A quiet, gentle birth

Ana in bed with her baby

Ana's Birth Story

Around 5pm, I started contracting. Around six my water broke and by eight I was ready to push. The midwives came shortly after and guided me through a beautiful, gentle birth. The three of them surrounded me, but kept so quiet that sometimes I didn’t feel their presence at all.

The lights were low and the atmosphere intimate. I remember wishing to relieve the pressure I was feeling. I was so focused on the task that I hardly gave thought to the baby’s arrival. In fact whenever the midwives tried to bring my attention to the baby, I focused back on the pressure. The midwives were giving me verbal cues that reminded me of my body’s capabilities. They reassured me that what I was going through was natural and expected.

After 3.5 hours of pushing hard and strong, out came a whole human—a jiggly baby that super-manned into my arms. How magical and surreal! I saw it was a little baby girl, which was a surprise. My husband had such deep conviction that it was going to be a boy that he had persuaded me.

The feeling of her passing through my belly and coming into my arms was the most satisfying, fulfilling physical sensation of my life. I wasn’t instantly in love as I have heard some women describe their reaction to seeing the baby for the first time. I was in awe. My love grew with time.

In the first 3 days I couldn’t get enough of her. I kept her jiggly little body in my arms and on my breasts and tummy as long as I possibly could. I didn’t want to miss a thing. I lamented each passing minute because I was in bliss and I wanted it to last. At 6 days, I already missed those first few moments. I just wanted to stay suspended in time.

I’m grateful to my mom who gave me the opportunity to enjoy my baby girl without any household responsibilities. She allowed Eric and me to bond with our new baby. I also feel grateful to the midwives and Eric who did a wonderful job supporting me through the birth and first few days of Maritza’s life.

St Luke's Women Center moves to new building

CPMC's new Mission Bernal Campus has bigger, more comfortable, and safer rooms for birth

Labor and delivery room at the new Mission Bernal Campus - check out the views!

Labor and delivery room at the new Mission Bernal Campus - check out the views!

I’ll focus on the nuts and bolts of the new labor and delivery unit, which I toured along with a group of doulas and midwives before it opened.

Hannah Epstein, the lead midwife for the St Luke's Women Center, organized and led the tour. She says the new building won’t change the care - it’s just moving to a lovelier environment. In addition to looking nicer for patients, she emphasizes that the majority of the improvements are meant to streamline operations for the providers. Instead of wires literally underfoot in the operating and delivery rooms, cords run from the ceiling and the medical equipment is organized for a smoother workflow.

It’s also substantially more secure, with locking doors that patients and families will have to get buzzed into. But Hannah says that if your baby is coming very fast it’s okay to go straight through the doors and trigger the alarm - that will alert the staff to attend to you right away!

The new unit is twice of the size of the old, with 6 labor and delivery rooms, 16 postpartum rooms, and 2 operating rooms. There is also a 4 bed nursery. All of the birth rooms have large tubs for laboring in (not birthing, I’m assuming) and nitrous oxide for pain relief. They also have sleeper sofas which are slightly bigger and more comfy than the old. All the rooms had big windows and great views.

The tubs are more roomy than most hospital tubs although they aren’t meant for birthing in

The tubs are more roomy than most hospital tubs although they aren’t meant for birthing in

There are 4 triage rooms, which will do double duty as antepartum testing rooms until eventually that function is moved to the Hartzell building. They will also be called on as needed for early inductions.

The main entrance to the building on Cesar Chavez will be locked after 7pm, and everyone in labor, regardless of the time, is encouraged to use the ER entrance on 27th St off Guerrero. There will be a pull in spot on the street where you can leave your car, drop your keys with security and go up to Labor and Delivery on the 7th floor. Once the laboring person is settled, someone can come down and move the car into the Duncan garage, which also have two dedicated OB spots closer to the entrance.

The heightened security of the new unit comes with a few downsides - only nurses have access to the kitchen for example (where there is a fridge for patient food). Also, if you want to stair-walk in labor, there is no way to get back into the unit after you’ve been badged onto the stairs, so the only option is to walk all the way down to the first floor and take the elevator back up.

The new cafeteria will be open from 6:30am - 6:30pm with the same food but in a nicer space. Eventually, the current hospital building will be razed to make way for outdoor garden space and there will be a conference room available to rent. Other amenities include a meditation room open 24/7, a family waiting room and play area outside of the locked unit, and a lactation and breastfeeding room.

This is a typical postpartum room - same views, much smaller. The loveseat pulls out to a bed.

This is a typical postpartum room - same views, much smaller. The loveseat pulls out to a bed.

Although Hannah hopes that the care won’t change, Sutter does want the new unit to increase their volume to 120-150 births per month. There will still be one midwife and one doctor on duty around the clock, just like now. Currently St Luke’s only has one full time lactation consultant, which results in spotty coverage, although Hannah says that she would like to hire more as the volume increases.

There is also the possibility that other medical practices will have privileges at the hospital, and that there could be some shared call in the future. That means that St Luke’s Women’s Center patients could potentially end up with a doctor from another practice managing their birth.

My colleague Firen Jones already wrote a great blog post on the care and policies at the old unit. Ultimately, those factors are more important than the physical building - but the new space is an upgrade that will definitely feel nicer and positively impact family's birth experience.

Already the World - Victoria Redel

I’ve loved Victoria Redel’s poetry since I stumbled across her first book of poems for a dollar in the basement of a Saint Paul discount book store. Look at her, coolly facing down the reader in a leather jacket on the back cover - how could I not take her home?

I bought this book in my early twenties, before the idea of becoming a midwife had implanted itself into my consciousness. How satisfying, then, to revisit these poems after years of walking with families through pregnancy, birth and the postpartum wonderment of suddenly cohabiting with an almost alien being.

VictoriaRedel

Redel captures those moments so well - the loss of sovereignty as the pregnancy takes root and can sometimes seem to take over, the bittersweet of the last few weeks as the first separation approaches, and the desperate patience parenting demands.

***

Third Month

At first you were in the mouth,
nausea uncalmable.
Or you were the hard stools of constipation.
At night rocked
over to sleep at a child’s hour,
I slept with pillows layered
to ease my swollen breasts.
In books they claimed you were
no bigger than a fingernail,
but I could feel you, gargantuan,
settling in my body, assuming
what you needed to live,
risking everything
even if it meant risking
mother love.

 

Ninth Month

Already you are moving down.

Already your floating head
engaged in the inlet
from where you will head out.

Already the world, the world.

And you are slipping
down, away from my heart.

 

Psalm

All night pacing.
The baby hanging off my tit.
He has been at it for hours.
Four to be exact.
My one with eyes open
cannot cast himself
out into his blue sleep.
In the darkness singing,
in the darkness singing,
my off-pitched voice
trying every note
to save us both.

Birth is like jazz - Elizabeth Alexander

In honor of Black Maternal Health Week, here's a birth poem by Elizabeth Alexander. I delved into her poetry after reading her beautiful memoir about the death of her husband, The Light of the World.  

Neonatology

Giving birth is like jazz, something from silence,
then all of it. Long, elegant boats,
blood-boiling sunshine, human cargo,
a handmade kite —

                            Postpartum.
No longer a celebrity, pregnant lady, expectant.
It has happened; you are here,
each dram you drain a step away
from flushed and floating, lush and curled.
Now you are the pink one, the movie star.
It has happened. You are here,

and you sing, mewl, holler, peep,
swallow the light and bubble it back,
shine, contain multitudes, gleam. You

are the new one, the movie star,
and birth is like jazz,
from silence and blood, silence
then everything,

jazz.

Letter to Malakai

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Hi little one.  Its me your auntie Erin.  I am writing my perspective of your arrival here into this world.  

I had been on-call to fly down to Oakland from Orcas Island since the middle of November.  Your momma thought you would come early so by the time her due date of Thanksgiving came and went, we were all very eager for your birthday!  Your momma and I talked on the phone every day.  She was loving her last days of being pregnant with you, what she called "the in-between time".  On December 1st, the midwives checked her and her cervix was 3cm dilated,  almost fully "effaced" and she had had a few contractions that woke her in the night.  So we made the decision that I would fly down the next day.  December 2-5 were sweet, sunny days, long, full super-moon nights.   It was like being on vacation, enjoying this sweet time with my best friend before she would become a mom.

One day, we got kimchi, persimmons and mandarin oranges from an old hippie selling his goods from a trailer on the way to a beautiful hike in Tennessee Valley to an incredible black sand beach where we spent the afternoon laying in the sunshine, laughing, sharing memories and dreaming about the future.  Another day, we ate Burmese take out, hiked in the Berkeley Hills, walked to the Essex tub house where we lazed around naked under the redwoods. I gave your mom lots of massage with clary sage oil, we got acupuncture together, your mom knitted, your dad tried to work remotely and we all enjoyed a sense of timelessness and being in the mystery, knowing you would be born any day but not knowing when.

We were sure the full moon would pull you earthside so when that passed, your momma was ready to help nudge the birth process gently.  She had several periods of having mild contractions over the past week but nothing that progressed in time or intensity.  Tuesday she took a cocktail of lemon verbena and castor oil twice and used a breast pump to get things started and waves of contractions came but then left.  You were still not ready.  The next day, Wednesday, your momma took more castor oil and her midwife Ellen came over and swept her membranes, feeling the cervix was even more ready.  She said there was a 99.9% chance you'd be born that day or the next. 

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I went to a yoga class and came back to your parents sweet apartment around 2pm.  Your mamma was in the bedroom having mild but consistent contractions that were coming every 4 min. but would lessen if she interacted with anyone.  She wanted to be alone.  Your papa was quietly working on his computer in the living room.  Around 2:30 your mom and I left for a walk to see if things might progress.  They sure did!  We were walking around the neighborhood and contractions started coming on stronger and stronger.  Every few minutes your mom would lean into me, we embraced and swayed as I rubbed her low back and she moaned.  A man passed us walking his dog, another man got into his work truck, and life continued on in a dreamy, surreal way around us as it became clear we needed to make our way back to where your mom wanted to be to give birth to you.  Castor oil, however, does a number on the bowels and suddenly we needed a bathroom asap.  I saw a portapotty in a front yard of a house that was being remodeled.  I ran inside to ask the carpenters in Spanish if we could use the bathroom and barely waited for their nod before running outside to help your mom onto the toilet.  Inside that green plastic porta potty, there was a moment of truth (and some fear); this labor was really finally happening and happening fast and strong and there was a gush of fluids.  We needed to get back to apartment 2 blocks, 1 big intersection and 4 flights of stairs away.  One step at a time, stopping on the sidewalk for contractions, we finally made it back to the apartment building on Telegraph Ave and up the stairs to your parents home by around 3:15pm.

As soon as we entered the door I told your papa to call the midwives and get the birth tub set up.  Daniel sprung to action.  Rebecca went straight to the bedroom and I followed.    The next moments felt hectic and wild as we all adjusted to what we'd all been waiting so many days for.  A text went out to close friends and family, the midwives and Laura, your moms therapist, were called and the tub was getting inflated in the living room.  I supported your momma as she surrendered to increasingly stronger waves of sensation in her body.  Intense waves of nausea pulsed through your momma and I was baptized with her purges.  Within a half hour Renee the midwife arrived and found us in the bedroom getting through one moment at a time.  We moved into the bathroom and the golden light of winter's sunset glowed through the window above your mamma's head as she sat on the toilet.  The day was turning to night.  More purging on the toilet thanks to the castor oil and we all become hypervigilent about hydrating your mom from here on out.  

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Your momma wanted to be in warm water but the birth tub wasn't filled yet so I filled up the bathtub in the bathroom.  She labored in the tub for quite awhile.  She moaned and surrendered through each intense wave.  In between waves, she shared her fears with us about how chaotic it all felt, how intense it was.  We reminded her to let her body go into total relaxation in between the contractions.  I sang to her, "You are opening up in sweet surrender to the luminous love light of the One, you are opening, you are opening..."

At some point Laura, your mom's therapist, arrived to provide a sweet, peaceful presence.  Your papa turned on beautiful music that felt timeless and sacred.  I lit candles around the apartment, burned white sage and we thawed soup in preparation for after the birth.  I could tell this labor was happening fast and that you would be born that night.  

Your mom, however, was feeling lost in the intensity of it all and we reminded her constantly of her strength and helped her stay in the moment.  We let her complain and curse, a few times she exclaimed, "oh heavens" which I thought was old fashioned and endearing.  Your papa reminded her of how much he loved her.  

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The next phase of labor was a moving constellation between trying the big birth tub in the living room for 10-15 minutes (which your mom didn't like), being on the toilet, and on the bed in the bedroom.  The midwife Ellen arrived.  At one point all 6 of us were crammed in the little bathroom while your momma labored on the toilet.  The midwives regularly checked your heartbeat and we could hear your strong heartbeat throughout the birth.  We kept your mom hydrated, we fanned her, we kissed her and we moaned with her.  Although she was the only feeling her body open to the universal energy of birth and it was the scariest and most painful thing she'd ever experienced, she was not alone.  She was naked except for the necklace of beads given to her by her dearest girlfriends at her Mother Blessing ceremony and at one moment she clutched the necklace saying, "help me".  She prayed to God, she remembered her ancestors and all the women who had given birth before her.  She was healing her own birth trauma.  She was connecting to you moving through her bones.  I believe because she was so fully surrendering, she dilated so quickly.  And it was scary for her.  She had moments of doubt and of feeling so out of control but each time she felt that, we brought her back and reminded her of her strength and her power.  

She asked Renee to check her dilation because if she wasn't very dilated she was threatening to go to the hospital.  I was sure this wasn't the case.  We moved from the bathroom to the bedroom where after checking Renee announced there was no more cervix, she was fully dilated and there was a bulging bag of waters still cushioning your head.  This was around 5:30pm.  Rebecca began to feel urges to bear down and we moved back to the bathroom where sitting on the toilet felt most comfortable and where opening up to bear down felt easiest.  Each contraction now was your mom pulling me into her arms, tapping her hand against my back and groaning like a momma bear.  I could feel her entire belly surge up and then down against my own belly which had done the same thing 2.5 years ago when I birthed my baby Matia.  I felt merged with your momma in these moments, allowing her all my loving power as another woman who had done this before.  I had total faith in her power and in her body and in you.  A few times between pushes, she said, "I cant believe how powerful my body is!" Everyone in the tiny bathroom was present to her primal power.  Your papa cheered her on with each push.  Between contractions, she would let go into a deep trance of exhaustion and altered consciousness.  She reached her fingers in to feel your head at one point, yes she could actually feel you coming down the birth canal.  At some point,  there was a "pop" as the bag of waters finally broke.  Because your birth was so fast, the order of what happened when is a blur to some degree.  

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We all moved into the bedroom since your mom didn't want to give birth to you on the toilet:)  The room was aglow in candlelight, that same ancient music floated through the apartment and there was a sacred stillness between each series of pushes.  Your momma could feel your head moving down and out, your papa watched in awe as your head began to be visible.  Your mom got onto all fours and I stayed by her head to cheer her on while everyone else watched your head slowly emerge.  Your head finally emerged, chubby cheeks and all and your whole body came into this world at 7:37pm on December 6, 2017.  Your papa was crying as he helped bring you onto your mamma's belly.  Your papa whispered a secret blessing into your ear.  The lights were turned on so the midwives could see.  You were perfect.  You sputtered a few squeaky cries as your momma held you and your parents welcomed you.  

The next 5 hours were spent taking care of you and your momma.  I made food for your parents; congee, black sesame paste, mung beans, kale, warms teas. You found your mommas nipples to suckle on.  You stayed skin to skin with your momma and your papa.  Your placenta came out and you got to stay attached to it for awhile.  Lots of photos were taken and your extended family was notified of the wonderful news of your arrival.  The midwives cared for your momma while the support team cleaned up.  Your parents were busy falling in love with every little part of you.  

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I hope one day you'll know how blessed your birth was.  To be born in the comfort of a home, to be welcomed in such a holy way by such loving parents who were so fully loved and supported by their intimate, chosen birth team.  Your mom fully empowered.  No interventions.  May this way you came into the world imprint upon you love, trust, safety, and life long bonding with your parents.  May you know in your cells that you entered this world in love.

I hope to know you and witness you and love you for a long, long time.  Your momma is like the sister I never had, so that makes you like a nephew to me.  I love you and your parents very much.