Birth Story III

Part the Third: Pushing

I had heard stories of women – even other first-time moms – who pushed only three or four times before their babies came out. And the incredible pressure in my personal region made me very motivated to get him out quickly. But with the first push, I began to have some doubts that this would be a fast process. And I was right: it was nearly four and a half hours from the time I started pushing to when O made his big arrival!

I didn’t know that, of course. I kept asking for updates on my progress and hearing that I was pushing just fine, but that they could only see a tiny bit of his head starting to emerge – a dime, then a quarter, then “a handful of change.” My OB said that she expected that each push would move the baby out by one millimeter – argh!

The rhythm of pushing gave me plenty of time to reflect on this experience, strangely enough. You only want to push during a contraction, both to make them as effective as possible (your uterus is also trying to squeeze the baby out) and to save your own strength. You also want to aim to push three times during each contraction, with only a quick break in between to catch your breath. However, when the contraction ends, you get to rest for a moment. If you are me, or you are as exhausted as I was, you may even find that your mind wanders in unpredictable ways and you feel almost like you’re dreaming… until the next contraction starts to build, and it’s time to push again.

A brief word on labor pain for a moment. My epidural had a “window” when it was first placed where the lower left quadrant of my abdomen was still feeling the pain of the contractions. It was fixed initially but at some point during the pushing I began to feel it again, only a brief twinge at first, but then more and more. I wasn’t able to communicate very eloquently at that point, so I started just saying “quadrant!” when it was hurting. Thankfully, the anesthesiologist was able to adjust my epidural again, and after a few minutes the pain went away so I was only dealing with the overwhelming pressure, and I started once again pushing with all of my might.

While we’re on the subject, I remember at childbirth class that we were told that pushing was the hardest physical work we would ever do. Ummmm… I’m not sure about that. I don’t want to toot my own horn here, but I’ve definitely had harder workouts! (Or maybe I’m just sufficiently out of shape so every workout seems really hard – take your pick...) It’s hard, don’t get me wrong. It’s more like weightlifting than true aerobic exercise in that you really need to psych yourself up between sets, and because I didn’t know how long I would need to push, I didn’t know how much more psyching-up I would need to do. That was the hardest part, not knowing how much longer it would last and hearing that I was only making infinitesimally small gains with every push.

Time dragged on. One hour, two hours, three hours, four… and as O started to crown, two things happened. First, I tore just from the prolonged pushing, and second, O’s heart rate got pretty low. Nobody panicked and it wasn’t very dramatic, but my OB suggested an episiotomy to help get him out as quickly as possible. On the next push I heard and felt the snip, snip, snip of her little scissors, but when he didn’t immediately emerge, I began to seriously lose patience. We went through IVF, a complicated pregnancy, and I consented to an episiotomy for this? Oh, HELL no.

On the next contraction, I pushed – and pushed – and pushed – and the contraction ended and I still pushed – and the nurse and my husband tried to hold my chin to my chest and I refused – and I kept pushing – and I felt a new and sharper kind of pain that could only be crowning – and then something unbelievably large slithered out of me – and that something started crying – and I opened my eyes to see my OB holding a baby between my legs! O was here! Everyone was relieved and smiling and my husband’s eyes were a tiny bit misty and then there was a seriously pissed-off baby on my chest. His tiny hands looked like miniature versions of my own and in between wails he opened his eyes enough for me to see that they looked exactly like his father’s. 

We were a family.

Birth Story II

Part the Second: Active Labor

I had thought the that the instructions to eat a good meal and take a shower the night before the induction were because it was going to be my last opportunity to do so for a while. But with the morning came a shift change, and my new nurse made it her mission to see me freshly bathed and fed. The shower was no problem but, man, I did not want to eat. My stomach was already upset by the long night of contractions and by the time my scrambled eggs arrived, it was all I could do to choke down a few bites.

They started the Pitocin drip around 8:30 AM. The dosage started low and slow and gradually ramped up, and the nurse said that her goal was to get me contracting regularly every 2-3 minutes. That sounded pretty quick to me and she confirmed that in a naturally occurring labor it would take much longer to get to the 2-3 minute mark, but in an induction, they usually only saw significant dilation with the quicker contractions. Great.

At this point, I got a chance to play the role of “laboring woman,” just like you see on TV. First, I walked the halls (wearing two hospital gowns, one covering my back and one covering my front like a kid in art class) pushing my IV along with me. Then I lay around on the bed in different positions, trying to sleep between contractions. Then I got in the rocking chair and rocked my way through them. I asked for ice chips and breathed the way I had been taught in childbirth class. The only thing I didn’t do was get into the Captain Morgan position – everyone deals with pain differently, but for me, just getting through the contraction took all of my energy and I had to stay as still as possible to concentrate on breathing. I even commented between contractions that I had no idea how I would possibly get into any of the positions on the poster in class!

Around noon, two things happened simultaneously: the OB on call decided he wanted to break my water, and I decided it was past due time for an epidural. And this is the only part of the story where my fears about needless pain and lack of control in labor nearly came true: I told the doctor that I wanted an epidural prior to my water being broken since the contractions were likely to get a lot stronger after the membranes were ruptured, and the OB said back – I swear – “We’ll see. You know, we do this a lot. You need to trust us.”

My husband, my mom, the nurse (who knew my concerns), and I all exchanged glances. Or so I’m told, because I actually had my eyes closed as the next contraction started. I squeaked out something about being afraid that a painful and traumatic labor would affect my ability to bond with my son, and mentally began preparing to actually have the argument I had been dreading since my IVF days. But the compromise we struck was that he would check my dilation before we did anything else, so I staggered back to the bed and lay down just as another contraction began…

Pop! went something inside me, and I felt a warm gush between my legs. I knew instantly that the amniotomy would be unnecessary and managed to say “water – gone – ruptured” or something like that. The OB was there to see the fluid come pouring out just as he established that I was 5 centimeters dilated, and confirmed that it was clear (that is, free of signs of meconium or infection, though evidently pretty bloody.) And, blessedly, the next step was to call anesthesia.

What was it like getting the epidural? Painful in a new and exciting way, I suppose, but not terrible. It was actually kind of fascinating to feel sensations and nerves in my back that I had never known existed. The worst part was actually that as the anesthesiologist began her work, I was hit with a serious wave of nausea and puked up my breakfast from earlier that morning (um, I told you eating a big meal was a mistake!)

Once the epidural kicked in, I felt much better… on about 75% of my belly. The lower left quadrant wasn’t covered at first, but a few tweaks of the catheter and a bolus of Fentanyl later, I was really quite comfortable. I was talking and joking with everyone until – it’s hard to describe, but something changed. The epidural had gotten rid of the belly pain but not the pressure of the contractions, and that was manageable, but all of a sudden it moved lower and got very intense.

I went through maybe three contractions like this, but before anyone could come see how dilated I was, I discovered what pushing felt like. Why? Because I started to do it involuntarily. It was the craziest feeling and I was worried that I was doing something wrong, but within minutes, my OB showed up and checked my cervix. I’d never been so happy to see her in my life, especially when she said excitedly that I was fully dilated and ready to start pushing!

Birth Story I

For several days after arriving home from the hospital, during the rare occasions that I found myself drifting off to sleep, the events of O's birth kept replaying themselves in my head. I was tired beyond all recognition, but I couldn't drift off without trying to process everything that happened to bring him into our lives.

My entire labor and delivery took place in one room over a single 24-hour period, but in my head, there were three distinct phases and they might have taken place on three different continents for all I know. This is going to be long - of course - so I'll split it up into three separate posts.

Part the First: Early Labor
There was a fair amount of drama about when I would be induced. We were given a window of five possible days that we might receive a phone call in the afternoon that would ask us to come in to the hospital that evening. Mentally, we prepared for a long wait, which is why I was shocked to look down at my phone at 11:00 am on the very first day and see a missed call from the hospital. Harry and I stared at each other as I listened in disbelief to the message. It was happening. I needed to check in to labor and delivery by 8:00 pm that night. The heparin shot I had taken that morning was to be my last. I should shower before coming in and eat a substantial dinner, and prepare to stay in the hospital for a few days.

Naturally, with all of this advance notice, Harry and I arrived at the hospital right on time. Ha! Of course we were running late, enough that we got a little bit of side-eye from the receptionist. Still, they let us in, and Harry and I started exploring my new digs - there was already a bassinet in the room with two tiny hats, one blue and one pink (just in case)!

I was scheduled to be induced using a Foley catheter, though if the catheter didn’t work we would use misoprostol as a backup. The trick with the Foley was getting the balloon inserted into my cervix, which was still only a little over a centimeter dilated. It was, frankly, not the best experience. The doctor who placed it seemed surprised at how difficult and bloody it was to get the balloon in, and apologized at how painful it had been for me. He said that I would have some cramps from the initial placement, but – famous last words – “don’t worry, they will stop after a few minutes!”

I didn’t feel anything until the door shut behind the doctor and nurse, and then almost immediately I had – oh wow, I had forgotten all about this – a menstrual cramp! No kidding, it was so instantly familiar that I almost wanted to laugh. Nine months without them (longer, really) and all of a sudden the endometriosis memories came rushing back. It was painful, sure, but nothing out of the ordinary… with one exception. The cramps didn’t stop after a few minutes. They didn’t stop after three consecutive late-night episodes of “Friends.” They didn’t stop, in fact, all night long. And I couldn’t take my usual handful of Advil to help numb them. According to the monitors and the pain in my uterus, the contractions continued at irregular intervals ranging from 6-9 minutes apart. Not enough to count as active labor, said the nurse. I could really go for some Advil right now, I said, only half-joking. How about some Benadryl instead, she offered. I accepted and got about 4 hours of not-great sleep.

At 6:45 AM, I gave up on the pretense of trying to rest and got up to use the bathroom. Sploosh went the catheter, and the little swollen bulb fell into the toilet along with a surprisng amount of blood. I expected to feel some relief, but my sore belly kept on contracting every few minutes and an exam revealed that my cervix was dilated to approximately 3 cm. It still wasn’t active labor, said the nurse, but the good news was that I was officially no longer being induced: I was being “augmented!”

Baby!

He's here! Our son, who shall be referred to as O on this blog, has emerged into the outside world and everyone is happy and healthy. Photographic evidence appears below:

Pics or it didn't happen!

I really want to write down the birth story (to quote one of my favorite bloggers, it was not too long and not too awful) but with parents and in-laws arriving today, I think that will have to wait for a bit. Turns out having a newborn keeps you pretty busy, who knew? Anyway, thanks to everyone for your support and well wishes, and I'll write more soon!

How I Learned to Stop Worrying and Love My Induction

So - we're there. Despite a few positive signs that my body is considering going into labor on its own, the time for my induction is almost at hand. Not that long ago I would have fought an induction tooth and nail because I wanted to do everything as naturally as possible, but that has changed, because of one giant reason:

By inducing labor in the hospital, I get to have the same pain relief options as a woman who isn't on heparin - up to and including an epidural.

For the past nine months, I've been worrying about being in agony during labor while doctors and nurses deny me pain relief. I think I would have always been worried about this, but after my experience with my egg retrieval during IVF, it became an obsession. The idea that I might be told (for very good reasons!) "no, we can't give you an epidural right now" was bringing back all of the panic, anxiety, and anger from back in January. There are plenty of things that can still go wrong with an induction, but complications from an ill-timed heparin shot at home won't be one of them. I get to concentrate on meeting my baby instead of worrying about his birth, and that is a gift that has absolutely no price tag.

Catch you on the flip side!

A Month of Sundays?

First of all, I refer you to this website for updates on my current condition: http://haveyouhadthatbabyyet.com

That's correct, I'm still waiting around for something to happen (something amazing, I guess!) In the meantime, I'm "enjoying" maternity leave as much as a person can enjoy being off work while in a constant state of hyper-awareness about one's body and whether it may, at any moment, send one into spasms of pain/release amniotic fluid from between one's legs. I am convinced that if I'm one of the 15% of women whose labor begins with ruptured membranes, it will start while I'm standing in a check-out line someplace, partially because I feel like I'm spending all of my precious free time in check-out lines. They really do move so much slower during the weekdays. It's crazy.

Besides rolling my eyes in check-out lines (all I need are file folders and pens! I'm not setting up an entire home office like the woman ahead of me! Why does she have to order furniture from the only open cashier? There should be a dedicated furniture-ordering desk so people like me don't have to wait for 20 minutes to buy their file folders and pens!), I'm treating this downtime like I would an idle Sunday afternoon. There are chores to be done around the house that I've neglected for months, and they're really satisfying to get done. I've dropped off pictures to be framed, cleaned the bathroom including the molding, and any moment now I'm going to sit down and write the thank-you notes from my baby shower, I swear. Yesterday I even made this and it was very tasty:

The problem is what will happen when I run out of chores and have to decide between starting a new, honest-to-goodness project and catching up on reruns of "ER" and "Designing Women." My next doctor's appointment isn't until Friday, so I won't know for another two days whether all of this hip pain and general physical discomfort has actually resulted any measurable progress towards labor. Over the weekend I swear the baby dropped even further - my bump looks like it's about to enter a "how low can you go?" limbo contest and I really think I have a baby head crammed into my pelvis since my waddle went from decent to comical - but there's been no more bleeding since last week, no identifiable mucus plug, no regularly-spaced contractions, nothing. So we're still waiting, and making pies. I think today's selection will involve pears...

1 Down, 9 More to Go

Centimeters, that is! Whatever happened on Sunday night, it resulted in my cervix being 1 cm dilated and 50% effaced. You know what that means? It means that things are really happening! My body is getting ready to give birth to a baby. Insane.

Now, my doctor was quick to mention that it doesn't mean I'm about to go into labor. There are women who walk around at 3-4 cm dilated for weeks without making any other progress. However - remember back in February when the Maternal-Fetal Medicine doctor first mentioned induction to me? And then in July, when they changed the plan a bit and said that I could probably go to 40 full weeks and then be induced, as opposed to doing it early? Well, my feelings about inducing labor have been mixed from the very beginning. Inductions apparently work best when your body is beginning to go into labor a little bit already (when your cervix is, ew, "ripe"), and have the highest rate of complications when your cervix is still long and closed and the induction process has to start from scratch. My OB had warned me that if we got to 40 weeks and the baby was still just hanging out in my belly with no indication of busting out anytime soon, he might not want to start an induction because the last thing we want is (and this is a direct quote) "a long, hard labor followed by a c-section." Um, yeah, let's not plan for that.

But! As of yesterday, we know that my cervix is already beginning to change and my body is tentatively getting ready to give birth. I wouldn't necessarily want to induce today, but I'm already in a better position for an induction than I could have been at this stage. And I might go into labor on my own anyway, who knows...

When the Time Comes, You'll Know?

As of Sunday night, we have officially entered a new phase of this pregnancy: LaborWatch 2012! What kicked it off? Well, there I was, cooking dinner and watching Lady and the Tramp on ABC Family (which, FYI, if you are a dog owner expecting your first baby, brings on some major guilt). I went to use the bathroom and, for the third time since getting knocked up nine months ago, saw some blood. It wasn't much - not nearly as much as the bleed I had at 9 weeks or the bleed I had at 21 weeks. It was really just some spotting, and for once I didn't immediately panic. It could have been my mucus plug/bloody show, which is entirely normal to see at 37 weeks. Normal, but perhaps an indication that I was about to go into labor? Yikes! Quick, grab the hospital bag!

In the end, despite some frequent Braxton-Hicks that night, everything stayed quiet and I haven't gone into labor yet. At least, I don't think I have. Who really knows? There's active labor, which by all accounts is hard to miss, and then there's early labor, which apparently can go on for quite some time and be practically indistinguishable from false labor. Near as I can tell, nothing has really started yet, although I have started paying more attention to the timing of my Braxton-Hicks contractions. And so we wait. Here's what my waiting looks like, by the numbers:

Amount of times per day I really, genuinely believe that I'm about to go into labor: 3-4
Amount of times I have actually gone into labor: 0
Amount of times I have talked myself into thinking I'm about to go into labor because I just really don't want to do some chore at work or at home: Many

Number of Braxton-Hicks contractions I have each day: 15-20
Amount of times these Braxton-Hicks contractions have had a distinguishable pattern: 0
Number of "real" contractions I have felt: 0? I think? Who knows! Apparently sometimes they feel the same as a Braxton-Hicks!

Number of birth videos I have watched, or re-watched, in the last few weeks: 10, maybe?
Amount of education I now have about the birthing process: High
Level of comfort I continue to have with the idea that I am shortly going to be asked to push an infant out of my personal region: Exceedingly Low

If anyone needs me, I'll be over here obsessively staring at the clock!