Wednesday, July 17, 2013

The Birth

Note: This is a birth story. It's not as graphic as it could be, but if these things weird you out, skip it. If not, read on.

My plan for Wednesday, May 15th, was to see the midwife at 9 am and then spend the rest of the day cutting down one of my chapters to submit for publication. However, as I laid in bed around 7:30 am mustering the energy to get up, I felt a little gush of water. I froze and my first thought was, "Oh no, did I pee myself?" Then I felt a little more and I knew it was my water breaking. I got Jon's attention and more water came out when I got out of bed and stood up. I wasn't having any contractions and already had an appointment with the midwife, so I put on a pad and we took stock of the situation. The baby was on her way, about 2 weeks before her due date.

We spent the next hour packing a bag for the hospital in case we ended up going straight there from the midwife, though we figured we would probably come home first. The night before I had prepared several questions for the midwife to finalize our birth plan. The first question was about how long past due I could go before being induced, which was crossed right off the list since clearly she was coming before her due date! I also had questions about the time from water breaking until induction, which now was highly relevant. My goal was to have a natural, vaginal birth without medication, but I was not completely opposed to using drugs and certainly if the midwife said I needed a C-section then we'd roll with it.

At the midwife's office, she explained that she didn’t want to do an exam because the time since the first internal exam is more important in infection risk than the time since the water broke. I was pleased to hear this from her, since it was consistent with what I had read over the weekend. And it bought us time.

We went over the rest of the questions with her, and she told us to go home and wait for labor to get going. She wouldn’t be on call at the hospital (there are several midwives in the practice), but she said she would stop by on Thursday afternoon before seeing patients at the clinic (connected to the hospital), since by then we’d probably have a baby. She told us to page the midwife on call by around 6 pm to give them a heads up even if we weren’t ready to go to the hospital yet.

After leaving the midwife, I stopped at the chiropractor’s office next door to cancel my appointment for Friday morning. Then we ran a couple of errands on the way home, like picking up my transit pass and getting the extra pieces I needed for my breast pump.

We spent the rest of the day hanging out at the apartment. Around 11 am, I started having some mild contractions. Jon downloaded a contraction timer called Full Term on his phone, and we used that. I worked on the final birth plan, Jon installed the car seat, and I sent a few emails. I think we watched some Arrested Development. Jon moved the recently acquired dresser for clothes and diaper changing upstairs, cleaned it, and I filled it with baby clothes that were previously covering the guest bed. We called my parents and told them to come Thursday at lunchtime. I tried to eat and drink plenty.

Around 5 pm my contractions started being somewhat painful. Throughout the evening, I put my arms around Jon's neck and swayed during contractions. Around 9 we called and talked to the midwife on call about how I was doing (let's call her K) and mentioned that we would like a volunteer doula when we get to the hospital. My contractions were about 4 minutes apart but only about 50 seconds long. She said wait until they are longer and stronger, but we could plan to head in around 11 pm so we were there before midnight. Between 9 and 10, my contractions got up to about a minute long, so we called back and headed to the hospital around 10:30 pm. As we’d learned in our hospital tour just a couple of weeks before, we parked in the temporary parking, went in through the ER, and they called OB triage. Jon went and parked the car in the garage, and we waited just a few minutes before they wheeled me off. We went right into a birthing suite with a tub. The tub wasn’t a real birthing tub, more like an extra large bathtub, which was a little disappointing.

We met K, who did an internal exam and said I was 3-4 cm dilated and the baby’s head was fairly high. She also said that the lower part of the bag of waters was still intact, so although it ruptured up higher, there was still a lot of fluid in the lower part. They drew some blood and put in a heplock in case I needed an IV or decided to get drugs. They had to monitor the baby’s heart rate for a while, so I was stuck on the wired monitors for much longer than I would have liked and I was very grumpy about it. During much of that time I was standing and swaying during contractions. When I finally got off of the wired monitor and onto a “wireless” monitor, then I could walk around the room, which I did. Jon followed behind with the thing on wheels that was holding the “wireless” monitor (it did have a strap that I could have worn over my shoulder). Throughout this time I was occasionally drinking gatorade and sucking on ice. At 2:20 am K checked me again and I was 4.5 cm dilated. She suggested breaking the lower part of the bag to help the baby’s head descend because it was still fairly high. It was quick and I didn’t feel it at all but I felt a huge gush. Clearly there had still been a lot of fluid.

After K broke the lower part of the bag of waters, I laid down on my side for a while. During that time the doula pressed on my back and I squeezed Jon's hand. At some point while I was walking around, I started to feel like I was going to throw up. They brought over a garbage can and a contraction or two later I threw up several times in a row. First I just threw up liquid, but once that was gone I threw up the pasta I’d eaten around 9 pm before we left for the hospital. My guess is that that was sometime between 3 and 4 am. I was kind of excited to be throwing up because I thought it might mean I would be able to start pushing soon. Around that time the doula said she thought the baby would be born by 5:15 (ha!). The nurse brought in the delivery supplies, but they didn’t actually get them out and set them up until hours later. She wasn't born anywhere close to 5:15 am.

After laying down for a while and feeling exhausted but unable to sleep, I decided to get in the shower. Jon had to hold the sprayer because the sprayer holder had come off the wall (I’m sure from a woman in labor pulling on it). To make matters worse for Jon, the sprayer had a leak where the hose attached to the sprayer head so it sent water everywhere. I’m not sure how long I spent in the shower, but it was long enough for the tub to fill up. Sitting in the tub wasn’t very satisfying though, because by that time the water wasn’t very hot and the tub just wasn’t deep enough to be comfortable. I probably only spent 1 or two contractions in the tub. Around that time I started to feel the urge to push, so the nurse went and got K and she checked me when I got out. I was 6 cm dilated. She told me I wasn’t ready to start pushing, and she said I should breathe deeply through the contractions and try not to push. She said I was still progressing well though. The next few (several?) hours of labor were the most frustrating. I spent some of the time lying on my side again, some of the time standing, and some of the time in the shower again. I felt like I was fighting my body’s urge to push.

The volunteer doula shift change was at 7 am, so a new doula joined us. Then the nurses and midwives changed at 8 am, so K left and midwife P joined us with a resident who was on rotation with the midwives. The midwife checked me at 8 am, but I was still only 6-7 cm though the baby’s head was a little lower. Still not close to being able to push even though I felt like I needed to.

At 8:35 I was 8 cm. I remember laboring standing near the bed for a while the doula pushed on my lower back during contractions. I was continually leaking some fluid and blood that dripped down my legs. I regretted not bringing flip flops because I didn’t want get blood on my shoes so I was walking around barefoot. It didn’t bother me at the time, but later I was kind of creeped out and paranoid about picking up athlete’s foot or MRSA or something. I had the urge to poop, so I went and sat down on the toilet and did actually poop.

Finally, P checked me and said there was just a small lip of the cervix still in the way. She said she might be able to push it out of the way during the next contraction, so she waited and did. Then finally I could start pushing! The midwife and resident suited up, they set up the room for delivery, and P started suggesting different positions for me to push. First she had me squatting on the bed. The end on the delivery bed lowered (not tilted, but a whole section lowered), so I sat at the edge of the higher section with my feet on the lower section and held onto a bar they installed across the table. I’m not sure how long I labored there, but after some time she suggested I switch to side-lying. Then she had me switch again to a position where I was semi-reclined but I used a sheet over the bar to pull into more of a squatting position during contractions. I had my eyes closed for almost the entire pushing phase. I hardly knew what anyone in the room looked like because I was so focused. I made so much noise during contractions. P told me to grunt and groan more deeply.

Pushing was by far the most satisfying part of labor because I could feel the progress. The midwife told me to use the whole contraction and I usually got 3-4 pushes per contraction. I felt like it was 10 minutes between my contractions, but they said it was only 3 or 4 minutes (a bit longer than ideal perhaps but not as long as I thought). I could feel when the baby really started to descend, and when I had pushed her further. A couple of times her position felt precarious so I tried not to move between contractions so she wouldn’t slide back up, but both times she did. P said not to worry because I’d get her back there on the first push of the next contraction. So the goal each time was to first push her back to where she was, then push a little further. When they could see her head, they asked me if I wanted to feel. I reached down and could feel part of her little hairy head. The doula had a mirror so I could also see it. Based on feeling that little part of her head, I imagined how big her head must be, and it seemed quite small. Given that and her early arrival, I was a little worried that she would be tiny (under 6 pounds), though that would make her easier to push out!

I felt a little bit of pain in my pubic bone (like I had felt for the last few months of pregnancy), but just once. I suspect it was when the largest part of her head passed through my pelvis. After feeling her head that once when only a small part of it was at the opening, I didn’t feel her with my hand again. I have no idea how long it was or how many more contractions until she was out. The midwife noticed I was starting to tear, so they were putting pressure on that area.

They didn’t say when her head was out or that I was getting close. I don’t remember what it felt like when she finally emerged-- suddenly they were handing her to me and putting her on my belly and she was SO MUCH BIGGER than I imagined! She had a little misshapen spot on her head, which was the part I felt and why I thought she was tiny. She was crying little waaa waaa waaa noises and they were taking her temperature and suctioning her nose. She was warm and sticky. They wiped her off some and I moved her up to my breast and she latched on right away. As I held her I started crying tears of happiness and I said, “I did it.” The sense of accomplishment, pride, and relief that I felt was almost exactly how I felt when I turned in my dissertation.

Adele entered the world at 11:45 am, about 28 hours after my water broke and about 24 hours after contractions started. She was a perfect 7 pounds 10 ounces and 19 inches long. I did it without any medication, though I absolutely thought about pitocin and epidurals and c-sections several times during labor. I totally understand why they use them!

We delayed cord clamping, so after a few minutes the midwife handed me the cord and asked if I felt anything. I said no, so they clamped it and we let the doula cut the cord. After that, the midwife said, “Ok Karina, give a little push for the placenta.” I pushed, and it felt uncomfortable, then painful. Jon was in the middle of composing an email to his family on his phone and had typed, “Everyone is happy and hea” when things went terribly wrong.

Next post: The Calamity

1 comment:

Anonymous said...

A cliffhanger... I'm glad I already know that you and the baby are healthy now.