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Natural Birth in a Foreign Land

by Augusta Cherri

Quinn Justine Cherri—December 8th, 2006—4:17 AM 7 pounds 11 ounces (or thereabout) Born at home with just mom and dad (and older brother sleeping) in Abu Saiba, Bahrain

When I had Kai in 2004, I received prenatal care at a local hospital with a general practitioner. At some point during my prenatal care I decided that I wanted a home birth, but there was nobody in the area that attended home births. My mother has considerable experience in this area and I made the decision that I would attempt a home birth with her and my sister as attendants, only going to the hospital if there was a problem.

My labor with Kai was very slow and extended. I ended up having a slowly progressing labor over the course of about 4 days. By the last day of labor, I was exhausted from lack of sleep. During transition, I was too tired to keep any presence of mind about home birth and asked for my family to take me to the hospital. Once I got there, they broke my water and Kai was born less than 15 minutes afterwards, completely healthy. I did manage to have a drug-free labor (which was a high priority to me), but I found many of the hospital's standards and procedures undesirable.

Since then, I have reflected on my first birth experience many times. It only furthered my desire to have a birth at home the next time. I think the main reason my labor took so long and was so trying emotionally was because my husband had left me while I was pregnant and did not want anything to do with the baby afterwards. Needless to say, we’re divorced and he opted never to see his son. In the time since then, I’ve remarried to a wonderful man who loves Kai as his own son and was delighted to find out I was pregnant again shortly after we got married.

When I became pregnant with Quinn, my birth options became an issue again. I knew I wanted to have a home birth, but wasn’t sure what issues we might encounter since we are foreigners in Bahrain. We went for an initial prenatal visit with an OB that I liked, but I found out that the hospital had a 40% c-section rate. I searched for another provider and found a British midwife who had a birthing center within another private hospital here. I went to her several times, and considered giving birth with her in the birthing center. Something just didn’t mesh, though. She was very nice and knowledgeable, but I knew that I would still have a birthing experience that was ultimately controlled by someone else and restricted by hospital regulations.

I searched around for someone who would attend a home birth, but found no one. After weeks and weeks of poring over child birth literature and statistics, talking with Shawn about it and doing a lot of soul-searching. I decided that I still wanted a home birth—even though it meant not having a professional birth attendant. Shawn and I talked a lot about it and prayed about it. We both had a complete peace that God would give us a wonderful and safe birth experience. We decided to proceed in this manner and bought birth supplies, read up on minor birth complications and came up with a backup plan.

Fast forward a few months.

I had been having contractions on and off for several days, but they were not particularly intense and not at all regular. There had been a couple “false starts” in the week leading up to my actual labor that had produced some minimal cervical changes. On Wednesday evening I had some stronger contractions, but they were not regular either and I just figured it was more warm-up labor.

That night, I slept but was awakened periodically by a moderate contraction. This had happened before, so once again I just pretty much blew it off as just my body’s way of getting ready for labor. Shawn got up on Thursday morning, the 7th of December to get ready for work around 7 AM. During the time he was getting ready, I was having some contractions about 7 minutes apart or so that definitely had a different intensity than some of the warm up contractions I had been experiencing.

Shawn left and shortly thereafter I became quite convinced that these labor contractions were different. I got up and walked around a little bit and the contractions continued. Since Shawn was on his way to work, I figured that it would be better for me to call him and have him come back before he made it all the way to Base and then had to turn around. I called him around 7:45 and told him that I thought I was in labor and that I wanted him to come home. I figured that if it turned out to be nothing again that Shawn could go into work later in the day, but that if it were real labor this time, it would save him the trip.

Shawn came home around 8:15 AM and we spent the day just hanging out around the house. By about 10:30 AM or so, it was apparent that this was really it. My contractions had continued unabated for that entire time and they were staying at that same level of intensity. The contractions were definitely manageable and I was walking around during them to make them relatively easy to deal with. I wouldn’t characterize them as painful at this time, only uncomfortable, yet intense physically. Strangely, considering how important drug-free childbirth is to me, I’m a pretty big baby when it comes to pain.

Things continued in a mild manner all day. Around 4:30 PM, I checked my cervix and was 4 centimeters dilated. Progress! At 6:30 or so, I decided to take a bath and Kai got in with me. I checked my cervix again and was already at 7 centimeters or so. I was surprised how quickly things seemed to be going considering the marathon labor I had with Kai. I started to get a little hungry in the evening and Shawn went to the store to get some food for me at about 7:00 PM. While he was gone, something shifted gears in my labor and the contractions started to get stronger and more intense. Some of them at this point began to get painful and I found myself pacing back and forth in the kitchen during each one. They were coming about every 3 or 4 minutes apart. When Shawn got back from the store, I started to feel nauseated and went outside for a little while to get some fresh air. This helped a great deal and the nausea passed, but I never did end up eating any of the food Shawn bought me during labor!

Shawn moved a mattress into the kitchen for me to lie on in between contractions after he put Kai to bed. For each contraction, I got up and continued the pacing. I talked to my mom some on the phone and thought it would be really funny if the baby was born in the kitchen (because I am NOT gifted in the kitchen!). Sometime around then, though, I decided to go into the living room and continue my pacing there. Shawn and I listened to music and I was singing along to the Chronicles of Narnia soundtrack during contractions. For some reason, focusing on the lyrics and singing along helped me manage the contractions without feeling the need to do any more pacing.

At midnight things were definitely picking up even more, and I decided to take another bath. I was sitting in the tub, pouring warm water over my belly during contractions and for some reason started singing during them as well. The only thing that came to my mind at that point in time was “Great is Thy Faithfulness,” so that was what I ended up singing (off- pitch, I’m sure) as I repeatedly poured water over my belly. I checked my cervix and found that it was almost fully dilated, but the water bag was bulging against my cervix some and the baby’s head was still up relatively high. This was very similar to what I experienced in my labor with Kai.

After I got out of the bath, things started to get crazy. The contractions were coming about every 2 to 3 minutes and were getting quite painful. I felt a tremendous amount of pressure from the water bag pressing on my cervix and it made it difficult for me to get comfortable in any position I tried. I ended up peeling off my clothes and pacing around in our bedroom (sometimes in tiny circles). I started praying out loud (which is totally NOT my usual style) and saying, “Please help me, Jesus” over and over. This continued for about two hours until I started to reach that point in transition where I felt like I couldn’t go on any more. I started to yell, “Help me, Lord!” Shawn tried to calm me down, but I absolutely wouldn’t hear it. To say that I was panicking would be putting it mildly. I felt scared that it would never end and didn’t understand why it was taking so long for things to progress.

I asked Shawn to call my mom for advice on what to do. Things just seemed to be stalling out. Shawn checked my cervix at this time and found that I was fully dilated, but that the water bag was still bulging and creating a lot of pressure. My mom theorized that the water bag was keeping the baby’s head from descending, explaining why the transition period was lasting so long. She encouraged me to gently push, hoping that would relieve some of the pressure. Shawn relayed this to me and I tried a couple pushes. During the push, I would feel a relief from the pressure, but then the pain would get twice as bad when I stopped pushing. This sent me into an even more heightened state of panic and I could not be calmed at this point.

Shawn asked if breaking my water might help things progress, so I let him try to break my water around 2:30 AM. Some water came out, but the entire bag did not rupture. The pressure continued and I was still panicked and in a lot of pain. Shawn called my mom back around 3:30 to see if there was anything more he could do about the water bag because he could still feel it bulging when he checked me. I got into the shower to try to get some relief from the pain and the water did help a little, though not much. After consulting with my mom about our situation, he asked if I wanted him to try again to break my water. This time was successful and my water gushed out in the shower.

Of course the hot water ran out at this point, so I decided to switch to our other bathroom (they have separate hot water heaters) to remain under the water. On my way to the bathroom (immediately after Shawn broke my water), I had a very intense contraction. I got into the other shower and immediately had another very intense contraction. Near the peak of that contraction, I decided to give a slight push to see what happened---all the sudden the baby’s head dropped into my pelvis and after this, I felt an overwhelming (and I mean overwhelming) urge to push. Shawn was kneeling outside the shower and I dropped down into a squat as my body started to push uncontrollably. I reached down after a couple of contractions like this and felt the baby’s head near crowning. I couldn’t believe it! After that, I was much more focused and did not have any more pain. I calmed down as I pushed through several more contractions in the shower.

Shawn asked me if I wanted to get out of the shower to try other more comfortable positions for pushing and I did. He helped me into the bedroom where we had set up a plastic backed sheet on the floor covered in chux pads. I tried pushing on my hands and knees for a little bit, then squatting again. With each contraction, I felt the uncontrollable urge to bear down and did so each time. The baby’s head at this point was near crowning and started to crown with each push, but would not cross the perineum.

In between contractions, her head would move back up a little ways and I would rest for a minute or so. Even though her head was only moving a very short distance, it felt like her head was sliding way back up inside each time. We listened to the baby’s heartbeat at this point and everything sounded good, so I continued in this way for a little while. I kept feeling her head at my perineum and could tell she had a lot of hair. In between contractions, I could feel her squirming with her shoulders and her feet, as if she were trying to help herself get out easier. It was one of the most surreal feelings I have ever experienced.

Feeling Quinn help with her own birth motivated me to keep going. She was so close to being born! I put my hands down to try and guard my perineum against any tears. Shawn helped with this as well, depending on my position. I started to feel some burning and stinging (the so-called “ring of fire”) each time the baby’s head would crown.

At this point, I was wanting reassurance that it was okay that it was taking this long to actually push the baby out (Kai was a really quick delivery once I started pushing) and Shawn called my mom again. While he was on the phone with her, I was standing up and holding my perineum, trying to coax Quinn out saying, “Come on, Baby!” All of the sudden I got the urge to drop down on my hands and knees and gave a great big push. I ended up on my forearms, sort of in a leapfrog position, and her head came out. Shawn said, “I can see her head! I can see her lips moving!” I reached down and felt her head outside of my body. It was all slick and round. I moved my hand around her head and was a little shocked when I felt her nose and mouth.

Something in me changed. All of the sudden I was laughing uncontrollably! It was so amazing! The next contraction, I felt that same overwhelming urge to push and I laughed as Quinn’s body rushed out of mine. Shawn said at this point he tried to catch Quinn, but she was so slippery that she slid out of his hands some. Fortunately, she was only a few inches from the ground because of my low position and was fine. She didn’t like the jolt however, and immediately started crying.

I turned around to see this baby with her eyes wide open, crying at the top of her lungs. I cannot describe the way I felt in this moment—overwhelming emotions flooded through me. I was laughing and crying at the same time. I said, “We did it!” Shawn replied, “We DID it!” We were both laughing and crying. Shawn handed Quinn to me and I hugged her close, marveling at her. I checked to make sure she was a girl and started talking to her, saying, “Hello, baby!” Shawn and I both said, “Thank you, Lord!” It felt like such a miracle and I was humbled, awed and grateful all at once.

My mother had been on the phone at the time the baby was born (who was standing next to my dad, who was on his cell phone with my sister….). Shawn had put the phone on the ground and she was able to hear everything. He picked up the phone and said a few words to her (I don’t know what he said because I was laughing too much and just fixated on Quinn) then hung up. He handed me a towel for Quinn and I held her close to my body. At some point in there (once again, everything was sort of happening around me without my awareness of it---all I could see was Quinn), he took a few pictures of us and called his family to let them know the news.

Quinn had calmed herself down and was starting to nurse already. I felt a strange sensation and told Shawn to get the bowl for the placenta. He got it and helped me get up enough that I delivered the placenta in the bowl with no problem. It had only been about five or ten minutes since birth. We had delivered her at 4:17 AM.

After we got our bearings, Shawn helped Quinn and me to the bed. At this point, the cord had stopped pulsating and was like a piece of limp pasta. Shawn clamped and cut it about mid-way up, leaving a long piece still attached to Quinn just so we could move around easier. Quinn was still nursing and relaxing quietly.

We discovered that our water was on the fritz (that happens occasionally at night here) and so I could not shower right away even though I was covered in all sorts of fluids. Shawn started cleaning up everything, which was pretty easy considering he just rolled up the plastic sheet we had on the floor with all the chux pads inside and threw them into a nearby trash bag---hooray for planning! We noticed then that I had at least two tears, one up high near my clitoris and one down low, but they didn’t seem to be bleeding profusely. I couldn’t believe how great I felt. Positively euphoric and the pain was completely over all the sudden.

Within about an hour, we called my mom again to give her all the details and Shawn’s mom, too. They passed the information along to the rest of the family. The water started working again, so I took a shower and got cleaned up finally while Shawn held Quinn. After my shower (which was very refreshing), we officially cut Quinn’s cord after tying it with some cord thread and wrapped her up snugly. Around 7:30 AM we called Theresa to ask if she could come and be with Kai for the day so that Shawn and I could try and catch up on some rest. She was shocked to hear that I wasn’t in the hospital, but delighted for us. After that, Shawn, Quinn and I all settled in for some sleep.

At 10:00 AM or so, Theresa arrived and I showed her the baby. Shawn woke up, too and we decided to go to the hospital to get my tears checked out and to get the paperwork we needed for the birth certificate. We called the hospital closest to us (International Hospital of Bahrain) and they told us they couldn’t help us with the birth certificate and that we would have to go to the government health center in Budaiya to register her birth and get checked out. Note: we were in such a rush to get a birth certificate because we live abroad. We didn’t know if waiting would cause citizenship issues or difficulty obtaining her US passport.

We went to the health center, but it was closed since it was a Friday and I was too tired to try to run around any more that day. We went back home and spent the day resting and talking on the phone to our families. Shawn made the most wonderful dinner I’ve probably ever tasted that evening—seasoned chicken breasts, mashed potatoes with cheese and broccoli with cheese. It tasted so delicious and helped renew my strength.

The next day, Saturday, I decided that I wasn’t really too certain about the quality of care we would receive at a government hospital. Theresa said she had been to the Budaiya hospital and that it was crowded and difficult to get seen, so we decided to go to IHB anyway. Once we got there, they took us to the OB/Gyn department. The doctor I had seen there before talked with us about the birth. She and the nurse who met with us laughed about our birth story, seeming both amused and amazed that we did it at home by ourselves. When they asked Shawn who cut the cord, he said he did. For whatever reason, they both burst out laughing. Everywhere we went, people always asked us that question: who cut the cord? I think it must have some sort of cultural meaning, but I have been unable to discover what that is in the time since Quinn’s birth.

After that, the doctor examined me and said that I had two small lacerations by my urethra and a larger one internally near my perineum. The lower one was a second degree tear that was still bleeding a lot, so they wanted me to have stitches. They also did an ultrasound to make sure I didn’t have any major bleeding or retained placenta in my uterus. The ultrasound came back looking great and the ultrasound tech said that Shawn was a “very good doctor” since the results looked so good (like he had anything to do with it!). Then it was time for me to go upstairs to have the stitching done.

After getting stitched, I was wheeled back to my room. Shawn’s boss was there holding Quinn. He said she was absolutely beautiful, that I was “a really tough chick,” and that now he had told his wife that he wanted another one. He noted how alert and calm Quinn was as she looked up at him curiously. He told us about all the people he knew on the island that he had called while I was in labor to have on standby in case we needed any kind of assistance. He called people he knew at the closest fire station to our house to be on alert. He called two undercover cops who patrol our area to be ready in case we needed a police escort to the hospital. He called all the guys at work to be ready just in case we needed something. It was hilarious! He told us that after Shawn had called and said we’d had the baby and that everything was fine, he called all of his contacts and told them they could relax now. It was very sweet to know that there were so many people ready to help us had we needed it, as unnecessary as it was.

While I had been getting stitched, Shawn had taken Quinn to be examined by a pediatrician (once again, for requirements related to obtaining her birth certificate and passport). He looked Quinn over and declared her in excellent health and ran a blood panel. When her blood panel came back, her bilirubin was a little on the high side and he wanted her to have phototherapy under the lights for one night. We ended up staying that night in the hospital. I found this to be very stressful because Quinn didn’t like being in the bed and it was very difficult to get her to settle down in the bassinet, especially because she had to wear these little goggle things to protect her eyes. She kept pulling at them all night and Shawn and I did not get much sleep.

The next day, her bilirubin was essentially at the same level, the doctor thought it would probably be okay to take her home because the level was not as critical at three days old versus two days old. I was thrilled that we were going home! I had really missed Kai, as well as just being in our own home.

Tuesday morning we brought Quinn in for another bilirubin test to make sure the level was going down. Unfortunately it wasn’t. It had spiked up substantially and the doctor wanted Quinn to get the phototherapy again. We went back to the hospital. What followed was another two nights of fun phototherapy. Quinn did a little better this time because she was more used to it, but it was still stressful at times. I had all these instincts to just take her out of there and make her comfortable, but wanted to get her bilirubin levels back down. Thursday morning her level was way back down within a normal range and we were ready to go home AGAIN. Finally, our family was back together again.

Augusta

Afterword

In the months that have followed Quinn's birth, I have come to realize that birth is dynamic. I learned so much about myself from my son's hospital birth. I learned from that experience that I did not need to rely on "experts" to tell me how to birth; I already knew how and just needed to trust in that. Quinn's birth has taught me other things about my strengths and abilities. I feel confident that what I learned from the two birth experiences I have had will make my next one even better.

There are a lot of things I would have done differently with Quinn's birth, but most of those things have to do with allowing medical intervention into my life in the post-partum period. Next birth, I will be Stateside and plan on reveling in my birth experience with my loved ones at home.

Since our UC birth, my husband has become a major birth advocate. When the opportunity arises for him to dispel some myths about birth, he takes it. To my surprise, he so thoroughly enjoyed the UC process that he has told me that he wouldn't want me to birth any other way. I'm glad he feels the same as I do. As for our future family, we will choose to UC again in a heartbeat.

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