About a week before her due date, Aleks began having mild contractions and lots of bloody show. These signs of early labor continued intermittently for the next couple of days. On a rainy September morning, Aleks’ partner, Lev, called me to say that contractions had been more intense during the night, had mellowed out in the early morning, and were now more intense again. Their doula, Kate Dimpfl, had been with them throughout the night, and now they were requesting the rest of the birth team.
I arrived at the house in the early afternoon to find Aleks in what appeared to be moderately intense active labor. The contractions themselves seemed to be taking her full attention, but they were irregularly spaced out, with some coming every 10 minutes and some coming every couple of minutes. Aleks requested a cervical check and I was certainly surprised to find that the cervix was dilated to eight centimeters! We had thought a couple of days previously that her water had broken because she had passed some clear fluid, but I found the bag of waters intact and bulging in front of the baby’s head when I checked her. I called my assistant, Megan, and asked her to come and began preparing my supplies for the birth.
The afternoon passed with Aleks trying lots of different movements, activities, and positions to encourage rotation and descent of the baby. We all ate and chatted, with Lev bringing out delicious foods from the kitchen on a regular basis. Aleks appeared in good spirits, talking and laughing in between contractions and leaning over the couch or table or hanging onto Lev during contractions. After a walk outside with Lev in the early evening, Aleks came back in and decided to get into the birth tub. She sank down in the warm water with a sigh and a lovely smile on her face and proceeded to have some intense contractions while on hands and knees in the tub. During this time, Kate, Megan, and I had put our heads together to come up with some herbal and homepathic remedies, acupressure points, and specific positions to try to encourage further dilation and descent. Aleks was so willing to do anything, and tried out each of our suggestions bravely and stoically.
At about 7:00 that evening, I checked Aleks again and found just a lip of cervix remaining, although the baby’s head was not any lower. This can sometimes happen, so I was not concerned. We continued our efforts to encourage the progress of labor, with Aleks trying many positions, movements, and herbal remedies, both in and out of the birth tub. Towards 1:00 am, Aleks began feeling some increasing pressure very low down so I checked her again and found the rim of cervix gone! She began pushing soon after, and once again we tried many different positions and movements to encourage rotation and descent of the baby’s head. I checked the baby’s position and progress several times throughout the night, and although it was hard to tell due to extreme molding of the baby’s head, it appeared that the baby was in a posterior presentation. Kate, Megan, and I suggested everything we could think of to help the baby to turn into a more favorable position, including homeopathic remedies, acupressure points, lunging, hands and knees, belly lifting, rope pulling, squatting, dangling, and many other positions, but Aleks continued to labor and push as the sun rose and it became another day. Several times, I asked Aleks to stop pushing altogether and rest on her side and try to sleep. I could see that she was becoming discouraged and exhausted, and so it seemed that resting interspersed with strong active pushing efforts would be helpful.
As it became lighter and lighter out and the early morning progressed into a beautiful fall day, I began to think that transferring to the hospital might be necessary. I spoke with Aleks and Lev about this possibility, and although they were both disappointed, they agreed that it did seem like an appropriate course of action. We agreed to give it a final try for another hour, giving it everything we had, and hopefully this would work. Aleks rallied her energy and determination once more, and tried some new positions and movements as she bravely and fiercely continued to push along with the strong contractions. The baby’s heart rate was strong and regular consistently, as it had been throughout the course of this long, hard labor.
After about an hour the baby’s head had not moved any further down, and I decided that it was wise to seek support from a doctor at the hospital. Aleks and Lev were ready to transfer at this time, so we got in our cars and drove the short distance up the road to Cayuga Medical Center. I called ahead and gave the charge nurse a brief report of the labor and Aleks’ current condition, and told her we would be there soon. We arrived at the hospital and were shown into one of the labor rooms. Aleks was exhausted at this point and desired nothing more than a nap before she could make any further decisions. The doctor thought it would be reasonable for her to get an epidural, rest for a while, and then see how it would go to continue pushing efforts after that.
After an epidural and a two-hour nap, Aleks was ready to try pushing again. The doctor was incredibly encouraging and helpful as Aleks once again tried so hard to push her baby down and out. After a short time, however, it became evident that the baby was still not moving down. The doctor suspected a posterior presentation, as I had earlier, and believed that the baby’s head was wedged inside the pelvic outlet because of this. He recommended a cesarean. Aleks and Lev asked many questions and came to a decision together that this was the best option given the circumstances. It was a tough moment, and there were tears all around as we comforted Aleks and gave her and Lev hugs before they left for the operating room.
Early that September evening, Maksim Jozef Perelman was born, weighing 9 pounds 3 ounces. He was healthy and strong, and began nursing soon after he was born and reunited with his mother. Aleks was understandably overcome with emotion and exhaustion. It had probably been the longest, hardest couple of days of her life, and I truly admired her strength, fortitude, and flexibility to change and adapt with the circumstances. This is one of the strongest lessons that birth has to offer us—that even though we think we cannot go on, that we are not strong enough, that “this” is bigger than us—we learn that we are stronger than we ever imagined. That we are the very essence of the life force itself. That we can stand in the gate between life and death and bring another human being over into this world, with courage and joy and fierce strength.
Welcome to the world Maksim! Congratulations Aleks and Lev!
For more photos of Aleks and her family, check out the Photo Gallery of BirthRoot Families.