As we reached 13 days past my due date, having endured all manner of natural induction methods and intense pressure from the hospital staff to induce “now now now,” we realized that our carefully constructed vision of a homebirth wouldn’t become a reality. I hadn’t had a single contraction, not even Braxton-Hicks. We needed to decide how soon to induce labor. The Kaiser staff kept telling us that our baby Claire was post-dates, that induction is perfectly safe, that waiting is dangerous, and that SHE COULD DIE (they liked saying that a lot). The MD even implied that we were bad, selfish parents for postponing induction by 12 hours in favor of a full night’s rest. This seemed a bit dramatic since, by Kaiser’s own measures, Claire was doing fine in the womb so far and there were no immediate risks. Mason helped counter-balance the pressures we got from the hospital staff by explaining to us our options in a clear, non-judgmental way. She let us know that, although our child wasn’t in any distress or imminent danger, the risks were mounting: amniotic fluid was low, she might have already passed meconium (turns out she had), and her skull bones could be hardening. She also told us the downsides to inducing (something the hospital staff refused to admit) such as more painful contractions and a higher likelihood for further interventions. We were able to make what we felt was an informed decision. Despite the MD’s advice to induce immediately, we went home from our last evaluation late on a Thursday afternoon with plans to return in the morning, well rested, for an induction.

I was admitted to the hospital very early the next day (Friday morning), and we mostly waited and got 'settled' for several hours. The CNM (Certified Nurse Midwife) on duty laid out a plan to start Pitocin in the late morning. I am incredibly phobic of having needles left in my skin - the idea of anything stuck in my skin is nearly unbearable and I’m scared to death that it will either get stuck there or get painfully ripped out. The sight of the lock and IV in my arm was nauseating and the nurse ended up getting one of the newborn hats that open at both ends and covered it up, which did help. Still, I was scared of moving my arm during my whole stay in the hospital. I just kept picturing the IV getting ripped out. Additionally I was strapped down to a fetal monitor with a fairly short cord. While not that ‘invasive,’ it kept me tethered to an immobile machine. Every time either Claire or I moved at all, a nurse would come in to shift the little paddles around and try to Velcro them into place, only to have them slip again sometime soon. I felt like I needed to keep perfectly still my entire stay. (FYI, giving birth perfectly still is really really awful.)

I began Pitocin at 12:30pm. And then we waited. I had been told that I was only to eat ‘clear’ things, an instruction I promptly ignored (I figured you can aspirate Jello just as easily as pasta, and who ever heard of fasting before labor?!). After 5 hours I had reached my maximum dose of 20 mU/min, however I hadn't had a single noticeable contraction. I truly began to despair of ever having my baby vaginally and I was afraid of the bigger interventions soon to come.

The 5:30 shift change came and the next CNM offered Misoprostol as a next step – a drug that carries a whole host of risks that the CNM was vague on (even when asked explicitly). I knew of these risks through my own research, and Mason was able to confirm them. After we vetoed the Misoprostol, the CNM came back in with a prescription to give me Misoprostol – fortunately we caught her in time and reminded her that we had decided against it. We realized at that point that as a patient you must really keep your eyes open!

By evening my wife Nancy and I both desperately wanted to take a break from interventions to go home and sleep. We knew we both needed energy for active labor, plus I wanted the IV out and I wanted to eat without hiding. Unfortunately, the MD ‘running the board’ thought I should stay and continue some form of drugs over night. The CNM fought for us, though, and they settled on taking out the IV but giving me the Foley Bulb (which mechanically dilates the cervix). Not being able to go home was heartbreaking, because neither of us was able to get comfortable on the bed or foldout chair, neither could we relax, nor console one another, nor process our frustration, disappointment and fear. The next morning (Saturday), I started Pitocin again. The Foley bulb had fallen out, indicating further dilation to about 3 cm. The dosage schedule for the Pitocin was more aggressive and had a higher maximum dose. I was able to get the IV placed on the same side as the monitor, so at least my left side was free. I was still too scared to move my right arm much; phobias are persistent that way.

Mason arrived a little while after noon, though I still hadn’t had any appreciable contractions. I fully expected her visit to be a short one, since she would need to rest in preparation for birth. However at around 2:30pm, when Mason suggested I try and eat something, I was in the middle of a cup of Jell-O when I had my first stop-and-take-notice contraction. Still, at that point I don’t think anyone would have guessed that by 5:30pm I would be holding my baby. Over the next hour contractions started coming with increasing frequency. I focused on making low sounds as the more intense contractions came, which I found somewhat calming. Mason supported me through the contractions, reminding me to keep my voice low and my vocalizations long. She stayed with me through the entire afternoon, which allowed Nancy to occasionally step out to handle visitors, as I didn’t want interruptions. The nursing staff at the hospital left us alone with Mason, except to come in each time the fetal monitor slipped out of position. So far, the contractions all felt quite manageable.

Early in the afternoon, the CNM (our third since our arrival) came in to check my dilation and the baby’s station. While doing her exam she asked the nurse for the amnio hook. This was a surprise to us all since I had never agreed to having my waters broken. Once again it seemed like Kaiser was railroading us into having the birth their way. I kicked the CNM out of the room so that we could talk about it before proceeding. I was worried about having her break the amniotic sac because my contractions were not yet that strong, and I knew that it would lead to more interventions if I didn't give birth soon after. Mason let me know that, due to the Pitocin, the clock was already ticking for me anyway, and this might help speed up labor, so I ended up allowing the CNM back in to proceed. She was not able to get much of the sac with the hook during this second attempt, and no amniotic fluid came out anyway. Much to her genuine chagrin, she ended up scratching my daughter’s head, which we discovered later.

As labor carried on, the most comfortable positions were those where my supporting muscles – legs and arms – tired quickly, which was incredibly frustrating. I thought longingly of the birth tub that we had set up at home. If only I were floating I could stay in some of those more comfortable positions longer. Even taking a shower wasn’t an option as I was on continuous monitoring and an IV. Mason was incredibly helpful in suggesting different positions. Left to my own devices, I would not have moved much at all since I was so scared of the IV in my arm. She was also very encouraging, telling me that I was doing a great job using my tools, such as low moaning and slow breathing. As simple as it seems, knowing that I was doing good for myself really helped me rally through the ever-increasing strength of the contractions.

Contractions eventually became very intense, with a spike of incredible pain for the first several seconds, then a leveling off to strong-but-manageable pain for the duration of the contraction. Mason explained that that spike of pain at the beginning is characteristic of Pitocin contractions, making them typically more intense than natural contractions. After a couple hours, the first part of the contractions began to surpass my pain threshold. Contractions now had hardly any time between them. Mason told me to relax my muscles between contractions, which I resisted at first, but once I tried it I realized that it made a huge difference. Mason suggested I try lying on my side, though it seemed that no position was comfortable. I wished I could toss and turn a bit, but I was still scared to death of moving my arm with the IV in it. Again, all I could picture was the IV ripping painfully out of my arm. At this point, I didn’t want to say anything negative, but I felt that I couldn’t take anymore and I feared facing another 6 hours of labor.

Finally, when it seemed there was no space at all between contractions, I insisted on an epidural. Mason told me to wait for three more contractions and then we would call the nurse. I said, quite distinctly, “No,” but in the span of that exchange, another contraction had come and gone. I despaired of how many contractions it would take before the anesthesiologist could come. At that moment, three nurses and the CNM entered to check my dilation. I truly didn’t think I could bear an exam as the contractions were so intense, but somehow I managed. Upon examining me, the CNM declared that there was no time for an epidural since I was fully dilated and needed to start pushing. I had absolutely no urge to push, but once I gave a little trial push, the contractions seemed to stop, so I kept my “lack of urge” to myself.

As soon as I started pushing, I could feel my baby’s head against my rectum. Pushing really felt a lot like pooping and it was neat to feel her head move down while I pushed. Pushing was tiring work and painful, but not even a quarter as painful as the contractions, therefore it was a great relief. I was still on my side and the nurses and CNM started breaking down the bed and setting up the stirrups for me to get on my back. They told me it was time to get on my back and I said very directly, “No, I don’t like that” and Mason, Nancy and eventually one of the nurses helped support me on my side by holding up my leg, etc. The CNM had to sit in a really uncomfortable position, which Nancy heard her grumble about, but I was not going anywhere.
After about 15 minutes, I did end up on my back because the CNM claimed that being on my side was creating an ‘asymmetry’. (In retrospect, this sounds strange because being on one’s side is, worldwide, an incredibly common birthing position). I desperately wanted to be on all fours rather than on my back, but I couldn’t really express this, nor muster the energy to put myself in that position. Also, to do so would mean crossing the lines for the IV and once again my phobia kicked in – I envisioned the IV ripping out of my arm and decided that moving would be too scary. After pushing for 10 minutes or so I was able to touch my daughter’s head, but it wasn’t quite as inspiring as I thought it would be. I was too busy pushing. After 20 intense minutes, 9 major pushes, and some hearty roaring, Claire was born at 5:33pm (yes, that’s just 3 hours after my first major contraction). She was placed on the belly she had recently vacated and Nancy cut the cord a few minutes later.
I’ll admit, I was underwhelmed by my first chance to meet my daughter. I felt like I had just run a marathon and someone just randomly handed me a baby. What was I supposed to do with a baby? The Kaiser staff knew what to do – she got swept up right away by the nurse and placed on the warming table. Claire was born virtually dry (no amniotic fluid), and had passed meconium. This meant that she was suctioned extensively at birth and the CPAP was used to assist her breathing. Fortunately, this was done in the same room as me and Nancy was in contact with her the whole time.

Despite the best efforts of the (very experienced) CNM who used oils and aided my tissues in stretching, I still ended up with a lot of very painful stitching. I got to face my needle phobia yet again as I saw her sewing up my flesh for 20 minutes. Finally, about a half an hour after the birth, Claire was returned to me, the hospital staff left, and Mason helped me try and breastfeed. I still wasn’t allowed to take the IV out for another six hours. Breastfeeding was entirely unsuccessful, perhaps due to the recent suctioning of Claire’s stomach. It took Claire six weeks, three lactation consultants, and two rounds of acupuncture before she would accept the breast. After our first attempt at breastfeeding, Mason left and we were alone to enjoy and explore the beautiful and slightly enigmatic little person in our lives.

Overall, we found the hospital experience to be overwhelming and disjointed - but maybe part of that is about becoming a parent for the first time. It was hard to let go of our hopes for a home birth and to do what was ultimately (we believe) the right thing. We were really grateful for the continuity and objectivity that Mason's care provided to us. It's sad to not be able to proudly proclaim that our baby was born at home, but like the rest of parenting, we did the best we could for our daughter with the information we had.

Vijay took a break from his supporting role in labor to fetch Gaudrimas. As a result, a useful odd job man was found to help with everything from timing the contractions to photographing and filming the entire event. This experience should stand Gaudrimas in good stead in any career that requires steady nerves; his camera did not falter a bit when capturing his mother giving birth to his sister—if anything, the only aspect of his technique that might need improvement is the part about blending into the background; his eagerness to get a Kodak moment may have resulted in a couple of Heisenberg-like effects, such as when Rasa asked him to get the camera away from her face because it was disturbing her concentration. (For pretty much the same reason, she also asked Vijay to stop growling in imitation of her sounds—something she had asked him to do earlier—unless he could make his frequency lower. A natural tenor cannot become bass on demand, so Vijay excused himself from the sound effects.) Only at the very end, when Indre was starting to come out, did Gaudrimas’s calm desert him, and he momentarily forgot to film the birth; still, he got off half a dozen good shots on the camera. Ashvin, working the kinks out of the system

But the story is getting ahead of itself. When Rasa’s contractions started, it was early, around 2:00 AM. Ashvin behaved quite well, mainly by agreeing to stay away from the birth itself. He was still fast asleep, and being a good boy, he stayed in his bed at 3:00 AM, when Rasa decided that she wanted to go down to the big tub in the living room. (A big tub in the living room would be remarkable anywhere except here in the Bay Area.) Gaudrimas also helped by slipping out of his bedroom to snuggle up with Ashvin, when Rasa and Vijay snuck downstairs. The contractions were still irregular, coming about 20 minutes apart. Rasa got into the tub, Vijay brought her chamomile tea and water laced with Recharge, and she read a couple of books on homeschooling. Vijay snuck back upstairs to fetch his laptop—an important chess tournament was on in Wijk aan Zee, and he wanted to watch it on the internet, while waiting.
The warm water mellowed Rasa out, and at around 6:00 AM, she decided to go back up to the bedroom to take a nap. But she was back within an hour or so—being in bed had started the contractions again. Gaudrimas made himself breakfast and left for school, and Vijay continued to watch the chess. Ashvin woke up at around 8:30. Rasa’s contractions were coming about 5 minutes apart by then, but she did not get back into the tub in order to not distract Ashvin. He quite cheerfully allowed himself to be bathed and dressed by Vijay, not letting out the slightest whine, even when he was driven off; the only mild protest he registered was when Vijay did not let him take his pet bear to pre-school (the authorities had complained that the animal was too big), but he agreed quite amicably to take his two pet monkeys instead.

With the kids out of the way, the action then started heating up very quickly. Vijay dropped off Ashvin, got himself charged up with a cappuccino on the way back, and went straight upstairs for a nap. Rasa slipped back into the bathtub, and read some more on homeschooling.


Gaudrimas, relaxing after hard photoshoot
Things proceeded at this breakneck pace for a while. The midwife, Mason, came to the house to check on the situation. She examined Rasa, and found her about 4 cm dilated; the baby was ready, in good vertex position, less than an inch in, meaning the biggest part of the baby’s head had already worked itself past the smalest part of the pelvic structure. Mason thought that Rasa should not spend too much time in the tub if she wanted to keep up the intensity of the contractions. The nurse from school called, Vijay left and came back with Gaudrimas. Mason left, and Rasa promptly got back in the tub. Eventually, the three lunched on stir-fried vegetables and rice that Vijay and Gaudrimas cooked.
By 2:00 PM, the contractions were coming on quite frequently and with much higher intensity. Rasa was having difficulty walking around, so she and Vijay practiced their version of tango for turtles, set to Julio Iglesias’s music. Gaudrimas snapped off a few pictures half-heartedly. Around this time, he absent-mindedly formatted the memory card in the camera, and so the pictures he had taken till then will now forever be sheltered from posterity. He resolved to be more attentive, and indeed he was quite brilliant, all the way to the end, only briefly dragging himself away to read a hundred pages or so of The Count of Monte Cristo.

Rasa was quite relaxed all the time, even when leaning heavily on Vijay to walk. She had to be escorted to the bathroom frequently, but it was difficult for her to follow up on the urge to pee—by then, the baby was so far down its head was like a cork keeping the fluids bottled in. Mason came back around 3:00 PM, and soon thereafter, Liesl, who is an apprentice to Mason, also came to help. Periodically, they checked the baby’s heart rate. They used an ultrasound monitor, whose probe could be placed underwater on Rasa’s underbelly, close to the baby’s heart. (Midwifes use the latest in technology too, when it suits them.) The heart rate, relayed through a handheld speaker, has to be listened to, not read out from a digital display. The baby almost always held steady at about 130 beats per minute, which sounds like a fast canter of a team of horses, and only rarely, right in the middle of a contraction, did the horses practice galloping to 160. Mason and Liesl set up station in one corner of the living room; they had warm coddling blankets to use on the baby when it came out, a small oxygen cylinder, just in case, and the usual assorted instruments of torture such as clamps, scissors, forceps, etc.

At 4:00 PM, Rasa made her last bid to pee freely and forcefully. She was not successful, and this helped make up her mind that the only path to relief was to get the baby out. Mason made another quick check and estimated that Rasa had only four or five contractions to go. Rasa got back into the tub and stayed there till the end. The contractions were now strong and steady. With every one of them, Rasa pushed off of Vijay, who was kneeling outside the tub with his hands in the water, grabbing her around the chest and bracing himself to lift her. Mason and Liesl sat nearby, checking on the baby, murmuring words of encouragement. Gaudrimas started photographing and filming in earnest, until the aforementioned moment when Rasa told him to back off.

The last few contractions were incredibly beautiful. As they built momentum, Rasa would moan and raise her legs in the water, spreading them and staying almost horizontal for nearly a whole minute; the baby’s head would break out through the vagina and show itself during the peak of the contraction before being hauled back in when things began to ebb. Mason would reach forward with a gloved hand, clearing the mucus and wisps of membranes from around the baby’s head. At some point, the bag of waters had broken, but it was not a discrete, dramatic moment; rather, the bag seemed to just melt away, naturally and continuously. Rasa was quite heroic during this phase when the contractions came rapidly together, without let up. She was also quite determined to get the baby out. With one hefty heave, the baby’s entire head came through; to everyone’s surprise, it was in the posterior vertex position, i.e., ‘sunny side up’, and from their vantage point, Rasa and Vijay could see the serene face—eyes closed, mouth slightly open. The hands were held up, close to the face, in little fists, and the cord was wrapped around the body and the neck, but not too tightly. Mason thinks the baby was in the anterior position when it worked its way down, but then corkscrewed around when it came out. (Time will tell if the cork metaphor will stick as a nickname.) The head stayed in that position for a heartbeat. Rasa says virtually all the pressure had been released quite a bit by then; with another heave, she pushed the rest of the baby out.

Mason quickly grabbed the baby, which was slightly blue, wiped it off, and handed it to Rasa; Liesl checked the heart rate again. The cord had already stopped pulsing, and so Mason put clamps on it quickly and handed Vijay scissors to cut it. The baby was squeaking and gurgling, trying to work fluid out of its lungs. Mason took the baby from Rasa, put it on a coddling blanket and gave it a few toots of oxygen; very soon, it became pink.

Rasa got out of the water and onto a mattress that had been spread out on the floor, with a tarp and warm sheets covering it. She squatted and quickly and without fuss delivered the placenta into a salad bowl that had been made ready to catch it. Gaudrimas seemed quite intrigued by the placenta since he took many pictures of it, from different angles.


All in all, the whole process was remarkably (or does one mean unremarkably?) normal. Rasa bled very little, had no tears worth suturing. She did not take any pain medication, before, during, or after the birth. She stayed alert, and in good humor throughout. In fact, once the baby was delivered, she got up and walked around under her own steam. Soon, she even got what she really craved—a good pee. The baby’s vital signs also appeared completely normal—heart rate of 130, and respiration rate of 54—but her body temperature, between 97.7 and 98.0, was on the low side of normal (this may be a natural consequence of water births).

The birth of the baby and the placenta were quite well timed. The show was over by 5:30 PM, leaving enough time for Vijay to jump in the car and get Ashvin out of pre-school before 6:00 PM, when the authorities start auctioning off the kids. Ashvin had been bragging about his baby sister to his teachers for a whole week, and they were never quite sure if she had already been born or not. When Vijay announced that she had actually been born just a little while ago, everyone broke out into smiles and congratulated and high-fived … Ashvin!