Wednesday, October 15, 2008

Birth Story

I've been writing down notes on my labor and delivery for several weeks (3 weeks, in fact), and have finally gotten everything together. It's long, but I wanted to remember what happened, so feel free to skip sections (or the entire post) if it's boring.

We were supposed to call the hospital Thursday morning at 6:30am, to hopefully be to the hospital by 7:00 to start the induction. Our bags were totally packed, I had eaten the suggested "very light breakfast" (just a bowl of cereal), everything we needed was sitting in the car... we were ready to go! Instead, when we called, they told us to check back in a few hours. We called again at 8:30am, then again at 1:30pm, but they were still too busy to let us come to the hospital. We waited at home, with S doing random chores around the house and me watching movies to try to distract myself. At 3:30pm, we finally got the call from the hospital saying that we could come in. Finally, we were off!

We got to the hospital around 4:00. They immediately hooked me up to monitors for contractions and baby's heart rate, while asking me lots of intake questions and having me sign lots of forms. Much like the NST on Monday, the baby went back and forth between periods of reactivity and non-reactivity. A lot of the time, his heart rate would stay completely stable, not reacting at all to movement or contractions, even when the nurse "buzzed" him to try to wake him up. For short periods, he would react a little, but his heart rate stubbornly refused to go over the minimum threshold of 15 bpm above baseline. For a while, we weren't sure whether they were even going to go forward with the induction, but they eventually decided that he was "reactive enough" and they started the pitocin, letting us know that unless his reactivity improved, they would be upping the pitocin at a slower rate than usual, to avoid undue stress. Before starting, they checked my cervix, and everything was exactly as it had been the week before: just over 1cm dilated, 70% effaced, -2 station.

Despite the relatively low pitocin levels, after only 2 hours of pitocin, my contractions were coming every 2 minutes or less, lasting for 60 seconds each, and were already fairly strong. At that rate, I was getting basically no rest at all between contractions. I couldn't really concentrate on anything, but had the television on in the background to try to distract myself. I was also getting tired already, from not eating all day while waiting to be induced.

The nurses at our hospital believe in doing cervical checks as infrequently as possible, so I wasn't checked until 10:30pm, after more than five hours of labor. A new nurse had come on at 10:00pm, and she introduced herself by saying, "I'm Rachel, and I'll be the nurse delivering your baby! Well, actually, probably not, because you're really not going to be ready in 8 hours when I'll be going home." Hearing that you've got more then 8 hours to go, after you've already been contracting non-stop for 3-4 hours, is extremely discouraging, but it's even worse when it's said with such confidence despite never actually checking whether I was progressing. I asked her how she knew I wasn't progressing if nobody had checked, and she told me it was because I was still "too chipper." This pissed me off immensely at the time, but it turned out she was totally right -- I wouldn't be that chipper again for a very long time. And when she did check me at 10:30pm, I had made no progress at all, still only 1cm dilated.

I spent the next hour being extremely discouraged. My pain was increasing with each contraction, but I no longer believed that they were being at all productive. The nurse asked me if I wanted a narcotic pain killer, but I was determined to hold off on medication until I could do an epidural at 3cm. Instead, I wanted to try the other coping techniques I had planned on. Could I take a warm shower or bath? No, because they needed to continue monitoring my non-reactive baby, and the monitor couldn't go in the water. Could I walk through the hallways? No, because they couldn't switch me to the telemetry monitors because they weren't as sensitive, and they didn't want to miss something if the baby started experiencing further distress. They allowed me to pace back and forth within reach of the monitors (about 4 steps in each direction) which was of very limited help -- it basically left me feeling like a caged animal, which does very little to decrease pain and anxiety. I refused to get into bed, because lying down was excrutiatingly uncomfortable, so I alternated between pacing my 4 steps and sitting in a rocking chair for hours at a time.

S fell asleep around this time, and I was sitting alone in the labor room trying to breathe through contractions that were coming immediately on top of each other with no relief. By 1:15am, I was at the end of my rope from the pain. I called the nurse and told her that I needed the narcotic, which was administered at 1:30. It was supposed to last an hour, but I only got 45 minutes of partial relief. At 2:30am on the dot, I asked for a second dose. This one was even less effective, providing very limited relief and wearing off entirely by 3:00am.

S had woken up by this time, but no longer had any idea how to help. My pain for the last several hours had been a 10 on the 1-10 pain scale, and I was reaching the point where I didn't think I'd be able to cope. The nurse told me that I was allowed only one more dose of the narcotic, but she wanted to check my cervix again before giving it to me, since it hadn't been checked in the past 5 hours. She checked at 3:30, and low and behold, I had progressed to 3cm. Adding only 2cm during 5 hours of excruciating pain was discouraging, but it also had brought me to the point of "qualifying" for an epidural, so all wasn't lost. The nurse asked if I wanted an epidural now, and I gasped "Yes, yes yes!" over and over. The anesthesiologist arrived quickly, and the nurse went off to get a last narcotic dose to help me to stay still while the epidural was put in. (This was actually the most annoying part -- the nurse got locked out of the computer while trying to get the narcotic, which left me and S alone with an extremely shy anesthesiologist for what seemed like ages, with him holding the epidural drugs I was so desperately waiting for while he mumbled apologies that he couldn't give them to me yet.) Once he was able to start, however, the administration of the epidural was actually MUCH easier than I expected, and I was gratefully feeling the pain lessen dramatically by 4:30am.

The pain had largely returned by 7:30. The nurse determined that I probably needed a boost to my epidural, but first decided to check my cervix one more time. I had progressed a bit more, to somewhere in the 4-5 cm range, but more importantly, my water broke as she was checking, which promised to bring along faster progress. An internal monitor was placed on the baby's head (a big relief to me, since I meant one fewer strap around my belly -- those straps had been on continuously since the previous afternoon, and I hated them with a passion). Then, I was okay'ed for the epidural boost, this time from a different anesthesiologist. This event turned into the most surreal part of the delivery.... I THINK that the anesthesiologist was simply trying to confirm that the extra medication was working by asking me questions and judging how coherent my answers were. At least, I like to think that's what he was doing. I'm pretty sure that's how he started anyway. He asked where I worked. He asked what kind of work I do. I answered each question, and eventually assured him directly that I was feeling much better, the medication was working, everything seemed much better. But, rather than leave, he told me that he was fascinated by artificial intelligence, and started asking me in-depth questions about my research. Um... okay. I'd been having non-stop, no-break contractions for more than 12 hours at this point, and as much as I love my research, this wasn't really the time or place to be discussing it. When he switched from mild interest to actually challenging the research itself (my "favorite" of his questions: "But how would you know if it were really intelligent?") I was done playing along. I gave some sort of clipped answer in my best leave-me-alone-already voice, then turned to S and pretended the anesthesiologist no longer existed. I'm still shaking my head that the conversation ever happened. I really did not expect to be doing a thesis defense dry-run while in labor....

The next 4 hours are kind of a blur, but by 11:30am, it was time to check my cervix again. Yet another nursing shift change had happened, and I no longer believed that it was possible for me to have progressed more than a centimeter or two. To my surprise, the new nurse announced that there was no cervix left at all -- fully dilated and effaced. Finally! He called the doctor to check me to be sure that things were looking good (both me and my non-reactive baby), but told me to wait to start pushing until the baby dropped a bit more, because he was still quite high in my pelvis. We sat in that holding pattern for more than an hour. The baby was still having periods of non-reactivity, but overall looked good. He still hadn't dropped, but since he seemed to be holding up okay, they decided to have me start pushing, even though I'd be pushing him a very long way. Starting to push was fine with me -- after sitting around being fairly passive for so long, I was anxious to take a more active role.

The nurse was able to verify that I was pushing effectively and fairly strongly, especially given the epidural, which was still partially numbing my lower half. After 45 minutes of pushing, he checked to see how much the baby had advanced. He felt around for a while, then felt around some more, then frowned and checked even more. Eventually he came around to the side of the bed and explained the situation. He had felt all the way around the baby's head, which was firmly lodged in my pelvic opening. Normally at that stage, they feel around the head to see how many finger-widths they could fit between the head and the pelvic bone, to get a sense of whether the baby will need to turn at all to fit through. In my case, the baby's head was firmly against the bone all the way around, making direct contact around the entire circumference. And this was NOT the widest part of the head.

I remember trying to process this information, asking the nurse what that would ultimately mean. The answer: the baby was not coming out this way -- I would need a C-section. S and I looked at each other, and I could see concern and fear in his eyes. We asked a lot of questions, but it mainly came down to this: I could keep pushing if I wanted to, and it was theoretically possible that the head would deform enough to fit through, but the odds of it working out were very slim. (We were asking so many questions that, at one point, he looked at us and said, "Look -- this is a fairly common procedure, but you do need to understand that it is major abdominal surgery. It's not something simple like knee surgery." S and I looked at each other and burst out laughing, which confused the nurse until we explained that S had knee surgery less than a year ago, and the recovery sucked, and he's still not 100%. As I've been recovering these last few weeks, our constant refrain is, "Take it easy and give it time -- it's not something simple like knee surgery!") Anyway, at that point the nurse left us alone to talk while he went to get the doctor to verify his conclusion.

When the doctor checked, and confirmed the cephalopelvic disproportion (CPD -- a fancy way of saying "big head, small pelvis"), we asked her the same questions, and essentially got the same answers. I could keep pushing if I wanted, but it would probably not help. But there was one thing that I just couldn't get past: I wasn't exhausted yet. I was a little tired, but I had gotten quite the hormone-induced energy surge when I started pushing, and I hadn't used up all that adrenalin yet. If I gave in to a C-section (and yes, it really felt like it would be giving in) before I was truly exhausted, I was afraid that I would always feel like I gave up. I told the doctor that I was feeling pretty good, and we wanted to keep trying, for another hour or so. Her response: "Okay, we'll let you give it the ole 'college try,' but we'll need to recheck you at the two hour mark." So, I kept pushing.

When we reached the point of 2+ hours, the nurse checked again. The baby hadn't moved at all -- his head was still firmly lodged in exactly the same place. The only change was that the baby's head was starting to swell "alarmingly" (his word) from the unrelieved pressure, and he was showing more and more signs of distress on the monitor. I still had some energy to spare, but the stress on the baby clearly outweighed my desire to deliver how I wanted. I squeezed S's hand, and agreed to go ahead with the C-section.

After that, things moved very quickly. Forms were signed, belongings were moved to a recovery room, S changed into scrubs, and I was wheeled down the hallway to the obstetrics operating room. I was introduced to my third anesthesiologist, who went along with my request to keep up a running commentary on what the heck was going on behind that annoying blue screen. After just a few minutes, I was told that I would feel pressure, like someone was sitting on my abdomen. That pressure was quickly followed by several baby cries, the best sound in the world -- the arrival (finally!) of our LL. He was quickly rushed off to the nursery, with S in hot pursuit, leaving me in the operating room to listen to my (female) surgeon and (female) anesthesiologist discuss how awesome it was that they had such great families and careers because they both have stay-at-home husbands. (Told ya I lived in a liberal, progressive area!) As they were finishing up, I asked how big the baby was. The surgeon's response: "They weigh him in the nursery, not here, so I don't know. But I'll tell you this: he sure wasn't small!"

Not small, indeed.

Coming up next: my attempt to get my posts caught up to the present day. Annoying confusion in the hospital; at home with 8 million out-of-town family members; the picture-perfect no-tears bris; settling in, complete with grandparent slave labor; and finally, the three of us alone as a family.


Fertilized said...

wow what a story. I am glad that you can still find humor in it all. Can't wait for more. Sounds like you are doing pretty well considering

Amanda said...

What an amazing story! I'm looking forward to reading more!

baby changing stations said...

You have beautiful way of expressing your events and experiences.I love to read your stories.waiting for new one's.

Candid Engineer said...

Congrats on that! Enjoyed reading your story. Looking forward to hearing more about your new life with the baby.