July 9, 2013 by 8junebugs
It’s not entirely accurate to say everything went wrong. That would imply that there’s a right way to have a baby, which I don’t believe, or that I had some control over what happened…which I didn’t. All we were able to control was the order of things that happened on the outside.
At 42 weeks, my doctor finally broached the subject of induction. I’d been at 50-60% effaced and 1 cm dilated for weeks — that she didn’t touch the subject with a ten-foot pole before then is (a) somewhat unusual, and (b) much appreciated.
I didn’t want an induction.
I didn’t want interventions or pain meds.
Of all the things I didn’t want, a c-section topped the list.
I got all three. This is the story of how we managed that in a way that allows me to look back with more confidence than disappointment. (It has already been assumed, verbally, more than once, that I “must be so disappointed.” I assure you, I am not.)
So we set the induction date (28 April) and time for when my doctor would be on duty. We wound up seeing half the doctors in the practice roll through; fortunately, we’d already met most of them. I had a hard time with the induction decision, but by the time we checked in, I’d…come to terms with it. I’d tried every legitimate, non-old-wives-tale method to try to get labor moving — repeatedly — to no avail. I mean, how many mucus “plugs” can one person pass? It was time to kickstart my uterus. Despite my best efforts, the birth process was pretty much out of my hands. You’d think I might’ve noticed earlier on, no?
The first confrontation I had with the hospital was over the IV catheter, which is standard procedure for birth, with or without induction. I HATE IVs. I also hate “just in case” hospital procedures and people who work with veins for a living and have a hard time finding one in me; I’ve given blood regularly since I was 17 years old and know how easy I am to stick. And even though I have zero trouble giving blood, I have a hard time with fluids flowing the other direction through the needle.
So I pushed to have the IV cath put off. The nurse supported my decision at least to the point of running it past my doctor. “I hear you’d like to opt out of a procedure,” she said, hobbling in with a recent back injury. “That usually means someone’s been googling something.” I explained where I was coming from and she was okay with it…until two things happened: They tracked a blip in the baby’s heart rate (not an immediate concern) and found that I’d developed an antibody I hadn’t had in the first-trimester blood tests. That led to a whole new round of “just in case” procedures, such as calling the blood bank for matching to be sure they could give me transfusions if necessary. At least I was able to request their best IV-putter-inner, an Italian from New York who was freaking hilarious as well as good at her job. One vein, one needle, one stick…done.
The nurse administered Cervadil at 9pm. By 3am, I could no longer sleep through the contractions. My doctor was thrilled.
“This is what we wanted,” she said, “We just needed to jumpstart your labor. Let’s let it progress on its own.”
Works for me!
Sometime in here, we called our doula…way earlier than we should’ve, but there was a definite pattern to the contractions — they were five to six minutes apart and took me out of myself, which are the signs we would’ve looked for to call her to come to the house. Unfortunately for her (and her backup), we didn’t know yet that I was still only 3cm dilated.
Even so, having her there was a tremendous help. Unexpectedly, I didn’t want to be touched or talked to during a contraction. AT ALL. I didn’t even want to hear people talking around me. So much for the “supported squat” position I thought I’d use and the “encouraging words” Graham was ready to say — all touching and talking had to happen between contractions, which got harder when I started to have them back to back. Francine, our doula, was great at managing that and at giving Graham direction.
“At this point, we don’t ask if she wants water,” she said, “we just hold the straw to her mouth.” (Dehydration, of course, would trigger the use of that stupid IV catheter.)
I made it to 5cm on the Cervadil before they started talking about rupturing the amniotic sac, which was bulging out of the cervix and making it difficult to gauge the baby’s position. I gave it a little more time, which I tried to do with most of these steps. Why? I’m not entirely sure. In my head, I was trying to give everything a chance to work so I would know I didn’t escalate anything just because I was sick of it already. Remember: At this point, I still thought this kid was coming out the birth canal.
I labored for about two hours in the jacuzzi tub before we decided to break the sac. I felt better for having used the tub, as it’s a first-come, first-served amenity and my being in that room meant someone else didn’t get to use the tub. I did not feel particularly better in terms of pain; the tub didn’t do jack for my contractions, but it was nice in between them. We tried, too, having Graham pour hot water over my back during a contraction, which…oh, god, that did not help.
Back labor. I had it. For a really long time.
That should have been a sign, but it’s hard to see every single sign when you haven’t been down a road before. Back labor = posterior. My baby was facing the wrong way and needed a serious about-face to get out vaginally.
They broke my water when I remained stuck at 5cm late Monday night. In case anyone’s curious (no, I really don’t expect that you are, but…), my amniotic sac had the structural integrity of mithril. Rupturing that, like all the other steps listed here, took a long goddamn time.
There was another bizarro complication. The heartburn that plagued me all through the pregnancy became a real hindrance during labor. It didn’t matter that I hadn’t eaten since Sunday night — every sip of water would cause reflux that disrupted my breathing, and it was a thousand times worse if I was lying flat…like during cervical checks and sac ruptures AND left-side positions designed to get the kid to turn himself (especially those). Sometime during the first 12ish hours, a nurse let me take my Protonix. That did not happen again, and they could not (or would not?) settle on a drug that they could use instead, other than a 20-minute pre-surgery fix that turned up in my chart even though I hadn’t taken it (and Graham and I had to keep fighting to get the nurses to believe that it had not been administered, no matter what the chart said). Eventually, every time I knew I was going to have to lie down, my fight-or-flight kicked in.
Adrenaline! The opposite of what one needs for labor and delivery.
Anyway, we tried to turn him with my position. As much as I’d loved the idea of laboring on all fours during childbirth class, it did not work well for me in practice. I’d spent at least 10 minutes running around on my hands and knees almost every night during the third trimester, too, though (which Rodney thought was AWESOME), to no avail, so it wasn’t a huge surprise that trying again in middle of back-to-back contractions wasn’t effective.
Breaking my water got me to 7cm, eventually, and boy, was that the ickiest thing I’ve ever experienced. Just when I thought, “That must be it — there can’t be any more fluid left to come out. They said it was getting lower when they checked on Friday…”
Here, too, the doula (the backup, at this point) was useful. My visualizations had tanked, and she was able to get me to focus on a new one and direct my breathing in a way that worked for me. That helped a LOT…for a while, anyway.
Seven centimeters is where my cervix stopped. I labored on post-sac-rupture, sitting, standing, swaying in the bathroom…nothing. Eventually, very, very early Tuesday morning, the doctor monitored my contractions from the inside to see if they were even strong enough to progress. The data were inconclusive, not least because of several equipment failures. It took several tries to get the monitor in, and I had to be flat for all of them. Whatever the reason, though, I was stuck at 7cm after hours of contractions, and the only way forward was stronger contractions, and then the doctor would have to turn the kid to get him to come out.
So. Pitocin. The drug that makes regular contractions look like gas pain. At this point, I’d been having back-to-back contractions, with back labor, for over 24 hours. I was hoarse and exhausted, and there was no way I could manage Pitocin-induced contractions without a rest. I asked for an epidural before they administered the Pitocin, and that…was not fun. The nurse on duty at that point was my least favorite of all the ones who helped us, and that includes that one we asked to have reassigned (by the time this nurse came on, I had nothing left for administrative requests). The idea was to get the catheter for the epidural in between contractions, but they never slowed down enough for that to work, so I was getting stuck in the spine while trying to breathe through contractions, with a nurse who was the WORST about talking to me during a contraction (that “don’t talk to me” thing never went away).
The epidural helped. I felt nothing for at least the first hour of Pitocin and got a little rest.
And then it stopped. I kept hitting the button as directed, but the pain kept getting worse. I was ready for pressure, but this was contraction after contraction. Instead of calling the anesthesiologist when I said something was wrong, the nurse tried rolling me on my left side again, flat. This did not go well. I couldn’t breathe because of the heartburn, again, and I wasn’t able to manage the pain without being able to control my breathing. This did not matter to Nurse Ratchett, who had been an L&D nurse at that hospital for 33 years, etc., etc. She was going to turn that baby.
This also led to blips in the baby’s heartbeat, in addition to my obvious distress. And they had a knack for doing stuff like this when Graham went to the bathroom, so every time he came out of the bathroom, I was surrounded by extra nurses Doing Things without telling him what was going on. Here, too, the doulas were a godsend — they could explain whatever the nurses bothered to call out and narrate what they didn’t.
Eventually, the nurse gave in and called the anesthesiologist, saying she had a patient who couldn’t manage the pain and needed another Whatever Epidural Hits Are Called. I was PISSED. I’d been managing pain for a very, very long time, even when she’d just made it worse for me, and I didn’t think it was too much to ask that someone find out why the pain medication had stopped working.
The catheter had fallen out. It took Dr. NumbYouUp a split second to see that. So we had to reinsert the epidural. Hooray! I did have the wherewithal at this point to tell the nurse to back off. For the second round, contractions rolling through me, all I did was lean on Graham and tell everyone else to shut up. It was awful, but it was better than the first time.
Pitocin got me exactly nowhere. When hours on Pit passed and I remained stuck at 7cm, I talked to the doctor about the odds. It came down to this: The baby was “sunny side up” in a persistent posterior position, and even though my contractions seemed strong enough, they weren’t working. We could up the Pitocin and give me about six hours to try to get past 7cm and she could reach in and try to turn the kid, but her gut said we were still looking at a 75-80% chance of a c-section, even after six more hours.
Six more hours of my uterus contracting around my baby, with a high probability of going in to get him surgically anyway. Six more hours of Pitocin and epidural. Six more hours of nurses trying to position me when I was having a hard enough time telling left from right.
We chose not to wait. When even our super-committed-to-natural-birth doula(s) agreed, we knew we’d gone as far as we could. Almost as a bonus, it was time for a shift change, and we got a nurse who was much more fantastic, so at least we went out on a good note. This was also the nurse who told us Alta Bates has an awesome VBAC rate, so let’s hope that was true.
The anesthesiologist was the only downer at this point. “So, you gave up, huh?” he said, coming into the room to prep me for the surgery round of drugs. I don’t think I managed more than a withering look of disgust; I sort of wish I’d been able to eke out a “Fuck you,” but this was also the dude who was going to keep me from feeling a scalpel, so…you know. Bygones.
He still sort of screwed me, though. He got to make the call on who would be allowed in the OR with me. We’d asked for an exception so our doula could assist Graham (you’d think hospitals would be a little more accommodating of patients or partners with disabilities); instead, the surgery was about half over by the time they walked Graham up to sit by my head.
Dr. Thomas actually chuckled when she finally saw Grayson. Lodged in that position, closer to 9 lbs. than to 8, there was just no other way he was coming out.
They asked Graham to stand up if he wanted to see his son coming out, and he did, but that was a bit of a shock — they might have phrased it “Would you like to to see the woman you love gutted like a fish?” (Neither of us had planned to watch the vaginal birth, with mirrors or without.)
And then…he was here.
After that they pulled Graham away for the cord and the cuddling — Alta Bates’s policy is to give c-section babies skin-to-skin with the other parent right away, then transition to the delivering parent within 30-60 minutes in recovery. Which is swell, but chest hair and meconium do not mix well.
I don’t know if our doula was with me after that. Someone was, eventually, but all I knew was that I was freezing and felt like I was going to throw up. Not that there was anything to throw up — I hadn’t had more than a few spoonfuls of pudding for almost 48 hours — but I clamped my mouth against it anyway.
It took a long time to not feel cold. The recovery nurse brought me blankets, but…it took a long time. I found out later that I’d lost about 50% more blood than average, and they had me in an oxygen mask for a while.
It also took a LOT of drugs for me to pass the “Can you feel this? How about now?” tests before they started the surgery, the consequences of which would plague me for almost three weeks after the birth. The post-surgical edema was a level of ongoing discomfort I had not factored in, never having had major abdominal surgery before. The swelling in my legs, from hip to toe, and the sensation of half of my body not responding to commands pretty much terrified me, even though it was “normal.”
And that’s how our boy came into this world.
(He also came in ready and more than willing to nurse, but was thwarted by an absurdly common and easily remedied complication. Although he’s a hale and healthy giant of a child now, he lost 16% of his body weight in that first week, which set the tone for most of the issues we’ve faced with him since. More on that later.)