Wednesday, February 5, 2014

An Announcement and a Story

My last entry, I said I'd be taking another 4-month hiatus, and people, I keep my promises. Actually, I'm 18 days short of four months, but who's counting?

I could have posted in January, with big promises about better upkeep of the blog. But you, dear reader, can thank me for failing to do that. Because I would have failed miserably. It turns out, I'm busier this year than I was last year.

In 2013, I left out a pretty big detail of my life. You see, I spent a large part of the year pregnant. And on November 2nd, I gave birth to a beautiful baby boy!

© Shelley Kemp Photography

I'd like to take this opportunity to share my birth story. I wrote it during the weeks after my baby was born, and I needed to get it out of me while it was still fresh. 

***

The following is the opening statement from our birth “plan”. I placed “plan” in quotation marks because at no point in the document did I actually call it a plan, and at no point in conversation with my doctor or nurses did I ever refer to it as my plan.

Thank you for taking the time to read our birth preferences. Our goal is a natural, unmedicated birth. We understand that changes may be medically necessary, but please discuss all options with us and allow us ample opportunity to give informed consent. We appreciate your willingness to work with us.

Throughout the vast majority of my pregnancy, I strived to be realistic and logical. Of course, I feel I was also na├»ve – I literally had no idea what I was really in for. Labor, delivery, and the first week of my son’s life have been nothing like what I imagined.

The “plan” pretty much went out the window when I woke up early on the 1st of November, noticing that it felt like I’d wet the bed. The bed itself wasn’t wet at all, but the pants I’d been sleeping in were very damp. I pried myself up, walked to the bathroom, and went to the toilet, where a small amount of fluid leaked out. Nothing very significant, but definitely unusual. I took note that it didn’t smell like urine, but actually smelled very sweet.

After cleaning myself up, I woke my husband. I told him that I thought my water might have broken. He later told me that I was very calm and matter-of-fact about it. I’d been instructed to call the hospital if my water broke so that we could remain in contact, so I found the phone number and called. They asked me to lay down and do a kick count to make sure the baby was still active, and to call them back in an hour with the results. I had no problems feeling Baby’s movements and this was very reassuring.

There has long been confusion about my due date, as throughout the pregnancy this had ranged between 26 November and 13 December. This put me somewhere in the range of 34 to 36 weeks pregnant. Pre-term no matter which date you pick. Because of this, the hospital asked me to come in so that they could perform a check to determine whether or not it was, in fact, amniotic fluid leaking from me. They said not to rush, so we took our time packing up a small bag just in case we wound up staying there. It didn’t have much more than the normal contents of my purse. Our drive to the hospital was pretty leisurely, though I did notice what felt like light cramping as we were driving. I really wasn’t worried about having to stay in the hospital.

Once we arrived, a nurse swabbed and tested the fluid, determining that it was, in fact, amniotic fluid. And then she told us we had to stay in the hospital. A 20-minute fetal monitoring session confirmed that baby was doing absolutely fine and I was, in fact, having very light contractions. I’d agreed to have a saline lock, so the nurse placed the line.

I was able to get up to go for a walk while we waited for my doctor, and I used that time to call my mom. “Surprise, mom! Your grandson is coming a month early!” She rushed to make travel plans for the following day.

After about 45 minutes of walking, our nurse found us in the hospital lobby and told us that my doctor was ready to see me. We went back to the room, hooked back up to the monitor, and the doctor came in and checked my cervix. I was 2cm and 50% effaced, and again, definitely in early first stage labor.

Because of the preterm premature rupture of the membranes, and was already starting to dilate, my doctor recommended starting me out at the minimum dose of Pitocin so that the labor would continue to progress. He explained that frequently, when the water breaks this early in pregnancy, it is indicative of another issue. And being in the hospital put us on a timeline. Not a crazy-strict one, but one that would require antibiotics at 18 hours after the rupture, and they strongly preferred that I deliver within 12 hours. I wanted time to decide. I did NOT under any circumstance want Pitocin. But, after going for another short walk and discussing it with my husband, we decided to let them start the Pitocin drip.

The Pitocin came with other things that I hadn’t wanted. First, IV fluids, which were at least set to flow at a fairly low rate. Second, continuous fetal monitoring. Fortunately, I was not entirely restricted when it came to movement. I couldn’t handle being in the bed, especially once the contractions kicked up, so I was able to walk around the room, stand through contractions, and sit on my ball. (My husband ran home and dug through the entire garage to find my birthing ball for me. I hadn’t had a chance to pull it out yet!)

My contractions gradually got more and more intense throughout the day, especially as they upped the Pitocin drip. They were very good about raising the Pitocin levels slowly. I appreciated that. I found that as the contractions became more difficult, the things that helped me relax and breathe through them the most were sitting on my birthing ball, where I could slightly move and rotate my hips, and just letting go vocally. Although I’d practiced it, and it was plenty relaxing before, the Bradley Method’s side-lying position was never comfortable for me during labor. I needed to be standing or sitting upright on my ball. When I got especially tired from either of those, I would get on my hands and knees or lean against the bed. What I really needed was a hug. 

At midnight, I was started on antibiotics because we’d passed the 18 hour window since my water had broken.

At the point when my Pitocin drip was upped from 7 to 8, my contractions went from being manageable (45 seconds, 2-3 minutes apart) to completely, ridiculously unmanageable (8-10 minutes, with maybe a 2 minute break). I’m pretty sure no woman out there is superhuman enough to withstand that kind of contraction. But, I continued to labor through them sans pain medication. I felt like I went well beyond my breaking point over and over again. I found myself saying things I never thought I’d say out loud, that I couldn’t do it anymore, and that I was going to die. The nurse said something about how if I was saying things like that, I had to be close.

At one point, when I was on my knees leaning on the bed, I felt a vague urge to push. Looking back, I’m sure I imagined it. My husband and the nurse helped me turn over so that she could check my cervix. Let me just break from the story here to say that I absolutely hated receiving vaginal exams. As much as I tried, it was nearly impossible for me to hold still during each one. I felt like I made it more difficult to check each time, but it wasn’t on purpose.

After this exam, instead of telling me I was ready, or at least very close, the nurse left the room. Another nurse came in to do another check. I was only at 7 cm, and everyone was shocked. It was well past midnight, and I still had a long way to go.

I kind of wish they hadn’t told me, because I felt completely defeated. They turned the Pitocin back down by one so that I could have a bit of a break. I think they may have broken hospital policy, since my water had been broken for a while, but they let me get in the shower. The shower was the most amazing thing imaginable at the time. The heat and the pressure made my contractions melt into almost nothing. I found myself thinking, “I can do this” again. But it was too soon before I had to be hooked back to the monitor, and none of that lasted outside the walls of the shower.

By 3am, I was exhausted and mentally defeated again. I asked for pain relief, but I did not want an epidural. I can’t remember the name of the medication given through my IV, but it was not effective. It made me feel dizzy, which distracted me only slightly from what felt like one constant, endless contraction.

After the second dose, I asked if I had any other options for pain relief. It was at this point that I was offered an epidural. I have to say a short kudos to the nursing staff here, because they were actually very good about respecting my wishes to NOT be offered pain relief. It was me who asked. And at that point, I badly wanted relief. I was exhausted and I needed a break, and I needed to relax, or there was no way I would be able to push the baby out later.

I hated almost everything about the epidural. On the positive side, I slept a few hours through what were probably the worst of the contractions. On the negative side, I was officially chained to the bed. I made a comment at one point that I felt like a beached whale. Everything felt tingly from my belly button down. Worst of all, because I couldn’t feel it, I was subjected to vaginal exams and internal monitoring. I hated that I wasn’t able to consent to these things, and worse, I hated that I didn’t care anymore.

I was vaguely aware for the first few hours after receiving the epidural that one side of my body was less numb than the other. Apparently this is a common issue. In the morning, I could feel the contractions on the left side of my body. One of the nurses pointed out that I could press a button for more pain relief, which they had not shown me before, but I didn’t want it. I wanted to be able to feel again. I knew I was going to have to push soon, and I wanted to know when.

I never did feel that urge to push. At around 7:30am, an exam showed that I was fully dilated, minus a small bit of the cervix that they felt they could push back if I started pushing. So, even though I probably wasn’t truly ready, my nurse started coaching me through some practice pushes at 7:45. My husband was dozing on the couch next to me, but he soon woke up and I was actively pushing by 8:15. Because I could feel my left side, I at least knew when I was having a contraction and I knew approximately when to push.

I spent about two hours doing this semi-guided pushing, and it was really tiring. Eventually, the doctor came in. It was not my doctor, but one of the doctors he had a partnership with in case he could not be there. I was sitting completely naked on the birthing bed, in between contractions. The first thing he said was, “Well, now that we have all of the formalities out of the way…”

I laughed. It was actually a very helpful light moment in the midst of everything else.Then, he said some of the scariest words possible: “We need to talk about your options.”

The first option wasn’t really an option in his book: I keep pushing, even though I was clearly worn out. The second was to attempt a vacuum extraction. The third was cesarean. I did not want cesarean, so I was very willing at this point to try the vacuum. He explained that I’d be allowed to push through three contractions, but if we went beyond that or if the vacuum popped off more than once, I’d have to go to the OR. He then discussed a little more with my husband and I was done with that. I remember saying, “Well, let’s stop talking about it and just do it, then.”

They got to work. The doctor gave me an episiotomy, yet another thing I hadn’t wanted, but I didn’t protest. He was making extra room for the vacuum and eventually the baby. I was surprised how little I cared about it.

Mom & Baby, shortly after birth
I pushed harder during those three contractions than I had been pushing the rest of the morning. I was determined to have my baby in my arms. Before, I’d pushed about 3-4 times each contraction, but during those three, I pushed 5-6 times, and with as much effort as I could possibly give. During the second contraction, the vacuum came off. It was repositioned for the third and final contraction. I knew that if he wasn’t born with these last pushes, he wouldn’t be born vaginally, and that thought gave me the energy I needed to finally push him the rest of the way.

I felt his head, and then his shoulders, and then the doctor was asking me if I wanted to pull him the rest of the way out. With surprise, but without hesitation, I reached down, pulled him out, and pulled him directly to my chest. He was glowing, he was beautiful, he was perfect.

***

I wanted to end right there, but I still have a little more to say. The “plan” may have gone out the window entirely, as there were so many things about this experience that I did not want. I think most of the reason for that was that my labor was pre-term. It is still hard not to wonder how things could have been different.

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