Stories from our home birth that didn’t go as planned

This is the story of the first time I gave birth. I love birth stories.

I think that a person’s life and context has everything to do with how they experience their birth so I’ve included these details below.

The birth story, like my birth, is long. If you’d rather you can just skip ahead to any part you please:

BRIEF SUMMARY OF EVENTS AND THEMES

I AM PREGNANT

PLANNING A HOME BIRTH

BEING PREGNANT

MY FATHER’S DAUGHTER

WELCOME TO CANCERLAND

A CHALLENGER APPEARS: THE ARRIVE TRIAL

HOW I BROUGHT ON LABOUR FASTER AT HOME

EARLY LABOUR

LABOUR

THE BASIC PLOT

I loved being pregnant and looked forward to the intensity, work, and cozyness of a homebirth. I was happy to have by my side my best friend and midwife Tracy, my confident and creative student midwife Anne, and my gentle husband, Jesse. As a midwife I had been to many homebirths and they are very cool.

A week before I gave birth my dad, who had just qualified for his eleventh Boston Marathon, was diagnosed with terminal metastatic prostate cancer. He had just turned 61. The cancer was caught by bloodwork on a routine physical he gets every two years to renew his recreational pilot’s license. He had no symptoms so it was very surprising. Folks with his type of prostate cancer typically live one to five years. I was bummed.

I started doing lots of things to bring labour on so I could go be with my dad three hours away. I asked my midwife for an induction at the hospital. She wisely talked me down from that – I would have significantly upped my risk of a section — but did offer things which bring on labour faster, like stretch and sweeps.

Once I went into labour I tried to time things so I could have the baby before my dad’s first chemotherapy appointment. That way he could still see the baby while he was visiting me in Toronto.

Contractions started Sunday midday. I had the baby Tuesday night, in Toronto, shortly after going to the hospital to start drugs to speed labour along. My dad met the baby, drove his butt off, then rolled into chemo just in time on Wednesday morning.

I was successful at safely producing a live baby, the first grandchild, in the timeline I had set up in my head.

The haste I brought to the labour and birth stuck with me as I settled into parenthood. In retrospect it felt really stupid to poke and prod my labour, which was doing just fine on its own. Labour is mysterious and once you start to meddle with one part you tend to have to meddle with everything and we just don’t have it figured out that good. I felt like I put my kid at risk for the sake of being a convenient daughter.

In the early weeks of being a mom I found myself tensing up against and resisting anything intended replace my presence: soothers, bottles, breast pumps, strollers, rockers, jumpers, containers, crap. I just wanted to be present and responsive for my kid and no one else. The opposite of my labour.

I started really thinking about the hurried pace of the week leading up to my labour and the labour and birth itself. I sensed that a big part of my buzzy behaviour had to do with the fact that I am a sweet oldest daughter raised in a religious rural setting so I wanted to avoid conflict at all costs, be aware of everyone else’s time, and keep the community happy.

I always assumed that my arrangement of growing up surrounded by family, family as far as the eye can see, family family everywhere, was the ideal. As I traveled for school I met kids my age who grew up without family close by. I couldn’t imagine the pain, struggle, and vulnerability of doing that.

Working as a midwife in downtown Toronto my client base was ~50% refugees and ~50% upper middle class families who had moved there for work. Family support was nonexistent as everyone was from somewhere else. I can count on one hand the number of grandmothers I witnessed present at their grandkid’s birth or on hand making bone broth in the early weeks.

As I was giving birth I considered myself lucky to have family family everywhere. What a rare, rural, special treat in this world. Of course I would make my birth convenient for them.

After I gave birth I was surprised that I had to reconstruct my identity as a daughter in order to become a mom. I planned for being tired and unavailable to cook or do laundry. I planned for breastfeeding every hour or two for the first six weeks. I didn’t plan for how strongly I loved my baby or the accompanying monster shift in identity.

I especially worried that if I drugged my kid and hurried him along for the convenience of others right from the start, when he was trying to figure his way out of the womb and into the world, would I do that his whole life as he did the work of becoming himself?

That’s the gist of it my pregnancy and birth. Thanks for reading.

If you are curious about the experience of being pregnant, going into labour, being in labour and giving birth please read on.

SO THERE IT IS. I AM PREGNANT.

One blizzarding morning in February I woke up seasick. The floor was sideways and my mouth was hot and fuzzy. I sucked back a coffee that both gave me life and made the seasickness more intense.

I drove to my office across the city where I see clients as a midwife. The hot fuzz sideways feeling persisted but I carried on visiting my new babies and expectant families.

In a lull in the morning I pulled aside one of our students, Teresa, and asked her draw my blood, which she nailed. I wrote my name and birthday on the pregnancy test and stuck it in our lab fridge. I went back to work.

The next day the low buzz of seasickness continued. I knew I was pregnant but I wanted to see it in writing! Between clients I lingered by our fax machine so I could snatch up my lab result up before anyone saw it.

When you get a pregnancy blood test they look at a hormone called “bhCG”. The amount of hormone in your body increases quickly as you get more pregnant – it registers around 200 when you miss your period at four weeks, 20 000 at six weeks’ gestation, and 200 0000 at eight weeks, and so on. Anything over nine means you are at least a little pregnant, somewhere in your body.

A fax came through that had my name, my birthday, and a bhCG. 27.

“Huh,” I thought. “So there it is. I am pregnant.”

I folded up the result, wriggled it into my luon pocket, and went back to work.

WHAT NEXT

I realize it sounds odd to folks in some circles but to me there was never any question about where I would give birth. I would give birth at home.

• I’m a millennial – I’m suspicious of brick and mortar institutions, including hospitals.

• I’m a clinician – I know the research (and the research and the research) that home or freestanding birth centres are the safest place to give birth. I know that in several settings including Canada and the UK healthy folks are advised to give birth at home for optimal safety.

• I’m a historian – I know that the decrease in maternal and infant mortality in the 20^th century happened because of concurrent gains in public health — improved nutrition, sanitation, hygiene, and education, and decreased poverty – and in spite of, not because of, the institutionalization of birth.  

• I’m a writer – I see the poetry of a person giving birth on her own turf at her pace rather than on The Man’s schedule, on his bed, beside his operating room “just in case” her body is a lemon and craps out at this pinnacle of evolution. And,

• I’m a midwife – I’ve been to many homebirths and only seen good things, even when they don’t go as planned.

At work I enjoy attending births in all settings and have a special insight into how complex and loaded choosing where to give birth can be.

Family often has a lot to do with it. I’ve heard both “I’m having a hospital birth because I could never tell my mom I had a homebirth,” and “my mom had me at home so I’m going to to.”

For many folks institutions confer a feeling of safety and control that is comforting in the face of the uncertainty and wildness of birth.

And for some people with complicated stuff like cardiac conditions or preterm labour home isn’t safer.

But when it came time for my birth I was all about the comfort and safety of home.

BEING PREGNANT

Being pregnant was extremely fun. I felt productive every day knowing I was growing a kid.

Catching a baby and being pregnant at the same time was just the grooviest experience, I felt rooted in this earthy ancient wisdom of creativity and reproduction.

There were challenges but they weren’t so much about being pregnant as they were being pregnant and being a traditionally productive worker.

The fatigue of the first trimester was surreal. If I had a few minutes between clients I would sleep on my examining table. I went to bed at 6 pm. Food tasted like sawdust so I lived for days on end on scrambled eggs. Halfway through my pregnancy I weighed less than before I was pregnant. In retrospect my body was telling me to slooow down.

When I was ten weeks pregnant all of my clients for the month of May and most of June had their babies one at a time, night after night, every night for a week straight. For seven nights I laboured with families all night long, leaving the room once and a while to barf and ice my hemorrhoids, crawling into bed at 9 am and waking up at dinnertime to go out and do it again.

 At the time it seemed manageable and reasonable – as things always seem when you are in the thick of it. Who was I to complain – I spent my work nights with people in the throes of labour.

I had seen so much loss in my work that in my head I wasn’t growing a kid, I was just “pregnant”. Miscarriage, abortion, stillbirth, genetic stuff. So much genetic stuff. They say genetic stuff affects 3/100 pregnancies but in my experience it’s more.

Every day I thought about the prospect that I might just start bleeding and then I would be no longer be pregnant. Just a little “what if?” in the back of my mind. I planned for it as I moved through my day, “if I start miscarrying now who will go to Judy’s birth tonight?” I was surprised when I didn’t miscarry. Everyone I knew seemed to have a miscarriage or three.

One day I was suddenly five months pregnant. I had the cutest little bump that made everyone who saw it happy. I had energy. Food tasted like the food of angels and it was peach and watermelon season so I would just sit in the Toronto sun with my legs up enjoying warm juicy peaches for half an hour while my kid danced around inside me. Magic.

When I was 28 weeks pregnant I went hiking in the mountains of a remote part of Wales with my family – dad, mom, sister, husband, sister in law, close friends.

I thought about the risk of going into preterm labour hours from a hospital and the possibility of having a million-dollar bill for an overseas NICU stay and decided screw it, pregnancy is a state of health, my kid and I would be better for the hike, you only live once, and went for it. I carried a few vials of antihemorrhagics in my backpack just in case. Not sure what I was thinking – I guess I wanted my hiking peers to just have to carry one dead thing off the mountain, not two.

I scaled back my work as I got more pregnant because I didn’t want to deal with having a baby in the NICU if I didn’t have to. I work a physically demanding job and I work at night – two risk factors for preterm labour, a common reason why kids go to the NICU. I knew many residents and nurses who worked similar hours to me and had had preemie babies and I wanted to feel like I had made every effort I could to avoid that.

I AM MY FATHER’S DAUGHTER

I am my father's daughter
I have his eyes
I am the product of his sacrifice
I am the accumulation of the dreams of generations
And their stories are in me like holy water
I am my father's daughter
-Jewel and Dolly Parton, My Father's Daughter

At 35 weeks pregnant I traveled to Chicago to watch my sister and dad run the marathon. My amazing sister qualified for her first Boston Marathon by a seven-minute window. My dad qualified for his eleventh Boston Marathon. Hugging them at the finish line is a sweet, pure, crystal memory for me.

My dad is my world. He grew up the middle child in Chatham, Ontario, a tiny town that at the time was built on tobacco farming. My dad’s parents had an elementary school education, ran a bookshop, had no money, and were religious, rural, musical folks.

My dad, a mischievous, scrappy little Ravenclaw, grew up working in the local nursing home. He went to university – a first in his family – with the singular goal of becoming a physician. He married my mom, who looks and does business like Kim Kardashian, and then graduated president of his class from University of Toronto Medicine in the 80s.

Growing up I remember having so much fun all the time with my dad. He worked family-friendly hours while my mom embarked on her rockstar career where she started as a lab tech for an international petrochemical company and worked her way up to global head of quality.

The rural ethics of my dad’s practice are a big influence on me. Relationships are an essential part of medicine for him. He plays a game with his medical students where he asks them to find out one thing about his patients that he doesn’t already know. No one has ever been successful!

Like many rural folks he holds a deep mistrust of any institution nice enough to have a pretty lobby. Hospitals, churches, banks, anything.

He was awarded a lifetime achievement award by the Anglican Church of Canada a few years ago for organizing a triathlon every summer that has raised hundreds of thousands of dollars for our little church. He didn’t go to the dinner, which was specifically organized for him. “I served 80 meals at the Inn of the Good Shepherd last weekend,” he said without looking up from his new fav pastime, imgur, “when I can serve no meals, that’s when I’ll go to their nice dinner.”

While running his full-scope rural family practice and doing hospitalist call on weekends my dad has also done 88 marathons, 11 Ironmen, hundreds of Olympic-distance triathlons and two ultramarathons.

He also has his pilot’s license and hobby plane, potters around on his boat, sings in the church choir, and plays the piano.

He packed my lunch every day in elementary school with simple rural athlete fare: a blue Gatorade and a chocolate PowerBar.

He raised two kids who adore him.

• 

• 

WELCOME TO CANCERLAND

When I am 39 weeks pregnant my dad is diagnosed with metastatic prostate cancer and given a couple of years at most to live. He is 61 years old.

I immediately decide to scrap my homebirth and induce my kid in the hospital with Pitocin so I can be done with the uncertainty of birth and travel the three hours home to support my dad.

My midwife, who knows our family well, approaches the diagnosis with a clearer head. “I don’t think we should induce you,” she tells me. “You’ll be no good to your dying dad if you’re lying around asking him to get you water after a C Section.”

She is referring to the statistic of 40% of first-time labour inductions ending in sections at our hospital.

“You won’t be pregnant much longer,” she adds. “Let yourself just have the baby.”

She offers several alternate plans, a classic Tracy move. She’ll come home with me three hours away and deliver my baby there – what a saint. Or she’ll see if a midwife in my hometown can take over. Or we can try to encourage the labour along here in Toronto so I can get home with my baby sooner. Or we can slow down a minute and stick with the plan to wait for labour and have our kid at home.

I talk it over with Jesse and we decide to try to encourage labour along.

OTHER REASONS I WANTED TO BRING ON LABOUR FASTER

My sudden desire to induce my labour and see my dad happened in the context of two additional factors: I was anxious about giving birth and just wanted it to happen, and I knew that our large tertiary hospital had recently been overcome by ARRIVE Trial fever and was treating any pregnant person past their due date as a ticking time bomb that needed to be defused delivered.

The ARRIVE Trial is a new study that found that that if all healthy pregnant folks have their labour induced in a hospital with doctors at 39 weeks there will be fewer sections than if we waited for them to go into labour on their own.

The decrease in section rate is miniscule: 19% of people induced will have sections versus 22% of people who go into labour on their own.

I sense that hospitals with high section rates are keen to lower them and in that context a 3% gain is significant.

That we are even studying the concept of induction of labour to lower the section rate feels insane to me, like eating low-fat dessert to lose weight.

Our midwifery practice has a section rate of ~10%, which is well below the ARRIVE result. The midwifery-led birth unit in Markham regularly publishes their section rate and it’s around 5-6%. And the outcome for babies is no different. Why not just hire midwives? And nurture the body to do its work?

A medical induction is not as simple as starting a drug and having a baby. It involves days of work, drugs, IVs, and additional pain. It inhales resources, invites new risks like uterine rupture, assumes we’re omniscient about due dates, and replaces the sparkling magic of going into labour on your own with a soul-crushing medical-bureaucratic process.

Even though I knew in my head it was perfectly fine to be pregnant well past your due date I just haaated rocking the boat at this point in my life. I didn’t want to be the worm who showed up to our hospital at 42 weeks for whatever reason with a kid still inside me. I knew how it would be received as I’d laboured with many folks in that situation and I just didn’t want that drama for my own labour.

(Now that my kid is in my arms and I am obsessed with him I positively love rocking the boat for his sake — I crapped my kid in international airport security on the floor 😉 I wanna take drama on head on! Next time.)

So, not wanting to rock the boat, I looked for alternative ways to bring on my labour at home.

HOW I BROUGHT LABOUR ON FASTER AT HOME

My approach to hurrying labour up involved four things:

1. A lot of stretch and sweeps
2. Sticking Evening Primrose Oil tablets up my vagina every night
3. Acupuncture
4. Walking 10 – 20 km a day

Stretch and Sweep

A stretch and sweep is where someone puts their hand inside your vagina and uses their fingers to stretch your cervix over your kid’s head a little. It is not comfortable but it has been shown to shorten the length of pregnancy.

After my dad’s diagnosis my midwife and I did stretch and sweeps just about every other day. We would text to see where in the city the other was and meet up – sometimes at clinic, sometimes at our homes. We did four total.

At each stretch and sweep I was a little more dilated and a little less uncomfortable. I was 1 cm dilated and 4 cm long at the first and 3 – 4 cm dilated and 2 cm long at the fourth. There was more bloody show — a sign of progress — every time. A heaping tablespoon of gooey blood pooled in my midwife’s gloved palm at the last one.

For anyone wondering about the sensation of a stretch and sweep – it is unpleasant but not memorable enough that I can think of a good description. Easier than a pap smear. Bring a hand to squeeze and you’ll do great.

Evening Primrose Oil

Evening Primrose Oil is an old wives’ recipe for getting your cervix nice soft and mushy and ready for labour. It is thought to contain prostaglandin precursors that among other things break down collagen in your cervix.

Every night starting around 36 weeks I put an Evening Primrose Oil tablet in my vagina. I picked nighttime because then I was laying down so the oil could theoretically not fall out as much.

It was the perfect at-home intervention. It didn’t hurt, it wasn’t expensive, and it made me feel a little more in control.

Would I do it again? Hopefully I’ve learned from this labour and will approach the next one less obsessed with managing my timeline and outcome… but I get why I did what I did.

Acupuncture

Acupuncture was my favourite intervention at the end of pregnancy.

I went into acupuncture curious and inexperienced. I knew that there was good research that acupuncture gets your cervix mushy and and ripe for labour and maybe reduces your chance of a section. I had also had seen stubborn breech babies resist all efforts to turn and then flip head down at the whiff of moxibustion. But I had never been acupuncture’d before and had never seen a Chinese Medicine healer so had no idea what to expect.

I found a beautiful witchy Brazilian healer, Guia, who works out of her must-be-seen-to-be-believed-breathtaking new age home overlooking a leafy ravine in West Toronto.

Guia spent an hour getting to know me and asked me questions about my family, diet, pregnancy, and hopes and dreams. She was the first person to share my worry that, at 39 weeks, my kid was in a bogus position for labour – Right Occiput Posterior.

In both of our experiences, kids in Right Occiput Posterior just take foreeeever to be born, likely because they aren’t as nicely lined up with the birth canal as their Left Occiput Anterior peers and have more figuring out to do to get born.

Kids can flip flop between positions in utero. Often a baby who during pregnancy is persistently and stubbornly in a less favourable position (anything on the Right or Posterior) will move with the contractions of early labour into a more favourable position (Left Occiput Anterior).

Even with the possibility of moving into a more favourable position with contractions, in my experience kids in Right Occiput Anything positions before labour are born by instrumental deliveries more often (vacuum, forceps). I’m not sure why — maybe it’s because we use Pitocin on them more because they are slower to be born so they have more heart rate drama? Birth is a mystery.

So Guia and I worked together to get me into labour and to flip my kid to the more favourable Left.

We couldn’t have known that my kid was in the position he was in because that’s the way he could wrap his hand around his ear and suck his wrist. He was born with a hickey and blister on his wrist from sucking so hard! I hope all the sucking was pleasurable for him — it was a long slow birth. My body had to figure out how to birth a 38 cm head with a hand beside it! We did it in the end :]

Guia stuck me with needles in my neck, shoulders, wrists, and ankles. It didn’t hurt. The big sensation came afterward, when I felt hot and tired.

As she stuck me she asked me to hum as low as I could. She pressed a comically oversized, very beautiful millenial pink crystal bowl up against my kid’s back through my belly. She swirled an equally pink crystal mallet along the rim.

A deep bullfrog vibration filled the room, buzzed my brain, and spilled out into the ravine. The kid jumped immediately into the ideal Left Occiput Anterior! He stayed there for a few hours before slinking back into Right Occiput Posterior. He totally found his wrist and started to suck on it again.

In retrospect when I wanted to get labour going faster I shoulda called Guia of the Crystal Bowls before starting Pitocin.

I tried all the Spinning Babies moves over and over – nothing got my kid to move like Guia. In retrospect I think Spinning Babies just wound me up and Guia calmed me down.

While Guia stuck me she commented that I had too much shortness of breath. What? Doesn’t everyone have a hard time breathing when they are very pregnant?

Guia told me to cut dairy including my beloved chocolate milk and focus on black earthy foods: black beans, black berries. She told me that my crap diet had blocked up my kidneys and that fluid was spilling up into my lungs. The result was shortness of breath and an inflexible diaphragm that was affecting the position of my kid.

I didn’t believe her but I did what she said anyway and man she was right my shortness of breath disappeared! But my kid stayed put.

The internist Victoria Sweet MD shares a similar story about a dietary treatment for asthma based in Ancient Chinese Medicine in her delicious book Slow Medicine.

EARLY LABOUR

It was a snowy Monday afternoon in November and my husband and I were walking along Bloor and Avenue in snowpants, enjoying the city, when I turned to him and said, “I am going to have the baby soon.”

I had been contracting every ten minutes or so with increasing intensity since the previous afternoon and there was a splash of mucousy blood in my underwear. I was two days past my due date.

We hurried home as it was twilight and labour tends to get going after the sun sets. The moon, two days til full, vibrated in the sky above us.

As the winter evening settled in my contractions increased in intensity and came every four to five minutes. They felt like cramps.

I asked my husband to help me bake a birthday cake for our new baby to pass the time. I had eaten many early labour birthday cakes in my work and wanted one for myself!

Baking the cake involved mostly me on all fours pooled over my birth ball moaning and thumping my head while Jesse dutifully followed the recipe in Joy of Cooking.

The pain of early labour wasn’t excruciating but it was enough that I couldn’t make nice, be fun in the kitchen, or sleep, even after taking a heaping fistful of Gravol.

I lost sense of time. Jesse went to bed in the other room in our tiny apartment and suddenly it was the middle of the night. I hung out on all fours, draped over the birth ball, rocking and humming low during contractions and then laying in the fetal position on the floor between them.

I remember staring dumbly at the twinkling, snowy, dark Toronto sky and marvelling at the silence of the ravine in winter beside me.

My brain felt so cool – sparkling and light like pop bubbles.

My thoughts had the lifespan of a pop bubble as well: Jesse tells me that around 4 am he went to the bathroom and found me in the living room surrounded by “about 20 small glasses of water.” He watched as between contractions I would look for water, not find any, and then lurch towards the kitchen to get a new glass.

It was an eerie sight, this crawling creature in the dark of winter with bloody legs surrounded by a religious amount of tiny water glasses and a few electric candles dimly glowing.

When the sun came up I was pumped because I was going to finally be in labour soon and gods be good maybe have a baby today. I also felt bone crushingly tired.

As the day went on the contractions spaced out from five minutes apart to eight to ten minutes apart. They were blindingly long, like eighty seconds, and white hot with pain, which was new. It felt like two boulders were grinding together in my belly. The fiery sparks emitted from the friction were the chief source of pain – blinding, sharp, hot.

Jesse squeezed my hips, kept the heat packs coming, and texted our midwife, who was just going to sleep after being up all night at another birth. Full moon.

A warm bath appeared. I had never taken a bath in my adult life. “Try it,” my husband encouraged. I squatted down into our small rental apartment bathtub. As a contraction reared white hot I fell to my hands and knees and rolled to one side. My big body bobbed in the water. It was kinda pleasant.

My cat jumped up and began drinking the bath water. It was adorable. “Take our picture,” I commanded. The result looked like an American Apparel ad.

A text from my family. “They are on their way,” my husband looked at me apologetically.

My family is on their way.

My family.

My dad starts chemo tomorrow.

This baby might not even be born by tomorrow.  

This baby needs to be born.

My heart raced and my ears got hot. I was no longer keen to experience everything life has to offer. I was no longer a beast surrounded by tiny water glasses with blood down my legs, sparking boulders for a belly, and pop bubbles for a brain.

I was a daughter trying to get her dad to chemo tomorrow.

“Call my midwife.”

Tracy confirmed I was 7 cm dilated, totally effaced, and in transition. I requested a change of plan. Screw the homebirth, I said. I wanted an epidural and Pitocin – the quickest way to get this baby born.

Tracy reminded me that transition meant I was almost there. The last hoorah before you start to push; a big rush of adrenaline that wakes you up from your groggy early labour daze and gets you back in the game.

Often the adrenaline of transition means that people freak out like I was doing and if you just wait the freak out passes as the adrenaline rush subsides.

She offered a tub at the nearby birth centre. Laughing gas. Moving things along by breaking my water. Nipple stimulation. Anything to keep things as safe and least-interventionist as possible. I knew that once you start managing one part of labour you tend to need to meddle with everything.

As we debated what to do my contractions became closer together and stronger. I start pacing the apartment and screaming very high.

I was finally here, labour, and all I could think about was my family in Cancerland. This baby meant hope to them. I doubled down. Hospital. I needed the tools of the institution so I could host my family at the birth of their first grandchild.

LABOUR

We drive down Avenue Road at 5 pm on a Tuesday. It is… not great.

I have a contraction in the elevator up to labour and delivery. It is just me and a well-dressed middle-aged woman. I scream my head off and run in circles – the fiery sparks lighting up my belly are becoming more powerful! The well-dressed woman looks very supportive but is white-knuckling her bouquet.

I know I have five minutes until the next contraction so I hustle. I swipe myself into labour and delivery. I wave to Jason, our ward clerk, and tell him I’m in labour so he can please get a chart ready. I pick one of the smaller rooms and as I walk there I grab the epidural cart from the hallway with all the supplies. My husband is somewhere between parking the car and registration.

I retrieve a hospital gown from the cupboard because the open back will expedite the epidural. I pee and then I lay out my midwife’s supplies for starting my IV in a neat row, in the order she’ll need them. I pause to scream HURR HURR HURRRR and then crawl into bed with a hot towel on my arm to make my vein stick out.

My midwife glides in with a coffee, her grey lavender curly hair tumbling gloriously behind her. She efficiently inserts the IV into my nice warm vein and summons a handsome anesthesiologist.

With each contraction I scream what sounds like a parody of a scream it’s so loud and high. I pace the room quickly as if I could powerwalk away from the tumbling boulders in my belly and their hot sharp sparks of pain.

For the epidural I sit on the bed with my shoulders slouched and back hunched out. My husband stands nervously in front of me with his hands on my shoulders and his forehead against mine.

Anesthesia inserts the epidural needle in my lower back. As a contraction rips through me I scream HOUSE HOUSE HOUSE HOUSE HOOOOUUSE — an old midwife trick that helps you stay still through a contraction during your epidural insertion so you don’t move and get paralyzed.

The next contraction starts at the base of my spine and vibrates up to my skull and down to my toes. It feels like all the little sparks just – WOOSH – exploded into a big roaring fire. I yell and grunt HRRRRRRRRNNNNNN. HRRRRRRRNNNNNNN.

“I thin you’re pushing?” my midwife wonders as the anesthesiologist continues working on my back.

I am asked to lay down so I curl up into the fetal position. My bare butt is sticking out of the hospital gown, there are forks of blood down my legs, and I am mashing my head into the bed rail to counteract the sensation in my belly. I am yell-grunting and it feels like I am puking out of my butt. I feel vulnerable but also dazzlingly powerful. Nothing could stop this cool grunty feeling.

The epidural takes two hours to kick in. I am grunt-screaming and mashing my forehead against the bedrail the whole time. The anesthesiologist gives me more drugs through a plastic tube into my back every fifteen minutes. They do not work. Eventually we try a different cartridge of drugs at a higher concentration.

All at once I feel nothing. The room is silent except my midwife typing at the monitor beside me. I blink and feel my belly – rock hard like a contraction but I feel nothing. My family bursts in the door, fresh from their trip. What timing. I smile, wipe my brow, pull the sheets over the blood. “How was the drive?”

My midwife greets them kindly and then sends them to a nearby restaurant. “Let’s get to work.”

We turn off the lights and it’s just us and my husband and the twinkling dark Toronto sky. Anne my student is on her way — she got a little more sleep after last night’s birth than Tracy did. Tracy hangs a bag of Pitocin, the drug that brings on big strong contractions and gets babies out on a schedule. She also breaks my water with a big hospital-grade crotchet hook.

Over the next half hour I play with different body positions. Hands and knees. Squatting upright. Laying flat. No matter what all I can feel is the pressure of a bowling ball in my butt. I’ve never felt that before but I know what it means.

My midwife does a quick check and makes an theatrical “oof” sound as her finger bonks into my kid’s head. “MacKenzie! He’s right there! Great work!”

Time to push. I have seen pushing go on forever and I have seen folks blast through pushing. I wanted to give myself the best chance of blasting through pushing because I am obsessed with efficiency at this point in my life in case that wasn’t clear by this part of the story… so I spend a bit of time finding the position that makes my pelvis feel as open as possible. It is happy baby.

My midwife touches my belly and tells me I have a contraction and we should work with it. I take a big breath and try my best to throw up out of my butt. It works. A small mass of dark thick hair emerges. I reach down and feel it. My husband feels it. The head is half-in half-out. I no longer feel like I have a bowling ball in my butt.

Jesse is sitting in deep concentration between my legs, hands poised. Anne is suddenly here and she looks beautiful and confident and tells Jesse he’s doing great. My midwife reaches into my husband’s pocket, grabs his phone and starts taking pictures of this nativity scene.

I can see in the reflection of the lights above me that my body is pushing this black mass of hair out without my conscious effort. I am delighted to see that even though I drugged it to kingdom come my inner beast is still quietly at work.

My midwife mutters a joke about me pushing so fast the backup midwife is going to miss the birth and as I laugh a wet kitten slides out of me, into my husband’s hands, and slimily onto my chest.

I look up as the door bursts open. My beautiful sister and wise mother and my proud, strong father beam at me with full bellies and the smell of the winter city evening on their skin. I present the baby to them wrapped in a perfect bundle. They cry and hold him and I look for a warm towel to hold to my veins so my midwife can have an easier go of cross-matching my blood for RhIg. I am ecstatic – everyone I love is here. My husband is so beautiful. My family loves me so much. My dad might die tomorrow but today he has this baby. My midwife is the most brilliant person in the world.

The placenta slides out with a laugh. Everyone is happy.

My midwife brings the tiny bundle back to me. “Try feeding him,” she suggests.

I do as I’ve shown a hundred women to do before. I straddle his legs around my elbow so his spine runs along the inside of my forearm. I hold my hand firmly beneath his occiput between his shoulder blades. I place his little hairy body across my chest in “cross cradle” position. I sandwich my breast in the direction of his mouth and RAM him on (“rapid arm movement”). He sucks. I am breastfeeding.

I turn to beam proudly at my family but something catches me. The baby is looking at me. I have smushed his crumply little vernix-covered face directly against my breast and covered most of him with a bedsheet, but he is still looking at me. I stop and stare at this strange creature.

I feel his slow, drugged? fingers explore the skin over my ribs, sticky and cool. The red spider veins on his cheek swell bigger and redder as they heat up against my chest. I can’t stop staring at the intricate little veins on his cheeks. Like a map. To what? Warmth floods out of him and pools in my chest. My breath slows and so does my heartbeat.

My son.