Thursday, July 3, 2008

Our Birth Story

Setting the Stage:

This pregnancy was, by all intensive purposes, pretty easy. We never had any major complications, and sure, while some of the side effects that go along with pregnancy aren’t very comfortable or particularly pleasant, I enjoyed being pregnant very much.

When we got along in our pregnancy enough to discuss birthing methods, we decided that natural was the way to go for us. We hired a doula to help us in the hospital (the best decision we ever could have made) and took Bradley classes to help arm ourselves with the knowledge for a natural birth. We prepared a natural birth plan and specifically requested nurses and doctors who support natural childbirth.

Of course, things don’t always go as you planned…

About a month before my due date I started experiencing swelling. Everyone swells during pregnancy so I wasn’t too concerned about it. Unfortunately, I gained about 10 pounds in 2 weeks from water retention and developed carpal tunnel in my right hand due to the swelling. We monitored these symptoms but they never really caused us to raise any flags. About a week before my due date my blood pressure started to increase, enough that my doctors were concerned, and I also started having intense headaches. Still, I really didn’t think much about it until the Sunday before my due date the headaches were so bad that we went to the hospital to make sure everything was okay. The baby’s movement also decreased for a few hours so I got really paranoid that something was wrong (he was sleeping). On the Tuesday night before my due date I started having some cramps. We didn’t think much of them, however they were recurring and intense enough to make me slow down so Thad started keeping track of them just in case. They lasted for about 3.5 hours and then stopped totally. My doctors told me to keep my regularly scheduled Wednesday morning appointment. Little did I know that that appointment would move things along considerably.

At my appointment not only was my blood pressure high but there was protein in my urine. Between the protein, swelling, headaches, and blood pressure, my doctor advised a scheduled induction on Thursday morning because he didn’t want my pre-eclamptic symptoms to go any further. I was already 2 cm dilated at this point and about 50% effaced so my doctor felt that inducing labor by artificially rupturing my bag of waters would jump start my delivery. After a lot of discussion, Thad and I decided to go with the induction. I had carried the baby for 39 weeks and 6 days at this point. Sure, it’s not a spontaneous start of labor but when the concern is over symptoms that can get worse in an unpredictable manner we decided not to tempt fate and risk harm to me or the baby.

Birth Story:

We arrived at Fair Oaks Hospital on Thursday morning, May 29, at 0545 for a 0600 induction. Unfortunately our doctor had just had a delivery so we didn’t end up having my water broken until 0815 and there was meconium in the fluid. Of course this raised a flag for the doctor but since I was already 2 cm. dilated and 50% effaced the hope was that my body would take over the labor naturally. Unfortunately, this was not the case. Luckily my doctors were okay with me moving me around and Thad and I spent the next few hours walking to see if we could get things moving. I only had a handful of contractions but nothing too uncomfortable. By about 1115 they checked me for dilation and there was no progress. At 1145 we decided to try some pitocin at a very low dose to see if that would jump start my contractions. At 1600 my doctor came to check my progress and I was only 3 cm dilated. My doula, Mary Beth, said that at this point the contractions should be “knocking me down” and they weren’t that bad so we went with the doctor’s advice and upped the pitocin yet again. The contractions became steadily stronger and longer, and what had begun as contraction-talk-contraction soon quieted into focused, active labor. The pain of the contractions also steadily grew, with the breathing and positioning techniques becoming less effective as the contraction times grew to two minutes and the breaks between decreased, with contractions sometimes stacking three or four in a row. Around 2200 the contractions were so long and close together, the nurse began lowering the Pitocin dose, which did very little. By 2330, the Pitocin drip had been turned off completely, but the contractions were still extremely strong and abnormally long. The doctor was doing an exam every two hours or so at this point, and at midnight, I reached the 5cm mark. Thad and our doula were both hopeful that things would accelerate at this point, with the contractions being as heavy as they were. Unfortunately, after another two grueling hours, I was only 6cm dilated, and all of our energy reserves were running low. We pushed through another two hours which included vomiting and bouts of the shakes, and we had high hopes as the doctor entered at 0400. Unfortunately, it was not to be, as I was still right around 6cm dilated. With so little energy remaining, we decided an epidural would be the best path for rest and another session after a brief rest. The epidural was administered at 0515, and we all took a quick sleep until 0730, at which point the nurses started up the Pitocin again (contractions had slowed to a point where we would not be able to make progress). The contractions were not as painful with the epidural in place, and over the next five hours, dilation slowly progressed. By about 1300 I was nearing the 10cm mark, but the anterior lip of the cervix refused to retract properly. We waited through another hour of contractions (and a stronger epidural), but the lip stayed in place. The nurse and doctor felt it was soft enough that it would not present a danger to the baby, and at 1500, we repositioned and started actual pushing!

After about 10 minutes of pushing (learning curve!), the epidural wore off, and while the pain was more intense, I also had a much better sense of where and how I should push, and the nurse was more excited about the movement of the baby, or at least what we thought was progress. As we continued pushing, a number of things became apparent: the baby was not moving as much as he should, my temperature (approaching 102 degrees), pulse (150 sustained) and blood pressure (180/110) were all worrisome, and the baby’s heart rate was sustained around 190-200 during contractions, signaling distress. After 75 minutes of pushing, the baby had still not moved past the unretracted lip, and the doctor and nurse both recommended we move to an emergency c-section in light of both my and the baby’s deteriorating condition. At this point, the water had been broken for 30 hours, I was already on IV antibiotics to protect against infection, and it was clear that a vaginal delivery was not in the cards.

After being prepped with a chest-down epidural, I was moved to the OR. I fell asleep almost immediately (I have never been so tired in my life), and actually was next awakened by Thad to see our wonderful son as he was moved to the triage station. It was 1714, and we had an 8lb. 13 oz. baby boy. We also received a couple pieces of information that would have been helpful the day before – he was sunny side up, his head position was asynclitic, and the cord was wrapped around his neck twice, preventing his proper descent!


Julian's Birth


After the doctors sewed me up, I was moved to transition, where the nurses were wonderful – as soon as his breathing was steady enough, they gave us 30 minutes for skin to skin contact, and he snuggled right into me – it was amazing! Unfortunately, he wasn’t able to keep his oxygen numbers high enough on his own and was showing other symptoms of respiratory distress, so he was moved to the NICU for additional oxygen and monitoring. He ended up staying there for five days, working through the TTN (http://kidshealth.org/parent/medical/lungs/ttn.html) and then jaundice (caused by the difficult labor and delivery). We finally were able to bring him home almost a week after his birth, on Wednesday June 4th.

Thad’s input:

Obviously things didn’t go as we had planned. It was the most difficult and challenging 24 hours of my life, without a doubt. I’ve never been through anything like it, and doubt I will ever see its like.

As Pamela covered all the details, I won’t go into that, suffice it to say that the doula and I were both physically and mentally exhausted, so I can’t even imagine what place Pamela went to that allowed her to continue when we were both so close to collapse.

I will mention a couple of things, though, and they’re both Bradley related. Even though we weren’t able to deliver Julian vaginally, we still feel that we did the best we could have under the circumstances. There were so many times when we had a decision in front of us, and after discussion, we first tried things the natural way, and when that failed, we were forced to turn to the medicinal path to make progress. I can’t even count the natural things we tried – walking, squatting, raspberry tea, primrose oil, nipple stimulation, both blue and black cohosh, special positions with the doula’s riboso… the list went on and on. Unfortunately, they just weren’t enough. I believe that the baby wasn’t quite ready to come out, but due to the worsening pre-eclampsia and the meconium in the water, it is also clear that we didn’t have the luxury of time to wait, so we made the best of it.

Our doula was an absolute wonder. We are forever in her debt for the effort and comfort she provided during such a trying experience. She was a pillar of strength and also provided calm, sound advice during each of our decisions. I don’t know how we would have done it without her.

Pamela's Input:

I don't know if I'll ever be able to look back at the labor and delivery and not get emotional. It was the hardest single thing I've ever had to do in my life and I suspect that it will never be topped. The whole experience pushed me into a new place as well as pushed my relationship with Thad to a new place as well. Looking back, though, despite the difficult recovery and series of unexpected events, I would not change a thing. Bringing Julian into this world required a lot of determination, patience, and ultimately a lot of love between me, Thad, and our doula and I will never be the same because of it. Now we have a beautiful, healthy baby boy and I am slowly on the mend. How can I be disappointed about anything that happened when the outcome was so wonderful?

I'll never be able to thank Thad and Mary Beth for everything they did for me. The doctors and nurses were wonderfully supportive and I am in their debt as well. Sure, it wasn't the delivery we were hoping but we are so lucky to be where we are today. Julian is the most wonderful thing to ever happen to me and I am so grateful for him each and every day. 'Nuff said.

1 comment:

Amy said...

It brought tears to my eyes reading this. I'm sorry you had such a long, difficult labor.

It seems like Thad is sort of defending your decisions and I hope that's not because of any negative feedback you got. You did the right thing. The goal is to have a healthy baby and mama, not just to do it "naturally."