Friday, August 29, 2008

Birth Story

I wrote this up for myself more than anything, but I thought it might be interesting for some of you, so I decided to share. If you don't feel like reading a labor and delivery story, I really won't be offended. Here is a picture for you to tide you over until I post again; the birth story will follow for those of you who are interested.

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About a month before my due date, my skin started to itch. All over, all the time. It was the most intense itching I've ever experienced. I had experienced itching with the pregnancy before this, but it had always been confined to the normal places that stretch during pregnancy, like my belly and ankles. This seemed weird, so it raised some red flags, and I called my midwives.

The midwives told me that it could be a liver condition, and they wanted to do a blood test to rule it out. I wasn't surprised, because I am one of those people who goes to the Internet before my doctor, so I knew that there was a small chance that it could be something serious. But I also knew that it was much more likely that it was just another weird pregnancy symptom that I would just have to deal with, like losing my taste for coffee.

It was a Monday when I called the midwives, and I went in that day to get my blood drawn. I was 36 weeks along at that point. That Friday, as I was getting ready to leave work, my cell phone rang, and my midwife informed me that my bile count was really high, that I had obstetric cholestasis, and that they wanted to induce me as soon as I was 37 weeks. That would be Monday. As in three days away. And three full weeks before my due date. I was in shock. I'd had such a normal pregnancy, and I had been fully expecting the blood test to be negative, and for the midwives to tell me to take cold showers and Benadryl.

The next thing to cross my mind was what am I going to do about work? My manager was on vacation that week, and my maternity leave wasn't going to start for another week. Fortunately, my coworkers really stepped up to the plate, and managed to cover all of my shifts for me for the next week. I still offered to come in on Saturday night to complete all of the closing manager responsibilities and to give one of the other girls who had covered a shift for me a ride home. It was the least I could do, because everyone was being so awesome to help me out.

I went in to the hospital for a non-stress test on Friday afternoon. I called Jeremy, and he was able to leave work early and come into the hospital with me. I was still in a state of shock at the whole thing, and I was so glad that Jeremy could be there with me. Everything looked fine on the monitors. Auggie's heart beat was steady, and she was really active. It took a while to get the three heart rate spikes they were looking for, however, because whenever she moved, she would squirm away from the monitor, and they would only catch the tail end of the spike.

The good news was that, since everything went fine with the non-stress test, they didn't keep me in the hospital for the weekend. The even better news was that the contraction monitor was actually registering somewhat regular contractions, even though I wasn't feeling most of them. When the midwife checked me out, I was 1 cm dilated and about 50% effaced. That might not seem like much, but considering I was only 36 1/2 weeks along, any progress was great news. I had wanted, still wanted, a natural birth, and if my body could go into labor on its own, even partially, then maybe I could still have a natural birth. It wasn't likely, but there was a chance.

The weekend passed in a surreal haze. I took a lot of walks, and Jeremy's chiropractor was kind enough to come in on his day off and give me an adjustment and teach me a few acupressure points to trigger contractions. (Aside: They really worked; I could actually feel contractions start right after pressing on the acupressure points. It was cool.) I was feeling more contractions, now that I had seen them on the monitor and knew what they were. Nothing painful yet, but at least I could feel something going on, which gave me hope.

Sunday night, Phil and Rachel brought a movie over to keep us company and keep us distracted. I couldn't focus on the movie, and used the time to pack a hospital bag and write up a revised birth plan. I don't think I really slept Sunday night.

We went in to the hospital early Monday morning, August 4. They hooked me up to the monitors and stuck an IV in my hand so that they would have easy access to my veins in case some vampires showed up, or something like that. We had a discussion about how things were going to proceed, and I assured the midwife that I wanted to be patient and give the prostaglandins the chance to do their job as long as possible. At this point, I was still only 1 cm, so I took my first dose of cytotec and settled in for the wait. It tasted like chalk.

Not much happened with my first dose or my second dose of cytotec. I was mostly immobilized by the monitoring equipment, and I was only allowed to get up to use the bathroom. The fetal heart rate monitor kept slipping off the heartbeat, and the contraction monitor pressed painfully on my belly. We watched a lot of Animal Planet, because every other channel I put on seemed too stressful for me at that time. Every once in a while, the blood pressure cuff on my arm would tighten, and I learned to relax myself enough when this happened that eventually, I stopped setting off the high blood pressure alarm. My blood pressure fluctuates dramatically from one minute to the next, and it never concerns me, but the nurses didn't like it very much.

After the second dose of cytotec wore off, I begged for some freedom from the monitors before they put any more drugs in me that would require me to be strapped down again. They let me walk around for an hour, and it was a nice break. When I got back, it was time for cervidil. Cervidil is like a tiny tampon with a really long string that the midwife took what seemed like a very long time stuffing up inside of me. Unlike the cytotec, which immobilized me for 3 hours at a time, the cervidil would be immobilizing me for 12 hours. Yippee.

Almost immediately after I started on the cervidil, I started having cramps. The cytotec had been giving me nice, regular, painless contractions. The cervidil, instead, gave me one, long, horrible, uninterrupted, painful cramp. It was awful. Looking back, this was actually worse in many ways than the full-blown labor contractions, because at least, with those, I got a little break in between them to catch my breath. I called for the midwife at one point, because I didn't think I could handle 12 hours of this. While I was waiting for her to come, I started throwing up, over and over and over. I hate throwing up. In fact, including the one time I got morning sickness from taking my prenatal vitamin on an empty stomach, this was only the fourth or fifth time I had thrown up since I was seven years old. Not a pleasant experience, although it did relieve the cramping a little bit. When I talked to the midwife, she encouraged me to press on by simply asking me, "Well, what's the alternative?" I really did want to be able to deliver naturally, and, if this horrible cramping was getting my cervix ready for labor, then I could make it eight more hours. The nurse brought me ambien to sleep and put something for the nausea in my IV (which, come to think of it, now had a saline drip going, too, because in spite of my constant water-drinking, I was starting to get dehydrated).

I have to admit, I was glad I accepted the offer of ambien, because I felt much better in the morning for having slept the night before. I had now been in the hospital for 24 hours, and the midwives checked me out to discover that, after 24 hours of prostaglandins, I was only 2 cm dilated. I almost started crying. All those miserable, horrible cervidil cramps had accomplished nothing! They gave me another, short break from the monitors to take a shower and walk around before starting the next round of drugs.

The plan was to try one more dose of cytotec, because my body had responded fairly well to that, to see if it might make a little more progress. Then, we would probably move onto the pitocin. I was really dreading pitocin, because I've heard that pitocin contractions are unbearable, and almost everyone who gets pitocin ends up getting an epidural (and, statistically, a large percentage then end up getting a c-section). I really didn't want to start the pitocin, but if the prostaglandins couldn't get labor started, then we would have no other choice. So, the midwives gave me one more dose of cytotec, and told me they would be back in 3 hours to check on my progress.

Two hours and 45 minutes later, I had a fairly strong contraction. Not extremely painful, but strong enough to capture all of my focus. This was at 11:45 am on August 5. A few moments afterwards, I felt a huge twitch, like the baby was kicking or possibly like another contraction was starting. There was a pressure, then a "pop", followed by a gush of water. I had been worried before that my water might break without me noticing, and I almost laughed at this point, because there was absolutely no doubt in my mind about what had just happened. I paged the nurse, who was a little confused at first since she had just been in my room five minutes prior to check my blood pressure, and I had been fine at that point. I told them my water had broken, and the midwives were by my side shortly thereafter. My lunch had just arrived, and they told me to go ahead and eat if I wanted to, because it could still be a long time, and I might not feel like eating later. They told me to take an hour to walk around and see if gravity might get things moving without having to resort to more drugs. The midwifery intern checked my cervix, and when she found that I was 7 cm, she asked the midwife to double check, just to make sure. She confirmed it - I had gone from 2 cm to 7 cm in three hours. Something was finally happening. And the best part was that I was finally free from drugs, and monitors, and IV drips, and everything.

After my water broke, I started to really feel the contractions. They still weren't incredibly painful, but they started to capture all of my focus. I ate my lunch between contractions, shoveling as much as I could in during the breaks, and then breathing through the contractions. Jeremy wanted to go get lunch, but I didn't want him to leave at that point, so he ate what I hadn't been able to finish of my lunch. I went to the bathroom, and while I was in the bathroom, the contractions made the leap from "Okay, I'm definitely feeling that" to "Oh my goodness, I have never felt anything like that before in my entire life." Jeremy could tell that things were moving quickly, so he downed his lunch in record time, and by the time I was done in the bathroom, he was ready to be my labor partner.

I was pretty much screaming (yelling? groaning? moaning? crying? some combination of all of the above?) through the contractions, now. I never called the midwives, but somehow, they figured out that I was in labor and came to the room. I have no idea how they figured it out. They must be psychic. Or the door might have been open.

I was still standing at this point, leaning my head against Jeremy's chest, and hanging with my arms around his shoulders. I wasn't trying to push, but I found myself bearing down in spite of myself. I said something to my midwife about this, and she responded, "Yeah, that's transition for you." I remember being so completely relieved when she said this, because it meant that THIS was IT. The contractions were so incredibly painful at this point, and all I was able to think of before she said this was, "Holy crap, if this is what 7 cm feels like, I don't think I can handle 12 more hours and 10 cm." I don't know if any other woman would have been happy to find out that she was in the worst pain of the whole ordeal, but for me, it was such a relief to find out that THIS was the worst pain, and I was dealing with it. Without drugs. Once my midwife said those magic words, any thoughts I might have been entertaining about pain relief were completely gone.

I started to worry about dropping the baby on the floor, but my midwives assured me that they would not let me drop my baby. The nurse (for her own reassurance or my own, I'm not sure) put a blanket on the floor under me. I wasn't sure I wanted to give birth standing up, though, and the blanket somehow made me think twice about my laboring position. I could tell that I was going to need to open my legs wider in order to push the baby out, and I didn't think my leg muscles could handle the squatting position that would require. So I started trying to get onto the bed. I really, really did not want to be on my back, however. I don't know why, but I knew that I would not be comfortable on my back. The bed was still raised in the sitting position from when I had raised it to get out to go to the bathroom. I climbed onto the bed backwards (I think it took me two contractions to get there), and leaned over the back of the bed in a kneeling position. I was kindof in my own little world, and had been since the painful contractions had started, since I had been facing Jeremy at first, and now was facing the back wall. I know there were at least three other people in the room, but there could have been 30 for all I was aware of what was going on behind me. I knew the midwives were there to catch the baby, and I knew Jeremy was there, and that was all I cared.

At no point in time had I been timing contractions. They were close together, and I was obviously in labor, and it didn't exactly seem like a priority. Shortly after I climbed onto the bed, however, there was a slightly longer than normal pause between contractions. It was a nice break, and although I was afraid to jinx it, I said something about it to my midwife, and she said sometimes your body just knows when you need a break. She didn't mention that it probably meant my body was gearing up for something big - I guess she knew I would figure that out when the time came. She calmly encouraged me to try not to scream so much, because I was going to have a very sore throat afterwards, so I made an effort to moan more than scream, although I was only somewhat successful.

The next bit is a little bit blurry. I remember the midwife mentioning that my baby would have hair. I remember the nurse asking when she should get the nursery nurse (who witnesses every birth at this hospital), and my midwife answering "now". I remember feeling the baby's head crown, and being surprised that it didn't hurt more, because I had heard from so many people how painful the "ring of fire" was supposed to be. The baby's head came out either on that push, or the very next one. The rest of her body came out in one more push. There was a huge gush of fluid, and I heard someone say "1:06 pm" (which, for those of you who are counting, is 1 hour and 20 minutes after my water broke, and only about an hour after the painful contractions started). Jeremy told me it was a girl.

My midwife helped me pass my leg over the baby and turn over onto my back, and I wriggled the rest of the way out of my tousled hospital gown. They placed the baby on my hip. Her cord was too short to reach any further, so the midwife said we were going to have to cut the cord right away. She asked Jeremy if he wanted to cut the cord, and although he hesitated at first, she assured him that there was no medical reason for him not to, so he did. They handed me my baby and asked me what her name was. I said "Valerie" without hesitating, then called over and said, "Right, Jeremy?" He confirmed it. (Valerie was one of two girl names we had picked out, but I think we were both leaning towards it before she was even born.)

Somehow, when I was in the middle of labor, Jeremy had managed to surreptitiously send a text message to his dad that we were in labor, and they might want to hurry to the hospital. Within the first few minutes after they handed Valerie to me, a nurse came in and told me that my mom was on the phone, and she was really panicky, because she couldn't give her any information about what was going on. I told her she could put my mom through to the room. I answered the phone, told my mom that we had the baby, it was a girl, come to the hospital. Then I hung up.

I had been a little surprised when the midwives were in such a hurry to cut the cord, and I was more surprised when they started pushing and prodding almost immediately to get the placenta out. Someone came in and gave me a shot of pitocin in my leg to stimulate more contractions, and the midwives kept asking me to push to get the placenta out. It wasn't until later on that I figured out that they were rushing things along because they were worried about my bleeding. Once I passed the placenta, my midwife told me that I had a third degree tear, and that they had to call the surgeon to do the rectal stitches, and then she would do the vaginal stitches. The nurse told me that they had to take the baby, for her safety, while they did the repair, and I asked her if Jeremy could hold her, then. She handed Valerie to her daddy. My midwife asked me if I wanted anesthetic for the stitching, and I was starting to feel too out of it to make decisions anymore, so I asked Jeremy if I wanted anesthetic. I think he grasped the severity of a third degree tear more quickly than I did, and he told me I should get the anesthetic. They stuck something in my IV (I didn't catch the name, but it sounded like "bradol"), and the room started to go black. I was surprised, and asked if I was supposed to feel like I was blacking out, and they said yes, so then I let it take over.

I could still feel what was going on, and I could still hear people talking, but it took a lot of effort for me to say anything in response (and even more effort to open my eyes). I could feel them stitching, and I could feel them stabbing me all over my tender bits with a needle (the local anesthetic), and when the stitching started to hurt too much, I was able to respond enough for them to ramp up the local. At one point, I heard a nurse make some kind of comment about the baby getting pale because daddy was holding her too tight, and I think it was supposed to be funny, but it concerned me enough to open my eyes for a split second to see her getting passed over to the bassinet with all of the measuring equipment and everything on it. The stitching took about 45 minutes, and when they were done, I asked if I was going to be able to nurse the baby. My midwife said she would at least let me hold her again and get some skin-to-skin time, so that she would have smell association with me, even if she wouldn't nurse. I said, "Okay, that's worth fighting the drugs for," and I started trying to shake off the blackness and wooziness from the anesthetic. They gave Valerie back to me, and we tried to breastfeed, but I wasn't with it enough to really focus on getting her position correct, so she only managed to latch on briefly. Then they told me my mom was here, and that they wanted to get me into the post-partum room right away. I had thought they would let me stay in the labor room a little bit longer, but maybe they thought that it wouldn't be nice for people to come visit me there, since there was blood all over the place and it looked like a war-zone. I was still too out of it to care about much, though.

The nurse wheeled me into the post-partum room, where my mom was waiting for me. Then the nurse kicked my mom out of the post-partum room while she unloaded me onto the bed, which I thought was a little weird. They gave me percocet, and told me to sleep. I asked where the baby was, and they said something about having to go to the nursery first because of the sensor thing they had put on her belly button that would set off alarms if they wheeled her past the elevators. Jeremy showed up at some point and told my mom that his parents were watching the baby through the nursery windows, so everyone left me to go look at my baby while I slept.

Except that I couldn't sleep. I laid in bed awake, wondering what was taking so long, and why they hadn't brought my baby to me yet. After about an hour, I called the nursery to ask when my baby was coming, and they told me that someone was on their way to talk to me. Someone needs to give that nurse a lesson in things you DO NOT SAY to a new mom. My drug-addled mind was racing as much as it could, trying to figure out what went wrong between "We'll be right there with your baby" and "Someone is on their way over to talk to you." The nurse explained to me that Valerie was having some rapid breathing issues and had some fluid in her lungs, but they thought they would be able to bring her to me in about 45 minutes. An hour later, still no baby, so I called the nursery again. "They're on their way to talk to you right now." Are you kidding me? Not once, but twice, I get this ridiculous, fear-inducing response, and now, whatever is going on is bad enough that it's going to take multiple people to explain it to me?

They explained that they were going to have to keep her in the NICU (neonatal intensive care unit), because her oxygen levels were not high enough. At some point later, they brought me a breast pump and told me to pump every two hours, and maybe they would let me breastfeed in the morning. Eventually, they let me scrub my hands and come into the NICU so that I could look at my poor, little baby with a million cords and hoses coming out of her, in her little isolette. I sang to her, since I couldn't hold her. But, they took the nasal cannula out the next morning, and they let me start breastfeeding her. Shortly thereafter, they took her off the IV, and before too long, she wasn't on any monitors at all. They kept her in the hospital for six days total, because she was jaundiced, but they finally let me take her home with a portable UV blanket, and the rest is history.

5 comments:

jd said...

Bravo, both in literary content and actuality!!
Love you....

Heather said...

Wow, you're awesome. Read the whole thing. Twice. Congrats again!

Anonymous said...

wow! so sorry that you had such a bad tear! i was almost crying for you while reading.

glad both you and baby are doing well now!

megan
(latinlover1130)

Alana said...

I love hearing people's birth stories, and yours is great!

intensesimplicity said...

I started to get nauseous just like I do when one of my sisters gets hurt or distressed. My first birthing experience was long and included tones of sleep deprivation. Praying that you are getting plenty of rest. I remember so much of the birthing class stuff just getting thrown out the window while I was in labor and delivery:) I'm sending my last baby to kindergarten tomorrow:(