentially slower labour. Epidurals are a tool to help manage pain but should be used wisely, as with any medical intervention. Non-pharmacological pain management options, such as hydrotherapy and pressure points, could be considered before opting for an epidural.

Epidural rates are high in Canada, with 80-90% of people opting for it during childbirth. Tanya says it effectively diminishes pain sensations but may make pushing a bit trickier. Although epidurals have not been linked to a higher risk of C-section, they are associated with a slightly higher risk of forceps or vacuum delivery. The contractions will get closer together over time, and a rapid birth may occur, like in Alix’s third labour, which is more common in subsequent births. In some cases, like Vanessa's, an emergency C-section may be necessary due to fetal distress or failure to progress, which refers to the medical term labour dystocia or significant slowing of the cervical dilation or fetal descent in the pelvis.

c-sections

In Francesca’s case, she had a C-section for her firstborn, Tessa and was given the option to attempt a trial of labour for her second, but ultimately had a C-section. The medical criteria for a trial of labour after a C-section can vary depending on factors such as the spacing of pregnancies and the reason for the initial C-section. However, Tanya explains that just because a woman had a C-section once certainly does not mean that she will have one for the next.

On the other hand, Vanessa had an emergency C-section because her baby showed signs of distress during labour, such as a drop in heart rate. This may be due to strong contractions, a small baby, or a non-optimal position in the pelvis. In such cases, the baby needs to be delivered quickly. It can be a terrifying experience, and in Vanessa’s case, described as traumatic because of the urgency of it all. Still, it is usually necessary to prevent potential harm to the baby.

When addressing Vanessa and her story, she uncovers the potential link between her traumatic birth experience and a lack of immediate connection between her and her baby. Traumatic births, including unplanned C-sections or emergencies, can have psychological effects on a mother and impact her ability to bond with her baby. The perception of trauma is absolutely subjective, and it is the mother’s experience that determines if birth is traumatic or not, but in this case, that is what she believes may have been the cause of her later bonding challenges.

It is essential to understand that having an unplanned C-section can lead to mixed emotions, such as disappointment, anger, and resentment. It's critical to debrief with a knowledgeable person and discuss the reasons for the C-section. If the birth experience is causing distress, discussing it with the obstetrician is crucial. Prenatal classes can also provide information about C-sections, which can help understand their reasons.

Expectant parents need to be informed about their options and potential emotional repercussions. Many people view giving birth as an event that needs to be planned, like a wedding, and should be informed about their options just like they would plan a wedding with a wedding planner. Expectant parents need to be aware of their options and understand the chain of events that can occur during a C-section birth so they can feel more in control of their birth experience.

Empowering Your Birth Experience

Tanya highlights the importance of taking initiative in one’s birthing process and experience, as it can shape future memories and repercussions. She suggests investing time in learning about the process, options, and ways to optimize scenarios, such as taking childbirth classes and hiring a doula, to ensure a positive birth experience.