Monday, February 27, 2012

Birth Story

It only took me seven months and a sick day to finally finish editing my birth story, but at long last, here is the story of Josie's birth :)


I had an appointment with the midwives in the afternoon of July 7, 2011, to check my amniotic fluid levels, and if everything was fine, I was going to go in for a non-stress test at the hospital on the 8th, and then induction on the 12th (at one week and 4 days past my due date - the latest the midwives would let me go). During the ultrasound, the ultrasound tech noted that my fluid was at about 5.6cm, which is the low end of normal (5 - 25), and she said while she would normally be a bit concerned about that, she wasn't as much since she could see the baby's abdomen moving while it was taking practice breaths, which apparently a sick baby won't do. M. (one of the midwives) was to have the final say though, and her decision was that I would be going to the hospital that night. She was concerned about the fluid levels, especially given that I was a week overdue and the placenta would be starting to break down soon and wouldn't be able to support the baby as well. If I had been a bit earlier in the pregnancy they might have tried to bring my fluid level back up, but as it was, she wanted me to go to the hospital at 7:30pm (about three hours after the appointment) to have a Cook's catheter placed and then start Pitocin at 7:30 the next morning. M. was also a bit worried about the baby's heartrate, which was only showing to be in the 120s. I was still measuring 1cm dilated, but was now 100% effaced (up from 80% at my appointment the week before).

I called Ryan and my doula, Jen, from the parking lot of the midwives’ office to let them know what was going on, then went home and finished packing my hospital bag, crying through a large part of it since I was upset about the induction, scared to go through labor, and sad that the pregnancy was ending. Since we weren’t sure when I would be able to have a full meal again (since the hospital only permits clear liquids and jello during labor), Ryan fixed me up a big plate of meat and vegetables (finished off with a couple pieces of apple strudel for fortitude), then we went for a walk to see if that could help jump-start labor before we were due at the hospital.

[One last walk around the neighborhood before heading to the hospital]

We met Jen at the hospital and got set up in our room just after 8pm. I was hooked up to the external monitor around 8:30pm, and over the next couple hours, we were surprised to see that I was already having fairly consistent contractions. I still wasn’t feeling too much, but they were clearly showing up on the monitoring strip, so the 10 seconds of abdominal tightness I had been feeling every so often the previous week was actually likely the peak of a contraction. The midwife on call that night did an internal and confirmed that I was completely effaced and a "strong" 1cm, so the Cook’s catheter was placed at 8:45pm (which would manually dilate my cervix), with the plan for it to stay in overnight or until I was dilated enough that it would fall out on its own. After the catheter was placed, I continued to feel more contractions, now coming about 4 minutes apart and lasting about a minute, with some strong enough that I was uncomfortable and having a little trouble talking through them.

[Just after getting settled in our room]

The midwife and Jen left just before 10pm, and it seemed hopeful that my labor might start on its own before morning given how the contractions were the strongest and most consistent that I had felt so far. The baby's heartrate had been going from the 130s to 160s, and the nurses and midwife seemed quite pleased with that. The nurses had also wanted to place my hep lock that night, but since I wasn't going to be on any fluids overnight, we asked them to wait to place it until morning so I could sleep without that in. Ryan and I went to bed around 11:30pm and slept all right that night, with me in the rather comfortable hospital bed and him on the pullout chair.

The nurses came in around 6:30am with my breakfast (two packages of Cheerios, two bottles of milk, and grape and orange juice). Although I wasn't that hungry, I set out to finish everything they gave me since I wasn't sure when I'd be able to eat a full meal again.

[Working on my breakfast]

I was a bit worried that the catheter hadn’t worked since it never fell out like we were expecting it to once I was dilated to 4cm. My contractions also had slowed down again overnight and had been less consistent, although they had become fairly consistent again at 5 minutes apart once I was awake for the day. And while the catheter hadn't fallen out overnight, when it was removed in the morning, we were thrilled to hear that I had actually dilated to 6cm, rather than the 4cm we had hoped for (and I surprisingly didn’t have any cramping or discomfort from the dilation). I was supposed to be started on Pitocin before M. arrived at the hospital, but since my contractions had been a bit stronger and were consistent again, Ryan and I asked to wait on the Pitocin until we could talk to her first. The monitor was showing the contractions as being quite strong too, but they were still nothing more than a momentary discomfort, and I could barely even feel some of them. The hep lock had been placed in my arm prior to breakfast, so in the meantime, they hooked me up to the IV and started my first dosage of penicillin around 7:30am, since I had tested positive for GBS earlier in my pregnancy.

Although we got the distinct impression that M. wasn’t very happy that we had delayed starting the Pitocin, she came in to talk with us once she got to the hospital, and we asked if the Pitocin was still necessary given my dilation and the fact that I was having strong contractions so regularly. They wanted my contractions to be consistently 3 minutes apart rather than 5, though, so we agreed to move ahead with the Pitocin, starting at 2 units around 8:45am.

Ryan tried to establish what the plan was in terms of the Pitocin - when it would be increased, that we would like to be communicated with before that happened, etc. M. and Ryan butted heads over this a bit, but I think it was important that our concerns were addressed, since we were definitely not happy about being induced anyway - let alone with Pitocin - and now we were in the hospital and on their clock. Since I was on Pitocin, I also had to be on the external monitor continuously, which is not what we had hoped for - they had done an initial strip when I was admitted the night before, but now I had two sensors on my belly for the duration of labor, which was a constant battle to keep them in place so they could find the baby's heartbeat. While I was irritated about having the monitors on, I did also relax more since I was actually able to hear the baby's heartbeat throughout labor, so that alleviated my near-constant worry throughout my pregnancy that I had lost the baby.

The contractions almost immediately picked up in strength once the Pitocin was started, although they were still perfectly manageable. We decided to go for a walk to see if that would help as well, so I put a hospital gown over my nightgown as a robe, put on my slippers, grabbed my IV pole, and headed off into the hallways with Ryan… only we quickly discovered just how small the birthing part of the hospital was, especially since we had to stay on the L&D side of the building. So basically we could walk an L, with the nurses' station (and our room) at the juncture of the L, so I felt a little awkward passing by the nurses so frequently. Then it turned out that there were some problems with picking up the monitors at certain points in the hallway, so our walking path was even more reduced.

After maybe 10 minutes (or less) of walking, we headed back to the room, both because it was a little silly to pace the same 40 feet of hallway, and because they wanted me to get back in bed for a few minutes so they could more closely monitor the baby's heartrate. The baby was still laying with its back to my left, feet to the right, so they had me lay on my right side to see if gravity would help shift the baby to a better position. They were also concerned since the heart tones were very consistent - which seemed like a good thing to me, but apparently they're supposed to vary with contractions. So I laid there for a while until the nurses were satisfied that the heartrate was increasing appropriately during contractions, and the Pitocin was also increased by 2 units around 9:15am (up to 4 mu/min).

After I was cleared to get out of bed again, I moved over to the rocking chair in the room. The contractions still felt like they were about the same intensity as I was feeling before, so while I was still fairly comfortable during them, I was feeling more of each one rather than mainly just the peaks. We decided to play some Uno to kill some time, so I proceeded to undertake the longest reading of instructions ever. The contractions started to get a bit stronger as we were playing so that I had to stop, close my eyes, and breathe through more of them. Jen suggested I lean forward during them (rather than leaning back, as I had been doing), which helped make them a bit more comfortable. They continued to get stronger throughout the game, and I was leaning forward, rocking, and having to breathe through most of them towards the end. We were only able to get one round in (that I won!) before the nurses came in and asked me to get back in bed for a few minutes for monitoring.

I returned to the bed to lay on my right side while we watched the baby's heart tones and my contractions. The contractions were coming very consistently by that point, and Ryan was even able to predict when the next one would start based on the readouts. I had started to feel a bit nauseated before getting out of bed the last time, so I had put one of my Sea-bands on (the other one was blocked by the hep lock). I also asked for a basin to be put by me “just in case”, which ended up being almost an obsession throughout labor - whenever I changed positions, I always asked in a panic, “Where’s the basin?!” Then, invariably, someone would ask if I needed to throw up, and I would say, no, I just wanted to know where it was. It became my security blanket, and luckily I never needed to actually use it :)

There was still some concern about the baby’s heart tones, and I was concerned that if we couldn’t get the external monitor to cooperate that they would insist on an internal monitor (i.e., screwing electrodes into our baby’s head). And by this point, Ryan had gotten frustrated about two things at the hospital: 1) the spotty wifi connection, and 2) the focus on the external monitor. It was frustrating to have continuous monitoring, especially since it was restricting some of our activity (e.g., not being able to walk the halls, having to stay in bed for a while), and it did feel like everyone was watching the monitor more than watching me or listening to the baby itself.

[Ryan holding the monitor in place - I think his face says it all]

As the contractions continued to get stronger, I asked if I could labor in the tub for a while. There was a bit of a pause, and then M. said that she guessed I could do that, as long as I kept my IV out of the water. I didn’t think too much of it at the time, but in hindsight I think M. may have hesitated because it might have been more unusual for someone on an IV to labor in the water, since I think it’s more common for Pitocin to be paired with an epidural (which would have restricted me to the bed). But regardless, they were going to let me go in the tub, so M. did another internal exam first and then went to begin filling up the tub. I had asked not to be told what I was dilated to unless it was 9 or 10cm, and I actually don’t even remember having this internal (but it was in Jen’s notes, so I guess it happened!). This was about 12:15pm, so after laboring on Pitocin for 3.5 hours (and having it increased by this point up to 10mu/min), I had only dilated an additional centimeter to 7. I’m so glad that I wasn’t told this at the time, since I think that really would have discouraged me to hear that I hadn’t made much progress in dilating.

I was maneuvered into the tub once it was ready, which M. had filled up and placed towels and pillows in. I believe I laid down on my back first, but fairly quickly decided that position was too uncomfortable for me. I flipped over to my right side, and took several more contractions that way. The contractions had continued to increase in their intensity, and I then wasn’t sure if side-lying was really the best position for me either. I took one contraction on hands and knees with my back out of the water, and almost collapsed back down on my side before the contraction was even over since it was so much worse in that position, so I ended up staying on my right side for the rest of the time I was in the tub.

I had basically entered a very focused state of mind by this point, and kept my eyes closed for the most part for the remainder of my labor. The contractions were getting more difficult to handle, but I was now able to feel the wave of pressure beginning so I could get into a relaxed state very quickly before the contraction really got going. One tip that came in handy from our Bradley classes was the “duh” face - I tend to hold tension primarily in my face and shoulders, and doing a “duh” face was the quickest and easiest way to relax my face, and then I would just sink down into the tub while trying to quickly relax the rest of my body.

Since my eyes were closed, I’m not sure who was doing what at this point, but either Ryan or Jen was providing counterpressure on my back for each contraction, and also giving me sips of coconut water between the contractions. I pretty quickly started overheating, so while I was perfectly comfortable temperature-wise between contractions, I would get way too warm as each contraction peaked. Since I was trying to stay relaxed and not move during the contraction, as soon as it had nearly dissipated, I would launch myself out of the water to cool off. Ryan and Jen were trying to get me to calm down, since even though I wasn’t moving during the contraction itself, it was not helping me mentally relax to be counting down until I could get cool again. We realized a good way to fix the situation was for me to keep one leg out of the water and resting on the side of the tub, and then they got a good system going of giving me ice chips and wiping me down with ice and a cold washcloth.

By this point, the contractions were getting borderline intolerable while they were peaking, but there was still enough time in between contractions so that I could gird myself for the next one and make it through, since I knew that I could last through the contraction itself, and then I would at least have a short break. I was also shocked to see just how much of a difference it made to have Ryan and Jen’s support. At some point, they were talking with M. or the nurses and I took a contraction on my own, and it was amazing how much worse it was without the counterpressure or cold washcloth. Moments like those made me so glad that Ryan was supporting me so much and that we had decided to hire a doula, since if I had to labor without their help, I don’t think I would have lasted very long without opting for an epidural. As it was, the contractions sucked (as I had begun thinking to myself right around that time), but I also knew I could get through them with Ryan and Jen there.

One thing about labor that surprised me was how although I was in an alternate state of mind with closing my eyes and turning inward to focus on relaxing and getting through each contraction, I was also thinking in a fairly coherent manner. In addition to deciding that contractions sucked, I was also thinking that I could definitely understand why people get epidurals, and that I was going to get through this labor without an epidural, but since it was so important to us minimize interventions and avoid pain meds, that I didn’t want to do a natural birth again and so our baby might well be an only child (note: I’ve since gotten over this ;) ).

I also started to get a little apprehensive about delivery, since while I wasn’t too exhausted yet, I was a little worried about how much longer I would be in labor, how much more tired I would be by time I was ready to push, and how much more pain I could take by that point. I had been having these thoughts for quite a while, but hadn’t shared them since I was trying not to talk more than necessary to help maintain my relaxation and focus. I finally - rather plaintively - asked, “How in the world am I going to be able to push after this?” Ryan and Jen immediately shushed me and that was the end of that conversation :)

At some point, I heard M. talking quietly with Ryan and Jen, saying that they should let her know if I got pushy or if my moans got more guttural or grunty. After hearing her say that, I of course immediately felt like I needed to push, and my vocalizations got more guttural. Knowing that I probably was just getting inside my head too much, I tried not to influence the way I was moaning (since just making them more guttural was not going to bring the baby any quicker - if only it were that easy!) and told myself to stop thinking I needed to push, since unless it was completely involuntary and unstoppable, I probably wasn’t actually pushy.

Rather quickly, though, I had a contraction where my sighing ended on a decidedly guttural note, and got louder towards the end of the contraction instead of getting higher and then fading out as it had been. I also felt myself pushing. Thinking it was a fluke, I didn’t say anything then, and didn’t feel the need to push on the next contraction or two. However, I then felt an uncontrollable urge to push again, felt my body pushing against my will, and told Ryan and Jen I needed to get out - NOW - since I was pushing.

One of them immediately went to tell M. as I started to pull myself out of the tub. After taking a very quick bathroom break (being careful not to push and also taking a contraction hanging off M.’s shoulders), I then started to walk back towards the bed, which was the longest I had had my eyes open in hours. All I remember is seeing my goal - the bed - like it was at the end of a tunnel, and I only barely registered that there were quite a few other people in the room now. I got back into bed laying on my back so M. could check my progress again (this was around 2:15pm), and then she asked me to remind her at what number I wanted her to tell me directly rather than only tell Ryan. I told her 9 or 10cm, and she said, well, you’re at 10! Which I said was wonderful - I had been looking forward to pushing since I had heard it was a relief to be able to actually actively do something rather than just get through each contraction, and I was relieved that I wouldn’t have to worry about refraining from pushing if I felt the urge.

M. didn’t give me any guidance on when or how to push, which was great since I wanted to be able to push instinctively. So on the next contraction, I went with it when I felt the urge to push, and just tried to remember to push down and out. The back of the bed was slightly raised, and I had thought that I would like pushing in the “classic” position, with my back at a 45 (or higher) degree angle and my knees held up, and while I’m not sure if I ever transitioned fully into that position, I just didn’t feel that comfortable in the position I was in. Jen asked me what I thought of the position and I told her I hated it, which got a laugh. We decided to try having me kneel backwards on the bed, leaning against the top of it, which had been raised up to a 90 degree angle. This was much more comfortable, and so I pushed in this position for a while, still continuing to take sips of coconut water between most contractions and getting wiped down with a cool washcloth by Ryan or Jen during them.

I wasn’t able to get into the breathing rhythm recommended in the Bradley classes of taking two breaths in and out before beginning to push on the third breath (so that the pushing coincides more with the peak of the contraction), but instead I was usually taking one breath in and out and then pushing on the second breath until I ran out of air, taking another breath in and then pushing again. Usually by that point, I had grabbed onto the back of the bed and pulled myself up and my vocalizations began as moans and built into borderline screams by the end of the contraction, as I bore down with everything I could The contractions were intensely hard, but still manageable, perhaps because I had something active to focus on during each one. I still thought each one sucked, and I did not enjoy pushing, but I at least knew I wouldn’t need to keep pushing forever. I was in a zone for the most part, and didn’t feel like I was making any progress. It seemed like everyone else was being pretty quiet, and so at one point I asked, with a note of panic in my voice, if there was any progress. I got some incredulous looks back, and it turns out there was, in fact, progress being made, as they were able to see the intact bag of waters bulging with each contraction.

My legs began hurting from essentially kneeling for so long, so I eventually began sitting down on my heels between each contraction, and then pulling myself up during each contraction as it built in intensity and I started pushing. I was not relaxed in any sense of the word by this point, and I began to panic a bit between contractions, panting and whimpering. While it was probably fine that I wasn’t relaxing during contractions (since obviously I needed to be pushing), Ryan did remind me to relax and breath slowly between contractions. After a couple more contractions, I was able to get myself back under control between each one, and was able to rest and conserve my energy better - and eventually, I was even able to doze off between contractions.

While I was happy M. was letting me push instinctively, I perhaps wasn’t pushing as effectively as I could have been. I had been pushing twice while I felt the contraction, and at one point after the contraction was already winding down, M. asked if I could push one more time. I figured I might as well try, so I pushed and was surprised to hear that it sounded like that made some progress. So from that point forward, I pushed three times during each contraction, and I felt like the third one - which was well after the peak - was usually the most effective, since the first one usually felt like I was pushing against a wall, while by the third one, it felt like I was more open and that I was able to push down and out better.

After going through the “ring of fire” (which was a whole new level of pain as the baby descended past my pubic bone), I changed positions again lay back down on my right side. I opened my eyes at one point and looked down towards where everyone had gathered by my legs, and out of the foggy abyss, I saw Ryan coming toward me, with his face as excited as I’ve ever seen it, saying “You’re doing it!” I said, “Really?!” and that little exchange provided me so much encouragement. He had also said a few times during labor, “Who knew you would be so good at this?” but at the time I didn’t feel like I was being too good at anything - I just had a very difficult task at hand that I needed to accomplish, so I was just taking care of business. Only in hindsight did I realize how amazing the experience was and how there was far more that went into it than just my fortitude in “getting things done”.

After about an hour of pushing, my water broke at 3:15pm (a mere 3 minutes before the baby was born), which was a bit funny to me since I had been so worried about my water breaking while at work (so much so that I carried an “emergency bag” with me every day to the office, which had a change of clothes and towels in it). I do wonder how it would have affected my labor if my water had broken sooner, but we suspect it wouldn’t have made too much of a difference in the intensity of my contractions (since I would have been contracting on the baby rather than a squishy bag of water) since my amniotic fluid was so low anyway. There was also a concern that there would be meconium in the water since I was postdates, but the water was clear and everything was fine.

Finally, the baby’s head was crowning, and within another few pushes, I could feel the head emerge. I believe it was only one or two pushes later (possibly on the same contraction), and the rest of the body came out too. The baby was immediately placed on my chest, and while I had been worried about dropping the baby (since it would be so slippery!) or feeling awkward since I don’t have much experience with newborns, instead everything just felt so natural to hold our new baby. I asked Ryan what we got, and he checked and announced that it was a girl. I repeated that back to him, like it was the most amazing and wonderful thing in the world (which it was), and marveled at how big she was, and how warm and perfect she felt. One of the nurses asked what her name was, and I told them “Josie Marie” without any hesitation. I had also been worried that we wouldn’t like that name or it wouldn’t fit the baby once we saw her, but it just felt right.

Josie had been crying as she came out, and there was one comment about how she was a bit bluer than they would’ve liked as they were rubbing her down with towels, but then she pinked right back up again. There were several comments about how much hair she had and how beautiful her eyes were, but I could only see the top of her head by my vantage point, so my first view of her eyes was via a picture Ryan took of her to show me. We were wrapped up with blankets to keep us both warm while I delivered the placenta, which was a piece of cake in comparison to everything else. Her umbilical cord was clamped and cut about 5 minutes after birth, once it had stopped pulsing.

[Josie, 10 minutes old]

After we nursed and bonded for a while, the nurses took Josie so they could do their full evaluation, so Ryan went over to the bassinet with them while Jen stayed with me. They measured her at 20.1” long and 9lbs 8.9oz, and her Apgars were 8/9.

[Ryan’s first time swaddling Josie]

In the meantime, M. gave me a local anesthetic so she could repair my second degree tear. I apparently was also bleeding quite a bit, and M. was concerned enough to let me know she wanted to up the Pitocin to see if that would help my uterus contract down more quickly, so she went ahead with that with my okay.

Probably about an hour later, after Josie was done being evaluated and Ryan was holding her again, I felt good enough that I asked to get up to go to the bathroom. I gingerly got up with two nurses flanking me and made my way to the bathroom, but once I got there, I started to see some black spots and hear buzzing in my ears. I believe I told them I didn’t feel well, although I may have indicated that I was nauseated instead of about to pass out, and the next thing I knew my nose and eyes were burning and someone was holding my head. I apparently had passed out for about 20 seconds, but the nurses had gotten a basin of ammonia and had me woken up again pretty quickly.

I sat for a few minutes and then felt ready enough to try to get back to bed. They had a steddy cart there, so they had me step onto the cart and they folded the pedals down so I could sit. About halfway back to the bed, I told them I was about to go again, and then when I came to again it felt like someone was boxing my ears. I finally made it back to bed, considerably more shaken and light-headed than I was before.

I ended up staying in Labor & Delivery an extra hour or two until I felt ready to get moved to the post-partum wing. In that time, I was checked quite a few times since the nurses were worried about how “boggy” my stomach felt, so they were concerned that I might have retained some tissue. One of the nurses even did another internal so she could check it better, and that felt like it was even more painful than giving birth was - I’m not sure if it was because the pain came out of nowhere vs. building up over a several hour period, or if it was because it was pain without a purpose, but it was awful. They gave me my dinner in L&D, which I was able to eat most of without feeling too nauseated, although I couldn’t quite stomach the thought of eating the chipwich that was for dessert. I found it strange that they insisted I take that with me to my post-partum room, but I appreciated it the next day when I finally did eat it.

While I was recovering from passing out, Ryan had gone with Josie to the nursery and was able to give her her first bath there, around 5pm, and Jen ended up heading home at 5:15pm.

[Josie in the nursery]

When I felt up to it around 7:30pm, the nurses brought a wheelchair and wheeled me over to the post-partum room. I still felt pretty sick and weak, so I could barely look up as we went through the halls, but felt much better once I was able to get back in bed... especially once Josie was back in my arms again.

That first night, we parked Josie in her bassinet between my bed and the pullout chair Ryan was sleeping on, and I spent a good portion of the night just staring at Josie and marveling that she was finally here. She was all swaddled up and very quietly sleeping for most of the night, although we woke her up a few times to be changed and nursed. We spent the next day (Saturday) sleeping, nursing, doing skin to skin with her, visiting with family, and getting to know our daughter (in between all the screenings and evaluations).

Josie was slightly jaundiced, so the nurses had been monitoring her to make sure her bilirubin levels didn’t get too high. The second morning after she was born (Sunday), they came in to check her and Josie was pronounced ready to go from the hospital’s perspective, so we just needed the pediatrician to come back to check her and the midwives to check me. The pediatrician came by later to check Josie again, and said that she looked fine and was ready to be discharged. While her bili levels were still on the high side, we were just told to schedule an appointment with the pediatrician for the next day to check them again.

[Waiting to go home from the hospital]

Eventually, the midwife on call came by to check me out, and said my stitches looked good and that she would sign off on my discharge as well. We then spent the next two hours or so checking with the nurses to see when we could go home, since there was some final paperwork to be completed and material to review with us.

[...still waiting]

Finally, after we made a royal pain of ourselves, our nurse said we were free to leave. Since we were all hungry and exhausted, it wasn’t quite the triumphant homecoming it could have been, as we scurried out of the hospital with Ryan carrying Josie in her new carseat, and me following behind (sans wheelchair!). Josie did all right on the ride home, and while we had a very positive experience overall at the hospital, by that point we were happy and relieved to be back in the comfort of our home with our newly expanded family.

[Josie’s first car ride]

As a funny little story to end this on, while I was pushing, Jen went over to the window and opened the curtain to show everyone the thunderstorm that was raging outside. At the time, I thought that was kind of a funny thing to do (thinking, “um, I’m birthing a baby over here!”), but I’m happy she did so since little did I know that that would make me have a special affinity towards thunderstorms. Every time I hear thunder now, it instantly brings me back to that wonderful moment of having just delivered our daughter, with her laying warm and heavy on my chest for the first time.