A Homebirth Cesarean Story | Tampa Bay Home Birth Midwifery

"As a homebirth midwife I support families in so many different ways. My number one goal for all of my families is healthy mama & healthy baby- but sometimes that looks many different ways for many different reasons. The path to that outcome includes many nuances and throughout all of them I want families to feel like they are in charge. Even if things do not go as planned, that they had a voice and were able to use that voice to make decisions about their own care. I am not a dictator. This is not a dictatorship. Midwifery care should never look or feel that way. THAT is what makes a difference. Even when a family plans a home birth, no one can guarantee them that outcome.  What I can do is provide one on one support throughout every possible bend and turn and help families feel prepared for wherever their birth journey heads. The important part, after all is said and done, is that the family feels heard, respected, and loved throughout the whole experience. Having a homebirth does not grant you entrance into an exclusive club of women and families who have all pushed their babies out on their living room floors. Instead, I feel that PLANNING a home birth connects you with some beautiful people who will be your tribe. It is all part of finding community in a time where communities are sparse and support can be difficult to come by. You arm yourself with knowledge and carry some serious courage into what can be a very isolating event if you do not have that tribe with you. Karina's story reflects all of this and I am so grateful she has stepped up to share such an intimate experience with you all. A very special thanks as always to Marianne Power RN, LM from our sister practice Lakeland Midwifery Care who was covering call for me while we were on our family vacation and supported this mama so beautifully.

 A transfer from an out of hospital setting such as home or a birth center is NOT a failure. It is proof that when necessary we can transfer care to fulfill that first goal, a healthy mamababy dyad. If you were a homebirth or birth center "transfer" there are some great resources for you such as our local ICAN of Tampa, the National Homebirth Cesarean, and The Whole Woman has this great article about transfers."

Archer did not come into this world the way I had envisioned, but he came just the way he was supposed to.

After the difficulties postpartum that I suffered because of Amia’s traumatic cesarean birth, I really wanted something different this time around. We decided to pursue a homebirth with a midwife.

At about 38.5 weeks (a Tuesday), I started having some mild contractions. They were not very painful, and were very spaced out. They continued like that for a couple of days. On Thursday that week, they all but completely stopped. I think it was my body taking a break before the “big event”. Thursday evening, contractions picked up, and they were starting to hurt. I went to bed around 11, thinking I’d better get as much sleep as I could. At 1:30AM (Friday morning, at 39 weeks), I woke up because the contractions were too painful to sleep through. I got out of bed and paced around for a while with Matthew. I baked some cookies, set out some pumpkin bread, and just tried to stay calm. After a couple of hours, we contacted our doula, Melissa, and she headed over, arriving around 5:30AM. The contractions continued to pick up, getting longer and closer together, and not long after, Melissa suggested we call the midwife, Marianne. She headed over with birth assistant, Mary Catherine, and by 8AM, our house was full of people! Both grandmothers had been notified and were on their way as well.

Labor progressed pretty much normally for most of the day. Contractions got stronger and closer together (yay! that didn’t happen with Amia!) and I was handling the pain very well. Melissa and Matthew were my rocks, helping me through the waves. Amia was also wonderful. She was ever-present, curious, and excited. At one point, she asked about the noises I was making, and someone told her that happened when I had a contraction. Later, as I was moaning again, she told my mom, “Mommy’s having a con-trac-tion!” So cute.

I don’t recall when, but I did lose my mucous plug and have bloody show at one point – again, this encouraged me because that didn’t happen during my labor with Amia. Later in the afternoon, I wanted to get in the tub, so they filled it up and I relaxed in there. It eased the pain a little, and was comfortable and soothing to me. Amia loved the tub and the water. She wanted to be near me and play and talk to everyone in the room. My mom and mother-in-law stayed in another part of the house, ready to play hostess or help with Amia when needed. I did not want either of them near me as I labored; I just wanted privacy.

I remember that I got out of the tub at one point, hung out around the house again, then got back in. I remember wanting to push at some point, so I did. For a while. But I didn’t feel like it really did anything. I didn’t feel baby moving down; I didn’t feel like anything was changing. My contractions were very painful and I was feeling a little tired, and I really wanted to know what was going on. So, I asked Marianne to check me. As she was doing so, my water broke. Apparently the urge to push I was feeling was because of the bulging bag of waters. It was nearly 5PM and I was at 7cm dilated!

Several hours passed. I started to get very tired. Matthew was exhausted from not sleeping at all the night before, and he was literally having difficulty staying awake. He was so helpful to me during the waves, and not having him fully present as the evening progressed was hard for me. I kept calling for him, telling him I needed him, but he just couldn’t do it, physically. He started nodding off on the couch, standing up, wherever. Around 7 or 8PM, someone put Amia to bed, and my mother left at some point after that. My contractions were very painful, but had started to space out. Per Marianne’s and Melissa’s suggestions, we tried to get things moving again by walking, bouncing on the ball, laying on my side, sitting on the toilet… Nothing seemed to help. Everyone agreed that I needed some rest, so Marianne had me lay on the bed, on my side, and Mary Catherine gave me some homeopathic remedy to help me relax. I tried to sleep a bit on the bed, but it was incredibly painful. I spent half an hour on each side, and the pain made me want to cry. I moved to the living room, and sat on the ball and leaned forward on some pillows to try and sleep that way, all propped up. The pain there was nearly unbearable as well. Walking/standing was okay, but I was exhausted, and Matthew was not there to lean on, to sway with me. I remember feeling very restless. By 9 or 10PM, my contractions were very spaced out, and I was tuckered out. I wanted to know where we were, so I’d know how much longer I had to go, so I asked Marianne to check me again.

Imagine my surprise: I was still at 7cm, many hours after my water broke. Things are supposed to progress more when you water breaks, but that hadn’t happened with me. I thought if I could just get some rest, things would pick up again, but I couldn’t get comfortable enough to get any rest. I didn’t know what to do, but I knew something wasn’t right.

After much thinking (and a couple incredibly painful contractions), I brought up the idea of transferring to the hospital. Everyone was surprised to hear me say that, because they knew how much I did not want a hospital birth. I had fought so much for a homebirth. They told me I had been holding up so well, that I had shown such strength. And Matthew, especially, knew how much I did not want a hospital birth. He started to fight me on it, and kept telling me how much I would regret it, but the more I thought about it, the more that was what I wanted to do. I was just too tired, and the lack of progress after so many hours had me concerned. I thought perhaps, if I could just get an epidural and sleep for a couple of hours, my body would have enough energy to go through those last couple of centimeters and I could push baby out. Something told me I needed to be at the hospital. I told Matthew, very bluntly, “I need you to support me on this.” So he did. Marianne asked me if I was afraid to push my baby out of my vagina. No, I wasn’t. I just didn’t have it in me to deal with the pain anymore, not after so many hours with no progress. I was so tired, and feeling discouraged, and I really hoped the rest at the hospital would help me progress just a little more. Something wasn’t right; the home setting was not working anymore for me. Matthew needed some rest as well, so he could be present mentally and physically for the birth. So the decision to transfer was made.

Things got very busy then. Marianne was one the phone with the hospital, Melissa and Matthew were packing bags, Mary Catherine was cleaning up and assisting Marianne with whatever they were doing. I remember just getting a jacket to throw over my damp dress, sliding some shoes on, and waiting impatiently at the door. Once you decide on an epidural, everything seems to hurt more for some reason. It’s like, mentally, that decision zaps your strength to deal with pain anymore. No one was moving fast enough for me. I just wanted to get out of there! I just wanted that sweet relief of the epidural and some sleep! I was happy Amia was sleeping, and that my mother-in-law would be there for her in the morning. So I just wanted to go.

After waiting for what felt like hours, everyone was ready. It was a cold night and a short drive, but it was torturous. Sitting in a car is the most painful way to have a contraction, in my opinion. Matthew drove; Melissa followed in her car. Apparently Marianne was not to far behind, as she showed up not long after I was admitted to the hospital.

I struggled so much to get out of the car and make it to the elevator at the hospital. Matthew wanted me to ride in a wheelchair, but I couldn’t bear the thought of sitting. I remember moaning loudly in a corridor, then in the elevator, then at the admissions desk. There were several people in the waiting room in front of the desk, one of them obviously very pregnant, but everyone was calm and no one seemed to be in labor. Me, on the other hand, I was clearly far along and making lots of noises. I’m sure they were looking at me nervously and strangely. I didn’t care. I hurt. I figured if I made everyone uncomfortable enough, it would speed things along. It helped, a little. The girl at the admissions desk was so kind; she tried to move me to the top of the list, and even went and cleaned the triage bed for me (not her job) so that I could get in quicker. No one else was in a hurry, but eventually we made it to the triage room. They made me lay on the bed to place monitors. Doctors came in and talked to me. Marianne showed up and talked to them for me. It was probably midnight by that point, and I was still at 7cm. The main doctors treating me, Dr. G and Dr. J, were not encouraged by this, especially given my history with Amia’s cesarean (for a stalled” labor). So, I was admitted, and all the while I just kept holding out for that pain relief of the epidural.

Things were pretty standard from there, in terms of hospital care. Lots of nurses came and went, I signed consent forms, I talked to Dr. G about my desire to birth vaginally if I could. He told me he wanted to check me in two hours, and we’d make a decision then, but he wasn’t very encouraging or confident.

Finally, anesthesia arrived. They had to poke me twice to place the catheter in my back. Once that happened, everyone mostly left me alone to rest for a while. Matthew laid on the couch in the room to get some much needed sleep.

Oddly, however, I kept feeling my contractions. I told the nurse and Melissa several times. It was still hurting – badly – on my left side. The nurse said that perhaps because I was so far along in my labor already, that the epidural was having a hard time catching up. I figured she was right, and it would kick in eventually, so I tried to just sleep. My contractions were very spaced out at this point, but still rather painful, and with each one I woke up and had to work through it. Several times, doctors and nurses came in, as they were concerned about baby’s heart. His heartrate was declining, a lot, with each contraction. At one point, they placed internal monitors to get a better idea of what was happening. Marianne left at some point. And, just like what happened with Amia, the nurses had me turn to one side, turn to the other side, lay on my back – all in an effort to alleviate some of the stress baby was obviously experiencing. They also did some procedure where they pumped sterile water into my uterus – trying to put more fluid in there in case baby was laying on his cord.

After three hours of this (not the two he originally agreed to give me), Dr. G returned. It was around 4AM – nearly 12 hours since my water broke. He told me was very, very concerned about baby. He checked me, hoping I had made progress so we could proceed with a vaginal delivery. He thought I was at 9cm, and he tried to “stretch” me to 10, but in doing so realized that one of the monitors had pushed back my cervix. When that monitor was removed, it became clear that I was still at 7cm. Zero progress in terms of dilation in 12 hours. Baby had barely moved down, either. The physical exam was also incredibly painful. I was flailing on the bed, screaming. I realized the epidural was only one-sided and not working properly, so I requested anesthesia come back and fix it.

Dr. G and I had to have a serious talk. He stressed to me how concerned he was about baby, and “if it were my wife, I’d want her to have a c-section.” He believed baby was sitting on his cord, and really felt baby was in trouble – not life-or-death, yet, but given much more time, it might become that, or it might become a situation where baby’s brain suffered permanent damage. He recommended not waiting any longer and moving forward with a cesarean. After talking privately with Matthew and Melissa, I agreed. There were apparently four of us that morning that needed cesareans, and Dr. G – after looking at all the cases – decided that mine was the most dire, and so things got moving very quickly again at that point.

Anesthesia came in and adjusted the epidural. Suddenly my contraction pain stopped! Hallelujah! Matthew was sent to change and prep for the OR. Melissa was told to wait and that she could come see me at recovery. I was whisked to the OR. The anesthesiologist administered his drugs and performed his tests to make sure I was sufficiently numb. I don’t recall his name, but he was tall and dark-haired, and he had a very comforting way about him. He talked me through things, and was very patient. Later, during the actual surgery, he continued to check on me and was the only person talking to me rather than around me. I felt very calmed by his presence and I am thankful he was there with me.

As they prepped for surgery, I had a little trouble breathing (pregnant women should not be made to lay on their backs!) but they were giving me oxygen so I tried not to worry about it. I also felt incredibly out of it, spacey. I remember blinking a lot and moving my head around, unsure of the sensation I was feeling. I realized a couple of days later it was the Dramamine patch they gave me to control nausea. The doctors began cutting right along my previous incision line, and Matthew came into the room and sat next to me. I was feeling emotional, very anxious to meet baby and know that he was okay.

Dr. G told me I would feel a LOT of pressure, and I did. They were pushing baby out. And suddenly, the weight was lifted and I heard a little cry. What a beautiful cry! Archer Paulo was born! I suddenly felt so much relief – relief of a worry I didn’t know I held. Amia was not breathing when she was born, and took quite a while to start crying. She had an initial Apgar of 1. So to hear Archer crying the moment he came into this world was quite wonderful to me!

They took him over to the side of the room to examine and clean him up, and Matthew joined him. Someone announced his weight: 9 pounds, 3 ounces. Over a pound larger than Amia at birth. Dr. G made a comment at some point about “no wonder he was having trouble coming out.” He told me that Archer had his umbilical cord wrapped tightly around his neck, which explained his heartrate decels, and perhaps was acting as a tether, preventing him from moving down in the birth canal.

Moments later, a nurse brought Archer over to me to show me what he looked like. He was such a big boy! I remember thinking he was perfect, beautiful. The nurse took him away again, to do what they do. I felt happy and patient to wait for him again. I was not anxious; I was elated. I did not have feelings of regret or sadness. I just wanted to hold my baby. To my surprise, the nurse brought Archer over to me a second time, and I was able to get both my arms up and hold and touch him. He was rooting around, so I let him suck on my pinky for a bit. I kissed him and touched him and talked to him. Then, it was time to go, so they took Archer to the nursery with Matthew in tow, with promises of skin-to-skin in the nursery. (I don’t think the skin-to-skin actually happened, but Matthew told me later that Archer was very calm and content, and sucked his finger the entire time they were there waiting for me to be transferred to recovery.)

I laid there, staring at the ceiling, as the doctors closed me up. I don’t really remember much from that time except that I felt like it was taking a while and I was so, so tired. I had to fight the urge to sleep. I was glad that Archer was healthy and that Matthew was with him, and I just could not wait to hold him.

In time, they completed the surgery and took me to the recovery area. I was the only one there. A nurse checked on me, called for Matthew, and gave me pain medications and ice chips. Matthew was exhausted, and after making sure I was okay, he tried to lay down on the floor to rest. The nursery staff then brought Archer to me. What a sweet, beautiful, perfect baby! He was alert and I was already in love. I immediately tried to breastfeed, and he latched on beautifully right away. I was in heaven.

It was sometime near 6 or 7AM – just before shift change – and the nurse was feeling generous so she let Melissa come into recovery to see me (normally that isn’t allowed). She stayed with us for a bit, chatted, and then I told her to go home. She promised to check in with me later and left.

I don’t recall much after that other than Archer nursing for nearly an hour. I was so tired. We were moved shortly to our own room, and there was a lot of routine stuff at that point – taking Archer to the nursery for tests, etc., administering my medication, that sort of thing. Once we were settled, I sent Matthew home to get Amia so she could meet her brother. He told me later that when she woke up and he explained that there was no water birth and that I had the baby at the hospital, she was incredibly upset and troubled by this. He focused on how Archer came out of my scar, the same way she had, and that seemed to give her some comfort. (Weeks later, when my placenta pills arrived, she again became very upset. Amia told me how she had wanted to bring me “a special bowl for the placenta”. She was so sad that she wasn’t able to do that for me, and it’s one of the few things I feel a little regret about. I really wish she had been able to experience that, as delivery of the placenta was something she had been looking forward to for weeks.) Amia was thrilled to meet her little brother and snuggled up on him right away. It was clear what a caring, doting big sister she was made to be.

I never understood the term “birth high” until those few days in the hospital following Archer’s birth. I was so completely and utterly in love with him. My mom and dad, mother-in-law, and Amia came to visit regularly during the daytime, and I was alone at night because Matthew had to go home with Amia. It was hard, no, nearly impossible to get out of bed that first night to take care of Archer because of the surgery, but I did it and I didn’t care. I wanted to do everything for him without the help of the nurses. He was so calm, so sweet. I’ve never been a fan of Elvis, but in those first couple of days, all I sang to him was “I can’t help falling in love with you.” I held him and snuggled him and babygazed constantly. I wanted to sleep with him but it was against hospital policy to bedshare, so I made the best of it that I could and positioned his bassinet so that I could look right at his face at any time.

Archer developed mild jaundice, and also had to have a lot of testing done because of some risk (perhaps due to the Anti-E antibody? I cannot recall for the life of me). I developed hives from the medications and adhesives used during delivery. None of that really mattered though. I felt so happy, so complete, so warm and full. Archer nursed constantly, which made me really happy since Amia was never a comfort-nurser. At some point, Amia crawled into the bed with us and we had our first tandem-nursing sessions right there in the hospital. Archer barely cried, even when my milk came in (day two) and he was spitting up everywhere from all the milk suddenly in his belly. I still can’t get over what a calm baby he was. I knew right away that things would be different with him than they were with Amia. He was going to be a different kind of person altogether. Gram said he has a calm about him that was the same as Pop-pop, who passed away earlier this year. He would have loved to have met Archer.

We planned for an HBAC but the Universe had a different plan for us. Archer came out big and very healthy, and despite all my wishes for a natural birth this time, I feel really good about everything. I got the homebirth experience I wanted during my labor; I had the freedom to do what I needed to do, was able to keep my toddler involved, and I made a thoughtful, informed, pressure-free decision to transfer to the hospital. The doctors did what they could to enable me to birth vaginally, but it wasn’t meant to be, and I made the decision to go forth with a cesarean. All those labor hormones got to flood my system and help me in bonding with baby and establishing my milk. I didn't have those opportunities last time around. I don't regret it one bit. I say that because I see so many people say that they "failed" in their VBAC attempt, but I disagree. There is a time and place for a cesarean, and we shouldn't consider ourselves failures when things beyond our control necessitate surgery. I never thought I'd feel good about a cesarean, but I really do. It needed to happen, and I am so grateful for the support of my midwife, doula, and the doctors who had the skills necessary safely deliver my wondrous baby.