Friday, July 30, 2010
Elijah's Birth Story: July 23, 2010
I was five days past my due date and I had had some contractions, but they were mostly Braxton Hicks contractions and were obviously not going to produce a baby. I went to my doctor's office on Thursday, the 22nd, to do a non-stress test and have an ultrasound to check my amniotic fluid levels. The NST came back fine. His heartrate was fine and the nurse seemed to think there was nothing to worry about. However, when the ultrasound tech did the ultrasound, she noted that my fluid level was a four. Apparently an ideal level is somewhere between a seven and a ten and the lowest they let you go and continue the pregnancy is a five. So she paged my doctor, who said she wanted to get me into the hospital that evening and induce me.
I made several phonecalls, including one to my husband and one to my doula, Ashley, and headed home. My husband was just getting back from a two hour trip out of town for work. Fortunately, he was pretty much all the way back to Kansas City. He had to drop off the government car, though, before he came home. (He works for the US Department of Labor.) So it took him awhile to get back home and then I wanted to eat before we went to the hospital since I assumed they don't let you eat once you're there. So we got to the hospital about an hour later than we said we would.
Around 5:30 we did arrive at the hospital and they got me set up in a room and placed cervadil to encourage my cervix to efface. I was already dilated a centimeter and effaced about 50% prior to that, so I was hoping the cervadil would push me into labor on my own. Otherwise, they were going to start a round of pitocin in the morning.
I had decided that I wanted to have a natural birth if possible. For that reason I had attended birthing classes and hired a doula to help manage my pain. The main reason I had made this decision was because I was trying to avoid a c section since I did not want to have to be recovering from major surgery while attempting to care for a newborn. And I had read plenty of things that indicated to me that the more medical interventions you have, the more likely the baby is to go into distress and, therefore, the more likely it is that they will order a c section.
Anyway, I slept most of the night at the hospital with the cervadil in that night, although I did have to get up several times to use the bathroom (those of you who are or have been pregnant will understand). I was having contractions most of this time; most of them were slightly worse than the contractions I'd been having at home. Around 5:00 a.m. I woke up again to more contractions. These were strong enough that I could no longer sleep through them.
Mike woke up shortly after me and my nurse came back in the room around 7:00 a.m. I was due to start a round of pitocin sometime that morning, but I asked her if it would be possible for me not to have pitocin since I was clearly starting to labor already. She offered to check my cervix and then page my doctor and ask her if I could avoid the pitocin. I had heard and read that contractions induced by pitocin were much much worse than contractions that occurred naturally and since I didn't intend to use pain medication if I could avoid it, I was also really hoping to avoid pitocin.
The nurse checked me and said I was dilated to 4 centimeters and about 60% effaced. She went to page my doctor. I was really starting to hurt so I asked Mike to call Ashley, my doula, and ask her to come to the hospital.
By the time Ashley got there I was obviously in serious active labor. We never did time the contractions, mostly because I was on the monitors the whole time so there was no need to do so. So I don't know how far apart the contractions were, I just knew that they hurt and they were mainly in my back.
My doctor approved us not using pitocin since I was already laboring and had progressed to 4 centimeters. Ashley and Mike took turns pressing down on the small of my back to help relieve the pain. Ashley was much better at the back pressure than Mike was, but later on that evening, he was starting to get the hang of it and do a better job.
This pressure did help, but back labor is the worst pain I have ever felt. In fact, if I had only felt my contractions in my abdomen, I would say I would have been in about half as much pain. The only other things that relieved the pain slightly were bending over at the waist and getting in the tub. In fact, I could barely stand a contraction if I wasn't bending over at least somewhat to relieve the pain in my back.
They checked me again after a few hours and I was up to six centimeters. By that time I was no longer simply breathing through my contractions, I was moaning and wailing somewhat. I was trying to concentrate on my breathing, but it's difficult to do when you feel like your insides are on fire. Ashley and our wonderful nurse, Jayne, were having to remind me to breathe in rhythm with them so I didn't start to hyperventilate.
My doctor came by not long after that and asked how I was. Even though I was progressing, she suggested breaking my water to get the progress to step up. I agreed since I really just wanted to get to a ten and get this baby out. So she broke my water and I got back in the tub to relieve contractions that were getting much worse.
Finally when the contractions were coming one on top of the other, I was dilated to an eight. By that time I was starting to scream through some of the contractions, especially the terrible ones that would tease me and make me think they were tapering off, only to come back up again.
I got dilated to a 9--almost a 10--and finally was saying "I can't do this anymore, I can't do this anymore" and asking for an epidural. Ashley consoled me and told me that every mommy she helps gets to the point where they're saying they can't do it anymore and that usually it means they're about to start pushing. So I agreed to have my cervix checked one more time.
I was still not totally a 10 yet. Jayne said that there was just a tiny bit of cervix left and suggested that she put her finger on it and I push against her finger when I had a contraction. It seemed like a sensible plan to me, but I hurt way too much to try it.
My doctor came back not long after that and checked my cervix herself. She seemed to think I could go ahead and start pushing. And I was starting to feel the urge to push. So finally I got to start trying to push my baby out.
The pushing relieved the pain of the contractions somewhat. However, even though Ashley and Jayne both said I was pushing properly, the baby was not moving down. So we started trying everything we could think of. I pushed lying on my side in the bed with one leg up. I pushed on my back playing tug of war with Mike for a hospital sheet. I pushed squatting on the toilet. I even finally agreed to try pushing on my hands and knees, even though that position made the pain worse.
Still my baby would not move down. My doctor told me later that Jayne had said she did not think the baby would come out vaginally, but mercifully, she did not tell me that until after he was born. Ashley thought that my baby had been posterior (facing up instead of down), hence all the back labor, and that he was trying to turn and ended up transverse, or facing the side, which was making it near impossible for him to move past my cervix.
I pushed for an hour and a half with no meds and he hadn't moved at all. At that point I was so exhausted that my pushing was not correct anymore. I just didn't have the energy to push correctly any longer. It had been all day that I had been laboring actively. It was about 6:00 p.m. by that time.
So finally, even though I had really hoped to avoid it, I asked for an epidural. Ashley spoke with me again to make sure this was my choice and I didn't feel like I was being coerced to do it. I insisted that if I had to continue pushing for an hour or two or three, I had to be able to rest a little, which I could not do with the labor pains. I think if the baby had made some progress prior to that time, I could have finished it without the epidural.
The anesthesiologist came in shortly thereafter and began the process of giving me the epidural. I had two contractions while she was doing it and it was very very hard not to move, but I told myself that these were the last ones I would have to feel and that made it possible to stay still. I thanked the anesthesiologist woman for working so quickly.
After that, Ashley asked me if I needed her to stay, or if I'd like her to come back when I started pushing again. But I told her to go on home and have dinner with her family.
At first, I could still feel the contractions slightly in my upper abdomen and asked them to fix it. After all, if I was going to go completely numb and not be able to feel my legs or feet, I might as well have no pain at all. The epidural kicked in finally and I was able to rest. I wasn't able to sleep because I was shaking. The nurse said they were hormonal shakes, since I wasn't really cold. And there was pretty much nothing anyone could do about them.
My mom and some of Mike's family came in for a few minutes to visit me, but left shortly thereafter to go to dinner and get some dinner to bring back for Mike. Prior to that I'd been wandering around the room in the nude and so I hadn't wanted anyone else in the room. But now that I could lie down and rest--although not sleep--I was able to cover up in the bed and could let people in for a few minutes.
I was hooked up to all sorts of tubes and such. I had a catheter. They placed an internal fetal monitor (mostly because the belt monitor was not working properly and I no longer needed to be able to move around). And, of course, I had an IV.
Now that I had an epidural, my doctor suggested they start a pitocin drip in my IV to see if that would encourage the contractions to move the baby down. So they started that after my visitors left. I could see on the monitors how the contraction would shoot straight up and then come back down, rather than increase and decrease gradually.
A few hours later, after the nurses' shift had changed and we got a new nurse, it was time for me to start pushing again. This time they threw my feet up in stirrups and the new nurse Lacey pushed back on one of my legs while Mike pushed on the other. I pushed for about another hour and a half like that and once again was told that I was pushing correctly, despite the fact that I could no longer feel anything.
My doctor came in and checked again and still the baby had not moved down at all.
I wanted to cry, but I think I was too exhausted at that point to do any crying. I knew I was really too exhausted to cry or care about almost anything when my doctor reluctantly suggested a c section. She said the baby's heartrate was fine and I could keep pushing as long as I wanted to as long as his heartrate remained high. But she said she really did not think that he was going to come out vaginally.
I was very angry. Not at anyone in particular, but just at the situation. Here I had labored so hard for more than ten hours and pushed for an hour and a half without meds, and then another hour and a half with meds, and still I was not going to get the vaginal birth I wanted.
But, as I said, I was so exhausted that I no longer could get that upset. I asked my doctor if this would mean that I had to have any children by c section and she said no, that she did many VBACs. That reassured me somewhat and so I agreed to the c section.
My mom came back in and hung out with me for the hour it took to get an operating room. But then it was finally time to move. They wheeled me into the operating room and refreshed my epidural with even stronger meds this time so I couldn't feel a thing. It took longer to get me prepped for the birth than it actually did for my doctor to get him out. I threw up the acid reflux preventative they gave me to drink and I was getting the shakes again.
Finally, around 10:00 I heard the beautiful sound of my baby's first cry. My doctor held him up so that I could see him over the curtain, although it was hard to see him through the tears in my eyes. I watched as they took him to the side of the room and cleaned him off. Mike got to touch him and talk to him while they did this. After that he picked him up and brought him to me.
He was all gross but the sweetest thing I'd ever seen. Even though he was a c section baby, he ended up with that conehead that vaginal babies get because his head had already been engaged in my cervix and I had pushed on it for so long.
After I got to see him and hold him for a few minutes, he and Mike went with the nurses to the nursery to get washed up. The doctors and nurses finished removing my placenta and then closing me up. I was then moved to a recovery room where I had to wait for about 10-15 minutes before anyone came in to see me.
It was my mom who came. Mike was still in the nursery with Elijah. I had asked him to stay with Elijah the whole time so that at least one of his parents would be with him at all times.
A nurse came in shortly thereafter and told me that Elijah's temperature was too low and so they were keeping him under the warmers and as soon as his temperature came up enough they would bring him in to me. A part of me was upset since I think that if he had been immediately placed on my chest after birth he would have warmed up a lot more. In fact, if I hadn't been so excited that he was finally here, I probably could have gotten very upset that I didn't get my initial bonding time with him just after his birth. This was another reason I had really hoped to avoid a c section.
It was about another twenty or thirty minutes before they finally brought him in and let me hold him. He was just the perfect little baby boy. I tried to nurse him, but had a lot of trouble. He finally did latch on and nurse at the left breast for about ten minutes.
It was past midnight when they finally moved us to our postpartum room. Mike set up his cot next to my hospital bed and lay down. He was exhausted and I knew I should be exhausted, too, but I think I was riding on hormones and adrenaline.
The nurse came in and checked his temperature again and said it was low again. I suggested that I take my top off and hold him against my chest and put blankets on top of us. I was feeling a little hot anyway. The nurse said that was a good idea so she gave him to me to hold for an hour or so to try to get his temperature up.
That was the obvious medical goal, but I was actually thinking of something else. I hadn't gotten to have my time holding him just after his birth like I wanted, so even though I was doing nothing besides holding my sweet baby boy against my chest and watching him sleep, that hour passed much too quickly. I hadn't gotten to hold and bond with him immediately after his birth, but this time kind of made up for that.