lindseykuper

Four weeks ago today, we welcomed Sylvia Dawn into the world! I got a lot out of reading other people's birth stories as we prepared for Sylvia to arrive, and so I'm sharing ours in the hope that someone else will benefit from it in some way, whether they're preparing for a birth themselves or are just curious about our experience.

Sylvia's due date of Monday, July 17 came and went without much fanfare. I had an appointment with Kavita, my midwife, that day, and she checked my cervix and reported that I was one centimeter dilated (out of the standard ten centimeters that one's cervix must usually dilate before one can push a baby out). It's apparently common for the cervix to dilate a centimeter or three during late pregnancy before labor actually starts, so it didn't mean much that mine had begun dilating. Still, Alex found it very exciting that Kavita was able to poke a finger in and feel the top of the baby's head through the amniotic sac ("You're the first person to touch our baby!"¹). I couldn't tell that my cervix had begun to dilate (and I couldn't feel anything unusual or painful during Kavita's exam), but I was happy that my body seemed to be preparing for labor and birth.

My parents arrived in town two days later, on Wednesday the 19th, but they didn't come to visit us yet. Their plan had been to come see us a day or so after I gave birth, and they wanted to leave us some space until then. They got an Airbnb in the next town over and found tourist activities to occupy their time. I was on leave from work, and I puttered around the house, cooking, cleaning, and organizing things. A friend had asked me a few weeks previously if I had been "nesting" yet, and I hadn't been sure what that meant. "You mean, like, buying stuff for the baby?", I had asked. "No," she'd replied, "I mean, like, organizing the spice rack." The week starting with Sylvia's due date turned out to be when the "nesting" thing finally kicked in. I did not organize the spice rack, but I did construct, bake, and freeze two pans of enchiladas. I like to cook, but cooking and freezing food in advance is not typical behavior for me!²

On Friday the 21st, I lost my mucus plug, the small glob of mucus that fills the cervical opening during pregnancy. I had never imagined that I would be excited about a glob of yellowish mucus in my underwear, but I was pleased to have another sign that my cervix was beginning to open. I excitedly texted my mom, who said, "Are you sure your water didn't break?" (Yes, I was sure.) Like me, my parents were eager for things to move along, and by now they were running out of tourist things to do. My dad finally announced that it was ridiculous that they'd been in town for several days and not seen me yet, and that they were coming over the next day, which was Saturday.

On Saturday, we all went out for a nice brunch together, and then we spent the afternoon at home, where I gave my parents a tour of all the many baby accoutrements that we'd been given by friends and relatives.³ At some point in the afternoon, I noticed that I seemed to be having some watery discharge. I called Kavita, worried that it might be a slow leak of amniotic fluid. She told me that she'd come over around 8:30 the next morning and check on me. Eventually, my parents headed back to their Airbnb, and some time later, Alex and I went to bed.

Around two-thirty in the morning, I started to feel what were...well...I thought they might be contractions, but I wasn't entirely sure. How is a first-time birth-giver supposed to know what a contraction feels like, anyway? I knew from the childbirth class that Alex and I had taken that during early labor, contractions would last less than a minute and would be between about seven and twenty minutes apart, and that this stage of labor could last for a long time, possibly days. But, although I was sure I was feeling a sort of discomfort that was new to me, I couldn't put my finger on how long the contractions were, nor how far apart they were. I got out of bed and googled for things like "can't tell when contractions start and stop", to not much avail. I downloaded a contraction timer app and tried using it, but that wasn't particularly helpful, either. Eventually, I decided to call Kavita to let her know what was going on, although I didn't think there was an urgent need for her to come over yet. She told me that she would come over at some point, but that instead of coming at 8:30 a.m. as she had said previously, she wouldn't plan on any particular time and would instead wait for another phone call from me. At that point, I think I went back to bed and tried to sleep, with mixed success.

Around seven in the morning, I still couldn't tell when the contractions were starting or stopping or how long they were, but I was beginning to have an increasing amount of lower back pain. I took a hot shower and put on a loose-fitting dress, then moved restlessly around the house, trying different ways to sit or stand and googling "when to call midwife". After reading one too many stories on pregnancy forums from people who waited too long to call the midwife and regretted it, I began to get worried and decided that I really wanted Kavita to come over soon. I woke up Alex and asked him to call Kavita for me; I suppose I felt like I'd been calling her too often and that she might think I was crying wolf, and that if the call came from Alex, she might take it more seriously. Kavita asked Alex for more information on what had been happening for the last few hours. He truthfully replied that he didn't know, because he'd just woken up. I think the fact that Alex had been asleep was a sign to Kavita that I was still not very far along. She had Alex put me on the phone and confirmed that I could still talk through a contraction, then gently explained that she didn't think I needed her to come over yet (and that this was really the sort of situation that called for a doula -- which I didn't have -- and not a midwife). But I was nervous and asked her to please come over, and she acquiesced and arrived at our place an hour and a half later. I had gotten back in bed and was lying on my side and pressing a hot water bottle against my back. Kavita immediately noticed that my lips looked dry and admonished me to drink more water. She checked the baby's heart rate, which was 130 bpm, just as it had been throughout most of pregnancy.

Then, Kavita got out a TENS unit, a small battery-operated device for treating pain with a low-voltage electric current. We had very briefly discussed this thing in the childbirth class, but I hadn't actually tried it out during the class, and had felt a bit skeptical of it at the time. Kavita showed me how to use it: there were four small, flat electrode pads that attached to my lower back with a very sticky adhesive, and wires ran from the pads to a handheld device that I could use to control the intensity of the current. The handheld device had a big, easy-to-press button that would toggle between two settings: a lower-intensity, pulsing setting and a higher-intensity, steady one. Kavita explained that I could leave it on the former setting when I wasn't having a contraction, then press the button to switch to the latter setting and get more pain relief during contractions. We put the pads on my back and set it to about a third of the maximum intensity, and it felt great -- a bit like someone was massaging my lower back with warm hands. Turning it up more than that began to feel more prickly than therapeutic, so I left it at the one-third setting. Having gotten me situated with the TENS unit, Kavita left for a while to take care of some other errands and appointments.

The TENS unit was awesome. I left it attached to my back pretty much continuously for the next twenty-four hours, only taking it off a couple of times to take showers. Not long after putting it on, I felt comfortable getting out of bed and walking around outside a bit with Alex. I also sat on our exercise ball for a while, and I ate a sandwich that Alex made me and did my best to drink a lot of water.

The contractions were gradually becoming more distinct and more uncomfortable, and I really appreciated having that button to press and turn up the TENS unit whenever I had a contraction. I wouldn't say that it took the pain away, exactly, but it provided an effective distraction from the pain, in the same way that scratching an itch distracts from the itch. Most importantly, being able to press the button made me feel like I was in control! It occurred to me that my earlier questions about when exactly my contractions started and stopped could be answered by looking at a log of data from the TENS unit: a contraction could be said to start at whatever point I got uncomfortable enough to press the button to switch to the steady setting, and it could be said to stop at whatever point the discomfort lessened enough that I pressed the button again to switch back to the pulsing setting. I remember wishing that the TENS unit talked to my phone and provided that data (notwithstanding the serious security and privacy implications that such an arrangement would have), or at least that there was some kind of logging facility so that I could show the data to Kavita.

Throughout the day on Sunday, Kavita checked in periodically via phone or text message, but I didn't have much to report. I knew that it was a good idea to keep moving during labor, but I found I was most comfortable lying in bed on my side, with the TENS electrodes on my back, and sometimes with the hot water bottle on top of that. Kavita had brought her birth pool (the brand was "Birth Pool in a Box") over to our house some time previously, and Alex got it inflated and set up in our spare room (soon to be the baby's room!) and put a tarp under it. We didn't start filling it with water yet, though, since it might be some time before we actually used it. I was very much looking forward to getting in the pool, but Kavita had said it wasn't time yet.

By the early evening, my back pain had become more intense, and by now it was quite obvious when the contractions were starting and stopping. Alex ordered a pizza, and I remember trying not to make any noise while the delivery person was at the door. I wasn't interested in eating any of the pizza. When Kavita returned that evening, I had sort of draped myself over our exercise ball on the floor of the bedroom and was rolling around miserably. Kavita determined that I hadn't been eating or drinking enough, and she fed me some yogurt with a spoon. I asked hopefully if it was time to get in the pool yet, but she felt that the pool should be more of a last-resort pain relief technique -- the equivalent of an epidural, if I'd been in the hospital -- and that I still wasn't nearly far enough along that it should be necessary. She didn't want to check my cervical dilation yet, either, because she suspected that the number wasn't what I wanted it to be and that hearing it wouldn't do me any good. I felt like a wreck, but Kavita told me that I looked like I was coping quite well. This wasn't particularly encouraging to hear, though -- if I could feel this bad and still look like I was "coping well", I was worried about how much worse it might be possible to feel!

As a substitute for the pool, Kavita suggested getting in a hot shower. I was reluctant at first, because I didn't want to go to the trouble of getting undressed and then dressed again; I ended up half-solving that problem by simply not getting dressed again after the shower. On the way to the shower, I had a painful contraction and had to stop and sort of hang from the top of the bathroom door frame and groan for a while. I was glad that Kavita was there to see me having some really painful contractions -- I wanted her to see that my pain was real.

Alex moved the exercise ball into the shower -- where, happily, it just barely fit -- and I sat there on the ball and didn't get out for almost an hour. I had begun to have some abdominal pain in addition to my back pain, and Alex brought me a large plastic cup so that I could pour hot water on my belly as well. Sitting on the ball in the shower, with hot water pouring down both my back and my front, I could almost pretend that I was immersed in the warm birth pool, which was where I really wanted to be. It felt good. I made low moaning noises when contractions came. Kavita, knowing that I still had a lot of laboring to do, insisted that I keep taking in more calories, and she fed me the rest of the yogurt right there in the shower. When I got out of the shower, I felt much better. I'm sure both the shower and the calories played a role.

It was getting to be late at night, and Kavita prepared to spend the night on our futon. She and Alex arranged to take shifts so that someone would always be awake with me, but in practice, there were times when they were both asleep. I didn't mind at all -- I wanted them both to be well rested, and I knew that I could wake them up if I really needed them. I spent most of the night either in bed with the TENS unit, or back in the shower. Alex was very tired, but he was worried about me being alone in the shower, and he insisted on getting up and going into the bathroom with me and bringing me juice to drink. In one photo he took, timestamped 1:58 a.m., I'm sitting naked in the shower on the exercise ball, water pouring down on my back, nonchalantly drinking grapefruit juice from a cup with a straw with my eyes closed, as if that's the most normal thing in the world to be doing in the shower at two in the morning!

Monday morning arrived. I had re-attached the TENS electrodes to my back after my last stint in the shower, and I'd fiddled with the TENS unit's settings and found that if I left it on the steady setting all the time (rather than switching back to the less intense intermittent setting between contractions) and turned it up to two-thirds of the maximum intensity -- a level that had felt uncomfortably prickly the previous day -- then it provided enough of a distraction from the pain that I could get through my contractions without making any noise at all. That was good, because Alex was now sleeping more or less peacefully in bed, and I wanted him to have a chance to sleep. He woke up long enough to help me get situated in the old armchair in our bedroom, TENS device in hand, surrounded by pillows, my phone, and the by-now-indispensable hot water bottle. Then he went back to sleep, and I settled down in the chair to wait for whatever came next.

A bit later, around eight in the morning, Kavita came in to check on me. I told her that with the TENS unit cranked up, the pain was quite manageable as long as I didn't move from the chair where I was, but that I didn't think I was making much progress. My contractions still weren't all that frequent or regular. Some were only five minutes apart, while others had a longer pause in between. I asked again if she wanted to check my dilation, hoping that I might somehow be wrong about my lack of progress, but she still didn't think there was much to be gained by checking at that point. She said that if by that afternoon or evening there hadn't been progress, we could think about ways to induce labor, which might or might not include going to the hospital. Then she headed out briefly for another appointment, leaving Alex (who was still asleep in bed) and me alone in the house for a while.

For me, this was an emotional low point of labor. I'd now been having contractions of one kind or another for more than twenty-four hours, but I didn't seem to be making much progress. I felt that I must not be particularly close to giving birth, or Kavita would have cancelled her other appointment and stayed. I was frustrated with myself for not making progress, and I was afraid that I'd end up having to go to the hospital for a chemically induced labor, which sounded really unpleasant.

Around ten in the morning, my friend Jessica texted to ask how I was doing, and I told her the same thing I'd told Kavita. Jessica asked if I was in a "get on with it" mood or a "nice to have a break" mood, and I responded emphatically, "I would love to get on with it, get to transition and get in the pool." ("Transition" refers to the part of labor when the cervix dilates its last few centimeters, after which it's time to start pushing the baby out.) Jessica asked if there was anything I could do to make my contractions faster or more intense. Thinking about that brought me to a turning point: I realized that if I wanted to make progress, I needed to get my ass up out of that chair and do something about it. And so -- very slowly, painfully, and resentfully -- I dragged myself to a standing position and made myself go walk around the house.

I remembered that grabbing the top of the bathroom door frame had been helpful during a painful contraction earlier, and so I decided that I'd take a stab at hanging from the pull-up bar mounted in the doorway to Alex's and my office, which was right next to the door to our bedroom where Alex still slept. I found the birthing stool that Kavita had brought over the previous day, carried it over to the pull-up bar, and tried positioning myself with my hands on the bar, my right foot on the floor, and my left foot up on the stool. I still had the TENS electrodes on my back, as well. I had one or two strong contractions in that standing position, stronger than the ones I'd had been having sitting in the armchair. Then I had a contraction that felt stronger still -- and then my water broke, suddenly and explosively, all over the floor! The splash it made was loud enough that Alex jumped out of bed with a yelp. I was elated -- finally, a sign of progress!

My contractions started to become more regular, more frequent, and more intense. I was so delighted to be making progress that I didn't mind the pain. I kept telling Alex how happy I was. I didn't feel much like moving from my position on the pull-up bar with my foot up on the stool, so I stayed right where I was while a now-very-much-awake Alex got a towel and handled the rather disgusting task of mopping up the amniotic fluid around my feet, which was clear with bits of grayish-brown meconium in it. Happily, most of the fluid had gone onto the wooden floor of the hallway, where it was relatively easy to clean up, instead of onto the carpet of the office or our bedroom. Then Alex called Kavita, who was already on her way back over.

It was around this time that the TENS unit stopped being effective for keeping me quiet during contractions. I asked Alex to close all our windows so that the neighbors wouldn't have to hear my moaning and groaning. He was reluctant to do that ("You know what? Screw 'em!"), but I insisted. When Kavita arrived a few minutes later, I was still hanging from the pull-up bar in a most undignified way -- naked, smelly, groaning, and soaking in bodily fluids -- but in much better spirits than I had been when she'd left just a couple hours previously. Kavita decided that it was finally time to check my dilation, which she was able to do right there where I stood without making me change positions. I was absolutely thrilled when she reported that I was eight centimeters dilated, and even more thrilled when she told Alex that it was time to start filling up the birth pool. She also checked the baby's heart rate, which was holding steady at 130 bpm.

I had a couple more intense contractions while Alex and Kavita proceeded to use up all of our hot water filling the pool. Alex helped me get in the pool, which felt wonderful, but it still wasn't quite as warm as I would have liked, so he and Kavita started some pots boiling on the stove to get more hot water to pour in with me. I kept asking for more and more hot water, and they kept pouring more in -- until, abruptly, it was very hot and I had to take my hands out of the water to regulate my temperature. They also brought me water, juice, and soup. I didn't feel hungry, but Kavita told me to eat anyway.

It was now around noon on Monday, and I was imagining that I "just" needed to finish dilating and that I would then push the baby out and give birth right there in the pool. (It's called a birth pool, after all, not a labor pool!) Even with the nice, warm pool, those last two centimeters of dilation were the most physically painful part of labor. My back pain was now gone, but it had been replaced by even worse abdominal pain. When I had contractions in the pool, I heard myself make noises I'd never made before -- inhuman-sounding noises that I can't characterize as a moan, a groan, or a yell. In particular, I made a noise that was almost like a yodel. It had two distinct pitches that alternated very quickly, and it was loud! When I yodeled, Alex sometimes sang along with me or drummed a beat with his hands, until I asked him to please stop doing that. Meanwhile, Kavita sat on the floor, knitting a baby hat, completely unperturbed by my yodeling. She'd seen people go through transition hundreds of times; this was nothing new. (I asked her later if I had even been especially loud, and she was like, "Nah.")

I tried a position where I was on my knees in the pool, leaning forward over the edge of the pool and squeezing Alex's hands tightly during contractions, making my loud yodeling noise. When I didn't have his hands in a death grip, Alex held a cool washcloth to my head and gave me sips of water. At one point, Alex asked me if it was the worst pain I'd ever experienced. I didn't answer the question at the time, because another contraction was starting, but yes, it was. The blister on my toe during mile twenty-three of the marathon I ran in 2009 had been pretty bad, but the difference between that and this was that during the marathon, I could have stopped running if the pain became intolerable, whereas with labor, the only way out was through.

After a while, Kavita suggested that it might be a good idea to get out of the pool. I wasn't very happy at the prospect, because I figured that that meant that she thought it would still be a while before I actually gave birth. I'd really been hoping that once I got in the pool, I wouldn't get out again until I had a baby! Besides, I thought my abdominal pain would be unbearable if I was out of the pool. But Kavita felt that since this was my first time giving birth, it would be easier for me to push the baby out if I got out of the pool and had gravity working in my favor.

It took some time for me to be convinced to get out of the pool. Alex asked me if I wanted to get out, and I got upset at him, saying, "You're asking me to choose between one kind of pain and another kind of pain!" (Weeks later, I happened to be reading one of our books about pregnancy and birth, and I came across a section that had advice for partners on how to help the birthing parent get through transition. One of the pieces of advice was, "Don't ask her questions." Hah! Quite so.) Finally, though, I was willing to get out, and Alex and Kavita helped me make my way out of the pool and lie down on the bed. It was around this time that Shannon, the other midwife who was assisting Kavita for this birth, arrived to help. I was lucid enough to say hello to Shannon, who I hadn't met before. I couldn't help being amused at the situation: "Hi! I'm naked, wet, smelly, and groaning in pain. Nice to meet you!" Shannon, of course, took all this in stride, as any experienced midwife would.

Kavita checked my dilation and reported that I was nearly at ten centimeters, and that there was only a tiny rim of cervix around the baby's head. She asked permission to push back the cervix, and I said to go ahead. I've heard people report that this is excruciatingly painful, but I honestly didn't feel anything at all. It's possible that my abdominal pain was strong enough that I just wasn't noticing any other kind of pain. In any case, Kavita was able to push back the last bit of cervix without much trouble, and she said that I was clear to go ahead and start pushing.

This should have been welcome news, but I found that I didn't feel any sort of urge to push. I attempted a few pushes, but I didn't understand how I was supposed to use my contractions to help me push effectively, and my abdominal pain persisted. I let out a few loud yells. These weren't like the inhuman-sounding yodeling noises I'd made before, which had come purely from a place of pain. Rather, they were recognizably human sounds, and I was really yelling more out of fear and frustration than out of pain. I think I was afraid that, after all this time and effort, I wouldn't be able to carry out the last step and actually push the baby out. As I was yelling, I caught a glimpse of Alex, and the look on his face in reaction to the sounds I was making was somewhere between "concerned" and "impressed".

Thinking that perhaps a change in position would do me good, Kavita and Shannon helped me out of bed and got me seated on the birth stool. I had a difficult time sitting in the way they wanted me to, though: they wanted me to plant my feet widely, but I wanted to curl my legs up under me in reaction to my abdominal pain. Adding to the tension and frustration was the fact that Kavita was getting worried that it had been a while since I had peed. I had been drinking lots of water and juice, but the last time I could remember peeing had been in the shower the previous night.⁴ Kavita and Shannon put a bowl under me on the stool and suggested that I try to pee in the bowl, but I didn't feel the slightest urge to pee. I felt overwhelmed with everything that I was being asked to do: I didn't know how to push, I couldn't make myself pee, and I didn't want to move my feet. I told Kavita and Shannon that the birth stool wasn't working for me and that I wanted to get back in bed, and they helped me return to bed, telling me that I was doing fine and that it was okay to take a break. Kavita checked the baby's heart rate again; still 130 bpm, just like always, with slight speedups during contractions. Then she pulled Alex aside, and I overheard her quietly telling him that there could be several hours of labor still to go. I tried to come to terms with that unpleasant reality.

Alex curled up next to me in bed, while Shannon and Kavita rubbed my feet gently. I pushed ineffectually a few times, yelling again in pain and frustration, and one of the midwives -- Shannon, I think -- suggested that I try to use my voice as a tool to help me work through and take advantage of the contractions: with each contraction, she said I should try to bear downward with my diaphragm, making a low, loud, sustained sound. I began trying to do that, and Kavita and Shannon encouraged me, telling me over and over that I was doing "great" and "amazing". I wasn't sure if I was really accomplishing anything or not, but their words made me feel better. In the choir I sing with, we spend a lot of time working on breathing exercises to strengthen the lungs and diaphragm, and I'd like to think that all of the time I'd invested in doing those exercises helped me during this part of labor.

The midwives predicted that sooner or later I would start to feel some pressure on my rectum from the baby's head, as though I needed to poop, and that I would be able to use that sensation to help me push. A few contractions later, I indeed started to feel as though I needed to poop. I announced to the room, "I've got rectal pressure!", to which Kavita and Shannon responded with cheers. For me, this was another turning point of labor. Pushing out a baby wasn't something I had ever done before, but pooping? That was something that I had a lifetime of experience with! I told Kavita and Shannon, "I'm literally just going to try to poop whenever I have a contraction." They seemed to be on board with that plan.

After a few pushes, Kavita suggested that I should try sitting up and making use of gravity again, but I didn't want to return to the birth stool after my unpleasant experience sitting on it earlier. Instead, I decided to try sitting on the toilet. (I was trying to poop, after all.) I went down the hall to the bathroom, closed the door, and sat. The room was relatively dark, quiet and cool compared to the rest of the house; it felt good. I told myself that this was simple: all I had to do was try to poop, and that's exactly what I did. Somehow, my abdominal pain melted away, and with each contraction, I just did my best to poop. In fact, a few small nuggets of poop did plop out into the toilet, and I felt damn proud of each one of them. I may or may not have happily announced, "I POOPED!", loud enough for Kavita, Shannon, and Alex to hear from down the hall.

After a while, Kavita came in to check the baby's heart rate (which was still at its usual 130) and see how I was doing. She was concerned that I still hadn't peed, and she added to the toilet water a few drops of peppermint oil, which, she explained, would dilate my urethra and help me pee. She also thought that I might want to try a different pushing position. I told her that what I was doing seemed to be working well and I wanted to keep going with it for a while, and she left with some reluctance.⁵ The peppermint oil didn't help me pee, but it did smell nice.

I continued laboring in the bathroom by myself. For me, this was the most satisfying and pleasant part of labor. The amazing thing about it was that with each contraction, I felt pressure, but not any pain. A contraction would start; I'd exhale and push downward as though I was trying to defecate; and after several seconds of that, I would feel a tremendously powerful pressure -- but not pain! -- well up inside of me, and it was as though my body took over pushing for me for several more seconds. After perhaps forty-five minutes of that pattern repeating every few minutes, I started wondering if I was making any observable progress pushing the baby out. I reached down between my legs to see if I could feel anything different -- and felt the top of the baby's head bulging out of me! I was astonished, and called out excitedly, "Kavita, come feel this!" Kavita confirmed that the baby was starting to crown, and she quickly helped me get up from the toilet and waddle bow-legged down the hall to the bedroom, where Alex and Shannon were waiting.

From this point on, things moved very quickly. Kavita suggested that I climb up on the bed on my hands and knees, but that seemed like too much effort, and I was eager to get on with it and push the baby out -- so I just bent over the side of the bed, resting my forearms on the bed with my rear end in the air and my feet on the floor. Behind me, I heard Kavita say, "That works, too!" I had a contraction and pushed, hollering loudly, and behind me, I could hear Alex saying, "I can see the head!" I didn't know if he meant just the top of the head, or the whole head; I hoped it was the latter. It hurt a lot, and I said to Kavita, "Please, pull her out!" Kavita told me, "You need to push her out!"

Behind me, Kavita and Shannon were telling me to take deep breaths and push slowly. For some reason, though, I felt as though I ought to push the baby out as quickly as possible. It wasn't any kind of physical urge to push quickly; rather, it was a mental one -- some ill-conceived notion I had that the baby would come to harm unless I got her out in a big hurry. I didn't want her to be squashed up in the birth canal for any longer than necessary. (I wasn't thinking about harm that might come to me if I pushed quickly.) Also, in the childbirth class, we had seen a couple of birth videos in which babies had seemed to me to come flying out at top speed, and so that was the mental picture I had. Besides, I was just really, really eager to be done giving birth! All things considered, I probably pushed a bit more forcefully than I should have.

After another push or two, Alex exclaimed, "I can see her face!", and now I knew that her whole head was out. She was in occiput anterior position, that is, head down and facing my back -- the preferred position for birth. As Kavita and Shannon later explained, though, she had her head lifted slightly from her chest in what is apparently known as a "military" presentation, which may have made for a tighter squeeze. (It's more common for the chin to be tucked to the chest.)

Suddenly, Kavita and Shannon were telling me that I needed to flip over onto my back. I was surprised at this instruction -- everything I'd heard and read about birth had said that the all-fours position that I was already in was preferable to lying on one's back -- but now was no time to argue about it! With both Kavita and Shannon helping me, I managed to flip over astonishingly quickly, and was now lying with my back on the bed, legs hanging off the side of the bed, and feet on the floor. From that position, I just pushed once or twice more. I'm not sure if I pushed her out by myself or if Kavita did some pulling, but I don't remember this last part being especially painful or taking very long at all, and at 5:40 p.m., Sylvia was out! Kavita later explained that Sylvia had had a "tight shoulder", and that in my case it was actually the act of flipping over that had dislodged the shoulder, and that the fact that I happened to end up on my back instead of start out on my back wasn't as important. (I'd be interested to hear from other people who've had similar birth experiences, since my understanding is that it's a lot more common to move into an all-fours position to resolve a tight shoulder, instead of out of that position like I did. I'm no expert, though!)

Right after she came out, I remember just lying there for a few seconds in exhaustion, amazement, and profound relief that it was finally over. (I was apparently also bleeding profusely, not that I noticed or cared at the time.) Then there were about twenty seconds of furious activity: Kavita and Shannon had laid Sylvia down on the bed next to me and were using an Ambu bag to inflate her lungs. She looked healthy and pink -- she was still getting oxygen through the umbilical cord, which was still attached to my placenta and pulsating -- but had not yet started breathing on her own. I looked over and saw her whole tiny body lift up and convulse in response to the incoming air from the bag. Shannon turned to Kavita and said, "Call 911?" (Alex later said that he almost fainted when he heard that.) I was asking, "Is she okay? Is she okay?" Kavita exhorted, "Touch her! Talk to her!" I reached out and grabbed her tiny, chubby thigh, saying, "Sylvia, Sylvia, Sylvia! I love you, Sylvia!" Alex was next to me, doing the same, and a few moments later, Sylvia took her first gasping breaths on her own and started to cry, obviating any need to call 911.⁶

Kavita and Shannon put her on my bare chest -- warm, soft, pink, wriggly, and covered in slippery vernix and an appreciable amount of (my) blood. They laid a receiving blanket on top of her, but the room was extremely warm as a result of my insistence on closing all the windows hours earlier, and so the blanket was hardly necessary. I hugged her to me, stroking her damp, fuzzy head. Her nose and mouth were buried in my breasts, and I worried that she would suffocate, but Kavita and Shannon told me that she would be fine. They kept saying how good her color was and how big she was.⁷ Her one-minute and five-minute Apgar scores were seven and nine, respectively -- a strong, healthy baby!

After a little while, Kavita and Shannon reminded me that I still needed to deliver the placenta. I told them that I didn't think I could do any more pushing, but even as I was saying those words, one last contraction welled up, and I was able to painlessly push out the placenta, along with yet more blood. (The placenta is now frozen solid in a bag in our freezer. I've promised Alex that I'll bury it in the back yard and plant flowers or something over it at some point.) Kavita squeezed the umbilical cord a few times to get the last of the blood in it to Sylvia, then clamped the cord and asked Alex if he wanted to cut it. He emphatically declined, and so Kavita cut the cord.

I held Sylvia for a while longer, then gave her to Alex, who took his shirt off so that he could have skin-to-skin contact with her, too. Although holding her myself for the first time had been indescribably great, looking at Alex holding her was somehow even more emotional for me. She was taking quick, shallow breaths, and Kavita suctioned mucus from her nose and mouth with a bulb syringe a couple times, but for the most part, she seemed extraordinarily healthy and vital, even making a valiant effort to hold up her head (which most newborns don't do for some time). A bit later, I breastfed her for the first time -- another amazing feeling. Shannon fussed over me, tucking a pillow under my elbow so that I could relax my arm while feeding her. Shannon was concerned that she wouldn't nurse if I wasn't relaxed, but I've found that she nurses quite enthusiastically whether I'm relaxed or not! While we nursed, Shannon gave Sylvia her first shot, a vitamin K injection in her thigh, and she didn't even flinch.

Kavita and Shannon stayed for several more hours, taking care of me⁸, measuring and weighing Sylvia, making notes for their records, and cleaning everything up.⁹ I took a shower; Alex gave Sylvia her first diaper; we all had something to eat. Eventually, Kavita and Shannon packed up and left, and Alex, Sylvia and I settled into bed for our first night as a family of three.

Welcome, Sylvia! I'm so glad that I got to bring you into the world in this way, the way I had wanted, and I'm excited for us to get to know you in the months and years that lie ahead.