Soon after my daughter's unmedicated birth, I began writing this birth story for her. I thought that if Audrey decides to have children someday, she might want to read about my labor experience. Before I finished writing the story, I learned that a good friend was pregnant. My friend had questions about labor, and I realized that my labor story might be helpful for her, too. (She was intrigued by natural labor, but was scared enough of labor to harbor a secret desire for a C-section.) So, with my friend in mind, the labor story expanded to include my thoughts on natural vs. medicated labor. My friend ended up giving birth without drugs, and really appreciated my tale. So, when my husband got a web site for our daughter up and running, I decided I might as well include the labor story on it in case it might be useful for anyone else. Since then, I've been a bit surprised at the number of people who have told me they read and enjoyed the story.

Given that folks are occasionally reading this thing, I thought perhaps I should update it a bit. Since Audrey's birth, I've learned more about natural labor through reading and discussions with several friends who have given birth without drugs. I've learned that my very positive, intense birth experience and the sense of euphoria and accomplishment that I experienced after it are very common to women who go through natural labor. I've also learned that I kind of lucked into a successful natural labor thanks to stubborn determination and a wonderfully supportive spouse. If I had done my homework better, I would have known I should take additional steps to make an unmedicated birth more likely. So, to the end of this story, I've now added some additional recommendations for women considering natural labor.

Thursday, August 12th 2004 at 5:56 p.m. at 38 weeks and 6 days of pregnancy

I wasn't sure that I'd be able to tell when I was in labor. My mom had been surprised to learn at pre-natal checkups that she was in labor with both me and my sister. (With me, she was 7 centimeters dilated at her exam, and the doctor advised her to drive herself across the street to the hospital. Dad said he luckily received the call to come to the hospital in the 5 minute period between when he got home from work and when he went out for his daily hour-long jog, otherwise he might have missed the whole thing.) Besides that, I'd been experiencing a lot of Braxton-Hicks contractions since around 24 weeks or so, including a bout of painless contractions at 32 weeks that were less than 5 minutes apart and necessitated a trip to the hospital and a few boring hours on an external monitor. (The on-call OB determined that those contractions weren't opening my cervix and sent me home with a dose of a blood pressure medication that would increase blood flow to my uterus to slow things down, and directions to head back to the hospital if things got worse.)

As I reached my 38th week of pregnancy, there were signs that labor might be imminent. Some of my daily contractions were becoming somewhat painful, I'd lost a pound at my last pre-natal checkup, and I was 70 percent effaced and 3 centimeters dilated. Also, on Tuesday or Wednesday I lost my mucus plug and started producing a lot of mucusy discharge and some blood. I started wearing a pad. Another rather strange change was the change in my earwax. I suddenly began producing copious amounts of very liquidy earwax a couple of days before delivery. My OB was also becoming quite anxious for me to deliver. My regular OB, Karen Shin, was on vacation for my last prenatal exam, which was on a Monday. My blood pressure had been quite high at my doctor's appointments for several months, but had always been normal when I checked it at home, but by week 38 I was frequently getting readings of 130/90 even at home, and worse at the doctor's, and my reflexes were a little quick. I was annoyed that while I finally didn't have to worry about my premature contractions anymore, I now needed to worry about pre-eclampsia. After a rather painful internal exam (I think he was stripping my membranes without telling me) Dr. Shin's partner Dr. Sukhdeo ordered some blood tests for me, and told me to come in on Thursday for another blood pressure check. He informed me, "I'd be happy if this baby came today." On Tuesday he called to tell me that my blood work had been a little "off" and to let me know that depending on the pressure, they might want to induce on Thursday or Friday. If things looked OK on Thursday, they'd check again on my regularly scheduled Monday appointment. He told me to take it easy and rest. At first I was really upset about the possibility of being induced. It was distressing and stressful to be having pregnancy problems, and I knew pitocin contractions were worse than natural contractions, and would therefore make natural childbirth pretty difficult. But once I got used to the idea, I decided it would be a relief not to have to worry about my blood pressure any more. Given how high my blood pressure always was at the doctor's, I was nevertheless dreading the Thursday appointment. I didn't check the results of my bloodwork online, because I didn't really want to know exactly what "off" meant, since I figured it might be depressing. James told folks at work that he might not be coming in on Thursday, and I told my mom about the possible induction. James' co-worker Nupur, whose labor had been induced, called Wednesday night to offer moral support and answer my questions about the process.

Audrey's timing was perfect, though. James and I somehow ended up not going to bed until about 1:30 on Wednesday, and I grumpily complained that we really needed to be in bed by 11 in the future because I was having trouble sleeping in in the mornings. Those extra few hours that an 11 o'clock bed time would have provided would really have come in handy, because at 2:24 a.m. I woke up with contractions, and I knew immediately that I was in labor for real. I guess it was the intensity. I got up, had a very loose bowel movement (another labor sign that we'd learned about) and woke James up to let him know. We timed the contractions for an hour (it was more of a formality than anything else) and then, having confirmed that the contractions were less than 5 minutes apart and over a minute long, I called the on-call OB for directions. It was about 4 by then. The doctor (whose name I don't recall) let me know that she was on call only until 7 a.m., and that therefore, in all likelihood, a Dr. Aung would be delivering my baby. She asked if I was interested in trying to deliver without an epidural. I said I was. She therefore recommended that I try to labor at home for as long as possible, trying to arrive at the hospital before the half hour car ride would be unbearable.

James and I both got dressed. James packed up the car and did some dishes. I felt a little annoyed that he was off doing other stuff rather than tending to me, and I felt very curious as to how much progress I'd made, (especially knowing that my mom's labors had been really fast) and anxious to get the car ride over with. So by 5, despite the doctor's suggestion that we stay home as long as possible, we were on our way to the hospital. Already, the car ride was really unpleasant. It was dark, and the freeway was mostly empty. I would close my eyes during contractions and pretend that I was in an airplane that was accelerating down the runway for takeoff. It helped a bit.

We arrived at the hospital and James dropped me off at the door and went off to park. Then we went in together. The security guard/greeter asked James for his name in order to write a visitor's name tag. I started to give mine (we'd been to the hospital several times for classes and the premature contractions, so I knew the drill) but the guard stopped me saying that I didn't need a visitor's pass. Then we got in the elevator and headed up to Labor anbd Delivery.

The nurses checked us in, and found our paperwork, and then one of them took us to one of the triage rooms where she hooked me up to an external monitor to check the contractions and the baby's heartbeat. I was on the machine for quite a while. The contractions showed I was definitely in labor, but the baby's heartbeat, while it looked fine, wasn't changing a whole lot with the contractions (I think she was asleep, the same thing had happened the last time I was monitored) so they wanted to make double sure everything was OK. The nurse asked the on-call doctor if she wanted to check my progress, but the doc wasn't interested given that her shift was almost over and she didn't feel I was anywhere near delivering, so the nurse checked me. I was 4 centimeters and 80% dilated. I had been 3 centimeters and 70% on Monday, so that was progress. Officially in active labor. The nurse also said my cervix was very soft. Since the on-call doc had told her I wanted to deliver without an epidural, the nurse recommended that we walk around the hospital for a while. Since I wouldn't be able to eat after being admitted, she recommended that we wander around until the cafeteria opened at seven, and come back to be admitted after breakfast. (That turned out to be excellent advice.) So, I put my shorts back on and we headed back out into the halls.

I should probably expound a bit on why I was interested in delivering without anesthesia. There were a variety of reasons. Primarily, I wanted to be as independent as possible during the birth. When I went to the hospital at 32 weeks, I hated being hooked up to the external monitor because I had to have a nurse unhook me every time I needed to pee (and they were giving me lots of juice to try and stop the contractions, so I had to pee a lot.) I didn't want to be dependent on nurses to the extent possible, and when you have an epidural at Stanford, they confine you to bed and hook you up to a monitor, and chances are good you'll have to be catheterized. None of that appealed to me. Also, the idea of having a resident stick a huge needle in my back didn't appeal to me. The possible complications didn't appeal to me (rare as they may be). And the idea of not being able to feel contractions and push efficiently didn't appeal to me either. On the other hand, I was intrigued by natural childbirth. My mother had done it, and I sort of just wanted to know what it was like. It was something so many millions of women before me had experienced. Finally, an anesthesiologist who we heard give a presentation said epidurals don't affect newborns, but a lactation consultant at a different presentation said they sometimes do. So, I also wanted to do it without anesthesia for the baby's sake as well.

So, in a bid to avoid anesthesia, we wandered into the halls of the hospital in the general direction of the cafeteria. We slowly strolled along, pausing whenever I had a contraction. It was very early in the morning and quiet. We took in various sites including the newborn nursery (there were very few babies in there) and other departments. We stopped to go to the bathroom (I was still bleeding). As we approached the cafeteria, it was a few minutes before 7 o'clock, and the hospital was beginning to come alive. From the second floor, above the beautifully landscaped main entrance, we could see that doctors and nurses were streaming into the doors for their early morning shifts.

The trickiest part of the walk was when we got into the elevator to go down to the first floor where the cafeteria was, because I inevitably got a contraction just as the doors were opening, and it was really unpleasant to walk during a contraction. We arrived at the cafeteria a few minutes before it opened, so we hung around with some other folks waiting for the doors to open. The folks coming in for their shifts walked by us, grabbing free copies of newspapers (the Merc, the Palo Alto Daily News) as they strode to work. When they let us in to the cafeteria we gathered up a feast-yogurt, oatmeal, fruit, milk, hashbrowns, etc. It was quite tasty, and we ate in the hospital cafeteria, again pausing for contractions.

After breakfast we wandered back towards Labor and Delivery. The halls were much fuller, and it was less peaceful. One woman asked me if my baby was due soon. "Yes," I responded. "Today." When we arrived back at Labor and Delivery it was a little after 8. We debated whether to wander the halls more or go inside to be admitted. I was really curious how much progress I'd made, so we decided to go in.

A new nurse checked me. She said I was about 4 1/2 and 90% effaced. She also said I was really soft and she predicted I'd go fast. She gave me a hospital gown and asked if I wanted my epidural now. I said I was going to try to deliver without one. She didn't seem very enthusiastic. They gave us a Labor and Delivery room. The nurse also said she wanted to give me some fluids to get the baby moving more, and so she gave me a heparin lock and hooked me up to an IV. Then she left, explaining that she had a lot going on and she was going to have another nurse take care of me. (I figured that she just wasn't interested in helping a woman who didn't want pain relief.) I heard her describing me to another nurse as "she's just in labor." No induction, no premature labor, no epidural. Just a simple case of in labor. That was really nice to hear. Our next nurse did seem much more enthusiastic about the no epidural thing. She was quite nice and older. Don't remember her name. The new nurse seemed a bit aghast at how much fluid the first nurse had pumping into me. She declared that all was well with the baby and unhooked me. The on-call doctor also came by to say hello. She was a young, Asian woman, Dr. Aung, and seemed quite friendly. The nurses referred to her as Diana. The doctor asked if I had taken classes and if I was aware of all of my pain relief options. I said I was and I was going to try to do it without an epidural. Our nurse declared us free to once again wander the halls, requesting that we return in 45 minutes or so so that they could monitor the baby and me for a few minutes. We returned to the halls. We weren't sure exactly how far we were supposed to wander, but stuck closer to the L&D; wing this time. We explored, finding the rooms the doctors sleep in when they're on call. Then, we found a very peaceful outer courtyard where we could walk. James would press rhythmically down on my shoulders during contractions. After 45 minutes, we returned. The nurses checked my temp and blood pressure (I didn't want to know what it was, but whatever it was it wasn't concerning them too much) and the baby's heartbeat. All was declared well, and we were given clearance to return to our stroll. A worker was painting in our favorite courtyard, but we were able to find another one, though it wasn't quite as pleasant. Then my hands started to feel a bit weird, almost asleep, and they looked somewhat disturbingly purple. Knowing that puffy hands are a pre-eclampsia sign, I was worried, and we headed back to L&D.; We stopped at the nurses' station. Our nurse was unconcerned, though, attributing it to the fluids and the walking. So we went off again. The contractions seemed more powerful. (A nurse monitoring my contractions assured me those would be opening my cervix.) I started wanting James to apply constant rather than rhythmic pressure to my shoulders. While I was sitting, I had him apply pressure to my ankles. I also breathed rhythmically during all of the contractions. We did more walking and spot checks of me and the baby. The worst part was when I would have to pee, because I'd be in the bathroom by myself when a contraction struck. I don't know why I didn't just take James with me. At about noon, it was time for another internal exam, this one by the doctor.

After all of that work and all of those contractions and all of those assurances that I was going to go fast, still only 5 centimeters dilated and 90% effaced. Aargh.

Dr. Aung said she wanted to break my water to get things moving faster. But, she said if I wanted an epidural, she recommended that I get one before she broke my water because contractions were generally much more powerful and closer together after the water gets broken. I hesitated to approve the breaking of the water because I was scared of more frequent and powerful contractions. They were bad enough as it was. But James and I discussed it and decided it was for the best. We'd let her break the water, but no epidural.

The breaking of the water didn't hurt at all, but the bad part was that I had to be on my back for it, and I really hated that position. James was kind of hanging back since the doctor and nurse were tending to me, but I called him over somewhat plaintively when I had a contraction while on my back. After my water was broken, each contraction brought a warm spurt of amniotic fluid. It was an odd sensation. The doctor and nurse mentioned that women who have epidurals can tell that they're having contractions when they feel the fluid spurting.

Our nurse told us we were free to wander the halls again, though she predicted we'd be back sooner this time. Instead, though, I decided to try the shower in the room. I took off my glasses and clothes. The shower was OK. James sat by me for pressure during contractions. I actually kind of got stuck in the shower. I was in there for probably an hour or two. After a while it didn't feel that great, but I was kind of afraid of the pain and effort that leaving it would require. James regretted afterwards that he hadn't given me fluids while I was in the shower because it was quite hot and steamy.

Soon after I got out of the shower I had my moment of doubt. I wasn't sure I could make it without drugs. I was really tired after the shower and in quite a lot of pain. I told James that I wasn't sure I could make it. He looked at me somewhat helplessly. Our childbirth educator had said that the codeword for getting the woman drugs should be "I want drugs," not something like I'm not sure I can make it. So, James didn't offer to get an anesthesiologist. After drinking more fluids and spending more time out of the shower, my moment of doubt passed. I just kept taking the contractions as they came. They were really unpleasant, but in between contractions I felt fine. I could smile and converse. In fact, at one point the nurse commented to the doctor, "No epidural and still smiling." At another point the doctor commented to me what a good attitude I had between the contractions. I told her there was no point in having a bad attitude as that could only make things worse. Still, I was just never ready for the next contraction. There never seemed to be enough time between them. After the shower, I spent most of my time sitting on the bed. I tried standing for a couple of contractions, pressing down on James' waist, but it didn't feel very good. Sitting worked better. James kept applying shoulder pressure.

I sat. Contractions came. Our nurse got off at three, but I was nowhere near delivering. A new nurse, Filona, was assigned to us. She was an older nurse, just like our previous one, and she was also very nice. I continued to have contractions, and she mostly left us to ourselves. At one point she tried giving me back pressure during a contraction, but I didn't like it. Periodically she checked my temperature and blood pressure and the baby's heartbeat. At one point she assured me, "You've got a good one. The contractions aren't phasing her at all." The contractions were really quite intense at that point, and I didn't feel like moving around at all. At one point Filona came in and asked how I was doing. She mentioned that she would know that I was getting closer when I started to feel a sensation of rectal pressure. Then there were more contractions and time continued to slowly pass. Finally, I started to feel a glimmer of rectal pressure. I mentioned it to Filona on her next visit. She asked how strong it was and if it was continuous or if it came and went with contractions. I said it was weak and went away between contractions. She said encouragingly, "That's how it starts."

The contractions went on and on. I started to feel more rectal pressure. We asked if they could check my progress again, but they said it wasn't time. Finally it was time for the doctor to check me internally again. We awaited her announcement with great anticipation. Was it time to push? But no. She informed us, as reassuringly as possible that I was 9 plus! "Phooey!" I responded. She said she'd be back within the hour. It was a major disappointment that it wasn't time to start pushing yet. By now, the contractions were even worse because in addition to enduring them, I had to concentrate on not pushing during them. The doctor mentioned at that point that it was too late for narcotics, but I could still have an epidural if I wanted, but time was running out for the epidural, too. (Since they take a little while to kick in.) I brightened at the thought that it was too late for narcotics, because I knew that meant I was getting close. The doctor looked a bit surprised when I said "that's good!" in response to the fact that it was too late for narcotics. I think she was still thinking pain medication was a good idea. I wasn't really tempted by the epidural at that point. However, I did feel a few moments of fear about whether or not I could handle the pain of pushing without drugs. At that point, after the doctor had left, Filona cemented my decision by reassuring me, "You're doing a great job. I think you can do it." Then she, too, left the room. Her verbal support was exactly what I needed to bolster my confidence at that point.

The next 45 minutes or so crawled by. At one point, Filona said that the doctor had suggested that I try to stand and walk a bit. (I wasn't sure if it was Filona or the doctor who really recommended that as the doctor didn't seem big on natural childbirth techniques.) I tried to stand, but only made it from cross-legged to sitting straight with my legs bent at right angles. I asked if that was OK, and Filona assured me that it was. I kept checking the clock and enduring contractions during which I could not push. I was really anxious for the next stage! The only good thing was that Filona was busy prepping all of the equipment for the birth, so I knew things were really getting close.

Finally, at about 4:45, the doctor came back in to check my cervix again. The verdict: Still a tiny bit of cervix remaining! I couldn't believe it! After all of those contractions! But then came the good news. Dr. Aung thought the final bit of cervix was soft enough that it might disappear when I started pushing. She was going to let me get started.

The doctor and Filona moved around the room setting things up. Filona went and grabbed a mirror on a stand so that I would be able to view the action. I asked James to go into the bathroom and get my glasses. Up until that point, I had been very internally focused, but now I would need to see distances.

It was time to begin. "Here comes the hard part," the doctor chirped enthusiastically. I didn't feel that was a helpful statement at all. I certainly wasn't thinking of it as the hard part before she mentioned it! (And luckily, it didn't turn out to be the case.) Then the doctor mentioned to the nurse that the nice thing about natural childbirth was that the woman could really feel and work with the contractions. (Her first really positive statement about natural.)

Dr. Aung said the first few contractions would probably just be for me to get the hang of pushing. I was a bit surprised that it would be so complicated! Then she proceeded to give me a long string of directions. I would be on my back. James and Filona would each be holding up a leg, and I'd have my hands behind my knees. I needed to tuck my chin into my chest. I needed to take a slow breath when I felt a contraction coming on. Then I would take another deep breath and hold it in pushing as hard as I could. I would hold my breath and push three times during each contraction.

So I was on my back with James and Filona at my legs and the doc at the edge of the table. The first few pushes were a real mess. First everyone kept telling me I was doing things wrong. My instinct was to throw my head back rather than tucking it into my chest, but I was informed that would lead to a heck of a neck ache. Also, I kind of grunted while pushing during the first contraction, but I was informed that I was wasting energy and I should just hold my breath. Next, I started to get a cramp in my right leg. I stopped my pushing gasping "my leg, my leg." "Don't pull on your legs with your arms like that," Dr. Aung commanded as Filona massaged the cramp. "Let James and Filona hold up the legs."

I tried hard on the next push, but it still wasn't working. I was still getting a leg cramp. "Tuck in your head, don't pull on your legs," my coaches urged.

There's too much to think about," I whimpered.

They regrouped. Instead of having me hold on to my legs, Filona fiddled with the bed to bring up grab bars for me to hold on to. I could pull on those as much as I wanted to. This improved the situation immensely. Now I started getting praise for my pushes. "A few more pushes like that and she'll be out in no time." The doctor assessed. (But once again, the predictions of a quick birth proved unfounded.)

Contractions came, and I pushed during them. I quickly stopped making an intial preparatory breath, as I found it aggravating. Usually I gave three pushes, but occasionally, they lasted long enough for me to push a fourth time. Getting a baby out requires you to push really, really hard. (My fourth pushes were generally a bit wimpier than the first three, as I was really only mentally up for three, and the fourth push felt kind of like a bonus.) The most annoying thing was the doctor's cheerleading during the pushes. She kept saying things like, "OK, Lisa. Push push push push push push push push push. Get angry at it! Get mad! Come on Lisa, push!" I didn't comment out loud, but I felt her coaching was more annoying than inspiring. In retrospect, I probably should have asked her to stop. Up until that point, I didn't think I cared if the delivering doctor was a man or a woman, but during labor I felt that such coaching would have been practically intolerable from someone who didn't have a uterus. (Dr. Aung looked fairly young, so I'm not certain if she had yet put hers to use.) Another thing that the doctor did that was somewhat uncomfortable but fairly helpful was to apply pressure at various points in the vaginal area, and urge me to concentrate my pushing there. That did help me focus my energy. With each push I closed my eyes and visualized the baby moving down the birth canal. (I had tried to visualize my earlier contractions opening my cervix, but that didn't really work for me at all. The pain during those contractions was too intense for me to concentrate on the positive.) As with the previous stage, I was never really ready for the next contraction to come, but I found the pushing stage to be much more pleasant then the previous stage. It didn't hurt as much, and instead of simply enduring the contractions, I was actively working and participating.

I felt myself poop a couple of times as I was pushing. I'd heard that would happen. I didn't comment on it when it happened, and no one else did either. It was Filona's task to whisk the poop away.

After a while, the baby's head was visible. "I see thick black hair!" The doctor announced. Then she added, "I guess if it weren't black there might be some questions." We all laughed. Now my coaches started encouraging me to look in the mirror rather than closing my eyes so as to be encouraged by my progress. I kind of tried to do that a couple of times, but my instinct was to close my eyes, and I didn't care that much about seeing the head in my body. I figured I could see the head after it was out. After a while, my coaches gave up on encouraging me to open my eyes. Things were going fairly well, but the baby showed no signs of making a quick appearance. So after a while, Dr. Aung said she was heading out to check on another patient. With just James, Filona, and myself in the room, things were more relaxed. Filona periodically applied pressure in the vaginal area to help me concentrate my efforts, but she didn't tell me to get angry at the contractions and that sort of thing. At one point, Filona tried to encourage me by saying, "You're still making progress. These pushes are molding the head." It hadn't occurred to me prior to that that I might not be progressing, so I didn't find that comment to be particularly helpful.

Finally, the baby started showing signs that her head might stay out rather than slipping back with each contraction. In order to encourage this progress, Filona had me keep my legs up and bent rather than having me relax them between contractions. Nevertheless, the head slipped back for a couple more contractions. But then, with the next contraction, the head stayed put. Just then, Dr. Aung returned. "Great timing," Filona applauded the doctor. "This is the first time the head stayed out."

The pushing and contractions continued. Someone suggested that I might want some ice chips. I wasn't really sure that I needed them, but found them quite refreshing as James scooped a few into my mouth between each contraction. One time I had to tell him not to give me chips because I could feel that the next contraction was coming on too fast. Another time, the contraction built up really, really slowly. I bobbed my head from side to side, waiting for when it would be strong enough to start pushing, commenting to the doctor, "This one's a slow builder."

Take a preparatory breath," she advised.

I only had time to gasp, "I find it easier not to," before the contraction hit full strength and it was time to push.

At this point it was nearly 6 pm and I had been in labor since 2:24 am with no food since before 8 am. (Three cheers for the nurse who advised us to go to the cafeteria in the morning!) I had a lot of energy during the contractions, but felt utterly exhausted between them. After one contraction, I relaxed immediately and slumped onto the bed announcing, "Nap time!" Filona smiled saying, "Endorphins are amazing."

And I pushed and pushed and the baby came lower and lower. I wasn't really looking forward to the crowning, since that was described in our preparation class as "the ring of fire." But, it had to be gotten through. Things were really getting close now. The doctor asked if she could move the mirror for the birth, because it was kind of in her way. I was a little disappointed because, while I hadn't used it so far, I was intrigued by the idea of watching the baby make her appearance. But, I didn't want anything in the doctor's way, so I agreed. There was a little bit of hustle and bustle and preparation of equipment. There were more contractions. And then the baby was crowning. (I think I recall James saying something like, "Oh my gosh.") I was pleasantly surprised by the crowning experience. Sure it hurt a little, but really, I didn't find the pain to be too bad. Ring of fire seemed a bit overstated. I didn't notice contractions now so much as a constant sense of pressure. My instinct now was to give short little pushes rather than big pushes, and to my relief, that's exactly what the doctor instructed me to do. "Take it nice and slow," she encouraged. "Sometimes it's tough for women who are doing natural childbirth to go slowly," the doctor informed James. That wasn't a problem for me, though. Little push, little push, little push. I could feel the baby's head inching it's way out. "Great control!" the doctor praised.

I guess all of those Kegels were worth it," I thought to myself.

You can take a break," the doctor advised, "You don't need to push every time." I tried taking a break, but I had a really strong instinct to keep pushing and get that head out, so it was actually harder not to push than to push. "It feels better," I gasped. "I know," the doctor replied. I think she thought I meant that it felt better now that the ring of fire thing was over. But what I actually meant (and didn't have time to say between my pushes) was "It feels better to just push!"

Little push, little push, little push and boom. The head was out. It felt wonderful to have the pressure of the head gone, but I knew there was still a little more work to do. My urge to continue with little pushes was still intense. Almost immediately, I could feel the little shoulders working their way out of my body. It stung a little bit. Little push, little push. The shoulders were out, and, with an unpleasant sensation, the rest of the baby's body soon slithered out. Audrey was born, and she greeted the world with a furious wail. Now, my pain was gone, and my exhaustion was completely lifted (in fact, I had trouble sleeping for the next couple of days, not so much because of the baby but just because I was to wired to relax!), and I watched with fascination as the doctor and nurse went about the work of patching me up and going through new baby procedures.

My memories of the labor and delivery are still intense, though I am completing this memoir some four months after the birth. (I've worked on it in fits and starts for the whole four months.) My memory of the period right after the birth aren't quite as clear. The first order of business after the birth was cutting the umbilical cord. Dr. Aung asked James if he cared to do the honors, but he demurred, so she took care of it. Then the baby got handed over to the nurse, and the doctor proceeded to assess my condition. James had requested that I be allowed to breastfeed the baby immediately (as recommended by breastfeeding books and the childbirth educator). But the doc and nurse had said that if I needed any patching up, the breastfeeding would have to wait a few minutes. The doc's assessment was that I had one first degree tear that needed stitching. I was informed that a single first degree tear was an excellent outcome. Dr. Aung applied a local anesthetic, and told me to let her know if I felt anything. I could sort of feel something going on, and told her so. She then amended her directions, saying I should let her know if I felt any pain. As she stitched away, I watched Filona taking care of Audrey. She wrapped her in blankets and dried her off. She measured her head and length. She applied eye drops. The baby wailed and wailed. The baby also made some gurgling sounds as she was breathing. James and I were concerned, but the nurse and doc clearly thought it was no big deal, and tried to reassure us. Audrey coughed out a lot of gook from her lungs, and the gurgling lessened, though it didn't go away completely. The nurse encouraged James to video and to take photos of Audrey on the scale. She weighed in at 7 pounds 5 ounces, just three ounces less than I had weighed at birth. Her height was 19 1/4 inches. The four of us chitchatted a bit. We talked about how both the video camera and the digital camera were new purchases, and Filona said she and her husband, too, had purchased recording equipment when their kids were born. I told the doctor we had joked about being failures as parents when we showed up for our 20 week ultrasound with no camera, while the couple next to us were taping away and had brought Grandma to the festivities. Filona informed us that the baby's Apgar scores were 9 and 9, and said approvingly that natural childbirth really made a difference. At one point I started to feel the needle a little bit and informed Dr. Aung, who applied a little more anesthetic. Still, I commented that I didn't really care too much about what was happening down at the vagina end because watching Filona with the baby was an excellent diversion. Eventually, I started to feel another contraction (not quite as intense), and I informed Dr. Aung. "That's the placenta coming," she declared. "There's no hard parts, so this won't be bad." Then, she started up with her coaching, "OK, Lisa, one more time, push push push push push." I wanted to do small pushes again rather than hard ones, but I followed her lead, figuring that the sooner the thing was out the sooner the whole thing was over. It's true it didn't hurt as much coming out as the baby did, but it did sting a bit, so I was a little annoyed at having to deal with yet another creature passing through, particularly since this one wasn't nearly as rewarding as the arrival of the first. But, it was over fairly quickly. Dr. Aung examined the placenta, declared it whole, and asked if I wanted to see it. I kind of shrugged and was about to say "yes, why not," but she interpreted my shrug as a no, and quickly disposed of it explaining that some people want to see it, implying that she didn't understand why they might want to. I was slightly disappointed, but seeing the placenta wasn't really a goal I'd had. I was just mildly curious once she mentioned the possiblity, so I shrugged it off.

Finally, I was stitched up and the baby was ready for me. We said our goodbyes to the doctor, and Filona asked which breast I wanted to start with. I pulled my gown down on the right side, and Filona helped Audrey latch on. She sucked vigorously. James asked how it felt, and I replied, "interesting." It was a new sensation, not painful. Definitely interesting. She'll remember that, Filona said approvingly. Now it was almost 7 o'clock, and two things were happening. Filona's shift was ending, and we needed to vacate our room since they only give you an hour in the LDR room at Stanford. A new nurse appeared, and she and Filona chit chatted a little bit. Filona expressed surprise that the new nurse was there and ready to take over so soon after the start of her shift. The new nurse said that she knew Filona would be anxious to be on her way. Filona told the new nurse that I'd done natural childbirth, so there was no epidural to deal with. Then she addressed James and me sincerely, "It was a wonderful birth." And she headed for home.

The new nurse hooked me up with a Pitocin drip (standard procedure to help the uterus contract.) Then she prepared the wheelchair that would transport me to my hospital room, placing a soft pillow on the seat. She helped me put on a pair of mesh underwear with an ice pack to help with pain and swelling. I was in some amount of pain, but not too bad. There were some pains similar to menstrual cramps, as well as a bit of stinging and aching. As James held Audrey, the nurse helped me into my wheelchair. It was really hard to convince my legs to move. And, while the pain that I was in now was nothing compared to the pain of labor, the last thing I wanted to do was be moving, so I felt a little bit resentful. James handed the baby to me, and snapped a couple of photos. The nurse offered to take a family shot. Then she wheeled us into the hall and handed me off to an orderly. He was about to take me to my hospital room and James and Audrey to the well baby nursery where Audrey would get a bath and an hour of observation. We were about to discover the joys of sharing a hospital room with a woman who had frequent guests, the joys of meconium (well, James discovered those, I managed to avoid them), the joys of trying to get a meal for a famished woman who has given birth after the dinner hour, the joys of peeing for the first time after giving birth (it stung a little, and was incredibly bloody), and the joys of meeting our daughter with her strong little personality. (The night nurse's cheerful comment when Audrey howled lustily because she wasn't in the mood to eat and we were trying to get her to latch on, "You're in for it.") I would (later, when she had more of an appetite) experience a baby nursing for half an hour on one breast and then 20 minutes on the other. I would, after some hesitation (due to my fear of suffocating the baby) agree to let the nurse place the baby on my chest that night because she couldn't sleep in her bassinet. I would experience a shower that had only a "super power massage" setting, when I really wanted a gentle soak, wishing desperately the whole time that I had thought to bring shower shoes. We'd meet a couple of pediatricians, and see a couple of OBs. We'd have good nurses and not so good nurses. We'd be livid when my roommate got a private room for her second night that, by rights, should have been ours. We'd see a phlebotomist do a heel stick on our daughter because she was jaundiced, and we'd watch an audiologist test her hearing (after suggesting that nursing might calm our baby enough to let the testing proceed.) And, when they wheeled me and Audrey out of our hospital room on our way to be discharged we'd hear my nurse giggle cheerfully, "See you next time!"

Final thoughts on natural labor: In the hours immediately following the delivery, exhausted and with an aching body, I wondered whether all of the pain had been worth it. But by the next day, I was delighted that I'd done it. I was delighted to have full control of my limbs and bladder immediately (though they were a bit reluctant to get back to work they did what they were told with a bit of persuading). I was horrified by the thought of what I might be feeling in my legs if, sensations dulled by an epidural, I hadn't known that I was getting a Charlie horse. I was delighted by how much faster I seemed to be able to move around comfortably than my roommate, who'd had an epidural. I was delighted that I now shared the experience of natural childbirth with the billions of women who had experienced it before me.

My philosophy on natural childbirth is now this: Natural childbirth can be really amazing. I would recommend it to anyone. But it's also really hard, especially when you know that relief is a page to the anesthesiologist away. So, a decision to attempt natural childbirth is a decision that can only be made by the woman alone. No one gives you a medal for delivering without pain medication (though I'll admit that I swelled with pride when my regular OB, Dr. Shin, called me a star when she came by during rounds). Natural childbirth does have advantages for both mother and baby. But epidurals allow women to give birth with a minimum of pain, and that is a miracle of modern medicine that women should take advantage of if their primary desire is to avoid the pain of childbirth. Natural childbirth is something you should only do if it will make you happy for reasons that are important to you.

If natural childbirth is important to you, then I think succeeding at it is a game of confidence and good attitude.

And finally, while I had a wonderful birth experience, if I could do it over, here are a few things I would change: