Two Days Trapped in Temecula

A Home Birthing Tale

Southern California is a beautiful place. Rolling hills become valleys and mountains often with an ocean view. Sweet little towns tucked away with familiar patterns of shopping malls and fast foods blended into the uniqueness of an area’s history, wineries and attractions. Temecula, California is such a place. Secluded about 2 hours from Los Angeles (on a good traffic day) lies this little community amidst avocado farms, wine country and a casino. Families wanting to own a house can still find “affordable” property in the peaceful valley. It is quintessential SoCal with hiking trails and Macy’s and an Outback Steakhouse. On a hot day it can be very hot but for those who live and work there it is still of bit of paradise. The Eagles once wrote about paradise in their song, “The Last Resort”. (“They called it paradise. I don’t know why. Call someplace paradise…..kiss it goodbye!”). For those who have to commute on the infamous California freeway system to and from Temecula the kiss it goodbye part is quite appropriate. That’s where this story begins.

I met J, my Temecula birthing client, at about 38 weeks when she was referred by a local midwife because she was breech. I promised myself that I was going to simplify my life and not take on long distance clients unless they were willing to come to a birthing center near me. So this was the plan that entered my mind before the meeting. A lovely woman accompanied by her family and friends arrived for her breech consult only to find that her baby had flipped back to head down. After feeling her belly it was fun to put the ultrasound on and show her the head just above her pubic bone and see the joy and relief in her face. We talked about keeping the baby that way and home birth options with a local midwife as well as other delivery choices. It did not take long for her to ask if my team and I would attend her birth at home…..in Temecula! I have not quite mastered the ability to say no when I know in my heart that a home birth for her is a better choice than driving several hours in labor to the Sanctuary Birth Suite here in L.A. I have come to know that feeling safe and undisturbed makes the chance of a natural, unfettered birth so much more likely. So how could I say no? I checked with my team and we all agreed as long as no one else was in labor we would be honored to assist her.

In the next week she remained quiet while another breech mom and a VBAC mom had successful home deliveries. Midwife, Beth, had an even crazier week. All I had left was a mom having her 3rd baby who was overdue. So, the waiting game began and much to my relief that birth happened quickly in water a day or two later. So my plate was cleared for my Temecula adventure. We were able to get in a weekend home visit which was about a 6 hour turn around adventure. Carpooling in LA can help some but with its voracious appetite for revenue the lovely California government has begun to convert free tax-paid carpool lanes into toll roads requiring an electronic pass which we didn’t have, Grrrr! Needless to say it just another cost of living increase in paradise which I have since ordered. J makes it to about 41 weeks when she calls on a Wednesday afternoon around 5PM to report SROM but no labor.

Twenty plus hours later she is still leaking clear fluid and there are no contractions. So, early on a Thursday afternoon I head to Temecula to check on mom and baby. Never a good idea to drive in SoCal during a weekday, it’s even more foolish to go during rush hour. The two hour drive takes me three and a half. Thank you Steve Jobs for my iPod! Mom and baby are fine. We are group B-strep negative and my experience has taught me that 90% of women who break their waters will go into labor within 24 hours. Well, we are now at 24 hours and not a peep from this uterus. I have looked at the data critically and cannot really find where the infamous “24 hour” deadline came from. I know in the medical model it is a heavy club used to encourage intervention but the literature has evidence leaning both ways. I’ve seen a documentary, whose name escapes me, where a woman has a home birth 4-5 days after SROM. My own education has taught me that infection is unlikely when hands are off. After an informed discussion which included the pros and cons of induction and antibiotics J prefers to continue to wait, a reasonable choice of which I am quite comfortable. What I’m not comfortable with is the idea of the long drive home and likely having to drive back again soon.

Just off the 15 freeway, about a mile from J’s home is one of those brand name motels, The Marriott Fairfield Inn, where for $97 you get a room, lousy cable TV and a breakfast. It’s that or 6 hours on the road with possible panic driving back in traffic when labor comes. Easy choice for me. I’m all checked in when suddenly I realize that Temecula is less than an hour from San Diego. My daughter, who is at SDSU, has a free evening and sounds jazzed to see me. We grab dinner and a movie and share stories and smiles. Being trapped in Temecula can be a good thing, too.

Friday morning I go to visit J who is still not in labor. She had a decent night’s sleep, baby is moving and all vital signs are stable but nothing happening. My midwife associate, Beth, suggests nipple stimulation and blue and black cohosh. While J starts that I’m wondering what does one trapped OB do on a free day in Temecula wearing only dress shoes and work clothes….for the second day in a row! Of course, the local mall is just down the street. What California town doesn’t have one? Toothbrush, toothpaste, new shorts, t-shirts and Reef sandals are on the agenda. It’s getting pretty hot too so the movie theatre is looking inviting. Lunch consisted of popcorn and soda. Just when I’m thinking I might be having dinner at SDSU again J begins to have regular strong contractions now 48 hours after SROM. My midwife team heads down in separate cars on a Friday afternoon. Now there’s a great idea! I much rather be trapped in Temecula than trapped in traffic. I’m so happy I decided to stay and have my free day. Free days are few and far between for many of us. We should rethink our busy lives.

By 9PM the team arrives and we set up our supplies and the tub. Yet it is still too early for us to hover so off to the Outback Steakhouse we go for dinner. Comradery and stories and warm feelings among colleagues. Another nice side effect of working with midwives. Then it’s back to the house for the familiar night on the couch for all of us. Taking turns to support mom and family. J goes from being talkative to quiet to intense as the instincts of undisturbed mammalian birth take hold. Welcome sounds emanate from the birth tub just before dawn and it’s time to push. After 14 hours of actual labor, 1 hour of pushing, 62 hours and 17 minutes of ruptured membranes, 3 movies, 1 dinner with my daughter, a whole lot of driving, 2 ½ days in Temecula and a great deal of patience and trust in birth, baby A was born in water to the welcoming arms of her mother. Witnessed by grandparents, friends and family just as it should be.

I am an independent soul who prefers to take personal responsibility for my life and the decisions I make. In the medical world I clearly march to the beat of a different drummer. But it is an evidenced based and ethical drum that I hear. This woman’s labor pattern would not have conformed to the standard of care in a hospital delivery and surely intervention without much regard to her wishes would have been foisted upon her. Luckily, I resent conformity for conformity’s sake. My independence allowed me to take a day off, respect individual autonomy and informed consent, sleep in strange places and give this woman and her family a life changing experience and beautiful memory. Was I concerned that she might have to be transported as some point? Yes, of course. Was I concerned about the possible reception we might receive at a local hospital considering her story? Yes, of course. But our duty is to our client and to respect her reasonable choices. It was this defensible knowledge and position along with the wonderful teaching I’ve had from all the midwives in the birth community that gives me the confidence to take my hands and sit on them. Even if that means sitting on them trapped for two days in Temecula.