Tuesday, November 20, 2012
The Birth Story: Making Peace with My C-Sections
I'll start by saying that this labor was the longest. I was at the hospital for 34 hours before he was delivered, but it is also the delivery that I feel the most at peace with, knowing that we truly did everything that we could do... especially considering the surprise position he was in when he was finally delivered!
Many of you already know the beginning of the story, since I blogged while I was bored and Paul was napping in the hospital, as the many hours slipped by and the idea that we would need another c-section loomed larger and larger, until the doctors could talk of nothing else and we bargained for a few more hours, finally admitting that they were in fact right and that the VBAC simply wasn't going to happen. But I'm getting ahead of myself:
The end of this pregnancy was a balancing act. You see, I wanted a hospital birth with an OB, after the drama of Sadie's birth with five hours of pushing, and the failed miscarriage with a D&C three months later. I was incredibly fortunate to find a doctor who agreed to let me try a VBA2C, since the common answer to that question is an adamant "no." But there were compromises to be made. The first was that I wouldn't go past my due date if he was going to allow me to try, since we have had consistently large babies. The second caveat was that I would go to the hospital as soon as the contractions started.
Quite a few people questioned the wisdom of agreeing to the second part of that deal, but after spending nearly a week at the hospital with our not so little mystery illness, I actually felt pretty good about going in at the beginning of my labor. The nurses and doctors I'd met seemed incredibly supportive of their patients. Besides, it was part of the deal, and since I had a doctor that was actually going to let me try a VBA2C I thought I'd at the very least keep my word and do the things that I'd committed to doing to make the practice feel slightly safer about agreeing to a trial of labor.
On Wednesday morning I was supposed to arrive at the hospital at 9 am to have my water broken. At 8 am I called the hospital and found out that the induction had been cancelled, because labor and delivery was slammed. I had mixed feeling about the cancellation. You see, I'd been having pretty steady contractions if I was standing up... which pretty much meant contractions all day, on the previous day. According to the deal mentioned above, I was supposed to go in, but since I was being induced and since they stopped when I laid down, I'd put it off. Now I was up walking around and they were between a minute and a half and three minutes apart and were painfully strong.
After steady contractions all morning Paul and I decided to walk to the hospital, which is less than a mile from our house, and see if the contractions continued. By the time I got to the hospital the contractions were a minute to a minute and a half apart and strong.
I went inside and was admitted to the L&D triage, where I was checked. The Boy seemed to be in an odd position, they thought his arm was above his head, but after an ultrasound found that he was head down and ready to go. I was having regular contractions, but at that point was only at 3 1/2 and so they decided to release me. When Paul and I were in the room alone together I told him I thought that my OB would be mighty unhappy if he learned I'd been there and had been released.
A few moments later the door opened and another nurse appeared to tell me they'd gotten a hold of my doctor and I'd been admitted to labor and delivery.
Word came back almost immediately that whoever had told me that I'd passed the GBS test at the last appointment had been wrong, and not only had I not passed, but the strep was immune to pretty much every antibiotic available, and of the two that worked, one was penacillin, which I'm super allergic to. The drip would be another two hours of the super antibiotic I'd been on for the mystery illness. And they couldn't break my water until the medicine was in my system, so we were in for more waiting.
As we finished the antibiotic and the nurse came in to stop the sounding alarm that told us that the drip was empty, I felt a strange almost-not-quite pressure and thought "I think that my water's about to break!" About ten seconds later there was a pop and a rush, that was nothing like the movies, since it lasted for the rest of labor, anytime I moved or shifted and wasn't an-all-at-once sort of thing (my water broke at home with labor #1, but was only a few drops since the 9 lb baby's head was firmly in the way).
My OB appeared, about fifteen minutes later, to break my water and was happy to hear that it had happened on its own. This was it. It was time to have the baby. And I was thrilled that it might happen naturally without any induction at all.
Except that it wasn't happening naturally. The contractions, which had been fairly constant now even when I was laying down at around 5-8 minutes apart, tapered off to longer solid 10 to 12 minute periods. I went to sleep hoping that things would pick up and that we would have made progress in the morning.
In the morning I was still a disappointing 4 cm. But I was relieved that I'd slept through the night. And with twelve hours of nothing happening I agreed to a slow, slow pitocin start.
I was surprised when this time around having a pitocin drip was nothing like being hit by a freight train. With my first labor the pitocin was turned on, the epidural was turned off because of the decelerations in baby's heart, and the whole thing was incredibly horrible, really fast.
This time the contractions picked up slowly and were completely bearable. My doctor told them to turn it up at about half the pace it would normally be turned up at, and then gradually it was turned up higher. I spent the day walking and breathing and listening to my hypnosis tracks. I strolled the halls and bounced on my birthing ball. The contractions were less than three minutes apart but by using my hypnosis training from the past few months I was actually feeling pretty amazing. I told Paul that the "happiness" part of the hypnosis instructions that followed each contraction were pretty amazing because I did feel incredibly elated after each one.
When they came in to check me that evening, after having powerful contractions regularly all day, I was ready to be told that I was at least 7. I'd been 5 by late morning. I was sure we were nearly there. Maybe we'd even be 10. First a nurse checked and the news wasn't good. I was still 5. Then another nurse checked because they were really hoping for some sort of change. Still 5.
My doctor's office partner (one of the nice ones who I'd met during my last stay) came in and talked to me about an intrauterine catheter. He said that at this point they were becoming increasingly uncomfortable about the level of pitocin I was on (10-something, which was now being referred to as a "high" level) and how long I'd been on it and the stress on the scars. The catheter would measure the contractions and would let them know instantly if my uterus ruptured. Reluctantly I agreed.
The catheter was placed and it was obvious that contractions were incredibly strong and then... things got crazy.
The contractions were suddenly completely beyond anything I could deal with. The nurse who was in at the time thought it was likely a combination of the high levels of pitocin and the catheter irritating my uterus. Even with the hypnosis tracks I couldn't relax at this point.
I'd been at the hospital for 32 hours. I'd been having regular steady contractions for quite a bit longer. And I was still at 5.
I looked over at Paul, in between one minute apart still not doing anything contractions, and asked him to get somebody for an epidural.
My doctor's office partner returned and told me he could administer morphine if I still wanted to avoid an epidural (I thought, in some vague, not pain wracked corner of my mind that this was kind of funny since my own OB had really, really wanted me to get an epidural at the start). I shook my head and asked for the anesthesiologist. The doctor asked me to explain my logic and I explained how with my first labor I'd been stuck around five and had had an epidural and had pretty quickly progressed to 10. At this point natural wasn't working. Pitocin wasn't working. I thought that maybe, just maybe if I had an epidural I would be able to relax enough for things to begin to progress.
Three contractions later (which was actually a very short amount of time, but which felt like forever...) the anesthesiologist arrived. After another contraction while sitting up, the epidural was in and slowly began to work, while I panicked on the inside, thinking that it wasn't working because when I had my epidural with labor #1 it was pretty much an instant sort of thing.
The new OB came in and talked with me about their concerns because nothing had happened. She told me that she was praying for me and the baby that this would work out, but that we needed to start thinking of other options too. I asked if we could give the epidural a few hours, and see if it would help me progress and she said yes.
I'd asked for the pitocin to be turned down while we waited for the epidural and it had been. Now we slowly had to restart it from a low level. Half way back up, baby started having decelerations and the pitocin had to be turned of completely for five minutes and then restarted again. Things weren't looking good for my VBA2C as the contractions went back to 10 minutes apart on their own. Slowly we successfully reintroduced the pitocin.
A few hours later I was checked again and received the news that we were still at 5 cm. I knew what that meant. After 34 hours of labor we were going in for a c-section.
I think everyone there was ready for me to have some sort of a nervous breakdown at the point. I'd been pretty adamant, throughout the majority of labor, about how I wanted to do this... and while I'd conceded to pitocin when nothing happened for so long after my water broke, I had hoped to go as natural as possible. The thing is, I wasn't devastated.
Oddly enough, I felt content.
We'd done all we could do during this trial of labor. I'd been up and about. I'd refused pain killers for 32 hours. There was really nothing else that we could do to make my uterus work. I do think that after two c-sections and the mess up after the miscarriage that involved contractions for 3 solid month, my body just isn't quite what it was. When I was having contractions the majority of the pain was right along my scar (although we'd soon find out that the scar tissue was thick and strong and that the doctors think I have another two c-sections in me). And I find myself wondering if the retained placenta during the miscarriage (and the 3 months of contractions that didn't get rid of it) was a sign that not all was right with how my uterus works after so many surgeries.
The operating room was crowded during the c-section, with lots of people ready to take baby once he arrived (I think because it's a teaching hospital, so there are always plenty of doctors and students there learning). The scar tissue was thick and I heard the discussion about widening the incision so that the baby could fit (sign #100 that baby wasn't small). Then he was out and was being cleaned up right there in the room.
I loved that! In California baby was taken away for over an hour both times just to be cleaned and bathed. Here they offered to put him on my chest, although I did have to refuse that until after I'd been sewed up because I was feeling so nauseous.
He was our smallest baby at 8 lbs 12 oz, but he was 22 inches long, just like his biggest sister and his head was 14 1/4 inches around.
After the c-section the doctors told me that he was actually transverse. Transverse babies that aren't turned are always c-sections. Sometime after the ultrasound when I'd come into the hospital he had turned back (he was transverse for most of the second and third trimesters). There was no way I could have delivered him naturally, even if my uterus was working properly.
Yesterday at his doctor's appointment a medical student asked me about the labor and I said that yes, it was a c-section after 34 hours of labor, but it really wasn't a bad labor at all. I don't think she believed me. But it's true. I would count this labor the best of the ones I've gone through so far. We did everything we could and things turned out the only way they really could have. I'm at peace with that.
And next time... if we are ever blessed with a next time... I know it will be an automatic c-section. And I'm at peace with that too. It may not be the birth that I dreamed up or hoped for, but holding my healthy little guy in my arms is all that matters!