Saturday, June 2, 2012

Eve's Birth

I found out I was pregnant on the morning of March 28, 2010. I woke John up to show him this!  We were surprised I became pregnant after we had been trying less than a month.  We were so ecstatic.

My pregnancy was completely uncomplicated.  Here are the 20 week sonograms where we learned we were having a girl!

And here I am 7 months pregnant:

As far as the delivery itself, I am keeping in as many details as I can remember so it is fairly lengthy and full of gory details that not all of you may be comfortable with so read at your own risk  I read every book I could on the birth process and concluded that I wanted to have a natural nonmedicated childbirth, although I wanted to have it at a hospital just in case something went wrong.  I wrote up an extensively detailed birth plan, essentially instructing the hospital staff not to offer me anesthesia/analgesia and to obtain my informed consent before performing any medical procedures.  My obstetrician said it was the best birth plan she’d ever seen, she agreed to support my goal of a natural nonmedicated childbirth, and she signed it right away.  Well, as the saying goes, the best laid schemes of mice and men often go awry.

My December 17 due date came and went.  I held out hope that Eve would arrive before Christmas.  Christmas came and went.  Here I am on Christmas morning with my first baby.  My cat, Luna.  

We met with my obstetrician on the following Monday, December 27 - 10 days past my due date - and I was still barely dilated to a 1.  She insisted that I needed to go into the hospital that night to begin an induction.  She said she does not want her patients to go more than two weeks past their due date as studies have shown an increased risk of major complications, including stillbirth past two weeks.  She said that past two weeks the placenta begins to decay, which causes fetal distress.

Now, as I said, I had done my research.  Many of the materials I had read said that the two week deadline my doctor was giving me was an arbitrary deadline substantiated by sparse medical evidence and that many women go on to have completely healthy labor and deliveries past two weeks.  On the other hand, my mother says that she went four weeks past her due date with me and she wound up having a Cesarean with me.  Needless to say, I was torn.  Should I listen to my doctor and go ahead with the induction?  Should I trust my own instincts that my body was not ready for labor my own research that going past two weeks is really okay?  In the end we decided to go through with the induction.  I was too afraid of the guilt and shame I would feel if something went wrong because I failed to heed my doctor’s advice.  To this day I don’t know if this was the right decision or not.

We went in to the hospital, Sharp Mary Birch, on December 27th at around 7:00 p.m.  I had not eaten much of anything that evening because my doctor had warned me that once I went into labor I would probably throw it up.  I had not slept since that morning because my doctor had given me the impression that I would be able to sleep that night as they started me on the initial cervical ripening agent.  Not that I was sleeping well at  nearly 42 weeks pregnant anyway.

We were settled into the LDR (labor delivery and recovery) room and they started me on 25mg of a drug called misoprostol (Cytotec), inserted vaginally, at about 9:30 p.m.  Apparently, because my cervix was barely dilated and not effaced at all, I could not be started on oxytocin (Pitocin) right away because Pitocin only works if the cervix is ready.  I know Cytotec is a drug that is not approved by the FDA for induction of labor but I also know that it is commonly used today for inductions and the research I read indicated it is actually associated with a lower rate of cesarean section than other induction methods AND that it can trigger spontaneous labor in the majority of cases.  Needless to say, my hope at that point was that the Cytotec would be enough to get my labor going and that I would not need Pitocin and that I could still have the natural (mostly) unmedicated childbirth I wanted. 

I was told that hospital policy required me to not have any food or drink once the induction was started.  I was hooked up to a contraction monitor, a heart rate monitor, and an IV for fluids.  The nurse then noticed that my birth plan said I preferred a heparin or saline lock on my IV unless medical necessity indicated I needed to be hooked up to the drip.  The first nurse I was assigned noticed this and gave me a heparin lock.   Then came the changing of the guards and I was left with soldier nightmare nurse for the evening.

This nurse was very professional and seemed focused on policy and doing her duty and my comfort was her last concern.  Apparently she was not comfortable leaving me on a heparin lock and reconnected me to IV fluids – even though I was regularly drinking fluids.  Almost immediately the Cytotec started causing me to have 2-3 minute apart contractions very regularly.  The contractions at that point were mildly painful – comparable to bad period cramps or (for the men who don’t know what that feels like) a side stitch while running.  The contractions alone were enough to keep me from getting a wink of sleep that night.  To make things worse, the soldier nightmare nurse would have to come in and adjust my monitors EVERY TIME I MOVED.  So all night I was lying there hungry, uncomfortable, and tired but unable to sleep and having to decide whether to move and deal with the nurse coming in to mess with the monitors within a couple of minutes or if I should just stay in the same position and not have to deal with the nurse again.

At about 3:30 in the morning on Tuesday the nurse checked my cervix again and there was not any change so she gave me another 25 mg dose of Cytotec.  I guess the hospital policy normally is to give Cytotec every four hours but because my contractions were coming so quickly they waited six hours instead (one of the possible side effects of Cytotec is uterine overstimulation so they have to be careful to not give the drug to much or too often). 

At 8:00 a.m. Tuesday morning my obstetrician came to check on me.  As soon as I saw her I burst into tears because I was already miserable and my labor hadn’t even started.  I asked her if I could eat and if I really needed to be hooked up to the monitors and the IV.  She said I could eat and seemed surprised I had been hooked up to an IV and the monitors.  Unfortunately the nurse fought her on the monitors – she said it was hospital policy -  and so I had to stay hooked up to those but they let me go off of them long enough to take a shower.  My doctor also checked my cervix and said I had only dilated a fingers’ width but it was enough that she felt comfortable doing a membrane sweep, which was mildly painful.  Then I took my shower, had some breakfast and relaxed a little before they hooked me back up to the monitors and gave me two 25mg doses of Cytotec.

Tuesday morning and afternoon was not as terrible as the night before.  I had a very nice nurse who was not nearly as vigilant about adjusting the contraction and fetal monitors, I was on a heparin lock, and had more energy after being allowed to eat a breakfast and lunch.  I might even have dozed a few minutes between contractions.  At some point in the early afternoon I was moving around to get comfortable in bed and noticed a small pill in the bed beneath me.  It turns out one of the 25 mg tabs of Cytotec fell out after it was inserted!  I also started noticing when I went to the bathroom that some water was leaking.  It was such a small amount that I thought it was just urine or something that I hadn’t wiped correctly so I didn’t say anything to the nurses.

At 4:45 my obstetrician returned to check on me.  After about nineteen hours on Cytotec I was still not effaced and was only dilated about a 1 and a half but she was able to physically push the cervix open further to about 3 centimeters.  I mentioned to her at that point that I thought I might be leaking fluid and she looked at it and agreed it was amniotic fluid.  She said that since my amniotic sac was already ruptured she might as well break it fully and get the labor started.  She asked when I started leaking and I told her I thought it was about 3:30 that afternoon, although I probably noticed it earlier and I suspect it was triggered by the membrane sweep she did that morning.  I told her 3:30 because I knew from the reading I had done about childbirth that time would set me on a 24 hour deadline to deliver the baby.  Most doctors set this policy because there is a higher risk of infection if you wait longer than that.

Almost immediately my contractions went from mildly painful to intense and excruciating.  Still every 2-3 minutes apart.  I was determined not to get started on Pitocin if at all possible and my obstetrician agreed to see if my labor would progress on its own.  Because I was essentially no longer on any drugs the nurses said I could labor at that point with intermittent contraction and fetal monitors for twenty minutes out of every hour.  I began moving around the room, using the birthing ball and using the breathing exercises I read about and had practiced from the Bradley method book I had read.  Over the next several hours the contractions became more and more intense and seemed to be coming closer together.  Sometimes the were right on top of each other – just as one would end another one would start.  John was there by my side the entire time comforting me through it.

At around 8:30 p.m. I started wondering how much more I could take.  I had never experienced pain like that before and I can barely put it into words now.  I was sweaty and shaky and threw up the cookie I’d had that afternoon and a bunch of the cranberry juice I had been drinking to stay hydrated.  From about 8:30 to 9:30 the pain was so excruciating and the contractions were coming so frequently that I thought “this has to be transition”.  Everything I had read said that transition (the point where the cervix dilates the last few centimeters) is the most painful and intense but it only lasts a brief period (maybe 30 minutes to an hour).  I thought I had to be transitioning because I had read that during transition you think that you cannot take it anymore but if you get through it the pain lessens during the second (pushing) stage of labor AND an epidural at that point is pointless because by the time you get it and it kicks in you are past the worst of it.

I remember one contraction that came around 9:15 that felt like it literally lifted me off the bed and my entire body was wracked with pain.  I felt like I must look like the girl in the exorcist but John said I was doing such a good job breathing through the contractions that sometimes he couldn’t even tell I was having one.  By about 9:30 (almost exactly 24 hours after the induction started) I broke down and told John I didn’t think I could take it anymore.  He called the nurses into the room.

Now during the last five hours the nurses basically left John and I alone – which is what I wanted.  My birth plan said that once I was in active labor I wanted as few interruptions as possible and I appreciated that the nurses respected that.  Once John called them in, the nurses responded immediately.  Two of them came in and explained to me that my doctor had told them she would be there by about 10:00 and that they did not want to check my cervix before then because my water had been broken and I knew that it was because cervical checks after the sac is broken introduce bacteria that can cause infection. 

They kept asking me to rate my pain on a scale of 1 to 10.  I did not know how to respond to this as I told them that I would think that I was in more pain that I had ever imagined was possible and then it would get worse!  They insisted I give them a number and so I told them 9.  We discussed and I decided that I should try to wait until my doctor could check my cervix to see if I should ask for an epidural because if it turned out I was transitioning then I would know there was an end in sight.  In the meantime I agreed to take a dose of a narcotic called Fentanyl that helped “take the edge off” my contractions.  It helped only a little.

My doctor arrived a little before 10:00, checked my cervix and said I was still dilated to 3 cm.  I had never felt so defeated before in my life.  After five and a half hours of the worse pain I had ever thought imaginable I had essentially made no progress whatsoever.  However, my doctor said that my cervix had actually effaced to about 90% and she felt comfortable starting me on Pitocin.  As I was having EXCRUCIATING contractions every 2-3 minutes (some even quicker) and I knew that Pitocin makes contractions even more intense, I knew that I had to get an epidural. 

The epidural was in and I was hooked up to the Pitocin by about 10:30.  The epidural mostly worked except for a slight ache I was feeling in my lower back.  I was stubborn and did not want to hit the button for more pain relief and decided I could live with the ache.  I think I eventually managed to fall asleep for an hour or so.

At about 2:00 a.m. Wednesday morning I was awoken by two nurses with concerned looks on their faces.  They gave me an oxygen mask and started flipping me from side to side and looking at the contraction monitors.  They told me that Eve’s heart rate was decelerating with each contraction.  As they were fussing with me I kept telling myself that the last thing Eve needed was for me to panic and so I started using my meditation/breathing exercises to keep myself calm.  Eventually the nurses got me in a position they were comfortable with but they said they were going to have to take me off the pitocin.  I was lying there for some tie, maybe half an in terror – afraid that if I moved Eve’s heart rate would start to decel again.  Eventually my panic caught up to me because my entire body began shaking uncontrollably and I felt like I was freezing.  The nurses came in and piled blankets on top of me and eventually I calmed down and went back to sleep for a bit.

At 6:00 am my obstetrician returned and checked my cervix.  I had only dilated one more centimeter in the entire night- so I was 4 centimeters at that point.  My obstetrician sat next to me and explained to me that my cervix and the baby’s head were swollen from the repeated impact against each other and that it looked like the induction wasn’t working.  She told me that given the 24 hour deadline we were likely looking at having a cesarean that day.  I think she was ready to bring me to the OR right then and there but I asked her if we were in any immediate danger and she said no.  I said I only wanted a cesarean as a last resort and asked if I could get started on the Pitocin again.  She said I could do that and so they started me on the Pitocin for the second time.

Around 9:00 a.m. Wednesday morning one of the nurses came back in to check my cervix.  She said that the she wasn’t happy with the way Eve’s heart rate was responding to my contractions and said that I had still not dilated past 4 centimeters.  She left and came back and told me she called my doctor and my doctor said she was calling the induction a failure and was coming in to do the cesarean.  At that point things moved VERY quickly.  I hardly had time to think about it and consent – I signed the form before even talking to my doctor and when the doctor came in she briefly talked to me about it before I was rushed off to the OR.  I remember that as they were wheeling me down the hallway to the ER I had tears streaming from my face because I’d had my heart set on a vaginal delivery.

Eve was born at 10:28 a.m.  The NICU team examined her and they cleaned her up before handing her to John.  I remember that during this time the anesthesiologist was trying to say something to me but I was to intent on following where Eve was and what was going on with her to listen and understand anything he had to say.  I couldn’t believe he was trying to talk to me and get me to understand something important only seconds after my baby was pulled out of me and before the NICU team had given her the OK.

Anyway, John brought her over to me and I got to put my arms around her and give her a kiss before they took her away again.  John left with her while they ran some initial tests and gave her the eye ointment, etc.  While my doctor was sewing me up she asked me if I wanted to know what she discovered once she got in there and of course I told her yes.  Apparently Eve was sunny-side up (meaning head down but facing my front instead of my back) AND the cord was wrapped around her tightly twice around her neck and once around her torso.  This baby was not going to come out vaginally as much as I had wanted that.  This also explained why my contractions were so excruciating because apparently when the baby is sunny-side up the mother has what is called “back labor”.  It also explains why I still had back pain after the epidural was in.  I didn’t realize it at the time because this was my first baby and I didn’t know what contractions were supposed to feel like.

Here are our first family photos:

Although my birth experience was exactly opposite from what I had hoped for, I am still glad I familiarized myself with the birth process because at least I knew what was being done to me.  At the end of the day I was just happy to have a beautiful little girl.  I would do it all over again in a heartbeat just to have her.


1 comment:

  1. Athena,

    I'm glad you created this blog. It's great to hear your story. Eve couldn't have better parents. You really are an inspiration and I hope I'll do just as much reading and research someday when we decide to start a family.

    Best wishes,