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Wednesday, January 03, 2007

Birth Story, part I


Ever since my research for a paper on Midwifery my sophomore year in college, I had been interested in natural childbirth. When I got pregnant, I decided to brush up on the subject, and by the time my due date rolled around on December 27th, I had read a variety of newer books, from the sensible (Henci Goer’s The Thinking Woman’s Guide to a Better Birth, which provided ample research and a balanced perspective) to the far-out (Birthing from Within, which suggested I draw pictures to exorcise my fears about giving birth, walk a labyrinth to envision the journey of my labor, and howl like a wolf when the time came). I had my birth plan all laid out. I was also trying to mentally and emotionally prepare myself for the possibility that interventions might become necessary, and that my baby might end up being born by c-section. I knew there was no way to predict or fully control what would happen with my labor, and I wanted to stay focused on my baby’s birth, not fixate too much on how we got there. Still, my research had convinced me that, if possible, a vaginal birth without drugs would be the best for me and for my baby.

Though my contractions began on New Year’s Eve, I didn’t go into full-on labor until Friday January 3rd. But even though those early days and nights of contractions weren’t actually “active labor,” they felt pretty damned active to me. By the evening of January 1st, the contractions had gotten stronger and were coming more regularly. I spent a nearly sleepless night that night, having contractions every 15 or 20 minutes, contractions that were most painful when I was lying down. When I woke up on the morning of the 2nd, I was pretty sure I was in labor, so I called my doula, Rae, and had her come over. My Old Man was with me already, of course, and so was my mom, who had come a week or so before my due date and had been keeping me company and helping me clean out my bathroom closet and engage in other obsessive nesting. Shortly after Rae arrived, though, my contractions stalled. So the doula, the prego, the husband, and the grandma-to-be sat around, making nervous chat like freshmen at the high school dance, waiting for the contractions to show up and break the tension. After a couple of hours, Rae went home.

I continued to have very irregular contractions throughout the day. During one of my many, many pees, I glanced down and found what looked like a raspberry-marled blanc mange in my drawers - my mucus plug! Very exciting, since it suggested that my cervix was dilating. That night, my contractions got stronger and more regular. So I had my second night in a row of shitty sleep, though slightly less shitty; I was figuring out how to nap between contractions, catching ten or twelve minutes here and there.

Friday morning when I woke up, my contractions stayed strong and regular, coming every 10 minutes or so. Rae came over in the late morning, and this time she stayed, helping me manage my contractions. My Old Man and I had taken a prepared-childbirth class that we found helpful, but when my contractions really began to be painful, the “visualization exercises” we had practiced became nigh unto useless. For practice, we had lain spoon-wise in bed, him holding an ice cube to my inner wrist (which does get painful after a bit), while I breathed and envisioned myself snorkeling among the pretty fish in the Gulf of Mexico. But an ouchy ice cube held too long to a tender wrist is nothing compared to a real, full-on contraction, which turns the entire core of the pregnant body into a band of writhing, clamping pain, and chases out all happy visions of blue water. Luckily, I had Rae, who served as a crash refresher course in the essentials of contraction-management. She repeatedly reminded me to breathe deep and slow and to relax my shoulders (which mysteriously kept bunching upward with the stress of labor), and she helped me find positions that were less rather than more agonizing. Laying down was totally out of the question by this point, and sitting was little better. Squatting was nearly bearable, but the very best position was hanging, with my arms wrapped around Rae’s neck or my Old Man’s, my body dangling limp. It seemed like taking any strain off the muscles in my core eased the pain to a manageable level. Lucky for my Old Man our doula was a strapping woman, six feet tall, and I could alternate hanging off him and her. My mom was wonderful as moral support, but she was just too little to use as a hanging post.

Laboring at home was a strange mix of sober work and exuberant socializing. During my contractions, everyone would get quietly serious and allow me to concentrate, and then between contractions we’d all hang out and chat and laugh. It was wonderful having a doula who was not only excellent in terms of labor support, but who clicked with me, my Old Man, and my mom, and who was great fun to hang out with. (It was a good thing, because we all ended up spending nearly 24 hours together.) Although I hadn’t slept well the previous nights, and though my contractions were getting painful and pretty long, I felt in very good spirits and excited to be in labor.

I had received my prenatal care from the midwife practice at our hospital, a team of six nurse-midwives, one of whom would deliver my baby. That afternoon I had an appointment with the midwife on call, Kristy. She gave me a manual exam, checking my cervix. I was completely effaced, but only 2 centimeters dilated. Kristy said my cervix seemed very pliable and offered to manually stretch it, which she said could open it up another couple of centimeters. I said sure, so she stretched my cervix (painful!) and got me to 4 centimeters. Then we went home and labored at home for a while longer. By about 6 PM, I felt ready to go to the hospital, so Rae called labor and delivery to let them know we’d be over soon and that we wanted to use the water birth tub. I couldn’t use the birthing tub right away, so after Kristy the midwife got us settled in our room, Mom, my Old Man, and Rae followed me to the Jacuzzi room and I labored in the hot water for a couple of hours. That was wonderful. It was so much easier to handle contractions floating in the hot water. It was a couple of hours of reprieve.

When we went back to our room, Rae suggested I lay propped up on my side in bed for a half hour or so before I got in the birthing tub, so that I could rest and conserve energy to get ready to push. Based on how long I’d been in labor and how long and strong my contractions had been, we all assumed I’d be pushing soon. So I rested on my side on the bed. This sucked, because my contractions were so much more painful in that position, but it was nice to rest in between. After about 30 minutes, it was time for Kristy to check my cervix again to see if I was close enough to being fully dilated to get in the water birth tub. She found that I was only 5 centimeters dilated, which was surprising to everyone and very, very disappointing. I was only one centimeter further along than I had been almost ten hours earlier at my afternoon appointment. It made no sense.

Kristy said we could do a couple of things to try to help my cervix dilate more, and the first thing she wanted to try was breaking my bag of waters. She said there was about a 50% chance that this would do the trick and help me dilate fully. So she pulled out what looked like a knitting needle and used it to break my water there on the bed, in the process discovering meconium in my amniotic fluid. Although this can be a sign of fetal distress, Kristy wasn’t worried because the baby’s heart rate was strong (and I guess it’s more common once babies are overdue – meconium is basically prenatal baby shit, so when they’re overdue they’re more likely to have their first shit in utero). But she was disappointed because that meant I couldn’t deliver in the tub (since they’d need to suction the baby’s mouth and nose as soon as the head was born). I asked if I could still labor in the tub, she said yes, and I was satisfied. I really wanted to get back into warm water.

So they filled the big tub with hot water and I got in. I labored for about two more hours. It happened that I was the only woman giving birth on the labor and delivery floor that night, and all the nurses on duty kept coming in to observe the proceedings. Apparently, it was a fairly unusual thing to see a totally natural birth in this hospital, which surprised me, given the strong midwife practice. Of course, it remained to be seen whether I would actually realize my goal of a drug-free vaginal birth. My contractions were even stronger and much more painful since my water had been broken, and I did many of them on all fours in the water, trying to imagine my cervix dilating and basically willing it to do so. The contractions were starting to feel like more than I could bear, and I was trying to keep my good attitude, but I knew that if I didn’t dilate now we’d be in trouble. I worked as hard as I could to help that happen.

After a couple of hours in the tub, Kristy checked me again and found that I was only about six and a half centimeters dilated, nowhere near the ten centimeters I needed to be to start pushing. This was such a dark moment. Kristy explained what I pretty much already knew: that we had to do something to intervene at this point. I’d already been in active labor for twenty hours and we were running the risk of my becoming exhausted and the baby going into distress. She mentioned pictocin (the drug they use to induce labor and strengthen contractions), but didn’t seem too excited to try that. Neither was I, since my contractions were already very strong and I didn’t see how that would help my cervix dilate. It was starting to feel like this labor might be a long road toward a c-section.

Kristy got a tentative, thoughtful look on her face and said there was one other thing we could try, but she couldn’t guarantee that it would work and she had to warn me that it would be very painful (I think her exact words were “it will hurt like hell.”) Her tone seemed a bit ominous, but I definitely wanted to hear about it, whatever it was…

3 Comments:

Blogger Lisa said...

Oh my GAWD -- way to leave us hanging!

Oh, well, I can't stay mad at you. Nonetheless: more, please.

11:55 AM  
Blogger DoctorMama said...

Oof, I'm writhing at the thought of what she might suggest.

6:17 PM  
Blogger Jackline said...

Hi Nice Blog .A labor time management that tracks both direct labor and indirect labor activity, including the employee, activity, machine, part, operation, project, date, time, and hours. This module is fully integrated with the Timeclock screens provided by Time and Attendance System

11:10 PM  

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