Wednesday, October 22, 2014

Sam's Birth Story or A Great Nurse Makes All the Difference

After all the anticipation of the last weeks of my pregnancy with Olivia, I discussed the possibility with my doctor of not doing so many cervical checks because the whole thing is just so stressful. She agreed that if everything seemed normal when I had the Strep B test done at 35 weeks, I could skip until 38 weeks. So not exactly what I was looking for, but at least it wouldn't be a weekly event where everyone and their brother would ask how far I, the freak show, had progressed without actually being in labor.

We also discussed how to approach my actual labor. I detest being hooked up to the machines. I hate that my comfort as a laboring mother takes second (or third) place behind the requirements of the machines and the convenience of the medical staff. We discussed, with the eventuality of inducement in mind, about the possibility of avoiding the machines. Since my induced labor with Olivia went so well and so quickly, my doctor agreed that as long as I was not on pitocin, she would only require a heplock during my labor. If I needed to be induced, she agreed to only break my water, not immediately hook up pitocin, and watch to see if labor would progress well enough on its own without further intervention. I was happy with this agreement. Even if not having the pitocin elongated the time of labor, it was worth it to avoid all those wires and machines.

We also had to discuss one last issue. During Olivia's pregnancy I had developed some pain in the area between my legs and my pelvis. This is a hard spot to describe where it hurts. Not really my legs, not really my hips, but it felt like my legs were being pulled out of their sockets. If I tried to stand on one leg, it was agony and very unstable. It was nagging but not terrible with Olivia and I didn't really research it to figure out what was happening. With this pregnancy, I had the same pain again except it hurt most of the time. I had trouble standing up and walking without warming up into a full upright stance. Putting on pants was a chore since you have that moment of balancing on one leg. I was in almost constant pain. The doctors seemed to have no answer beyond it being the normal aches and pains of pregnancy. I did a lot of research and found it was probably pelvic girdle pain and could be a pelvic separation. Doctors in Europe seem to recognize the problem, but doctors in America? Not so much. One of the tidbits I found in my research is that delivering on your back aggravates the condition. As a result of my reading I decided I WOULD NOT deliver on my back ever again. I had to explain my thoughts to my doctor and she was fully open to any position I preferred, so we were all set.

At 35 weeks, I had the strep test and first cervical check: 3cm. Of course. No check at 36 or 37 weeks which made my mother extremely nervous. She thought I was being reckless. I thought I was only trying to reduce my stress levels. There was nothing to be done no matter how far I had dilated so I'd just rather not know.

At 38 weeks came the next check: 4cm. See! That wasn't so bad. At 39 weeks came the next check: 5cm. "Do you want to be induced?" "Not really." "I don't want to wait another week to see you. Come back in a few days."

The day before Sam was born.

I thought this was a good belly shot. The view from above!

On July 1, 2010, at 39 weeks and three days, I returned to the doctor and she checked again: 6cm. "I want to induce today." "I suppose." I really don't like being induced but it is the standard treatment for precipitous labor.

My appointment was scheduled for first thing in the morning so afterward, I did the next logical thing; I went back to work. This was a surreal feeling. About ten days prior, word had come down that one of our servers was being taken out of service and all the users with our software would have to have an update installed to redirect the pointers to the new server. Since the shut down was scheduled to happen during my planned maternity absence, I had spent the last week or so in a mad dash to visit and reinstall all of our users in the building before I had the baby. Visiting so many people while nine months pregnant is comical. I had to repeat every detail multiple times a day. There's nothing to reinforce the ego like having a random acquaintance tell you that you look huge several times a day. Most times they also wanted to know when I would have the baby. On the day I went back to work after my inducement was set, I got the special amusement of telling my shocked audience that the baby would most likely be born that same evening.

After I was back at work, my doctor called and told me that all of the appointments for the day had already been booked so she scheduled me for 7pm that night. I now had an entire day to mull on my fate. Knowing that you are definitely going to be in labor later that day but aren't right now is pretty distracting.

To help pass the day, I decided my father was going to take me to lunch at a nice restaurant. I called him at work, told him that the doctor wanted to induce that night, and asked him to take me out to lunch at a local Italian restaurant. He obliged. We went to eat and I had a huge meal with appetizers and salad and bread and pasta with vodka pesto sauce, and dessert. Yummy and filling. I figured since I knew what was coming, I deserved a good meal on the front end. Daddy and I talked a bit about the upcoming evening and then he brought me back to work. I tied up all my loose ends and decided about mid-afternoon to go home.

After I was home, I spent the rest of the afternoon spending time with Grace and Olivia. At the end of pregnancy, I always feel compelled to gather my born children around me and soak in the last moments of the old normal. Dave took a few pictures of the girls during the day for us to remember them the day their brother was born. Since I had a huge lunch, I was not in the mood for supper. I took a shower. The others ate supper while I relaxed on the couch and then it was time. Around six we loaded the girls up in the van, brought them to my in-laws for the night, and then set off for the hospital. We finalize our name, Samuel David, on the way. We know that this baby is supposed to be a boy.

When we got to the hospital around seven, they told me the room wasn't ready yet so we had to wait. We sat in the waiting room for awhile and then finally they brought me back to a room. I think the time was 730-745. I walked into the room quite apprehensive. I knew that I had extensively discussed my expectations with my doctor, but my doctor wasn't there yet. I had to make it through the nurses first. I walked in expecting to have to argue and advocate of my behalf and then deal with nurses who thought me unreasonable. You never know who is going to be waiting on you at the hospital and I wasn't sure how much would be in my chart or even if the nurses would read it if it were there.

My main nurse, Susan, introduced herself and the assistant immediately started prepping me for all the bells and whistles. I quickly said that my doctor had agreed to no IV, only a heplock and intermittent and not continuous monitoring. The assistant looked baffled, but my nurse didn't miss a beat. She said they would have to confirm with my OB when she got there but it shouldn't be a problem. I then broached the topic of delivery. I explained my pelvic pain and how I did not want to deliver on my back. I expected some kind of pushback here, especially when I said that I also preferred for her not to count at me. Instead of giving me the hairy eyeball, she had a very positive attitude and immediately started making suggestions about positions that might be less stressful. I also told her that I did not want the baby given a bath after birth because I was not going to have the debacle with Olivia replayed a second time. She, again, indicated it was no problem, noted a non-separation order in my record, and acted like nothing I requested was out of the ordinary. And I breathed a sigh of relief. The assistant inserted the heplock, which was in a terrible place on my wrist and even to this day I can feel if I push on my wrist in the right spot, and we waited for the doctor to arrive. I, of course, also took my trusty Pepcid. Never labor without it.

It was after 8 o'clock now. My doctor arrived and she and the nurses all got on the same page. She also asked if it was okay if a resident delivered the baby. I always feel a strange obligation to let the residents deliver. I know that I have unusual births so I feel like the resident needs a chance to see someone like me. And, really, I don't mind. We were ready to begin.

For intermittent monitoring, she required that I be on the monitors for 15-20 minutes every hour and then I would have the rest of the hour off the machines if everything looked normal. She decided to do the first session of monitoring before she broke my water so we would have a normal base to compare. So I was hooked up to the hateful belts again, but it wasn't so terrible because I was not having contractions.

Me waiting for the party to start
My parents and my brother and his wife had come to the hospital to keep me company. We all just hung around and talked while the machines beeped. Finally the doctor decided she had enough data. I was freed from the monitors and it was time to break my water. Everyone stepped out of the room. The doctor checked my dilation one last time, 6.5cm, and then did the deed. This is always such an odd moment. The time was 9pm.

Everyone returned and we waited for the contractions to start. It didn't take long. I was having regularish contractions within ten minutes. Hello, back labor. I was sitting straight up in bed and moved around to find the most comfortable spot that kept the weight off my back. I think I was sitting up on my knees, but I don't quite remember. But the contractions weren't bad enough to make the company leave. That didn't last too long.

By 930, the contractions were pretty strong and I decided I wanted to go to the bathroom. My parents and brother used that opportunity to go visit the waiting room for the duration. I was so grateful to not have to unfurl myself from a hundred wires to get out of the bed. I walk over to the bathroom uneventfully and empty my bladder. The contractions were real and relentless now. I walk back over to the bed and lean into it with my weight on my arms. Wave after wave of pain in a near constant pain of back labor.

The time is now around 945 and it is time for me to be hooked to the machines again for the next session of monitoring. I have a moment of despair. How am I going to get back in that bed? I can barely move. How am I going to endure the worst of transition while having to lay back to let the machines work? My nurse asks if she thinks I can get into the bed. I just look at her and shake my head. In an act for which I will forever be grateful, she does not make me get into the bed. She reaches over, grabs the monitoring belt, and holds it to my belly while I stand leaning into the bed. And there we stand for fifteen or twenty minutes: she holding the monitor so I don't have to move and I leaning over the bed in agony.

The time for monitoring was finished and everyone knows that birth is close. The time is around 10pm. My nurse tells me she is going to stack pillows on the bed where I can be in a hands-and-knees position to push. My knees would be on the bed but the stack of many pillows would serve as upper body support. She also reassures me that we can change anything if it isn't working for me. I climb into the bed with help, grateful to not have to flip over. I put my knees down and flop forward into the pillows letting them completely support me. I begin to feel the urge to push, but the nurse tells me to wait. Everything is still being set up. I indulge a little, but not too much because I can't see what is going on. It is all happening behind and below me which is an exposed feeling. Dave reaches his hand to me.

Finally I am given the all clear and I begin to push. I feel his head engage and I push again. He is moving quickly and all of a sudden I feel him begin to crown. This time the pain does not shock me. I remember this pain and know it is almost over. I remember what the nurse from Olivia's birth said to me and I repeat it to myself here. "Don't draw back from the pain. Push through the pain." I give another hard push and his head is out. My doctor tells me to stop pushing because his hand is up on his face and she needs to adjust it. Again I am cleared to push and with the next contraction, I push and he is completely delivered. Time of birth: 10:14pm. He cries as they clean him up. His size is 7lbs, 10oz and 21in long. About the same weight as Olivia, but several inches longer than either girl. Total time of labor from rupture to birth: One hour and fifteen minutes.

Shortly after I deliver the placenta and I am stitched up again. Second degree tear right down the same ole scar line. I nursed him which went so-so. His latch as a newborn was never great. Everyone returned from the waiting room and we all visited for awhile. Since it was late in the evening, nobody was in a hurry to rush me out of the delivery room. So instead of being wheeled out at exactly hour after birth, I didn't leave until around midnight. This was so much more relaxing instead of being hurried out of there like I was in somebody's way. And when I got to the recovery room, I was even given the option of ordering some food, even though it was late. That was a nice change.

Sam was never separated from me and we visited until late in the night. The next day the girls were brought to the hospital to meet their brother and they were thrilled.

This birth was, by far, my best experience of birthing in a hospital. I was pretty much left alone as much as a hospital will leave you alone. My only complaints were that the heplock was in a really bad spot and the recovery nurse was apparently unaware that I had had no IV fluids and so expected a lot more bladder output than I was producing. Once that was clarified, she backed off considerably. I couldn't ask for better in my delivery nurse. She was positive and calm and helpful. She could have made me miserable with my nonstandard choices, but she went above and beyond to make everything go well.


The Sojourner said...

My baby was delivered by a resident, but that was not premeditated--the nurse had my doctor paged when I was 8cm and then figured out a few minutes later that he was not going to get there in time and dragged in a poor hapless resident. :) (My doctor showed up about 5 minutes after the birth and spent over an hour foiling my repeated attempts to bleed to death, so I think he earned his keep.)

Everybody seems terribly shocked by the fact that he didn't show up in time (as if he is neglectful or inattentive for it) but from reading other birth stories I think his only "flaw" is that he doesn't make you wait to push. God bless him for that. (And God bless my nurse for not trying to slow me down either.)

I hope you don't mind that I am using your birth stories as a platform to yak about my own. Birth is fun to talk about and I've only done it once so far (the birthing, not the talking), so I might get a bit repetitive.

Jenny said...

I love talking birth stories so don't you mind.

If your doctor doesn't make you wait to push until he is perfectly set-up and ready to go, that is rare indeed. The wait to push command is the only reason most doctors even attend births. They run around trying to be as efficient as possible and rely on the nurses to tell them when the business is at hand. Especially after the first birth, if you just pushed when you felt like it and told the nurse that you were pushing, the doctor would hardly ever make it in the room. My doctor was actually present here, but they were in the middle of tearing down the bottom of the bed and I didn't want baby to fall on the floor. :D

The Sojourner said...

He does have something of a reputation for missing births. :p It's probably the natural result of his reputation for being *the* guy to see if you want a natural birth, so A) he has a ton of patients, and B) they are waiting until the last minute to come in and not getting epidurals and doing all sorts of crazy stuff that makes it harder to time their labors exactly.

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