Ava's Birth

by Amber van Leuken

In college, years before I ever became pregnant, I had already decided that I'd want a midwife to attend the births of my children in the calm and familiar surroundings of my own home. A neighbor, who was a midwife in training, had introduced me to Ina May's Spiritual Midwifery book and shared with me her experiences of attending various homebirths. I continued to read more birth books on my own and ended up studying changes in the customs and beliefs surrounding childbirth in Nepal before I graduated. Years later, after marrying and starting a career in animal welfare, I became pregnant and was excited to put my book learning into practice. I chose a midwife and planned for a homebirth. The evidence was compelling. Homebirth was not only safe for most women, but compared to a hospital birth it greatly reduced the chances of unnecessary interventions and the physical and emotional harm that can result. Although pregnancy and birth were new to me, I was comforted by the knowledge that the process of giving birth was scripted in my very genes and passed on to me through over 10,000 generations of women. The odds were on my side. Even so, for me, pregnancy and birth was a long and difficult journey. Nausea and vomiting had overtaken me during my first and second trimesters and the nausea and resulting periodic dehydration persisted until the birth. With the expectation of a glowing pregnancy, I felt nothing less than betrayed by my body. My perceived identity as a strong, athletic, and healthy woman crumbled before my eyes, as I lay in bed, day after day, consumed by nausea. I oftentimes felt angry, confused and helpless. When dehydration and bouts of vomiting seemed endless, I took prescription medication, which lessened the vomiting but did little to ease the nausea. Several times I relied on intravenous fluids to counter dehydration. Natural and homeopathic remedies for nausea had little or no effect. Some made me feel sicker. The midwife and the doctors I had consulted had no “cure” my condition. I remember a night when I considered terminating the pregnancy and then wishing instead that I could die to end my suffering. Each day felt tenuous and long and disappointing. Half way into the pregnancy, with still no escape from the nausea, after tears of guilt, and anger and defeat, I let go of any career or athletic goals and accepted that while my body was doing the hard work of building a new life, my only job was to take care of myself and wait for the baby to come. I never discovered a way to escape the nausea and instead worked on ways to cope with it. The emotional support provided by my family and friends and weekly massages by a deeply empathic massage therapist provided me with the most comfort. By my third trimester, the nausea continued through each day and night, but was less intense and made it possible for me to eat more food each day. Despite slippery elm tea and antacids, heartburn and nausea kept me sitting up at night. As time seemingly stood still through the dark hours, I'd often wonder if the pregnancy would really ever end. At thirty-seven weeks and five days, when contractions began that were low and fully around my back and front, I welcomed their arrival. Through the day, the contractions felt deep and achy, but only came a few per hour. That night, around ten, the contractions came more regularly, five to ten minutes apart. I slept on and off until about two a.m. When the discomfort became too much for me to endure alone, I woke up my husband and asked him to call the midwife. The midwife and her assistant arrived an hour later, and for an hour or so after their arrival, my labor slowed. I finally decided to crawl back into bed, and soon after the contractions again became more intense. I thought that I was no longer able to fall asleep, but the assistant showed me how I could moan along with each contraction and then relax restfully in between. After the sun had risen, and a light dusting of snow blanketed the trees outside, the midwife measured my cervix and informed me that it was five centimeters dilated. My body was hard at work and amazingly my nausea had eased significantly and I felt hungry and wanted to eat. I sat on a chair, and then on the birth ball, and drank and snacked between contractions. The deep ache of labor was uncomfortable in my body, but felt good in my heart. It was bringing an end to my pregnancy. I would see my baby soon. By the afternoon, I climbed into the birth pool that my husband had set up in our bedroom, and I sunk into the bliss of the warm water. The contractions had become stronger and longer and were deeply painful. With my eyes closed, holding my husband's hand, I visualized riding the wave of each contraction, and became oblivious to my surroundings. The midwife's assistant sang along beside me, encouraging a deep bellowing note, like the letter O, rather than my tendency to say OUUUUch!, as each contraction peaked and then subsided. The warm water and throaty vocalizations helped me relax and allowed my cervix to open in the face of intense discomfort. By early evening, the midwife again measured my cervix and informed me that it had dilated to ten centimeters with a lip remaining. Upon the midwife's suggestion, I began curling my body into the letter C, when each contraction peaked, to aid in the baby's descent. I remember thinking that I couldn't go on, and that the pain was too intense to bear. I let myself state my feelings out loud. I then cried feeling sorry for myself and all creatures that suffer without escape. It felt good to let my emotions rise and flow out of me. I stayed in the warm pool, riding each contraction. The midwife used a hand held Doppler to monitor the baby's heartbeat at regular intervals throughout the birth process. With the baby close to crowning, the assistant, and then the midwife, confirmed that the baby's heart tones sounded stressed and indicated that the baby might not be getting sufficient oxygen and nutrients. At the midwife's request, my husband and the assistant helped me out of the water and I squatted over a birthing stool with their support. The midwife massaged the baby's scalp, while I pushed with all my might. Soon the baby crowned and the midwife reached inside me and wrapped her finger around baby's armpit. With the next push, she helped the baby descend. Then she discovered the umbilical cord around the baby's neck and unwound it three times as my daughter was born. Exhausted and shaking I watched my daughter, as if from far away, take her first breath, pink up, and let out the smallest of cries, like a little bird song. She was tiny and perfect, with a head covered in dark hair and a cupid's face. Ava, meaning “like a bird,” we'd later decide to name her. I was exhausted and feeling dazed. I settled onto the bed and rode the remaining contractions that were working to release the placenta, while my husband held our baby to my side and watched her begin to nurse. An hour later I sat up, and with the midwife's help, I cut the now lifeless umbilical cord and soon after birthed the placenta. It was so beautiful and strange to behold. The midwife showed me its arteries and veins that look like a tree and supported my daughter's life through those long months inside of me. Once the placenta was out, I settled into a state of calm awareness and immense happiness. All was well and my heart sang. That night, Ava slept peacefully on my chest, in the warmth and comfort of our family bed. My most precious memory is of that night, lying awake for hours, filled with boundless joy, and witnessing as she took one life affirming breath after another.