Tuesday, October 18, 2011

Birth Story: Part III

[Check out Part 1 and Part 2 to get the full story].

After a very rough day and a half in antepartum unit, I was ready for labor and delivery. Finally! Typically when you think of a woman having a baby, you think of labor and delivery. But I actually spent very little time there compared to antepartum and recovery. Here's how it went down.

The morning of May 5th, I was finishing up in antepartum with a little relaxation and breakfast. My contractions had calmed down from the previous night and I was pumped to get to labor and delivery. We got to labor and delivery sometime near 10:00 a.m., and my room was much bigger than the one we saw in the hospital tour (I was thankful for this). We did the usual checking-in type stuff and met our new nurse Mindy. I remember liking her a lot. The L&D nurses get lighter workloads so they spend a lot of time with their patients - understandably.

There is a whiteboard in the room, and I remember my nurse filling it out with the lowdown on me (first baby, Strep B positive, etc). At the bottom, she wrote, "Happy Birthday, Friglet!" I will always remember seeing that and thinking, "OK, he's definitely coming today!" It was all pretty surreal.

I was two centimeters dilated when I was checked in the morning in antepartum. I was disappointed that it had taken me so long to progress so little, like there was something wrong with me. After I started Pitocin, a doctor, Dr. Doro, from my OB group came in. I didn't know this doctor and I was a little bummed that my usual doctor, Dr. Bartfield, was now off duty (he was there for two days and we all thought he would deliver me, but I took too long). It all worked out, because I ended up liking her - she was very matter-of-fact which works well for labor and delivery.

She broke my water and said I was "3+." I barely remember the process of breaking my water. I do remember seeing the hook but I don't think it was very painful. She put it up there and I felt the gush of warm water like I had a big pee. It was relaxing in an odd way. We had a chat about my progression, that I was only 3cm and if I wasn't progressing, she wasn't going to let me labor all day and we may need to go the C-section route. I appreciated that she was up front about it so I could prepare myself mentally for whatever needed to happen. But I really wanted to go vaginal, especially with all the work I had already put into labor!

Every 15 minutes, the nurse increased my Pitocin by one level. I remember watching the numbers on the monitor but certainly can't remember what they were now. I want to say the max was 15, and I was around 7. I learned about "the hat," which is a plastic tub that sits in the toilet so you can measure your pee output. It's a little like potty training. You make a pee, then save it to show your nurse. Only there are no gold stars or M&Ms, which is a damn shame considering all that hoopla over your pee. I suppose a baby is a good prize. But still...M&Ms would help the whole labor process, I'm telling you.

The drug did its job pretty effectively and quickly. I got on the birthing ball because the contractions were coming again and they were strong. The nurse put a giant pad over the ball to catch all the leaking and oozing coming out of me (there's no point in wearing underwear). I kicked my parents out around this time. Things were getting intense and I didn't want to deal with extra people or wear my second gown to cover my butt. I was quickly reaching the point where you lose all sense of modesty. And I didn't want a lot of background noise. I remember it was around lunch time, because I asked them to get some lunch for John. I wasn't allowed to eat but I wasn't hungry; it's like the body is too busy doing other stuff to realize it's been a while since you've had anything to eat.

I stayed on the birthing ball, continuing my pyramid breathing through the contractions, and asked John to play my birth music. I'm glad we had it, it was very relaxing and helped me to stay calm through the pain. The doctor came in to check me again, and said I was at 5 centimeters. I was thrilled to be making progress! She said there was still fluid there, so she broke my water yet again. Another big gush of warm fluid. Birth is quite the messy process.

Dr. Doro said this gush of liquid had meconium in it, which is the baby's first poop. It born can sometimes happen before they are born. '"Crap," I said out loud. John was confused, but I knew what that meant. It's common especially with full-term babies, but it means there is a chance of infection if the baby ingests any through the mouth or nose. And you do not want a newborn to get an infection. The doctor explained that this means they wouldn't be able to plop him on top of me right after he was born; instead, they would whisk him to the baby area to suction him, hopefully before he takes his first breath and can suck in any meconium. I was a little bummed, but knew everything would be ok. When I envisioned my baby being born, I always thought he would be plopped on top of my chest and belly and I would get to touch him right away. But I quickly got over it and just wanted to see him so badly.

My doctor and nurse said they could tell I had taken a childbirth class and that I was doing a great job managing the pain. I felt like a complete mess, so I have no idea if they were being genuine or just nice. Everything changed after she broke my water for the second time. The contractions were coming at me fast now, with hardly any time in between. I remembered from my childbirth class that it's best not to wait too long for an epidural, mostly because you need to be able to sit still for it. I knew I was reaching that point where I wouldn't be able to sit up straight for much longer so I asked for the epidural, and my nurse agreed that was a good idea. It probably didn't take long for anesthesia to come, but it felt like an hour. Things were happening very fast all of the sudden, and I was getting seconds in between contractions. It was insane. I was on the birthing ball, trying to use my pyramid breathing. My nurse told me to calm down, that I was going to hyperventilate. She heard me do the 5 fast breaths and didn't realize I was using a method, and that it would be followed me a slow breath, then 4 fast breaths, etc. I couldn't get enough time in between contractions to explain it and it frustrated me. The nurse decreased my amount of Pitocin back down and stopped with the interval increases. The baby was tolerating the contractions well, but it was more intense than they aim for.

Anesthesia came in on a glowing beam of rainbows and sunshine, and I got into position. I decided to try the walking epidural first, which administers pain medication but doesn't numb you fully. I wanted to be able to pee on my own and walk around. Plus, if I changed my mind, all they had to do was change the IV. I sat on the edge of the bed with my legs dangling. They raised the bed very high so that my back was right in front of the anesthesiologist. John was sitting in front of me and I leaned forward and held on to him for support. The anesthesiologist prepped my back and we tried to time inserting the catheter between contractions but there was just no time in between them so I sat as still as I could through the contractions and he did his magic. People freak out about epidurals, but compared to everything else you're going through, it's laughable. I just felt a little prick, like I was getting a normal shot. I never saw the size of the needle, though.

The epidural took effect, and I realized that the walking epidural was NOT enough pain management. Screw  peeing on my own, just give me the full epidural and I'll take my catheter, thankyouverymuch. Anesthesia came back in (a different person this time), and adjusted my meds. Why would anyone not get an epidural? Seriously.

Once I was settled with the epidural, the doctor checked me again. 9 centimeters. Are you kidding me? I was just 5 cm last time you checked me, and was just 3 cm the time before that. Well that explains my crazy contractions, I thought. She said the baby was progressing down the birth canal like he should, so we were going to give it a try for a vaginal delivery, though she was still worried he may be too big for me. How was everything happening so fast? I was expecting a long day and it had only been a couple of hours. And my epidural had just now finally kicked in, and it was almost time to push? I guess the extra prep ripening my cervix in antepartum paid off. My nurse put in my catheter, and I couldn't believe I had worried about it. With my epidural in, I couldn't feel a thing.

My room began buzzing with activity. Baby nurses came in and got the baby area all prepped for delivery. There were a couple extra people in the room because of the meconium, just in case.

Now that my pain was under control, I had nervous energy and excitement that this baby was going to be here in the very near future. We waited a little bit, then my doctor and nurse checked me. My nurse asked me to push, and I realized I didn't know how. I had done Kegel exercises my entire pregnancy because I knew they help with labor, so I tried to do a backward Kegel. My nurse proceeded to laugh at me. She explained that I should push just like I was trying to poop. I don't remember covering this in birth class, I thought.

So I pushed like I was at home in the bathroom taking a poop. I thought this was just a practice run, that they were checking if I was ready. No, this was the real deal. Why wasn't there a big announcement? It's time to push! There should have been. Instead, they propped up these handle bars on each side of the bed and told me to hold on to those to help with leverage. My nurse grabbed my right leg, and John my left while my doctor was in the catching position. They told me I was a good pusher, and my doctor said, "Ok, I think you can push this baby out" (meaning he's not too big). I said, "Oh, I am going to push this baby out!" Adrenaline had kicked in and I was super excited - this was the finale I'd been building up to for 9 and a half months!

Dr. Doro explained that we were going to push twice for each contraction. Another contraction was coming, so I took a big breath in and pushed out while holding on to the bars and trying not to push too much with my legs (it feels natural to push your legs with all your might, but you have to redirect it). They all counted to ten, then I took a breath and we did it again. I saw John eyes get wide and he was getting excited. I asked for a mirror - I wanted to see what they were seeing. It was quite an odd sight. At first, I couldn't understand what I was seeing...then I realized I was watching myself poop. How lovely. Didn't even know that was happening. Beyond the poop, I realized I was looking at my baby's head! That was the motivation I needed. Next contraction, I pushed with all my might.

Dr. Doro told me to hold on and massaged me to try to prevent tearing. I asked her to try to do her best to prevent tearing and she was 100% on board with that. If I needed an episiotomy, so be it but let's try to avoid it all together. She explained that when he starts coming out, she was going to tell me to keep going and not take a break like every other time. I was ready.

I'm not sure how many contractions I pushed through, but it wasn't many at all and less than twenty minutes overall. On my last contraction, she told me, "Ok, now, go go go keep going" and I used all my energy to push push push. I felt him plop out in one giant, quick movement. The feeling was very similar to passing a bowel movement, only different. I think he was screaming before he was completely out of me. I loved hearing that sound, but had hoped he would wait to cry until he could be suctioned. I heard someone say "Sixteen forty-nine." (I later realized this was a nurse announcing his time of birth). The doctor held Caleb (now we could tell the world his name!) low between my legs and John cut the umbilical cord. I was glad they still let him cut it, since he had to be rushed for suctioning. I still hadn't seen him yet but heard him as he was carried over to the baby area. He had a strong,vigorous cry that was very reassuring.

I didn't have the strong emotional reaction I expected or envisioned, maybe because I didn't see him right away. It all felt completely surreal, I think I was in a daze. I just listened to him cry as I laid there for an uneventful afterbirth and then getting stitches (I did tear, and I don't recommend it. I will always remember the visual of my doctor bringing a needle up in the air like she was sewing a giant quilt between my legs *shiver*). Quiet tears ran down my cheeks and I took it all in. He was suctioned and looked over, and he was perfect. John carried Caleb over to me, and I took off my gown so I could put him against my bare chest. He was the most beautiful thing I had ever seen.

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