Birth Story, Part 4: Nighttime

The sun was down and it was dark. At about 5:30pm we decided to do another internal check for progress. I'm pretty sure Cathy was hoping things would get moving before her shift ended. She loved us and we loved her.

2-3 cm dilated, about 80% effaced. Still.

I believe this is when I broke down. It started to seem like my worst prediction was coming true. This induction was failing. These contractions were worthless. Though I had successfully kept the pain at bay, I was getting pretty exhausted from the effort. I know Erich was too--he was the one getting me ice chips, popsicles and damp towels for my neck and food and coffee for himself in between being there with me for every contraction, helping me manage the pain.

But I needed a break, and if this baby was going to come out naturally, it was going to take a long time, and something had to give. I asked for a narcotic to take the edge off. Erich knew how I felt about pain medication and encouraged me to wait half an hour. I waited for about one more contraction, and then I really knew I couldn't continue like this. Within 30 minutes or so, I was hooked up with a dose of Dilaudid and very quickly got to rest.

I continued to feel everything, but the edge was definitely off and furthermore, I just didn't care. The room seemed quieter, probably because everyone was acting like I was asleep. I wasn't. I could hear everything and responses to conversations going on took shape in my head, but I couldn't care enough to make them come out of my mouth. I decided to enjoy this sensation, and I tried to visualize my cervix thinning and opening with every wave. The theme was relaxation.

After probably about an hour, the narcotic started to wear off a little and I started to get more active. Though all the changing positions I had done all day hadn't seemed to do much yet, gravity was my best chance of getting the Pit to work.

It was time for a nursing shift change. Cathy bid us farewell by taking my hands, praising me again for my stamina and telling us how much she liked us. (Cue the tears.) She assured me I was "doing everything right" and whatever happens, even if I have to have a section, there will have been some reason I didn't progress, like a big baby or something along those lines. She asked for permission to call and find out what happened later that night, which I of course granted.

To be honest, at this point I was nearly certain this would end in a c-section. Wanting that not to be the case hadn't helped yet, and it seemed like I was running out of time. My water had been broken for nearly 12 hours, and they would certainly expect me to deliver within 24 hours of rupture. Doing the math, I knew my progress would have to speed up a whole lot for that to happen. I knew I could still try an epidural, but I would want to be more than 3cm dilated for that. And even then, I would use it only to see if it could help the Pitocin work better and not because I really needed it for pain. So I tried some optimism. Labor is unpredictable--maybe at my next check I would magically be in transition and deliver soon after!

Our new nurse, Melinda, was also very nice. She came in focused and ready to get down to business. She laid out the situation: progress was slow. I was up to 28 mU/min of Pitocin--most women deliver at half that amount. She checked the contraction printout and observed that this was not a normal contraction pattern. Luckily, the baby was doing splendidly and was tolerating everything well. My BP was fine, except for the one after the last exam, which was sky high for understandable reasons. Her recommendation was to get serious about moving around and trying more aggressive positions, hopefully to even out the contractions and make them effective. Meanwhile, we would stop the Pitocin and start increasing again from zero, as my uterus might be building up a resistance.

Dr. P called and asked how much longer I wanted to go. It seemed like she knew a section was inevitable and was simply allowing me to retain the illusion that I would have this baby the way nature intended, but once I got over that, she would come in and cut me open. Yeah, I've been known to read into things a bit. Regardless, I did not want to see her. I decided to give it two more hours and let her come back at 10 to check me.

Melinda got me on the ball, knees spread far apart. I rolled side to side, front to back. After a while, I stood next to the bed and squatted with each contraction. Just as that started to get more comfortable, she had me on the bed on all fours, shifting my weight back and forth. She was a bit drill sergeant-esque, which I really needed at this time of the day. My contractions continued to be irregular, especially after they cut the Pit. I remember waiting 5-7 minutes between them for a while. Erich and I both started entertaining a small hope that I had made no more progress because some progress would prolong this nightmare and it might still fail.

It was a burden and a relief when Dr. P arrived. I didn't want the c-section, but I couldn't do this any more. She asked how I was doing. "Pretty miserable, actually," I replied. "You poor thing!" she said. That was nice of her to say, but I blamed her for my situation. I still feel that if my bag of waters were still intact, we could have just stopped for the night and tried again later. Lily was fine, I was fine. And, incidentally, and to the surprise of no one, I had not progressed any further. 2-3 cm. Maybe some improvement in effacement, but I don't remember. It didn't matter any more. It was time to have major surgery because all these artificial interventions did what statistics say they will do (or fail to do) 50% of the time. My body and my baby were not ready for birth, so they were going to be forced into submission with the scalpel.

I don't think anyone even said the word at this point. Through my tears and utter defeat, I simply nodded.

Part 5

Birth Story, Part 3: It's the Pits

For weeks before I gave birth, I had contractions. Pitiful little tightenings of my belly, which I would have to touch to verify that I was contracting. And, given that they did nothing to progress my cervix, they weren't "real." After my Cervidil was started, these contractions got to be more noticeable, and I hoped labor would start before the Pitocin. It didn't really.

First thing in the morning, I got checked and was somewhat pleased to learn that I was now 1.5cm dilated. Not much, but more than nothing! The nurse hooked me up to the Pitocin drip and informed me that the doctor would come in soon and would probably break my water.

What.

As I keep having to remind myself, I am NOT a doctor. HOWEVER, there's a few things I know about labor and contractions. One is that Pitocin contractions are much harder than natural ones. Two, contractions get harder after the water is broken. I also (legitimately) feared that breaking my water too soon would give Lily less of a cushion for moving into the correct position to be born. Thus far, I had not been successful in standing up to Dr. P, but I was pretty sure I didn't want my membranes ruptured so early in the day. If you've been following along, you know by now that "pretty sure" is not nearly sure enough.

Around 7:30am my ray of sunshine arrived: Cathy the nurse. One item on my birth preferences list that actually worked out and was granted was my request for a nurse who enjoys working with couples who have prepared for a natural childbirth. Cathy was the bomb. I told her I didn't want my water broken. When Dr. P arrived to do it, I asked her if we could wait because I didn't want to be "on the clock." (Deja vu! I also wanted to wait to be induced, and we know how that worked out.) She got her annoyed/frustrated look that I now know well and asked when we should do it instead. I didn't really know how to answer that question, so I...gave in (regret #5--huge, huge regret). Cathy looked at me and asked if I was sure, standing up to Dr. P's mumbles of protest better than I could. But I continued the theme of resignation and let her get it over with. (I now believe I should have said I wanted to be at least 5cm before breaking my bag of waters. I now also regret not hiring a doula, who would have done the thinking and advocating for me.)

After a pull, a tug, a pop and a gush, I was on the clock. Labor was henceforth messy and drippy, and besides all the legitimate reasons not to have the membranes ruptured so early, I wished I could have had a few hours to labor without all the messiness. It was hard enough to lug my belly around without having to place towels and pads everywhere as well.

Oh, and by now, my contractions were real. I didn't have to wonder whether I was having any. Within an hour or so, I couldn't talk through them and I needed to enter hypnosis to keep the discomfort at bay. For the whole first part of the day, I thought I could handle this. Every fifteen minutes they upped the Pit until I was contracting regularly. Unfortunately, even when the contractions got to be close together, they were never really regular. I'd get one every 2-3 minutes and then go 5 minutes before having three every minute, etc. Furthermore, from looking at the monitors we could see that they didn't have normal peaks. They felt strong and looked strong, but it was impossible to measure their strength without internal monitoring, which I never had.

But I labored on and impressed Cathy with my pain management. I started needing Erich more and more with my hypnosis cues, and he was there each time with a hand on my forehead and/or pressure on my shoulder, helping me relax through the painful artificial contractions. My parents stopped by at one point, but they didn't stay in the room long. It's hard to receive visitors when everyone needs to shut up ever 2-5 minutes while I breathe through a contraction. I had ice chips and yummy cherry-pineapple popsicles. It seemed okay as long as I could concentrate.

Then, around 1pm we figured it was a good time for an exam to check my progress. The verdict: 2-3cm, 80% effaced. I was disappointed. I was prepared for a number lower than 5, but I was hoping for more than 3. All that work hardly did anything! I wondered whether an epidural or other drugs would help me relax more and let the Pitocin do its work. Cathy encouraged me to keep doing what I was doing, keep taking the contractions one at a time and don't think hours in the future because it was impossible to know what was going to happen and it wasn't worth the stress. Her attitude helped me soldier on, and I kept finding labor demanding but manageable.

They cranked the Pit some more. The contractions got pretty bad. I was still managing without pain meds, but if I found myself mentally unprepared for the next one, I was in a world of hurt. We had the iPod going, alternating between Hypnobabies scripts and quiet music. I moved around and changed positions. Cathy went in search of the perfect birthing ball as the one in the room was under inflated. She praised me for my coping skills, for vocalizing through the contractions. Erich was my rock, but Cathy really kept me going.

Four more hours went by and I consented to another internal exam...

I'll leave it here for tonight, but I will say that (spoiler alert), it doesn't get any better from here.

Part 4

Don't Starve Me

The Birth Story shall continue, probably next week. This weekend is LILY'S BAPTISM EXTRAVAGANZA! and I have a lot of cleaning to do.

But in the meantime, enjoy this article that explains why I should have been allowed more than popsicles and ice chips and why I'm liking hospitals less and less:

http://www.nytimes.com/2010/01/26/health/26child.html?ref=health

Birth Story, Part 2: The Storm Begins

In the intervening days between my last prenatal checkup and my induction, I tried to remind myself that recent-miscarriage-sufferer Susan would be annoyed at hugely-pregnant Susan for being so upset about an induction and heightened risk of c-section. Anything for a baby, right? Unfortunately, that did pretty much nothing to improve my mood. I was sure that recent-miscarriage-sufferer Susan would understand.

So, Thursday the 7th arrived, and Erich and I worked around the house nonstop to get as much ready as we could. I finally had my motivation to pack my bag for the hospital! I packed comfy clothes for myself, none of which I wore because it was all pants and shirts. I also packed a zillion other things that I did not need or use. Live and learn!

My mom came over to help us and she actually stayed till after we left getting the nursery ready. Thanks, mom! At around 4:00, it was time to head out into the gloom. The predicted snow storm was arriving, and Erich was on edge, not wanting to take any chances on getting delayed in trafic or, worse yet, slipping and falling in the slush. We went first to our favorite Chinese restaurant for our last meal together as a family of two. I got orange peel chicken. I wasn't that hungry, but I ate anyway since hospitals are mean and don't let laboring women eat anything substanial.

We arrived in the Labor and Delivery ward at 6pm sharp. We felt weird showing up at a scheduled time to have our baby. It felt like we needed to make excuses to the world and assure them that we are not "those people" who schedule their baby's birth for convenience. This was not our choice! But, we got over it and got shown to our room, the same large but awkwardly laid-out corner suite we had seen in the tour of the hospital. When I had first seen this room, I solidified my desire to labor at home for as long as possible. (Aaaand, so much for that!) Despite the wood floors and other attempts at a homey feel, this was a very medical place.

The nurse took my vitals and asked again why I was being induced. Why, for high blood pressure! Except, over the next 24 hours, my blood pressure stayed in the normal range. I asked for clarification as to when and what I was allowed to eat, and she reminded me that I would not be allowed to eat the next day, "because we have to treat everyone like a possible c-section." Well, with a 30% c-section rate at this hospital, I'm not surprised. Except very, very few c-sections even require general anesthesia and only a small percentage of those have any complications with vomiting and aspiration, and effectively no one ever dies from that. Yet that is the reason I was allowed nothing more than ice chips and popsicles. Ridiculous!

Ah, but I'm getting ahead of myself. And I digress. Sorry.

Another nurse poked and massaged my crazy-swollen arms for about ten minutes, unable to find any veins for the IV. She finally settled on my wrist so that I couldn't bend or flex my hand. They put contraction and fetal heart monitors over my massive belly, and then I was really tethered. From that point onward, just to get to the bathroom six feet away I had to unplug the monitors, drape the cords across my shoulders and have Erich follow me with the IV stand. It's already hard to remember the sheer effort it required just to get out of bed and waddle across a room. I really don't miss being pregnant, to be honest.

By about 7:30, after a baseline internal check (still no dilation or effacement--"unfavorable cervix," further upping my chances of a c-section), the nurse placed the Cervidil behind my cervix. At this point, Erich took the final pictures of me as a pregnant lady:

This is actually one of the only pictures that doesn't make me look frightening. There's another one I won't share that actually scares my own mother. No joke. Btw, my face is at least 30% smaller now, thank goodness.

The bed is pretty close to the bathroom door on the right there. On the left in the background is the couch where Erich slept. You can also see my awkward IV.

All we did that evening was watch TV, get ready for bed, and try to sleep. I was helped by a dose of Ambien, but Erich had to battle hospital noises and a drafty window. He's a real trooper, and I'm not being sarcastic. I think he worked even harder than I did this whole long weekend, but we'll get to more of that later.

I'll have to leave it there for today. The sleeping baby who's been farting on my lap for the last ten minutes is starting to stir a bit more. Sidenote/question of the day: will this baby ever consent to not being held while she sleeps?

Part 3

Birth Story, Part One: Pressure

This whole mess started on Tuesday, January 5th when I went in for my 39 week (minus one day) appointment. This appointment happened to be with Dr. P, who I hadn't seen much, but she and I go way back. She was the one who discovered my septum and always seemed pleasant, if a bit different manner-wise, probably due to her being from a different culture.

Anyway, Erich came with me to this appointment but had trouble finding a parking space, so he dropped me off so I could go and check in. I went down the dark corridor to the office, opened the door, and was greeted immediately by the backs of at least six other people in line. In line to check in. JUST TO CHECK IN. I've often been annoyed by the check-in process at this practice. It seems like they see about a thousand patients at any given time, and there are only two people in the reception area, one checking in and one checking out while the phones blink, all the lines busy as people also wait on hold to talk to a human. Every time someone checks in, the receptionist will not even make eye contact with the next person in line until they have everything organized, forms and insurance cards copied, etc.

Lots of women see their gynecologist once a year. And for some dumb reason, it seems a lot of them go in the first week in January. And once the calendar changes, the office people have to check everyone's insurance again, even if they're huge and pregnant and are there every week. So! It took at least five minutes per person in front of me to check in. And by the time I checked in, I had been standing there for

TWENTY MINUTES.

And the waiting room was PACKED. And, as usual and for some unknowable reason, the heat was cranked ridiculously high. Far too close to 80 degrees for anyone, let alone the hugely pregnant. Erich offered to stand in line for a while, which I should have taken him up on (regret #1). But it started to feel like my battle. When I got to the front of the line and the chick finally stopped ignoring me, I politely asked if the wait was a "Tuesday thing, or a first week in January thing?" She said, "Both." The usual two doctors were in and seeing patients, and it's a day the NP and u/s tech are there. So there were all kinds of people to be seen, yadda yadda THIS PRACTICE IS TOO BUSY. I know a lot of OB practices are crazy busy, but I have hope for the future. I won't stand for this.

Understandably, I was pretty grumbly by the time I finally got to sit down. Unlike the week before, when Dr. B said everything was fine, this week I didn't focus enough on staying relaxed and focused for my blood pressure's sake (regret #2). Despite the large crowds, I didn't have to wait super crazy long before getting called back. Urine was fine (I think), weight was fine, BP... "Hmm," said the nurse. "Oh no, what is it?" I asked. 120-something/90. That "over 90" part is what they really don't like. Crap crap crap. And she didn't even let me relax for a minute then take it again. I was concerned but didn't know what to expect next, so I just waited patiently.

Erich joined me in the exam room, and Dr. P came in shortly after. She studied my chart, measured my belly, took about a zillion hours to find the heartbeat (thank goodness for movement, which helped me narrowly avoid a freak-out), checked my cervix--still barely 1cm--and then looked at my chart again. "You know," she announced, "I'm looking at your blood pressure and you've already been to labor and delivery and you're about 39 weeks, so I'm thinking to myself... I'm going to induce you. I think Thursday would be a good time to start."

She went on to briefly describe how the process works, but I didn't care to bother to hear over the roaring in my ears. Induction. My first thought was, I'm going to have a c-section. No no no no no. This is not what I want at all. A small part of me was so very ready to be done being pregnant, but I had resigned myself to 2+ more weeks of hugeness. Anything to let my body and my baby decide when to be born and not my doctor.

I asked if we could at least wait until my due date, and Dr. P immediately seemed annoyed. "Then I'll have to send you to Labor and Delivery right now, and you'll have to come in every few days to be monitored." Should have said, "Fine! I'll do that." But she was wearing me down. (Regret #3.) I don't like to make people annoyed at me. She said, "You have to weigh the risks versus benefits." However, she never explained to me what those were.

In fact, no one ever really explained to me what pregnancy-induced hypertension is all about. I can't work a regret into this one, though, because I did call and ask. And I was threatened with a stroke if I didn't consent to the induction. *eye roll* Don't get me wrong, risks are risks, but I've had major abdominal surgery now. Isn't that risky too? (The answer is yes. Yes, it is.)

So Dr. P left the room and I lost it. That evil I-word enveloped me in fear. So much for my natural, drug-free birth. Now drugs were going to START and control my labor. I was automatically signed up for a hospital stay, IV, continuous monitoring, and a feeling like I had no say in what was happening to me. Because their stupid office can't manage its patient load (okay, that may not have been the total cause of my high-ish BP, but it did NOT help), I was now merely a sick patient instead of a mother giving birth.

Erich and I sadly went home, signed up for an induction starting Thursday evening with Cervidil and Pitocin on Friday morning. DID. NOT. WANT. I thought about how excited Lily's grandparents would be to know when to expect her, but it was at least a few hours before we could let them know while I tried to process this game plan. I was looking forward to her arrival and genuinely happy that I knew when it was going to be, but I was extremely unhappy about the induction, for reasons I believe are obvious by now. :)

Throughout my work with Hypnobabies, I knew there were tools for dealing with fear. However, in these couple of days, I was too afraid to use them. Stupid. Regret #4. I'm sure half-expecting a c-section, if it did anything, only made it more likely to happen. Instead, I focused on the last few things I could do around the house to get it ready for baby. That was worthwhile, of course, but I did spend too much time worrying and frantically seeking out anecdotes of successful inductions.

And I gave active patient-hood the ol' college try, but was shut down when the nurse on the phone told me that the numbers from my PIH labs were "going up" and it's much safer for me and the baby to have her out. In the words of any petulant adolescent, FIIIIINE.

So we were stuck with the induction, and I tried to feel resigned. A big storm was predicted for Thursday, but it didn't much matter for us since we'd definitely be stuck in the hospital.

To be continued...

Part 2

Preface

I'm getting so close to being ready to post my birth story. Again, it will be in several parts. I'm nothing if not thorough on this blog! But first I have to start with a preface.

I have never agreed with the sentiment: "at least you have a healthy baby" in regards to the manner in which the baby was born. Now that I have been forced into a c-section, it irritates me even more.

The arrival of my daughter into this world was wonderful and amazing. I'm absolutely thrilled to have her on the outside and I wouldn't change a thing about her. The birth? Just thinking about it still makes me bitter, upset, and fearful. Yes, fearful for the future. Because the Birth is not just about the health of the baby. It has implications for me, my health, and the success of any future births. So please keep in mind, I will not abide any comments implying that I should be happy with the birth because my baby is healthy. Or that it could have been worse, so just buck up. I'm allowed to mourn the birth I didn't get to have, and I intend to do so on my very own blog that has always been about grief.

In sum: baby's arrival and birth are two separate entities and my emotions surrounding each are completely separate.

Ugh, sorry for the downer. Happier days are ahead, Internet, I promise. Just bear with me for now.