Monday, July 30, 2012

Birth



I'll warn you in advance, this is going to be a long and difficult post. I feel it's important to be real and honest about our experience, even though it was difficult and traumatic. Please know that, despite it all, Daddy and I are ultimately so, so thrilled to have you in our lives, healthy and safe. And the immediate and overwhelming feelings of joy, love and awe were just as profound for us that day.

The story starts on Tuesday, July 17th. That morning, after getting out of bed, I noticed some extra wetness in my underwear. It wasn't a lot, but it also wasn't urine. Soon, I began losing pieces of the mucus plug along with a tiny amount of fluid). It was an exciting sign, but I knew it wasn't really an indicator of when labor would start, and that we could still have days to go. So, Daddy and I went about our day as usual. We had lunch at BJ's, and did a little shopping at Target, and I worked on a few finishing touches for your nursery while Daddy tended to the yards


Later that day, around 5:30 pm, I was in the master bathroom and I noticed a steady drip of fluid beginning to stream down my legs. Quickly, small puddles were forming on the bathroom floor. I called in Daddy, and told him I thought my water had broken. Unfortunately, contractions had not yet begun, making this a prelabor rupture of membranes (which is pretty rare)

I reached out to our doulas, to get their thoughts. We decided to stay home for awhile, and see if labor began on its own (had we gone into the hospital, they likely would have induced with Pitocin right away). Our main doula, Teri, suggested that you might be positioned posterior, as a water break without contractions could often indicate this. She gave me some suggestions of some moves I could try, like the cat cow yoga move. I spent a little while trying the various moves, and reading in some of my books for other ideas at the same time. But, I didn't feel you rotating, and it had started to get late. Daddy, in the meantime, had been busy in the hall bathroom -- first trying to clean it (thinking I may wish to get into the tub during labor), and then battling a stubborn clog in the sink he discovered. At one point he even had me out in the backyard, turning the hose (which he had fed through the guest bedroom window into the bathroom) off and on!

By the time 9:00 pm had rolled around, I suggested we eat something. We ended up ordering take-out from Taqueria Los Pericos. As we were eating, I started noticing what felt like contractions. They weren't spaced very closely together at this point though. We decided to head to bed shortly thereafter, figuring that we'd likely be meeting you soon, and should try to get some rest

We headed to bed, and Daddy conked out quickly. Unfortunately, my contractions started coming on more rapidly and strongly, and I found I couldn't get to sleep. After laying in bed for over an hour, I decided to get up and see if anything changed. I paced around in the master bathroom for a little bit, but the contractions continued, and I knew getting back into bad wasn't going to happen. So, instead, I headed downstairs, and perched myself on my birth ball at the end of the sofa in the back room, with a stack of pillows on the sofa for me to rest my head on. Using an app on my phone, I would time the contractions, and in between I'd lay my head down and attempt to rest. When I first began timing them, they were around 4-5 minutes apart, lasting around 45 seconds each. Within a couple of hours they had progressed to 3-4 minutes apart, lasting about 45-60 seconds each.

Around 4 am, I headed back upstairs, where Daddy was still sleeping. I was beginning to think we should head to the hospital in a little while, and wanted to finish getting ready to go. Daddy woke up as I was moving around the bedroom, gathering things, and I told him what was up. At first, he was a little upset I hadn't woken him, because he wanted to be there for me. But I explained that I decided to let him get his rest because I'd need him during labor, and figured at least one of us should be rested, if possible!
We showered, finished packing, and ate some breakfast, and started heading to the hospital just before 5:30 am. We checked in at the Emergency Room intake, and as we were sitting there a woman with her daughter began chatting us up, telling us she delivered naturally, and wishing us good luck. Soon, a nurse arrived to take us upstairs to the maternity ward, and got us checked into a birthing room (room 2905). It was about 6:00 am.

Our first nurse came in, and started hooking me up to the fetal monitor for the initial strip. She also began prepping me for a saline lock, and did a cervical dilation check (I was at a 4). Unfortunately, the monitoring seemed to show that your heart rate was "flat" (it was at a decent level, however, it wasn't accelerating when you'd move or I'd have a contraction). As a result, the doctor ordered me to remain on the continuous fetal monitor (something I had fought against in my birth plan originally). She also ordered me to be placed on an IV drip for fluids -- something else I had opted out of in my birth plan. They also did a quick ultrasound to verify you were head down, but were unable to tell which direction you were facing. Bloodwork was done too, and among other things my platelet levels were checked -- somehow they had shot back up to 133 in the last few weeks!

After a little bit, your heart rate/accelerations became normal. But the doctor refused to let me off the monitor. By this time, we had a new nurse (due to shift change), who brought in a wireless monitor, so I could at least get up and move around. Our doula (Kelly) had also arrived.

We spent the next few hours going through the motions of laboring. I moved around from the bed to sitting on my birth ball to standing and swaying. Daddy offered counter pressure on my lower back, as the pain had begun to intensify back there (another sign you were posterior). I was also using the Hypnobabies techniques intermittently. They worked really well -- in fact, the first time I put the earphones in and put myself under, I "woke" a little later to find Daddy, the doula, and a couple of nurses staring at me in awe. Apparently, I had been snoring through some strong contractions, and not even moving (whereas before I went under I was definitely moving around during the contractions, and in need of Daddy's hands for counter pressure). While I was under, I could definitely feel the contractions still, and I certainly wasn't asleep, but everything felt so much less intense and so much more manageable. I didn't need to move, and when it became more intense I moaned through it (which I'm guessing must have come out sounding like a snore!) The problem was that it left me tied up in bed, and I knew that it wasn't the best position for me to labor in, especially if you were in fact posterior.

Around 1 o'clock, the nurse checked my dilation again. This time, I was at a 6. Yay, progress! Following that, contractions definitely started getting stronger and more intense. Within a couple of hours, I was vocalizing loudly, and Daddy was having to use all his strength to apply counter pressure to my back, which hurt quite a lot during contractions. Self-doubt began creeping into my head, and I began wondering if I could go on, and cursing or crying out "no, no, no" during contractions. I knew this was often a sign that a woman was in transition (8-10 cm dilated), so I was holding onto that to push me through. A few times we looked over at the fetal monitor, and I was having some very intense contractions for sure!

Unfortunately, I was also beginning to feel the fatigue set in. At one point, I was sitting on my birth ball, leaning over the bed. Daddy or Kelly would apply counter pressure when each contraction hit, and I'd push through it. As soon as it was done, I found myself wanting to doze off -- sometimes even beginning to actually nod off, and having to catch myself as I began rolling off the ball. I knew this wasn't good, and began to worry too that I may not have the energy for pushing later.

A little after 5:00 pm I got up to use the bathroom. While on the toilet, a contraction hit, and I felt the urge to poop. Knowing this could sometimes be a sign that the second stage of labor was beginning, and dilation was complete, I mentioned it to the nurse. She had me climb back onto the bed for another cervical exam. Her check seemed to last a little longer than before, which got me a little nervous. When she finished, she quietly told me that I was still at a 6, and 90% effaced. It had been more than 4 hours since my last check, where I was also at a 6, and 24 hours since my membranes ruptured. She needed to report back to the doctor.

Our doctor was not pleased with the lack of progress and presented us with two options: we could either have a c-section now, or we could try augmenting with Pitocin to see if it would cause labor to progress. Neither option sounded acceptable to me, as both went directly against my wishes in my birth plan. We argued with the doctor a bit, and then I asked for a little time to discuss it with Daddy and our doula.
We weighed the circumstances: labor had stalled, we thought you might be posterior (making labor more painful), I was getting really tired and already doubting my ability to continue (even more so now that I knew I still had 4 cm to go!) We really, really wanted to avoid a c-section as well, so that option was immediately off the table. I didn't know what else to do. I ended up reasoning that perhaps the Pitocin would help get us over the hump. However, this brought up other concerns. The contractions I was having just then were quite painful, and I was very tired. Pitocin causes contractions that are much more intense and painful than they would be normally, and many women are unable to handle them without pain relieving measures, like an epidural or narcotics. I was also concerned that if it didn't work, and I had to have a c-section, that they would give me general anesthesia, and Daddy wouldn't be able to be there -- something I was not at all okay with. But, ugh... I didn't want an epidural or other pain meds! I had worked so hard for months to have a natural childbirth, and now I was being faced with having to opt for interventions I didn't want, and that carried risks that concerned me. But, what else could I do? I didn't know what other options I had available to me to try to fight for. I reasoned that if I got the epidural, it might allow me to rest while the Pitocin did its work (knowing full well that often the epidural slows labor, and thus works against Pitocin, causing doctors to up the Pitocin, which could lead to fetal distress and then a c-section... but it seemed I was heading that direction anyway if I didn't at least try). I figured that, if it worked, I would have them turn off the epidural for pushing, so I could at least feel through that.
It was a compromise that left me feeling somewhat defeated, as well as anxious and scared. Daddy was being so supportive and loving, but I could see the fear and sadness creeping into his eyes too. At 6:00 pm, they hooked up the Pitocin, and the anesthesiologist came in to administer the epidural. I felt like a failure. I was so disappointed that this was where things had ended up, after 21 hours of laboring naturally. I began the journey of collapsing into myself at this point. Sitting upright on the bed, as the anesthesiologist prepped me for the epidural, I felt like a puppet, being manipulated by the hands of another. As the epidural was being administered, a very strong contraction hit, but I remained perfectly still -- Daddy noticed, and remarked about it later. I was so lost inside myself in that moment, I'm not even sure I was aware.

Soon they had me laying back down on the bed. I began to develop the shakes, and the nurse provided a warm blanket for me. It didn't really help. I knew the shakes weren't good -- it meant adrenaline was pumping through my body, which also tends to stall or even regress labor. Fight or flight. In nature, an animal giving birth will actually stop and reverse the process if they sense danger, allowing them to get away and to a safer environment for birthing their vulnerable offspring. Here I was, a human animal, trapped in a scary, dangerous setting, with a doctor I had come to regard as a predatory threat. My hopes, admittedly, weren't high. I tried anyway to focus on breathing and relaxing as much as possible anyway for the next hour.

At 7:00 pm sharp, our doctor wasted no time calling the nurse for an update. The nurse began to check me -- and again, it felt like it was taking forever. Finally, she looked up at me with sadness in her eyes, and told me I was still at a six... maybe a 7, but that my cervix had also begun to swell, and that she wasn't sure but she thought she felt some swelling of your head too.

Our doctor immediately called for a c-section. No! I couldn't have that! There had to be another option. I began arguing and pleading for one more hour on the Pitocin, to see if a little more time would make a difference. The nurse spoke with the doctor on our behalf, to try to get this for us. The doctor refused. I asked to speak to her (on the phone... she was a mile or two away at her office). She began throwing out all kinds of reasons she believed a c-section was a better option. I argued back on many. Soon, she began pulling out the "big guns", and using extreme scare tactics to attempt to coerce us. She tried to tell me that if we delayed the c-section that I could lose my uterus and never be able to have children again! I felt like I was on the verge of drowning, but still thrashing in the water, trying to break my head free for air. I asked her for the statistics to back up her assertions, which she refused to answer. I cited my own concerns about the very serious, real and dangerous risks of c-sections, and why I wanted to avoid one, which she also coldly dismissed. I tried arguing for even 30 minutes more on the Pitocin, which she rejected. She was making this sound like an emergency (even though it wasn't). Daddy even asked to talk to her, and stepped out into the hall to have a "private" conversation with her. He tried his hardest to reason with her, but she would not budge. Instead, she started using her scare tactics on him, telling him at one point that without the c-section I could hemorrhage and need a blood transfusion, and that I could wind up with HIV or Hepatitis B! (We mentioned this to a nurse later when we were in the recovery room, who scoffed and replied "maybe back in the 80's!") She was relentless and unyielding, and no matter what we said, no matter how much we argued and tried to present other options (including a suggestion by our main doula to try having me lie on my side to see if that might help labor progress), she wouldn't allow us any other choice. And what other choice did we really have, short of getting up and leaving the hospital (and that wasn't really an option either).

So, we decided to ask for a second opinion. We knew it was unlikely we'd be presented with a doctor that would give us an evidence-based opinion, and that our doctor would most likely send someone to advocate on her behalf instead of ours. But, we felt we needed to try -- if for no other reason than to know that we tried everything we could at that point. Our doctor sent her colleague, Dr. Carlson, who was on call at the time (and who technically should have been delivering you, but our doctor apparently insisted she handle our case personally). Dr. Carlson came in and essentially told us that we needed a c-section, although she was at least a bit nicer about it (in the sense that she didn't use abusive scare tactics on us), although she was still somewhat cold, and very "to the point".

After talking it over with her, Daddy and I asked for a few minutes alone to talk. We knew we didn't really have a choice anymore -- so, we cried together as we acknowledged that to each other. It was so hard for both of us to see that it had come to this.

Soon they were prepping me for surgery, and things sort of blurred in and out for me. I remember them telling Daddy he needed to get into a "bunny suit" (the full-bodied blue gown, hat and mask), and handing me a hat to place over my hair. Our doctor even arrived shortly thereafter, and came into the room greeting us by saying "I know I'm not your favorite person in the world right now...." I really don't remember much else of what she said at that point. But I do recall asking Daddy to get the small birth plan I had typed up in the case a c-section was required. I presented it to the doctor to verify that at least those wishes could be respected. She agreed to all of it, except allowing immediate skin-to-skin contact and breastfeeding after you were born. I was told that the hospital doesn't allow that. I was, however, promised that I would be able to see you immediately after you were born, and that I'd be allowed one arm free so I could touch you, among other things.

The nurses began wheeling me out of the room to the OR, and I noticed there were alarms going off in the hallway. The nurses began talking about an emergency c-section, and debating what to do with me. They wound up wheeling us into the recovery room to wait for this other c-section to happen first. Daddy and I sat there alone and scared, and Daddy without a chair to sit on (I kept moving my numbed legs over so he could sit on my bed), for an hour and a half before they took me in for surgery. At one point my doctor came in to "apologize" for the delay. I pointedly asked her what kind of danger I was in because of this delay, since she had been telling us earlier that we couldn't have more time because all of these horrific things could happen... and she blew it off, telling us "not to worry" and everything would be "fine". Needless to say, I was pretty angry, but felt so powerless to do anything about it.

Around 10 pm, they finally took us in to the operating room. Emotionally, I wasn't really present; I had collapsed into myself quite a bit by that time, and can only remember bits and pieces of what happened. I remember that I was shaking quite a bit, so the anesthesiologist set a warmer up to help me with the shakes. I remember then strapping both of my arms down (despite my wishes and their earlier promises), but I was too out of it to even be able to fight anymore at that point. I remember as they were cutting you out of me, one of the doctors said "is that a cheek or the butt?" I remember them putting pressure on my belly, and trying to yank you out, and they seemed to be having a heck of a time. I remember hearing a female voice say "10:33", and I wondered to myself "is she out? Is that the time of birth? Or did that mean something else?"



Next thing I know, I notice that someone was heading over to the warmer, and then I heard a tiny little cry. From where I was laying, sadly, I could only see a part of one of your little legs -- the warmer was too far over for me to be able to see any more of you. Daddy was still standing a few feet away, looking at you, having not been invited any closer yet. They claimed, later, that this was because you were "in shock" and "not breathing" when you came out of me. But you started crying pretty quickly, and your Apgar scores were 8 and 9 -- so clearly you were fine.


Finally someone asked Daddy if he would like to cut the cord (which was kind of silly, because the cord had already been cut, when they removed you from my belly... but they did need to crop it closer, I suppose).



Daddy stepped in closer then, and got to take a really good look at you. I felt so crushed that they didn't let me see you right away. It was probably only a couple of minutes, but it felt like an eternity watching your tiny little leg, watching the doctors and nurses tend to you, watching Daddy interact with you, yet being strapped down, helpless and feeling so alone on that operating table.





Finally, they let Daddy bring you over to me. You were all swaddled up, and all I could see was your little face. No inspecting your little fingers and toes. No skin-to-skin. No getting to hold you close and smell you. But your face was so beautiful. It was an island of pure joy in a sea of sadness. Someone had mentioned, before they brought you over, that you had strawberry blonde hair -- but I didn't believe it until I saw it with my own eyes! It was certainly not what I was expecting, but it was such a wonderful surprise. Daddy handed our camera to the pediatrician, who kindly took some photos of us.



Daddy brought you in close for a kiss from mommy -- the closest I got to be to you for the next hour or so. And then, after getting less than two minutes with you, they whisked you and Daddy away to the nursery for tests and measurements and cleaning and all the other routine stuff (that originally I had wanted to delay so I'd have time to bond with and breastfeed you).




While you and Daddy were in the nursery, I was "alone" in the operating room, as the doctors finished working on me. It felt like it was taking forever-- I just wanted to see you again, and know that everything was okay with you. After awhile, a call came in and they announced (to the doctors -- nor directly to me) that you were 9 pounds, 3 ounces. I didn't get any other info on you until I saw you later.

When they were done, they wheeled me back into the recovery room. I waited there for a while longer, and then finally Daddy came in with you, and I was able to hold you, and breastfeed you for the first time.


Fortunately we're both healthy, and I am thankful for that every day. But I'm having a hard time with the way it all went down, and both Daddy and I were left feeling traumatized and upset at how things went down, and I'm now having to grieve the birth experience I had been so excitedly looking forward to, and couldn't have. It was an unfortunate outcome, but we feel so blessed by how beautiful, and amazing and precious you are. The rest -- we will heal and make peace with it in time.

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