I’m sitting here during a nap time, at almost 6 weeks postpartum and finally feel ready to actually reflect on my birth with Callum and put ‘pen on paper’ to share it.
The past 6 weeks have felt like a haze and gone by so fast but so slow at the same time? 

As I reflect I realize that - although my labour was long and my birth was a bit traumatic - I view it as a positive and successful experience.
I attribute that to my support team who made me feel heard, listened to my wishes, checked in with me regularly and involved me in decision making and my family and friends who have supported me during the 4th trimester and Lennon who provided comedic relief (most days).

LABOUR 

I went into labour Saturday December 30th right as I was trying to fall asleep at 10PM. I stayed in bed and rested as much as I could before contractions picked up. I had a long warm shower and spent some time on the birth ball in my living room and walking around the main floor of our home.

By 1AM, we called my mom to come over to stay with Lennon and paged our midwives team and my doula Jenny to give them a heads up that labour had started. I was still in early labour but felt enough intensity that I couldn’t carry a conversation with David through my contractions.
The midwives advised I could hold off at home a bit longer or come into the hospital and ultimately, I decided to head to the hospital as I knew I would mentally and physically relax into labour once I was there and admitted.

We arrived at the hospital around 4AM, followed by my doula Jenny. David and Jenny spent a couple hours walking the halls with me and labouring in stride standing (this felt the best!).

I discussed a pretty flexible birth plan with my midwife Crystalyn which included:

• I did not want to know how dilated I was during cervical checks because with my birth with Lennon, the slow progress in dilation made me very disheartened during my labour and made the experience less positive for me

• Trying to labour and birth without an epidural, as I wanted to experience the Fetal Ejection Reflex, the sensations of pushing and birthing in a gravity dependent position to be able to better speak to it for my job (professional research! lol)

Like I encourage all of my patients, my doula Jenny encouraged me to try going pee at regular intervals and sitting on the toilet created such intense contractions which was “bad but good”  - bad in a sense that it was much more intense in sensation but good because intensity = labour is progressing!

We tried many positions that promote progression of labour* (see below), my pain rating at this point was about a 8-9/10 and David and Jenny both took turns supporting me with pain management* (see below) and my midwife offered me nitrous oxide gas bedside which I happily accepted!

Around 2PM on Sunday I became concerned and did a mental check in with myself:

• I hadn’t slept since the Friday night

• I was refusing food because of the pain/nausea of labour and contractions

• I was super tense and clenching my jaw, my pelvic floor, my hips, my entire body

• My energy was low and my focus on my breathing and mindfulness was waning

• I was thinking “It’s been 15 hours…How much longer can I do this and then still have energy to push!?”

At this point, at 7cm dilated (I finally asked how dilated I truly was at this point!) I decided to get an epidural. Once I had my epidural, I was able to re-hydrate after this long stint of labouring and take a nap.
My epidural acted as a ‘reset’ button both physically and mentally and it was the right decision for me in that moment.

Jenny, David and I all caught our breath and I dilated quite quickly during this time as my body finally relaxed. Crystalyn checked me around 3:30PM and I was 10cm dilated and fully effaced, so we decided to artificially break my water to get the party started! 

BIRTH

Thirty minutes after my water was broken, I was feeling an intense pressure in my butt and felt that my contractions had changed significantly. David told Crystalyn and she suggested we start pushing!

I opted for side lying and holding my own leg. I tried both open glottis breathing (think making a “SHHH” noise on the exhale) and closed glottis breathing (think a breath hold and push) and ultimately found that closed glottis breathing felt more comfortable and was more effective for me.

After about 20 minutes of pushing we were told that Callum had shoulder dystocia* (his shoulder was stuck behind my pubic bone). This creates a lot of stress for babies, and Callum’s heart rate dropped significantly and was not picking back up between contractions. I was helped into a maneuver to try and free his shoulder (onto my back and holding both of my own knees into my chest) but ultimately an OB was called in to intervene.
The OB had to use the vacuum to help Callum out and I had 3 push attempts to make it happen because of Callum’s low heart rate.

Thankfully, I did get him out on the first push attempt with the vacuum assist. He was put onto my chest and we were all instantly relieved. Callum had entered the world after 25 minutes of pushing and 5 final moments of chaos at 9lbs 14oz.

Our skin to skin moment was short lived as Cal was having trouble breathing. Typically when babies are pushed through the birth canal, they get squeezed which helps clear their lungs and breathing pathway from mucus in the womb. Because he was birthed so quickly, he missed that ‘squeeze action’ and his lungs were still full of mucus. His lungs were cleared through suctioning and his shoulder was assessed for trauma from the shoulder dystocia (ultimately both his lungs and shoulder were fine!)

While Cal was getting treated, I began hemorrhaging after birthing my placenta. I was given medication and uterine massage to encourage my uterus to contract and quell the bleeding. This is when I was also told about my 3rd degree perineal tear that extended into my external anal sphincter. I was not surprised to hear this because of the shoulder dystocia and urgency and force that was needed to get Callum out. The OB was excellent and communicated this with me while stitching the tear immediately.

Despite the quick chaos that was my birth, I was so grateful that we were both healthy, that my experience and treatment was positive and supportive from my entire prenatal medical team and that I was on the other side of it!

4TH TRIMESTER

In my first week postpartum, I definitely struggled physically and mentally.

It’s very different shifting from a professional role of educating women on healing from a 3rd degree perineal tear to actually living through the experience myself.

To compound my frustration, my tear became infected and began opening again and my recovery was even slower than I anticipated. The silver lining was that I had an incredible support system at home that allowed me to completely rest and avoiding straining my wound, and I had time to bond with Callum, without interruption or other tasks as I healed and he…napped and ate!

As my perineal tear healed and I felt like something was still ‘not quite right’ and regularly assessed the tissue healing by looking at my vulva in the mirror. I saw signs of granulation tissue and told my midwives about my concerns. They listened to me, assessed and agreed to treat the granulation tissue with silver nitrate which was not pleasant at the moment but provided almost instant relief afterwards. I was so happy I took my healing into my own hands and regularly checked with the mirror and asked for an assessment and treatment prior to my 6 week check-in.

As I reflect on the past 6 weeks, I have lived through the traumatic births that I professionally support women through in my clinic.

I feel like I’ve gained a new gentleness and understanding of the healing journey for myself as a woman and that I can apply to working with other women when I return to work. This experience will shape how I present birth prep education to women  and has left me with two major messages to share with others:

1. We can control what we can, but there are aspects of labour and birth that are out of our control and we have to let those go. Control what you can, surrender the rest.

2. Our perception of our birth being a positive or negative experience in our eyes does not depend on tearing, birth trauma, medical intervention but depends on how autonomous we felt and how heard/seen/supported we felt during the process.

PAIN MANAGEMENT I USED DURING MY LABOUR

• Pelvis and sacral counterpressure

• Swaying

• Fan

• Gripping combs

• TENS Machine (I actually did not like this like I thought I would!)

• Nitrous oxide gas

• Cold cloth on my forehead

• Ice pack on my neck

• Epidural

LABOUR POSITIONS I USED

• Half kneeling

• Standing and swaying with David

• Sitting on birth ball

• Kneeling on the bed with arms/head supported on head of bed

• Sitting on toilet

• Walking

• Stride standing

• Side lying with peanut ball

MY RISK FACTORS FOR SHOULDER DYSTOCIA

• Macrosomia (Callum weighing over 9lbs)* definitely the biggest factor in my case

• Long labour

• Epidural and inability to maneuver into certain positions

MY RISK FACTORS FOR GRADE 3 PERINEAL TEAR

• Macrosomia (Callum weighing over 9lbs)

• Epidural

• Use of vacuum

• Shoulder dystocia

MY BIRTH PREP SCHEDULE

• Perineal massage with Therawand 3x/week at 37-40 weeks of pregnancy

• Pelvic floor mobility and hip mobility 2-3x/week throughout pregnancy (thanks to teaching Pilates for the most part!)

• Gentle Birth App guided breathing exercises and meditations

• Consulting and meeting with our Doula, Jenny about birth preferences, expectations, pain management techniques

• Prenatal chiropractic care from David, as needed

• Prenatal massage therapy with Kristen, as needed

• Daily movement practice throughout pregnancy (walking, running, weight training, Pilates)

MY PREP TO PREVENT PERINEAL TEARING 

This is why I don’t feel like a failure or feel ‘bad’ for my 3rd degree tear, I did all of the activities proven to reduce the risk of tearing during pregnancy!

• Perineal massage with Therawand 3x/week 37-40 weeks of pregnancy

• Pelvic floor mobility and hip mobility 2-3x/week throughout pregnancy (thanks to teaching Pilates for the most part!)

• Breathing practice for pelvic floor muscle relaxation

• Breathing practice for pushing and pelvic floor coordination exercises

• Practicing getting into push positions for vaginal birth

• Vulvar moisturizer throughout pregnancy

• Warm shower during labour

• Assuming positions to open Sitz bones for late stage labour

MY REHAB FOR 3RD DEGREE TEAR

• Sitz baths with Epsom salts (I opted to do this in the bathtub instead of the Sitz bath that sits within the toilet bowl, I found it much more comfortable and less pressure in the tub)

• Frida Mom ice pack pads

• Gentle laxative

• Peri bottle that shoots upwards

• Checking in on tissue healing with mirror daily

• Airing out my vulva twice a day for 10-15 minutes each time

• Changing pads every 2 hours for the first 2 weeks to keep things dry and clean

• Showering after bowel movements

• Investing in a handheld shower head instead of the stationary one (gamechanger!)

• Wearing brief style underwear for less friction on my perineum

• Managing pressure on my pelvic floor limiting stairs and lifting and breathing through position changes for the first 2 weeks

• Week 2-6: Gentle core and pelvic floor engagement exercises

• Week 2-6: Mirror work while practicing pelvic floor contraction/relaxation with breathing coordination

• Week 2-6: Gentle hip and low back stretches

• Week 4-6: outdoor walks with the stroller

• Week 5-6: gentle body weight and postnatal core workouts on Peloton app

• Week 6+ rehab: perineal desensitization training and scar tissue massage with Therawand (internal and external massage)