You know how they say, “Wear sunscreen? Well, let me be your cautionary person-writing-this-blog-post and say, up front, WEAR YOUR SUNSCREEN. On that note of “The more you know” (did you just hear the music?), let me also share that we need to watch our skin for more than just those changing moles we always hear about. Yesterday I had a Mohs procedure on a superficial basal cell
carcinoma on my face (yes, skin cancer). My only clue this was something that needed attention was the fact that, all summer, I had this spot on my nose that would scab up for a week or so, and then heal.  Scab, then heal. Scab, then heal. It was a shiny piece of flesh-colored skin that maybe looked a bit callused – no pigmentation, no mole appearance, just a regular area of skin that looked and
behaved a little differently. A visit to my dermatologist revealed it was problematic, and that leads us to the Mohs procedure.

In order to fully get the root of the tumor, a Mohs surgery can be lengthy.  The skin is numbed, the surgeon draws, and then they cut. They take that piece of tissue and essentially put a cross-hair on it,
mapped to match the area from where it was removed. This is examined to see if all the bad cells are gone (I never said I was an expert). If they see anything remaining on the sample, they know exactly where the offending tissue lies; my surgeon had to come back one more time in true, if-at-first-you-don’t-succeed fashion. There is a wait time of 30 minutes between each sample, which is why this isn’t generally an in-and-out procedure.  

After this was all taken care of, I expected my doctor would just swab some antibiotic ointment and slap a cutesy Band-Aid on and that would be it.  But I was wrong.  I actually had to go to a different part of the building. “I’ll meet you over there, “ my handsome, thirty-something, Mediterranean (Middle-Eastern? Spanish? Who knows) hunky doctor said. Then a nurse walked me through some doors, shoved some things into my arms, and said, “Go ahead and put your clothes in the bag.” Um, what? I am just getting
my nose bandaged!? What’s going on?

In the shock of suddenly realizing I needed to strip down, I couldn’t remember if the gown was to open in the front or the back. I tried it one way, spun it around, then twisted it back the first way.  Finally with it half on, fabric clenched in my hands to cover my behind, I stuck my head out to call, “Hey, what’s the story on the gown?  Open in the front or the back?”  The back, definitely the back.   

I continued with my booties and the ever-lovely surgical hair-net thing.  I was placed in a bed and my nurse brought me a warm blanket -- other accoutrements included an automatic blood pressure cuff, and a pulse ox on my right index finger.   My nurse sat and chatted with me for a bit, over such everyday topics as allergies to any drugs (none), was I supposed to take my bra off, because I did (there are so few places outside of one’s own home where I can do this, so why not?  But no, it was not required), and the fact that we both were breastfeeding mothers (can’t remember how that came up). 

I was actually wheeled, wheeled, I say! into the surgery (that sounds so Doc Martin, but unlike the European definition, this was the place in the surgery center where they do surgeries, not the office where docs do visits). When my doctor came in, I was kind enough to remind him that it had been a couple hours since last my nose was bee-stinged beyond feeling, so I would love some more drugs to numb that region. Here is the comment that started it all: “I think I have a pretty high pain tolerance, but I don’t want to feel this if I don’t have to.” His response was, “Oh, why do you think that?”  I shared I had 4 babies with no pain meds. He and the two nurses all gasped. Oh, I had one more coming, “And the last one was born at home.”  My nurse fainted to the floor.

Okay, not really. But I they were still abuzz with a lot of questions, that all sounded like “Why?” (Let me come down off my high-horse now.) “I wasn’t planning to have my first without pain meds.  In fact, I said, ‘I have seen women give birth naturally, I think it’s pretty crazy; I am totally getting an epidural.’  Well fast-forward to an unneeded induction, and I wasn’t able to get an epidural. My fear of throwing up won out over my fear of having a baby, so I somehow was able to give birth to my first baby without an epidural or narcotics. It took some time to work through mentally, but eventually, I was happy about
it.”

By this time in the surgery, my bed has been lifted up, the doctor has cleaned the left, upper quadrant of my face with iodine, my eyes stinging from the closeness of the fumes, and my face has been covered with a piece of paper with a circle cut out of it so only my nose is exposed.

I continued on…“With my second baby, I wondered what could birth be like if I actually planned to not use any medications?  I got a midwife who delivered in the hospital, and I waited to go into labor on my own. Third baby, the same.  Fourth baby, we moved here, there were no hospital-based midwives, so I found a licensed midwife who came to our home to help us have our baby there.”

“Why would someone choose to not have pain medications?  It is painful to have a baby!” he stated, with much authority (at this point, I did question how he knew this, had he ever experienced it?  To which
he conceded, no, but he had seen it a lot).  So I asked him this:  “Why would someone choose to climb Mt Everest?”

“That’s different,” came his reply, “I can understand that.  You want to see what you are able to
accomplish physically.  You are challenging your body, working toward a goal...”  My pulse-ox’d finger interrupted him, pressing, pressing on its imaginary quiz-show buzzer – or maybe it was my voice -- “DING DING DING! You got it!”

I couldn't see him because my face was covered, but his hands paused in their stitching.  “I…could see that,” he came around, slowly. The hands resumed their stitching.  “I am not sure what the big deal is about drug-free birth though.  There is so much pressure to have a natural birth, but we don’t have the
longitudal studies that show epidurals, or even c-sections, have life-long health risks.” On the spot, under the cover of plastic-y-paper, I couldn’t think of anything incredible to counter with.  I did cite that babies born via cesarean birth have higher levels of allergies, and that was about all I could think of.

I joined him, then, because I do feel it’s the truth, “There is a lot of pressure for women to go all natural, I see that. It is very similar to the pressure we put on women to breastfeed  -- ”  Okay, this is when he cut me off!  

“ – But those stats are there, we know breastfeeding is beneficial, we have that information.” Interesting! 
Super, hard-cord breastfeeding advocate, not so much on the normal birth platform! I decided, since I
couldn’t present any compelling evidence-based studies or data from Cochrane, I would just keep it simple and stick with his line of thinking. “We are humans, though, and we know as mammals, breastmilk is the optimal, species-specific diet for our newborns.” He agreed.  "Doesn’t it stand to reason, then, that
vaginal birth, as unhindered as possible, is the norm for us as well?  And even though we have the option for epidurals and cesarean births, that vaginal birth would provide the most optimal way for our babies to be born?” Honestly, I can’t remember what he said after that, only I know he wasn’t trying to refute anything.

The cover was lifted off my face and it was time for the nurses to step in and dress my wound.  As he stepped back to let them take over, he asked, “Are you a medical professional?”  I paused before my
answer, and then said, “No, I am a birth doula, a childbirth educator, and a La Leche League Leader.” He shook my hand, nodded his head to me, and then departed to fill out my discharge papers.

What fun!  It made all those 5 bee stings to the nose worth it. I can actually say, due to that conversation, I rather enjoyed my day at the dermatologist. The staff was incredible and attentive (and I am assured my scar will be minimal).  You never know where great birth conversations will happen! But the opportunity to have 20 minutes, one-on-one with a surgeon (albeit a derm surgeon), was pretty darn fun.

We decided to see Dr. James Jesse in San Bernardino, CA. It was a four hour drive for us, and to ease the stress of travel, Brad, Ezra, and I drove down the day before and stayed in a hotel.

During my Virtual Adventures in Tie-Land, I met a LLL Leader and IBCLC who lives about an hour south of me, Julie Huisjen.    She was the one who really planted the idea of visiting Dr. Jesse and seeking laser revision for the ULT and PTT, as opposed to scissors for the PTT alone. As much as I didn’t want to travel that far, I came to the realization that a trip to Dr. Jesse was the way to go. As a bonus, Julie asked if she could come and observe the procedure, and I was pleased for the opportunity to meet her and have additional support.

Julie was waiting for us when we arrived at the office, and although we just met, I was grateful for her presence. When Dr. Jesse came to our room he was friendly and up-beat. He examined Ezra and agreed that we could benefit from having the ties revised. He explained the procedure, answered questions, and was appreciative of Julie’s and my breastfeeding background.

I sat in the dental chair with Ezra’s head on my left shoulder. I held my arms over Ezra’s chest, thereby pinning his arms but allowing his feet freedom to kick. Dr. Jesse numbed Ezra’s mouth, and then we sat and chatted for a few minutes to allow the anesthetic to take effect. Dr. Jesse was very personable with a great sense of humor. We asked to video the procedure and Dr. Jesse welcomed it -- that way I could watch it later.

Two assistants helped, one holding Ezra’s head behind us, and another to the right of us who was holding the spit-sucker (I am sure there is a technical term for that!). Once started, the actual procedure took less than 5 minutes. Ezra cried and moved a lot, but I knew he was probably more bothered by the restraining of his head than the laser surgery happening in his mouth. There was a little blood to be blotted with gauze, and that was it! 

I sat up and looked at my fat-lipped baby as Dr. Jesse said, “From here on out things will get better.” I asked how soon I could nurse him, and smiling Dr. Jesse answered, “Moms like you nurse right away.” We tried, but Ezra’s numb mouth made latching difficult. I decided we would try again later. Dr. Jesse said babies cry for about 8 minutes post-revision, and then they are usually okay. We happened to have the appointment before lunch, and Dr. Jesse was kind enough to talk to us for another 30 or 40 minutes, generously sharing information, stories, and jokes.

We went to lunch and I nursed Ezra for the first time. I could already see a part of his upper lip turned out that I had never seen before – it wasn’t a huge flanging or anything, but it was something. I didn’t notice relief, though – if anything it felt a little tighter (read: worse).

Ezra was acting fine when we hit the road and headed for home. 30 minutes from home he began crying inconsolably. We stopped at Costco and I tried to nurse him in the car. He would attempt to latch, but then he acted like his mouth hurt (which I could believe!). I was worried about him not nursing, but they told me at the office he might not want to nurse too much in the first 24 hours, so it wasn’t a surprise. I decided at that point to give him Tylenol, we walked around Costco for about an hour, and then he settled down to nurse. I still couldn’t tell a difference in my pain level.

I gave him one more dose of Tylenol later that evening, and by the next afternoon, he seemed back to normal. Dr. Jesse’s office instructed us to stretch the upper lip and sweep under the tongue once every hour Ezra was awake. We went to a chiropractor the next day, and I have never seen Ezra so melty afterwards, if that’s a word.

Ezra’s “reflux” stopped almost overnight. He would still spit up, but it was nothing like it had been before. His clicking was mostly gone. That strange (cute) way he had of chewing up to latch on the nipple with a grimace on his face was gone, as was his way of sliding off the nipple while nursing. He seemed to be doing better, but I was still waiting…

Sometimes he didn’t mind the stretching, other times he hated it. One thing I figured out was to do the stretches as far away from a feeding session as I could, or we might have a hard time nursing afterwards. 

One week passed and although Ezra seemed happy, I wasn't noticing anything much more than not having to hold the breast for him every time he nursed. I am so grateful for Tongue Tie Babies Support Group, there I received realistic ideas about how things might shape up for us over time. Although some women note instant relief after their babies' revisions, it seemed to me for every one who had that experience, there were 4 women who said it took many weeks for full effect.  If I hadn't known that, I would have felt the surgery was a waste of time and money.  So I kept up with the exercises and tried to encourage wider and deeper latching.

Speaking of money, in my haste to get this done I didn't ask Dr. Jesse's office the price of the procedure or what my insurance might cover. As Ezra was a newborn, I hadn't thought to sign him up on our dental plan, which would have covered the surgery. I was surprised to have to pay out-of-pocket for the surgery -- it was $400. I was happy to do it (although I will be even happier if our medical insurance reimburses us some!).  Realistically, that is an affordable price for this procedure, in my opinion.   

Two weeks passed and I wasn't feeling better.  The nipple shape still showed some compression stripes after nursing.  Before the revision, it was more painful to nurse on the left side; after the revision, it was more painful on the right side.  This was not a miracle fix for me.  Again, I was uplifted by the stories of other mothers; I tried to be patient, continued with the stretches, and kept correcting shallow latch-attempts.

Around three weeks, I started to feel a shift.  One thing I have done since the very beginning with Ezra was talk him through our nursing sessions. Although this may seem silly, as in our family we already decided our dog is smarter than our baby (for now!), there is evidence that shows babies can learn when moms talk to them (parent–infant synchrony, or affect synchrony).  The left brain is the technical, watch-the-clock, math side, while the right is the emotional, easy-breezy side. It isn't really possible to get our babies to learn algebra or memorize a linear sequence of events, but it is possible for babies to absorb behaviors and coping strategies connected and displayed by their mothers or other caregivers. It's like a baby's first positive self-talk -- I let him know, not only with words but also with emotions and facial/body language, how we can improve our relationship.  It can't hurt, right?  I am not attributing our breastfeeding success entirely to this concept, but I feel it certainly can't hurt!

How this looks:  When Ezra would latch well, I would praise him and relax and smile.  If his latch needed adjustment, I would say something like, "Okay, let's try that again.  Open you mouth wider so it doesn't pinch." 

The most fun for talking and nursing was in a laid-back position while I was on my bed.  I would lie in bed and prop Ezra's upper half on my upper half, with his legs basically standing on the mattress. Babies have about 20 reflex responses that kick in when they are on their bellies as opposed to their backs, and one of these is called, aptly, "stepping."  As Ezra would step to get closer to the nipple, reaching it chin first and then latching over the nipple with his upper jaw, his upper lip would naturally be in an ideal position to flange open. We were also en face, ready to engage and exchange smiles, head bobs, and happy eyes. 

By four weeks (two days ago) I could safely say I believed we were cured.  So inappropriate in an essay, but I feel that statement deserves a smiley face.  This is where I go all Dorothy on you to figure out what I learned from my journey:

1. Find support.  It wasn't until I connected with the Facebook group that I found experienced, real-life helpers in my area.  Not only was this beneficial in assessing our situation, it also led me to the best practitioner for the job. If you haven't already met with an IBCLC experienced in ties, a group like Tongue Tie Babies Support would be a good place to ask for referrals in your area.

2. Get a second opinion -- and a third, and a fourth -- until you feel your gut agrees with what the professional is telling you. You have inner wisdom -- use it!  Everything we are told is filtered through someone else's perception and experience. The first idea to pop into one practitioner's head may not be the same thing to pop into another's. In healthcare, the difference between wrong and right can sometimes be a simple difference of opinion.

3. Don't judge a book by its cover.  And don't let your healthcare practitioner do the same.  This means, the appearance of the tie/s shouldn't be more important than how the tie/s affect breastfeeding for mom and/or baby. The first doctor we saw (who was also an IBCLC) said Ezra's tongue-tie did not look severe, but due to the clicking, sliding, and pain, warranted treatment.  If your practitioner doesn't value function over form, you may want to seek another opinion.

4. Continue to work with your baby patiently. It stands to reason the longer your baby has nursed with the tie/s, the more time he may need to get to a better place after revision. Resolution of the ties themselves is only the first part of the process; for continued progress, stretches help avoid reattachment that could come with normal healing. Your baby may also need to relearn how to breastfeed with this new and improved equipment, and that is where working with an experienced IBCLC can be integral, as well as getting bodywork done for your baby. I also chose to do tongue exercises with Ezra that are found in Breastfeeding Answers Made Simple: "Walking Back on the Tongue," and "Pushing the Tongue Down and Out."
   
5. Add your baby to your dental insurance. Or, be prepared ahead of time.  It may just be me who makes that mistake ever, but still, I wish someone would have reminded me of that 4 weeks and, oh, 3 days ago. :)

So in April I had a baby -- a sweet, gorgeous, pink little baby.  He is my fourth baby, fourth boy in fact -- and what a scrumptious, squishy baby he is.  I love him.  We named him Ezra.

Out in the world and on my chest, I soon began to see if he would nurse.  And he did.  Victoriously.  I was happy, and he was happy.  My midwife and I watched as his tongue passed his lower gum line and came out of his mouth, and we both hoorayed, "He's not tongue-tied!"  I have not previously had a baby who was tongue-tied, but my sister has, and it was a lot of trouble to get diagnosed and treated.

Fast forward to day three:  it's 10:00 at night.  I am perched at my computer, Ezra screaming on my lap as I watch how-to-latch videos through tearful eyes.  Each extra-pink nipple bears a horizontal stripe of raw, rubbed openness coupled with tiny scabs, and with every suck, I tighten and cringe and cry.  I hate this.  I label him.  He is a bad nurser. 

At this point in my life I have logged 11 years breastfeeding 3 different children.  I have been a peer-breastfeeding counselor for 10 years.  I have a pretty well-rounded knowledge of all-things-breastfeeding, both experiential and educational.  I have helped countless women in similar situations figure out how to better nurse to ease or eliminate pain.  And here I sit, alone at my computer, because he just can't do it right.  Because he is a bad nurser. 

Being new to the area, I don't have a clue who would be a good person to call for help.  I left an army of good friends and trusted resources -- IBCLCs, LLL Leaders, midwives, doulas, and nurses -- years in the making.  Okay, troubleshoot:  I try dragging the nipple down his face and over his nose.  I try teacup hold of the nipple.  I try the "flipple."  I try laid-back breastfeeding/biological nursing.  I keep my finger taut to the nipple to try and push/shove it further back into his mouth.  I try asymmetrical latch, symmetrical latch, sideways latch, and all-around-the-clock-face latch ("would you, could you in a tree?").  I even have my husband buy me a nipple shield and we try that (incidentally, that seemed to hurt even more, as Ezra couldn't latch to the shield so he would just chew my silicone-covered, damaged nipple).  Nothing works, for weeks.

I was still in great pain, but the physical damage to my nipples was not getting worse, and that made me
hopeful.  I found some Hydrogel Pads I had gotten as samples once, and they helped with the healing.  I figured out by latching him in football hold, nursing sessions became bearable.  We would also nurse lying down at night, turning on a small light to latch, stopping to make him try again when it was really, really painful (because it was never not painful).  I kept looking for answers for my bad nurser.

Aside from the pain I was dealing with, Ezra gained weight exponentially; at one stretch between weigh-ins, he gained 38 ounces in 21 days.  He did spit up a lot, like a lot A LOT -- overzealous amounts of milk, often flying out of his mouth in arching streams of stinky frothiness.  Keeping the nipple in his mouth was difficult, as it would constantly slide out unless I held my breast in place.  Once in a while when the nipple neared his lips, this disgusted look would appear on his face, as if I had presented him with something rotten and spoiled, and he would slowly chew his way up the nipple to latch.  And as he nursed, he clicked like a horse trotting on pavement.

Armed with a digital camera, I took pictures of this baby every day for sport -- ahh, the joys of the Digital Age!  When he was 3 weeks old I was scrolling through the latest batch, and suddenly, there it was:  Ezra was crying, eyes shut, mouth open, with a tongue that curled and cupped up.  Wait, I have seen that tongue before!  That's a posterior tongue-tie (PTT)!  Soon after birth I knew Ezra had a thick labial frenum (upper lip-tie, ULT), but I didn't feel this was the root of our pain; one of my other babies had one and it wasn't an issue, so I dismissed it without investigating the anatomy of his mouth any further.  Once I saw this picture and that light went on, I began searching online, I posted the picture on Facebook to an IBCLC friend, and my thoughts about this baby shifted:  Maybe he's not a bad nurser!?

I found Cathy Watson Genna's website incredibly helpful (http://www.cwgenna.com).  We had met a few years before when she was a keynote at our local breastfeeding conference, and I decided to share this picture with her.  She used the term "stingray tongue" to describe his posterior tongue-tie (PTT).  From her site I found a link to practitioners around the country who diagnose and treat tongue-ties.  I called to make an appointment at a clinic about 90 minutes away and was scheduled about 3 weeks out.

Although I have been working with breastfeeding moms for ten years, I had not heard the term "posterior tongue-tie" until about three years ago; even then, I had not helped a mom with a PTT -- it had all been hearing and reading others' experiences.  When we spoke of tongue-ties, we meant anterior tongue-ties, the obvious tethered (often heart-shaped) tongue, easy to spot, that could be clipped in a simple office procedure. While lip-ties I was familiar with, there still wasn't a lot of focus on it other than just getting babies to flange their lips out to latch.
 
By the time we met with the doctor (pediatrician and IBCLC), I was certain Ezra had an ULT, PTT, and high-arch palate; all three of my suspicions were confirmed.  This doctor agreed to fix (release or revise) the PTT but is not a believer in touching upper lip-ties.  By using scissors, a diamond-shaped cut under the tongue would give it more mobility and hopefully make breastfeeding better for us.  We had Ezra at home with a midwife, and as such, I chose to decline the Vitamin K shot.  This doctor wanted him to have that shot first as PTTs tend to bleed more than anterior TTs.  Ezra also had a cold with an impressive cough, so it was decided we would make an appointment to have the procedure done at a later date.  I left satisfied with the diagnosis and proposed treatment.

While waiting Ezra's cold out, I was hooked into an amazing network of parents and professionals who have experience, knowledge, resources, and often a unique understanding of all-things-tied-in-the-mouth:  Tongue Tie Babies Support Group on Facebook.  There I have learned not many professionals know how to identify ties (especially PTTs); not many professionals believe in correcting ties, especially in infants; not many professionals believe ties can interfere with feeding, speech, digestion, etc.  I have seen that many different kinds of professionals treat ties, from pediatricians to dentists to ENTs and GPs -- there isn't one kind of doctor who specializes in this area, it seems to be more about education and awareness than specific training that would come with a particular area of study.  While some doctors fix ties with scissors, others prefer to use lasers.  Some breastfeeding moms notice immediate relief and change, and others report it took weeks for things to feel better.

Having more information and more time to think, I began to second-guess taking Ezra back to the doctor we saw.  It had been brought to my attention by many people that Vitamin K, at this point, is most likely unnecessary because of his age.  And I learned I might have dismissed the role of Ezra's ULT a little too quickly; at the time I didn't think to ask about the Vitamin K and the ULT as I was a bit overwhelmed by my crying baby and the (unexpected, male, older) resident shadowing the doctor as she examined not only my baby, but also my breasts. 

I found a second choice, three and a half hours away, where the treatment is done with a laser; not only could we get the PTT taken care of, we could also have the ULT revised as this doctor (a dentist) does both.  I am not sure what to expect, but I am hopeful this is the right step for us...our appointment is next week. 

This is long!  Be warned!

I think when a person in is a position to serve a woman while she is in labor, that person should have required training every few years, like a recertification, on what it feels like to have a baby.  I am not certain how this certification could be obtained, virtual reality plus some sort of pregnancy suit? Actually having a baby? I haven’t figured out the logistics, but I have recently had a recertification of my own, and that is called, my fourth child.

This fourth pregnancy was a surprise.  Technically, I got pregnant at a time when no one would be able to get pregnant – only I guess more like I got pregnant at a time I felt I was highly, highly unlikely to get pregnant.  My last menstrual period was June 10th.  I did not get pregnant until July 13th at the earliest (a time when I was waiting for my period to start), to July 20-ish at the latest; looking at the date he was born now (April 6th), July 13th seems closer to the target date…we were on vacation.

I had lots of irritable contractions combined with irritable baby movements (probably more of the latter versus the former) that would happen around 10 pm to 1 am.  The week before labor began I pretty much experienced these every night and I hated them.  During these times, I would have waves of panic and anxiety about the reality of actually having to go through the birth process again, and I was always grateful when they were over and I could finally climb into bed.

Friday the 5th of April was pretty normal except I had two very serious bouts of grumpiness that made me feel deeply in touch with someone who was (hopefully!) going to start labor soon -- it was like total,
irrational, not-triggered-by-much anger that switched on so fast, I knew it was something else with some other root than just me being moody. 

We had pizza for dinner, and like I had for the last week, I restrained myself from eating too much (“If labor starts tonight I don’t want to be too full,” was my rationale).  I had two pieces and then cut myself
off. I took a little nap in bed, which I hoped would actually be “going to bed,” but I woke up at about midnight when I couldn’t ignore the antics of Wild Baby any longer.  I watched TV a little and sat on the ball to try and bounce my guy into a calmer state.  At 1 am I decided to watch the last episode of Mad Men on Netflix so I would be ready for the new season, with the intention of going to bed after that.

At 2 am, just when I was settling into sleep, I realized I was contracting, and these contractions felt different.  They came 5-6 minutes apart, were totally manageable, and lasted about 40 seconds. I tried to sleep, but I was also mindful of needing to recognize true labor so I could get my sister and my mom on the road from two and a half hours away if this really were it.  

Everyone was asleep, and as long as I was okay, I felt no need to wake them.  I was feeling hungry, so I ate half a lemon Chobani (again, not wanting to eat a lot) in the morning quiet. I did call my sister at 3 am to let her know it was go-time.  I labored longer, in the quiet of my living room, tending to small errands and tasks between contractions.  At 4 am I woke Brad up to tell him I was in labor.  He came out to the living room and asked, “What can I do?” and I immediately answered, “Take the recycling out, it’s driving me crazy and I have contemplated doing it myself for the last 2 hours.”  I was hoping he would just lie back down on the couch and snooze a little, but he was up and ready to go.

I thought I would wait to call my midwife until 5 am, but at 4:30 my contractions began to get stronger and longer and closer together, just as they should, and I finally had some show. I phoned Linda to let her know I was in labor.  She asked me a few questions, and then said she would be over soon.  She lives about 40 minutes from us. 

At 6 am, Linda arrived, and things were beginning to feel real.  We had our tub set up in the dining room and I was feeling a pull to climb in, but I didn’t want to stall labor if I wasn’t that far along.  I asked Linda to check me and she said I was 3 centimeters (“Not quite active labor!” I thought with a little disappointment), about 90% effaced, baby maybe at -2 station?  I can’t remember that part.  I mentioned I wanted to get in the tub, but I should probably try the shower instead (so gravity could keep helping my labor), and Linda agreed. 

I got in the shower, and I really don’t know how long I was in there.  The water felt great on my belly and during contractions I would swing from side to side so the water could fan over me.  In between contractions I alternated putting my foot up on the side of the shower to lunge, in case my baby was posterior like his two brothers before him.  Soon I found I had to vocalize during the contractions.  I was in the bathroom alone and I had a lot of time to think. The thought that kept coming back to me was, “All is as it should be,” which was part of a prayer Brad had said earlier in the week when I was feeling really overcome with fear.  I rubbed my belly and talked to the baby and told him to hurry, it all felt like it was happening in slow motion.

When I got out of the shower it was about 7 am and Linda checked me again.  I was 5 centimeters.  I went straight for the tub at that point, dropped my towel, and climbed in.

Jacob and Jonas were awake and had been for a while.  Soon Isaac woke up and came straggling out of his bedroom in his standard sleeping attire – undies and a t-shirt.  Brad told him we had company and he might want to put clothes on.  Before Isaac woke up I remember Brad asking Jonas if he knew why Linda was at our house so early?  Jonas admitted he didn’t, and we made a joke about Linda just coming for an early-morning visit.  Brad then said, “Your mom is going to have the baby today.”

I looked to the tub for the relief it had brought in the past; with both Isaac and Jonas I got into the Jacuzzi tub at 5ish centimeters and after an hour was at 9ish centimeters, and I was hoping for the same, with the addition of having the baby in the water. After 30 or 40 minutes it seemed the tub wasn’t going to work as I had planned.  I had intense pain in my lower abdomen to the point of not being able to sit in a relaxing position, so the whole time I was in the water I had to be on my hands and knees, and I didn’t want to stay that way much longer.  Also, Brad started making pancakes in the kitchen.

At about 7:45 my mom, sister Shiela, and her two boys arrived.  I headed to my bedroom, finished with the tub.  Linda had set things up around the pool in preparation of a water birth, so some rearranging was in order, moving things to my room, getting equipment ready if needed.  Once in my room it was just Linda, my mom, Shiela, and I.  Brad had the boys going with pancakes and if they were making any noise, I sure didn’t hear it.

I asked someone to bring the piano bench into my room as I was laboring standing up, and I wanted to continue to lunge in case I had a malpositioned baby (which I don’t think he was, but I was a little gun
shy).

I think I had Linda check me again, and I think I was 7 centimeters?  I am not really clear on this part.  I wasn’t ready to sit down, so I continued to labor standing up. Shiela was a super doula – she would squeeze my hips during my contractions, and it brought so much relief!  One thing I know about that double-hip squeeze is, it is hard to do when you have to press your arms together at the height of a woman’s hips – you get tired fast, and the laboring woman usually doesn’t want you to stop.  If the
mom can get on her hands and knees on the floor, you can squeeze her hips with your own inner knees by straddling over her back, but I didn’t even want to try or offer that as I didn’t feel good in that position. 
Over and over, a contraction would come, and I would tell Shiela, “Hips, hips, hips,” and she would start
squeezing.

In reality I have no idea what kind of time span this all happened in, I say over and over, but maybe it was only about 5 contractions?  Or maybe it was 10?  

I did finally sit on the bed for a bit. I remember taking my watch off and handing it to Shiela with the feeling that this was taking too long. I know for a fact I wasn’t looking at my watch or paying attention to how long it was taking in a linear fashion, but it was more some sort of symbolic resignation that I
would try to just flow with the timetable my body and baby presented even though I am as impatient as they come; in the last picture of me with my watch on, I see the time is 8:55 am.

I decided to visit the toilet.  I spent a couple of contractions there, and Shiela was with me. She said my noises changed and she knew I was getting closer.  As I sat laboring on the toilet, I opened the shower door next to me and contemplated getting back in -- I was looking for anything to comfort me at this point.  Then I decided to see if I could feel anything inside of me, so with one finger about one knuckle in I was shocked to find something!  “Is that a head?” I asked.  But then I realized it was a bulging bag of water, with a head behind it.  After all the years of hearing practitioners say, “I feel a bulging bag of water” (which I did remember Linda saying when she checked me last), I finally knew what that felt like and what it meant.  I think I almost gingerly hopped off the toilet at that point, feeling remotivated.

I had one contraction standing up, with Shiela at my hips.  Then I had another, and my water exploded all over the floor.  There was a little meconium but Linda said it looked old and there was no reason for concern.  I finally climbed into bed.

At this point I knew it would soon be time to push.  I suddenly had the need for Brad to come and be with me, so I called to him and patted the side of the bed next to me, I just wanted him to sit with me and be near. Shiela was on the other side of me, and Linda was at the foot of the bed.  My mom was by the door, ready with the camera, and the boys were in the living room playing Legos (again, I never heard anything from the boys, and there were 5 of them.  Actually, I think after they ate pancakes they walked to the park with the dog to play for a bit. But I do know when the baby was born, they were playing Legos in the living room).

I did begin pushing at some point, and Linda said I still had a rim of cervix and she was going to try and move it, and I was totally fine with that because if anything was holding this baby up, I wanted it gone.  So for a couple of contractions she worked on that and I guess it went away.  I was pushing with such intensity but it felt fruitless.  I truly felt nothing moving or changing and I imagined pushing forever
and not making any progress.  It was at this point that I remember thinking, “I should have gone to the hospital so I could have the drugs!”  (Interestingly enough, when I had my babies in the hospital, I never thought to ask for drugs, because I know if I had had the thought, I would have asked; maybe at home when it is not an option, my brain safely went there, just as a way to cope and vent.)  Brad and Shiela were helping me pull my legs back during the pushing.  Instead of rolling my chin to my chest, which I have helped women remember who-knows-how-many-times, I arched my head back against my pillows.  I also had my body twisted in some way, crooked a little. Linda gently reminded me to get better aligned (with words and heart I could understand at that point), while giving me positive encouragement for this task I had to undertake.  

Linda!  What else could you want from a midwife?  Really, not one thing.  As a doula, I get really uncomfortable when people say, “Stacie, I couldn’t have done it without you.”  Because, come on, you could have, and you would have.  I don’t want anyone’s birth experience to have me entangled as an
essential ingredient; it should be all about the mom and her family, not me.  But I have to concede that
when the right person is helping you with the right words and attitude and presence and spirit, it helps make the experience even more amazing, if that is possible.  When you have the right midwife, the feeling is similar to being in your own home – the comforts of being in your own bed, using your own bathroom, lunging on your own piano bench – Linda was a natural extension of that.  It felt right that she be here, in our home, unobtrusively watching over the birth of our baby.

The support Shiela gave me was also invaluable.  Family members don’t always make the best doulas. 
Shiela actually has taken a DONA-doula training, and that coupled with what she knows about me (just about everything), made her perfect for the job. She stayed by my side, she gave me verbal encouragement, she wished she could help me more.  The truth of the matter is, only the mother can have the baby, but she doesn’t have to be alone while she is having her baby.  I will forever treasure that my sister was there to support me during one of the most intense experiences of my life.

Pushing was hard, it was really hard – it seemed harder than it ever had been.  I know I was lost in my head, and in there, the storm was raging. Every push came with screams, I hate to say it.  I have never screamed with any of my other babies.  And also, I cried, which was something new for me.  In hindsight I probably could have pushed more effectively keeping those screams to myself, but they just came out.  I know the boys didn’t appreciate the noise (although they all later admitted they weren’t scared), I am thankful my neighbors didn’t call the police, and the screaming is not my favorite thing about the birth video – oh well!

After so much pushing (again my sense of time is really off here), finally his head emerged.  I felt his head with my hand, but it really didn’t mean anything to me, I just wanted the rest of him out!  I pushed for one or two more contractions, maybe three, and then his shoulders popped and he tumbled out on a
wave of fluid and tons of baby poop.  Linda helped bring him to my chest, all the while rubbing him and talking to him and watching him carefully.  I was so relieved and instantly went from that person experiencing the very hard work of pushing toward a goal, to that mother experiencing her baby
for the first time.  I was rubbing him and toweling him off and just taking him in, my body relieved of the burden with the prize in my arms.  He was born at 9:42 am.

We all watched as he turned from purple-y to pink.  His apgars were 8 and 9.  Very soon after birth he wanted to nurse and he seemed to know just what he was doing. The boys peeked in one by one, only appearing mildy interested (we had two 13 year olds, two 11 year olds, and one 7 year old), and then backing out of the room again.

There were lots of things in the birth kit we didn’t use.  My perineum didn’t need massaging, which Linda was prepared to do.  We didn’t need the bulb syringe to suction the baby’s airways. There are lots of Chux pads that didn’t get used.  Everything just happened easily and well, as it so often can when left to its own devices. I am sure the level of comfort and security factored into that for me as well.  I am still struck by how ordinary things were and how extraordinary they were. Within a couple hours I was back in my shower.  A little while later I threw a load of laundry in.  My mom bought donuts and I happily ate three.  Our new (nameless) baby was being admired and touched and held by his cousins and brothers and dad and aunt and grandma, while also nursing and visually taking in all he could.  In many ways it was like a normal Saturday morning at home, but then, it was also like some rare, high holy day, calm with introspection, peace and joy.

Ezra Christian was 8 pounds, 1 ounce.  There was much debate about his name – the other choices were Benjamin, Ruben, and Abraham. He was born on what we in the LDS religion believe to be Christ’s birthday, and also the day the LDS religion was restored; Christian is my brother’s middle name, and we
felt it appropriate for Ezra as well.

Moving through that birth, I didn’t feel alone.  I remembered so many births and situations and strong mamas moving gracefully through this work.  I could name each and every one that came to mind, but hey, this one’s my story.  Just know if I have been with you for the birth of your baby, you were with me during mine in spirit and endurance and admiration.  This has brought me so much more appreciation and compassion for birth and women while experiencing it – that’s why I feel there should be something birth workers can do every few years to get back in touch with what it can really be like to physically grow and have a baby.  It changes you, and sometimes we forget that.