Editor’s note: This article first appeared in The Birthkit, Number 32, Winter 2002.
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There is a strange feeling of acting out a story that has already been written as I begin to rub Karolynn’s feet. I am telling her about my dream in which she was in labor. In the dream, I was rubbing her feet and telling her how we all have such great faith in her strength and ability to do whatever she has to do. Karolynn has her midwife, Robin, with her, as well as the midwife’s assistant, Marie, and her good friends Kathy and Patricia. Her 6-year-old son, Devan, and his father, Gary, have made themselves scarce.
As it turned out, that was a warmup round. True labor did not begin for several more days. The baby was believed to be of good size, and Karolynn was a few days past her expected delivery date and getting increasingly uncomfortable. I called to check in on her frequently and invited my family over for a potluck dinner. This is not the way Karolynn and I usually relate to one another. We don’t just invite ourselves over. But now, here I am, she is going into labor, and somehow it all feels as inevitable as water swirling down the drain.
By the time everyone is fed, it is obvious tonight’s the night. Marie asks me to stay until Robin can come. I ask Karolynn, and she says it’s OK. Karolynn has begun to moan a little with each contraction. As one ends, she says, “Shouldn’t I be in the tub or something?”
“Anytime you want,” we say, but we can’t get her to stop putting her kitchen in order.
Marie asks me to time a few contractions. “Better call Robin and tell her the contractions are still less than a minute long, but only a few minutes apart and getting closer, and she wants to get in the tub.”
Marie calls everyone—Robin, Kathy, Patricia. They arrive quickly. “I’m glad you’re here,” Robin says to me. “I’m pretty psychically closed down, but I dreamt two times you were at this birth.”
At last, Karolynn leaves the kitchen and goes upstairs to the portable birthing pool. Gary has convinced Devan to take a bath, so we’re all upstairs. Karolynn gets into the pool. Looking a little uncomfortable, Gary follows Robin and Karolynn’s suggestion to get in. too. Devan’s already in, gleefully paddling around. Karolynn is disappointed that the water doesn’t make the pain go away. We keep reassuring her that it feels intense because her labor is moving along so well. Robin encourages Karolynn to look at Gary, to let him take some of the pain. At some point he begins stroking her arm between contractions. He stops and she says, “Don’t stop.”
It is beautiful to see them connecting. She squeezes his hand hard. Soon Gary is behind her, holding both her hands as she leans against him. Devan stops paddling about and touches his mother tenderly. Karolynn says she feels too hot. We get a bowl of cool water with ice and two small towels. Between contractions I pat her forehead with a cool towel and then lay it over her shoulders. When the contraction ends, I change the towels. Marie adds cool water to the tub. Devan gets out, is dried off and falls asleep. Fetal heart tones are taken periodically and are good.
Karolynn begins to say she is too tired. It’s too hard. She can’t do this. In the past I’ve wondered how I would react to statements like these. Would I believe the woman? Would I doubt her ability to do it? I don’t. I’m excited—she’s really moving along. She’s doing it. “You are doing it,” we tell her.
“How much longer will this go on?” she asks Robin.
“I don’t know. Until the baby gets here.”
Karolynn sighs and returns to the work at hand. As she moves toward pushing, Karolynn continues to lose confidence. Her sounds move from moans to screams. Wanting her to stay open and direct the energy down, we remind her to keep the sounds low, like a cow. “Do it with me,” she says to everyone. Immediately, a moaning chorus fills the room.
Robin tells Karolynn to try bearing down a little with a contraction to see if it feels better. She’s pushing, but having a lot of fear. Robin reminds her to keep her chin down.
Good. She’s doing it. Between contractions I remind her to breathe. I feel a funny pop under my hand.“I think the water just broke,” I tell Robin.
Someone shines a flashlight on the water. “What’s that?” A little vernix. Everything’s clear. “Good.”
Heart tones again. Just fine. Wake up Devan so he can see his little brother or sister being born. He’s sleeping heavily. Patricia holds him up near the tub. More pushing. A head. “Put your hand there,” Robin tells Karolynn. “That’s right. Feel your baby?” The head is born.
“Oh, my God. It’s a baby!” It sounds as if Karolynn just remembered there was a reason for what she was going through. She is laughing and crying. We laugh with her—a joyous moment. “There’s no cord,” Robin says.
It’s okay for Karolynn to push her baby out. But the shoulders don’t come. “Out of the water,” Robin directs. “Time. Somebody write down the time. I want oxygen on this baby!”
Marie notes the time, 11:42, as she brings the oxygen. Gary supports Karolynn. I lift her legs, one at a time, over the edge of the tub. Karolynn is on the carpet now, on her hands and knees. Robin is at the baby’s head. She directs me to push on Karolynn’s belly, right above the pubic bone. I remember this from the reading I did to get certified as a childbirth educator. Suprapubic pressure. You press on the baby’s shoulder to get it to move under the mother’s pubic bone so that the birth can continue. I straddle Karolynn, lean over, wrap my arms around her belly and feel for the baby’s shoulder, right above the pubic bone. “I feel it,” I say and press up against it.
Robin is at the baby’s head, but you can’t pull on a baby’s head without causing irreparable spinal damage. Gloves on, she reaches inside Karolynn, trying to reach the baby’s armpit, a shoulder, something she can safely use to help the baby make this passage.
Everyone is exhorting Karolynn to push her baby out. She pushes. I press. Robin maneuvers. Marie’s got oxygen on the baby. But the baby still won’t come. I start to doubt that I’ve got the right spot and ask Robin to put my hands where she wants me to press. I’m getting tired and stand partway up to shake my hands out. Kathy tries to take my place but doesn’t know what to feel for. I get back in position. Karolynn is starting to collapse. “Stay with us,” Robin urges. “Don’t sit on your baby.”
My back and thighs are screaming. My fingers feel like they’re giving out. “Is there another position?” I ask Robin.
“This is it,” she says. “Press harder.”
Press harder? This is my friend. I don’t want to hurt her. But how much more is it going to hurt with a dead baby?
“You have got to get this baby out,” I tell Robin. Later, she tells me that at this point she tried unsuccessfully to break the baby’s collarbone.
I’m pressing so hard I feel some weight lift off Karolynn’s knees. The shoulder just won’t budge! I finally realize that this is not a one-shot maneuver. You keep going until it either works or someone more qualified relieves you, or you are too exhausted to continue. Right now, that level of exhaustion begins to look possible.
A new level of determination rises in me. I will not be the weak link in the chain. “Amma,” I pray. “Give me strength.” Somehow, some part of it is out loud.
“Hail Mary,” Robin begins.
Marie calls on Sai Baba. Kathy’s chanting something Hindu. Later, I hear that Patricia was bowing to the East. If it weren’t deadly serious it would be comical.
Each time I lean forward my shirt, baggy and soaking wet from when I was leaning over the pool, gets in the way. Finally, I take it off and continue pressing on Karolynn’s belly. I feel Karolynn pushing my hands away and tell Robin about it. She speaks sharply. “Quit pushing her hands away, Karolynn.”
Somehow my world has narrowed to include just Robin and the small section of Karolynn’s back directly in front of me. Karolynn continues to push while I press and Robin maneuvers. Marie’s still got oxygen on the baby. I feel Karolynn closing her knees every time she pushes and again tell Robin. Robin has become my link to the rest of the world, including Karolynn herself.
“Karolynn, get your knees apart!” Abruptly Robin pushes her knees out. “I’ve got a shoulder,” Robin says.
Oh, thank God!
Keep pushing? Usually if you get one shoulder the other will naturally follow, but this one is stuck, too.
“I’ve got the other one.”
Still the baby won’t be born. I feel no movement under my hands. The hips are stuck, too!
“Aah!” The baby is finally out.
12:01. The longest 19 minutes on record.
Marie’s still got oxygen on the baby. Robin is doing infant CPR. She hands me the Doppler stethoscope and asks me to listen for the heart. I’m confused. I’ve never used one of those, and I want to feel for the brachial artery. I put the stethoscope on Marie so that she can find the heart tones. The heart is fine. Just breathe, baby!
Finally, a tentative breath. Talk to the baby. Massage his feet, his back.
“Feel the cord,” Robin says. “He was getting oxygen that whole time! The baby’s fine.” She slumps back. Relief.
What is the baby? Boy or girl?
“Nobody say anything and let Karolynn check,” Robin says firmly, and the whole room is quiet while Karolynn looks at her baby. I put my wet shirt back on.
“After all that, it’s a boy!” Karolynn sounds amused and disoriented. She had expected and hoped for a girl.
The baby still isn’t breathing easily. The DeLee, bring the DeLee.
“Talk to your baby, Gary, he responds to you!”
Robin uses the DeLee to suction the baby. He takes another breath. Gary lets out a war whoop of relief. Laughter erupts all around. Karolynn starts to faint. I feel myself start to lose focus and mentally shake myself—Karolynn’s fading, you can’t lose it, too! The placenta, I tell myself. It can be the most dangerous part for the mother. The placenta. We still have to do this.
Karolynn wakes up, murmuring, “I was playing with the baby….” Her voice sounds curiously childlike and amused, as though she can’t understand why we are all worried about her. Robin calls for some angelica and some pushing. She tries a little controlled traction. We remind Karolynn to let go of the pregnancy. More angelica. Nipple stimulation. More pushing. Lots of yelling at Karolynn to stay with us. Finally! The placenta.
Patricia cleans Karolynn up, and we get her into bed with her baby and a cold compress on her bottom. Thankfully, her bleeding is minimal, and incredibly, she did not tear. I bring her warm cereal and spoon it into her mouth. Then some chlorophyll with a straw. Patricia and I pass in the hall.
“It isn’t always like this, is it?” she asks, sounding pretty shaken. Her only child was delivered by cesarean.
“No,” I say, “it’s not always like this.” But I refuse to allow my mind to detail the many ways this birth was unlike the few others I’ve experienced. As I pass Robin in the hall, I tell her about Patricia.
“Don’t let anybody leave before I talk to them,” Robin says. “I’m just going to take a quick shower. We all need a debriefing.”
When she gets out of the shower, I say my goodbyes. But as I leave Karolynn’s house, the energy of life and death are still percolating through all of us.
The next day I hear the baby weighs 11 pounds—11 pounds! And Karolynn’s pelvis is anthropoid, a rectangular shape that makes it difficult to fit a larger-sized baby through. When none of the usual maneuvers for dealing with a stuck shoulder worked, Robin realized that not just one, but both of the baby’s shoulders were stuck behind Karolynn’s bones, a truly rare complication. Also, the baby had his arms pinned to his sides, leaving next to no room for Robin to reach his shoulders. Breaking the collarbone rarely works in a healthy baby, and this was certainly a very healthy baby boy. So Robin had to reach up inside Karolynn with both hands, pushing the baby’s arm with one hand until she could grasp it with the other hand and (blessings be) bring out his little arm. That left just a bit more room inside Karolynn so that Robin could coax the baby out.
As she explained this to me Robin grasped my arm tightly. “You can’t imagine how hard a uterus contracts,” she said, squeezing my arm till her own hands trembled. “It’s like this—it’s like a vise.”
Robin has consulted with friends in the medical community—an obstetrician and a pediatrician. They’ve confirmed for her that this unusually difficult birth was managed well. In some countries, they tell her, medical tradition would have chosen between the life of the mother and the life of the baby. With each piece of information, this baby’s birth seems more and more a miracle.
A craniosacral therapist spends several days working on the baby’s shoulder, collarbone, ribs, etc. Aside from a little bruising and stretching of the brachial nerves, he’s fine. Karolynn has a lot of healing work done during the first few weeks after the birth. She recovers well and never complains about her bruises. When I ask her if she would have preferred a cesarean delivery to this difficult birth, she is adamant, “Definitely not.”
This birth changed my perception of midwifery. I no longer feel that a midwife stands alone, responsible for two lives, and vulnerable in that responsibility. I experienced that when you place yourself in the service of life’s sacred passages, free will has a way of evaporating. On the night of Karolynn’s birth, I had the dizzying sensation of rising up enough to see a part of that web that midwives weave and are woven into as they support women and babies in birth. And although I’m back on the ground now, I’m still left with the feeling that the story has already been written. All that remains is for us to play our parts as best we can.
Editor’s Note: Some of the names in “Karolynn’s Birth Story” have been changed.