Friday, July 13, 2012

Birth Story Part 2: All stages of labor

Day 1 at 11 pm - Check-in at the Hospital
Due to hypertension and beginning signs of preeclampsia, I checked into UWMC to be induced. The baby was full-term and the only way to cure my symptoms was to give birth to the baby. My first cervical exam showed that my cervix was closed or 1 cm dilated, in need of effacing or ripening of the cervix before pitocin, and the baby was at a -3 station. A intravenous tube was inserted and I was started on magnesium to lower my blood pressure. Two monitors were placed externally on my stomach, one to monitor the baby (an electronic fetal monitor or EFM) and another to monitor my contractions; both of which were able to be wireless to allow for mobility.  

Up until the time that I had the contraction monitor attached I thought I had no signs of labor, mainly no Braxton Hicks contractions. I was wrong! On the monitor, I was having contractions. The pain level was a zero Face of Pain and what I had said for the past month or more was my "silly baby moving around." It had always been described to me as menstrual cramp like feeling and I was having none of those. Or, another description is a hardening of the stomach - which is really hard to explain or understand, so in the end the contractions did actually feel more like a hardening of the stomach. Hardening of the stomach feels like to the touch that you contracted your abs, but you did no such thing. When the contractions are light, the surface of that contraction will be smaller. Internally it feels like a full body movement by the baby. 

Day 2 at 2 am - Induction Process Started
My cervix was unfavorable for induction, so medicine was needed to mimic prostaglandin, the hormone the body releases to ripen the cervix. With three options to ripen the cervix: a pill placed next to the cervix (misoprostol), a gel attached to a string placed next to the cervix (dinoprostone), or a non medicinal approach of a Foley balloon catheter; we had to start with Cervidil due to the rate at which I was having contractions. Cervidil was inserted into my cervix where it would sit for 12 hours. Upon reexamination at 2 pm, I was not fully effaced, so we went with misoprostol which would take 4 hours of waiting, however while waiting for the doctor to insert, my contractions picked up and we had to proceed with balloon insertion as a result. After four tries of inserting the speculum and two insertions of the balloon - both fell out prematurely, even though they are to fall out when the cervix is ripened - we had to change pace and insert the pill instead. My preference from the beginning was to have the balloon catheter inserted since this required no medicine and mimic the pressure that the baby's head otherwise would have been placing on my cervix to naturally ripen the cervix. I knew from the beginning that I otherwise had no say in what would happen, but could make decisions as they happen; this is something that I dealt with well as the laboring process continued, as there were many decisions to be made as the day continues.

Day 3 at 2 am - Contractions Pick-up
After the gel and pill did its job at ripening my cervix, I was ready for starting labor/contractions with the use of Pitocin. In waiting for the doctor to place the order for pitocin, my body started to have more frequent and intense contractions. My doula came into the hospital at 2 am, which was good because the show was just getting started. As I was sitting in bed, I felt what I thought was the baby punching my vagina and in a playful way I said just that to the nurse, doula and husband. A few minutes later as I adjusted myself to prepare for a cervical exam, it felt like I was urinating, and the doctor confirmed with a medical stripe that the fluid was amniotic fluid. I was only 2 cm dilated when my water broke. From that point on when I would move, I had to adjust myself to ensure I was not causing the baby's heart rate to drop (due to her contact with the umbilical cord). In addition there was another level of discomfort as the loss of fluid made it the baby's movements more pronounced, as I was now aware there was a baby in my belly - it felt sharp. I was administered antibiotics since my water broke so early and there was the risk that meconium poop could be expelled by the baby into the amniotic fluid. 

Contractions picked up to the point that when the Pitocin order was finally filled, the nurse waited on administering it until the contractions slowed down. The whole time I was in the hospital I did not track the timing of my contractions, this was told to me by the nurses to be their job and not something that I would need to be concerned about; the contraction monitor was doing the job for me. I did lose track of time and had no sense of time from that point on. My doula would tell me that that one lasted a minute and a half or two minutes, and I thought it was a matter of seconds. I was doing textbook style deep breath in and moan out as the pain came in and I washed it out. I envisioned the pain coming from the top of my head and rushing down through my lower half of my body. I did my best to not tense up as this increased the pain. For most of it I was lying on my side with my doula massaging my lower back/pelvic area. My husband was placing pressure on my mid-back. I was having back labor, and what later would be confirmed due to the position of the baby. As the sun came up, I moved to my hands and knees to encourage the baby's position to change and the pain to lesson; however it did not.  As contractions picked up, I experienced a Face of Pain of 10 with pitocin, so the nurse backed off the pitocin as myself and the baby could not endure consistent intensity of contractions. When I was asked if I wanted the epidural, I was ready and willing - something I was unsure I would accept going into this as I had planned a non-medicated birth. The joy that came over me when I heard the epidural man wheel in his cart, it was like hearing the ice cream truck signing a tune through the neighborhood, was noticeable as I hurried to get out of the bathroom (where I was when he came in) and had a leap in my step as I got onto the bed. 

The insertion of the epidural was not as painful as the stories I had heard. The pain was the extent of lidocaine to numb the spinal area, which I thought was no big deal after having my IV inserted three times (starting with lidocaine) before the line was established. Going into it I was fearful of how I could manage to be still during insertion of the epidural while having contractions. This too was not so bad thanks to my amazing doula and nurse: my doula was right there in eye-sight talking me through it with focus, it was like we were playing "let's see who could flinch first" and my nurse had her forehead to mine during contractions for me to use counterbalance to get through the pain. After two contractions, the epidural was in and I was feeling relief. What contractions? I was having contractions on the monitor, but could not feel them. I was told that the IV would administer the drug, so I would not feel anything all the way up until the placenta was delivered and if I did need more "juice" I could push a button to add more to the line every 10 minutes to self-manage the pain. For now and the next two hours, I would take a nap and enjoy the next two hours, when the epidural is the most effective, and be examined after that time. 

As I sipped my broth and drank Ensure - no solids during an epidural - my body all-over started to shake and developed cold sweats. This was a good thing, as my body was ready for labor. This was confirmed with a cervical exam that put me at 10 cm dilated and a station of 1+. 

Day 3 at 2 pm -  Active Labor Begins
With my oxygen mask, to benefit the baby, I geared up for pushing with a sync between my doula, husband and nurses in terms of my wishes for active labor (per my birth plan). I took deep meditative breaths and visualized a smooth, quick birth. With a wish to start in squatting position (which I had done many times during prenatal yoga with the idea of birthing this way), active labor started off with a bust. I guess I had wanted to have progress fast after hearing stories of 15 minutes of pushing the baby came out. Well that position did not work, so on to the leg up on a bar, the other leg pushing into my husband who is counter-balancing my strength, both hands pulling myself up doing an abdominal push-up, and pushing. Okay seriously, it has been 10 months since I had done ab work and now I am asked to do an intense crunch! This position was encouraging as the room got excited when we could see her head. I had to shift position whenever the baby's heart rate would drop. The nurses had a constant monitor on her from the external monitor, but half way through put a probe on her head to monitor since the external kept shifting. I was monitored via regular blood draws and vital checks. The doctor kept coming in to check on my progress. The chief of staff came in to check contraction rate, the strength of my pushing and position of baby. The external monitor was replaced with an internal monitor (catheter) to track the true intensity of the contractions. The question was coming up, can I continue to push and get this baby out. There was enough room and I was pushing well, so we continued. However, as the time passed my condition continued to decline. I developed a fever and was feeling like I could pass out at any point. I started pushing with no feeling of where or if I was pushing correctly, so I let up on the epidural to feel the contractions. It was a good thing we did because I was started to understand the whole concept of holding your breath while giving three good pushes. I was on hands and knees and really giving it my all to push down, but nothing. I was thankful for the oxygen mask because I felt horrible. I wanted to give up, but knew there was no option. Then, the baby's heart rate started to drop with every contraction, so I was told I needed to stop pushing. The pain was beyond what the epidural could do for me. I could not breath through the contractions like in early stages of labor and I could not push to relieve the pain, all I could do was sit in it. I managed the pain through moaning and displacing the pain by smacking my doula's hand (thank you doula!). After an hour and a half of this, I called it quits with the decision to go forward with a Cesarean delivery. I guess I was not the only one with this idea as the doctors presented this to me as their plan of action too. This whole time the doctors had said that I was getting more sick, but it did not register what that meant. It was not until they had told me that they had blood on-hand in case I needed a blood transfusion during the c-section for my blood plate-lattes had dropped so low that I ran the risk of not clotting blood. I was very thankful that from the time I made the decision for c-section to the time I was prepped for surgery, it took only 30 minutes. As soon as I signed the consent paper, I was given pain medication through the epidural and two contractions later I had sweet relief! Her position remained at 1+ station. In five and a half hours of pushing she had not moved any further down in my pelvic. 

Day 3 at 8:03 pm - C-section baby girl is born
Off to surgery I went, nauseous from the pain medicine. I was put on the operating table with my arms out to my side and my body curtained off, just like you see on television. I am the type that does not like to see the needle when giving blood as I may pass-out, so the idea of being awake for the surgery was scary. I did not want to hear what was going on, which I was able to tune-out; 1. I felt like I was going to pass-out and 2. my doula kept me talking so I could hear my baby's first cry. There were so many people in the room, two sets to care for me and her. I saw my husband come into the room as the baby was pulled out. There was no cry at first as she was limp, but she came around (APGAR score of 4 then up to 7). I was hoping for delayed cord clamping, but that was not an option with an emergency c-section. Because my water broke so early, at 2 cm, and time had passed, the baby had her first bowel movement while in the womb; it was mot an issue as it was a small amount, which they were able to remove. and antibiotics were already administered to me in the event this happened. There was not much body space of my own for skin-to-skin, so my husband put the baby on my cheek. Seeing my baby staring back at me was beautiful! She was so close to me that I was seeing double, but it did not matter; she was very alert and already I felt a connection to her. I will hold with me forever the picture of her looking at me, with big eyes. 

The experience of having a c-section was traumatic to say the least, but one question lingered with me - why did it feel like my incision was by my ribs? I wanted to know what went on in there. A few days after delivery, I spoke with the OB who performed the c-section and this helped put my mind at ease. I could not feel pain during the operation, but felt pressure in my upper abdomen and plenty of movement thereabouts. All-in-all the reason for my back labor and the movement I felt during the c-section was due to the position of the baby - the baby was in an occiput posterior (OP) position, but she had her head craned back, instead of having her chin tucked under. Due to a combination of her position and how well lodged she was, it took three people to back her out of my pelvic. Then, due to her position, they could not deliver head first through the incision they made, above my pubic bone. Instead they had to turn her around and deliver her breech or feet first. And, this turning movement was what I was feeling in my abdomen. I felt at peace knowing what happened. 

I had planned to take my placenta home for encapsulation, but pathology confirmed that my placenta was infected. In addition the idea of ingesting the placenta, which essentially caused my sickness, or needed to be delivered for me to feel better just did not sit well with me. My placenta was discarded; just another thing that did not go per plan. 

I was wheeled off to recovery with my baby. I would spend the night with my nurse tending to me and my baby. Thankfully I was able to nurse and co-sleep with her as my nurse was monitoring us 24/7. My baby girl immediately found my nipple and we were able to intimately bond nursing. After four days of recovery I was able to go home with a prescription for blood pressure medicine and the most precious baby girl!

For information on why an induction process was needed, my birth plan, and my feelings around deviating from the birth plan, see Birth Story Part 1: Deviation from the plan. Or, for information on how to create a birth plan and what my original plan was for birth, you can read My birth plan.

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