Nicole's Birth Story

By Roots Community Birth Center client, Nicole Lakanen

On January 25, 2021, I had my third baby girl at Roots. After two pregnancies with some complications, including incompetent cervix with my first baby and a C-section with my second baby, my birth at Roots was a wonderful experience. Here is my story.

During my first pregnancy, I learned at my 20-week ultrasound that my cervix was short, and I was diagnosed with an incompetent cervix. I saw maternal-fetal medicine weekly for ultrasounds to watch the length of my cervix. At 23 weeks, they told me I was dilated to 1 centimeter and at risk for preterm delivery. They had me go immediately to Children’s, where they gave me the option to get a cervical cerclage, a procedure where the doctor places a single stitch around the cervix, or a vaginal pessary, a ring-shaped device that is inserted into the vagina and can support the cervix. Usually for treating incontinence, the pessary is more commonly used for incompetent cervix in other countries, and was a new method they were using in the U.S. I didn’t want surgery and saw the pessary as a less risky and less invasive option, so I chose the pessary.

The rest of my pregnancy was mostly normal. I saw an OB instead of a midwife until 34 weeks because of the risk of preterm labor. The pessary did its job, and I requested to have it removed at 39 weeks as opposed to 37 weeks, when they suggested I get it out. The day after it was removed, I went into labor. I had a natural vaginal delivery at a hospital, attended by a midwife. They broke my water and gave me Pitocin to help things along and after pushing for three hours, I had a healthy 8-pound, 11-ounce baby girl 

I lost a lot of blood during delivery and was very tired and short of breath after coming home. Two weeks after she was born, I had a delayed postpartum hemorrhage at home. My husband Kyle took me to the hospital, where I was losing a lot of blood because of retained placenta. I was told that if they didn't rush me into surgery, I was at risk of losing my life. They took me into surgery where they performed a D&C to remove the retained placenta. I received a couple units of blood after surgery and stayed in the hospital for a couple of days.

With my second pregnancy, I had placenta previa, which is when the placenta completely covers the cervix, making a surgical birth the only safe option. While it’s possible that the placenta can move, mine never did. By about 20 weeks, it seemed pretty clear that the placenta was not going to move, and I would need to have a C-section. It was scheduled for 37 weeks.

I talked with one of the OBs I had met during my first pregnancy and asked her about performing a natural cesarean. She had never heard of a natural cesarean, but she learned about it, watched videos, and was very open to everything I wanted. Sometimes called a gentle cesarean, this type of birth often includes a pause between the baby’s head being delivered and the rest of the body being born, allowing for fluid to be expelled from the lungs. They also allowed me to have a clear drape and immediate skin-to-skin contact. My doula said my C-section was the most natural cesarean birth she’d ever seen. I had another healthy daughter, weighing in at 7 pounds, 6 ounces.

Similar to after my first birth, I hemorrhaged in the operating room following my second baby’s birth because of retained placenta.This time I did not receive any blood after the hemorrhage, so it took much longer to recover from the blood loss, and I would get tired very easily. I took breaks after going up the stairs and showering for a couple months after the birth.

Planning a VBAC at Roots

In May 2020, when I learned I was pregnant with a third baby, I was going to the same clinic where I had received care with my other two babies. Because of the pandemic, the hospital was not allowing doulas to be present for births. When I talked with my doula, Laura Hanstad, she recommended Roots. I always thought I had too many risk factors to go to a birth center and didn’t think that would be an option. But Laura thought I was a good candidate and suggested I contact Roots.

Birth center birth is more in line with my birth plan, so I was happy to learn that the Roots team said I was a good candidate for a VBAC. Because of my history of incompetent cervix, I was doing hybrid care with the Roots team and maternal-fetal medicine.

The beginning of my pregnancy was normal, with the exception of seeing maternal-fetal medicine at 16 weeks to watch my cervix. During my routine weekly ultrasound at 23 weeks, they saw that my cervix had started to shorten. Maternal-fetal medicine no longer offers or recommends a pessary to treat incompetent cervix, but since I had one before and it was successful, they agreed to let me go that route again. Like before, I preferred the pessary over surgery, so that’s what I did, with the condition that the OB would continue to monitor my cervix until 28 weeks. It worked so well with my first pregnancy, why wouldn’t I do it again? Other than the incompetent cervix, my pregnancy was normal.

At 39 weeks, I got the pessary taken out, thinking I would go into labor the next day, like I did with my first baby. The midwives at Roots were prepared, my doula was ready, and my daughters were at their grandma’s house. Then, nothing happened. We waited for another two weeks, which felt like an eternity.

Laboring at Home

I was 41 weeks when I woke up feeling contractions at 2:30 a.m. on Monday, January 25. I was having back labor, like I did with my first, so there was no lying down and sleeping. I got up and let my husband sleep. I labored downstairs while watching TV and relaxing as much as I could. My husband woke up to begin working (he was working from home), and the girls were at Grandma’s that day.

At about 10 a.m., I called Laura, and she came over around 11. Since I was having back labor, she did some bodywork and suggested different positions to get the baby to move into a better position. After that, labor ramped up, and the contractions were right on top of each other. I couldn’t talk through them. When I was standing, I was bearing down, and I heard Laura tell Kyle that we needed to call the birth center because I was in transition.

We left for Roots around 12:30 or 1 p.m. While in the car, I listened to Hypnobabies, and that helped a lot. I was able to relax, and the ride didn’t end up being too terrible. My doula was nervous I was going to have the baby in the car or right after getting to the birth center. Everybody at Roots was ready for a baby!

Giving Birth at Roots

When we arrived at Roots, I wanted to get in the tub right away. However, I think riding in the car and being in the water made my labor slow down. I was still having contractions, but I didn’t have the baby as soon as I thought.

While I was in the tub, I fell asleep for a little bit and enjoyed being in the warm water. They were listening to the baby every so often since I was working toward a VBAC. Jaqxun was the midwife on call, and at one point I made a high-pitched noise and they thought my water broke while in the tub — only to find out later that it had not. Eventually they asked if I wanted to get out of the tub and I agreed. When I got out, I labored on the squatty potty and started to push out what I thought was the baby’s head, but it was actually the bag of water. Jaqxun asked me if I wanted them to break it, and I said yes because I was ready for labor to be over. They had me lay on my back on the bed, and my water broke as I laid down. I labored on the bed for a while, and then Jaqxun suggested I go to the bathroom and labor on the toilet. I do not like laboring on the toilet, so after just one minute, I was done with that.

At one point, whenever I was standing during a contraction I would say “catch me,” and I would lower my body while my support people caught me in a sitting position. I don’t know why that’s what I wanted, but it got me through the contractions. I was still having very bad back labor, so someone was always pushing on my back or squeezing my hips. Kyle said his hands got so tired from pushing on my back that he started using his head, too.

Eventually, I got back on the bed. As I was on my side, I thought I was pushing out the baby, but it was another bag of water, and Jaqxun broke that one. I don’t know how long I was pushing, but the head started to come out. Kyle was kneeling beside me, and Laura was pushing on my back. Kyle said it felt like I was going to pull his arm off. I was fighting the contractions because I didn’t want to feel that back labor. Mentally, I was not prepared to fully give it my all. Around this time Rachel, the midwife I had seen for most of my prenatal care because of my schedule, had come upstairs after she finished work downstairs and came into the birth room. I was happy to have her there as well. 

All of a sudden, there was a definite mood shift in the room. Jaqxun quickly asked me to roll onto my back and push. After the head was out, Jaqxun told me to get on all fours. It was shoulder dystocia, but I didn’t know. Jaqxun said they needed one leg up in a specific maneuver, which Laura knew how to do, so she put my leg up. I felt the midwife reach in and pull one shoulder and free it. Then, Laura helped move the other leg, and Jaqxun got the other shoulder unstuck. They rolled me back onto my back to push the rest of the baby out. However, the baby’s butt was stuck, too, so Rachel got on top of me and pushed on my belly to get the butt out. 

Finally, the baby came out, and Jaqxun put her on top of me. Allie was born at 5:25 p.m. January 25, weighing an impressive 11 pounds, 1 ounce, and measuring 21 inches long. At the time, she was the largest baby born at Roots. All I could think was that I was so glad that it was over. Everyone was holding their collective breath, waiting for Allie to cry. She moved her eyes and then took her first breath and cried.

Managing Another Postpartum Hemorrhage

I birthed the placenta, which was huge. Since I have a history of hemorrhage, they gave me Pitocin right away to try to prevent another hemorrhage. Plus, hemorrhaging is common after shoulder dystocia. I did still have some hemorrhaging, but I believe the Pitocin helped. 

Allie latched on right away and stayed on my chest for a couple hours. Nursing went really well right from the beginning. I was used to going to the hospital where they were always saying the baby was not getting enough food and that I needed to pump and give a bottle. At Roots, they didn’t scare me into thinking that my baby wasn’t getting enough to eat. That was nice to be able to feed my baby and know she was getting what she needed. I didn’t have to do any extra stuff. 

Since I hemorrhaged, we weren’t sure if I would need to go to the hospital. The Roots team had given me a lot of fluids, more Pitocin, and homeopathic remedies and tinctures — anything that could help with blood loss. Usually, Roots clients go home about four hours after birth, but I ended up staying about 10 hours. I had lost a lot of blood, and when I got up, I felt like I was going to faint. There was no way I could walk to the bathroom. They put the squatty potty on the floor, and I peed in a bowl. I did that a couple times until I felt OK to go to the bathroom. I relaxed on the bed with the baby and took a nap. My husband had gotten dinner earlier, so they left us alone, just coming in periodically to check vitals. They were in contact with the hospital, but it was a relaxing time. 

We left Roots in the middle of the night and got home at 3 a.m. Because of the blood loss, It was hard for me to get up the stairs to go to bed, so I crawled up the stairs, taking breaks occasionally. I made it to the bed and mostly remained there for the first week, with the exception of attending my appointments. My older daughters have wonderful grandparents who love to watch them, so they stayed with them for the week. 

My recovery was the best one I had. After hemorrhaging, my hemoglobin level came back up quickly. This was a huge contrast to my previous postpartum recoveries. After my second baby, it had taken me eight weeks to get back to normal, so the Roots team did really well. They helped me keep my iron level up during pregnancy. That way, in case I did hemorrhage after birth, the iron level wouldn’t be as low. The Roots team took such good care of me and my baby after the delivery with multiple postpartum appointments and making sure I was doing OK. I felt so great knowing that I was being well taken care of. When I was worried about a larger clot that I passed, they didn’t dismiss me and made sure I got it checked out.

Thinking Back on my VBAC at Roots

Before Allie’s birth, I didn’t know what shoulder dystocia was or why it was such a big deal. When Kyle and I learned more about it, we realized how well they took care of it — how fast they acted and got the baby out. It was only 30-60 seconds, and they were very calm. I was not worried or scared and never knew anything was wrong.

Kyle said he noticed a mood shift, and he could tell things were moving quickly. He said he was a little bit worried, but he thought, “They’re not worried, so I don’t need to be worried right now.” It happened so fast that we didn’t have time to think about it. Kyle was emotional — glad that everyone was OK and that I wasn’t in pain anymore.

With the shoulder dystocia, I believe the Roots team handled it better than a hospital would have. They would’ve used intervention at a hospital. With double shoulder dystocia, a lot of times babies have a broken arm or collarbone. Allie didn’t have any abrasions or injuries. Overall, I loved the experience of going to the birth center and will certainly go to Roots again in future.