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Tuesday, February 13, 2018

Ella's Birth Story or Average Length Labors are Lame

This birth started weeks beforehand when I had the long-expected conversation with my doctor about my labor history and when we wanted to schedule an induction. I should reiterate that I hate being induced. I hate picking birthdays. I am annoyed that if I lived close to a hospital, I would not be required to pick out my children's birthdays. But what do you do? After some schedule discussion, we arrived at Tuesday, September 12th as the agreeable date.

The first week in September I received a phone call from the hospital explaining their requirements for my confirmed appointment. I was to arrive at the hospital at 530 in the morning and also fast from 11pm the previous evening and refrain from even water after 4am. I politely acknowledged the information on the phone. I exploded in despair and indignation after I hung up. My last induction by advanced appointment did not require my appearance until 7 or 8 in the morning, and if you expect me to walk into labor starving, you're crazy. I've done that before and I am not doing it again. You can't make me.

My last appointment before the scheduled induction was on Friday morning, September 8th. I had an ultrasound and then the regular appointment. The strange thing about having all these ultrasounds is that it leaves little for the regular appointments. They take my weight and my blood pressure, do the cervix check that tells us almost nothing and do I have any questions. Not really. No belly measurements. No heartbeat check. It is all done by ultrasound. Boring.

At this last appointment for the final undignified cervix check, it was only 4cm. It had been 4cm the prior week too. I knew this was an ominous development for the induction. I have never previously been induced before 6cm and that particular measurement has never presented itself within a week of 4cm. My body was obviously still in a holding pattern.

The induction date was technically moveable except my doctor was leaving town for a week on the 15th of September. Asking to move the date would mean another week of Non-Stress Tests, which you have to sugar up baby to pass, another ultrasound, another appointment with a different doctor who would likely freak at an unknown patient walking around dilated at 4 or more cm, and another week of finding babysitters so I could spend four hours commuting back and forth to Nashville twice.

I inwardly sighed. I knew it was too early. Even though I'd be past 39 weeks, I knew my body wasn't quite ready to go. I thought I probably needed another week. But I was also tired. Tired of being pregnant. Tired of driving up to Nashville twice a week. Tired of paying for expensive tests. I chose not to open a new round of induction negotiations, but I knew it what it probably meant to go silently along. I did manage to get my last NST for Monday cancelled. Schedule nurse looked at me like I obviously hated my baby and dubiously cancelled the appointment.

On Monday night we had dinner at my MIL's house and we left three of the children there to spend the night in order to avoid an extremely early morning drop-off. I asked Grace if she wanted to come along to the hospital with us and she decided to go. My parents were coming to wait and she could stay with them when it all got real. I was wired late into the night getting everything together. I didn't get into bed until after 11 and am not sure when I fell asleep. The alarm was set for 4am.

The alarm sounded. Groan. Snooze. I barely budged. Grace was already up and dressed when I got out of bed. The nausea I had never quite shaken loose was still there. I got dressed. Dave made me a breakfast of toasted bagel with cream cheese and apricot jelly with a large cup of ice water. Fasting? As if. It was too early to eat anything much heavier. I took my last dose of the magic Prevacid. We got into the car around ten minutes after 5. We were officially running late. What else is new? We drove into Nashville in the dark in the pouring rain as the remnants of Hurricane Irma pushed through the area.

We arrived at the hospital a little before 6, checked in, and took our seats in the waiting room. The windows were dark, but the waiting room was bright with overhead fluorescents. The TV blared with some bad movie that is only played in the dead of night. Grace was excited to see the pregnant woman waiting across the room was reading Harry Potter. We waited for about 45 minutes. I was so sleepy.



Finally the nurse called us. Her name was Sam, short for Samantha. This is funny because our Sam didn't exactly believe that girls named Sam existed and now he would get to meet one. As we walked back to our room, she asked me, "Are you ready to have a baby today?" "Not really," was my response. She didn't know what to think of this. She was rather taken aback.

We arrived in my room and my medical history taken. After the fact I discovered that Grace was recorded as a neonate death. Weird, huh? I confessed that I was not fasting and, shockingly enough, nobody cared. The horrible monitors strapped to my belly. The nurse inserted my IV and I learned my gut feeling that she hadn't been nursing very long turned out true when she put the needle into my arm and struggled to feed it into my vein. Ouch. Ouch. Then the more senior nurse came over to talk her through it. But she has to learn somehow. Why not me? My veins are easier than most. The resulting bruise took over two weeks to resolve.

I was handed my neverending cup of Sonic ice and waited for the doctor arrive. Since I was Strep B positive, the original plan was for me to be hooked up to the antibiotic IV for at least an hour before starting the induction. They prefer the antibiotics be present for at least two hours and preferably four before delivery. With my history, there was no guarantee we would hit the two hour mark if the antibiotics and the induction started at the same time. With my lateness and the waiting room delay and getting all the things hooked up and recorded, it was now approaching 8 o'clock. My doctor had office visits to attend. She decided to start the antibiotics and break my water together without a delay in between. She checked my cervix one last time. Still 4cm and 60% effaced. That's it?!? I knew this labor was not going to be the same. The deed was done at about ten minutes to 8, and I was now on the clock. After the bag of antibiotics finished, the IV was disconnected and a heplock was taped into place.

Whether by induction or spontaneously, all of my labors have begun with my water breaking. After that, the contractions begin within 20 or 30 minutes. That did not happen this time. 20 minutes passed. Nothing. 30 minutes passed. Nothing. I was restless and bored. My parents arrived at some point. Nothing was happening. Baby's heart monitor blipped away, but the contraction monitor was flat.

Finally, after about an hour, I felt the first twinge. Slowly over the course of the next hour I fell into a labor pattern of one contraction every five minutes or so. My dream of delivering in the ten o'clock hour withered on the vine. (All my previous kids were born in the 10 o'clock hour, am or pm.) Some contractions were strong; most were weak, but they steadfastly stayed at five minutes apart.

After the contractions fell into a pattern, we began playing the game I hate the most about birthing in a hospital: attempting to keep the baby on the monitor. I move to get comfortable, the monitor loses the baby. Baby rolls away, the monitor needs readjusting. Everything focuses on that blipping machine. People who are in the room to supposedly support me watch the machine instead. The nurses come to check on the machine not me. My pet peeve is when someone who is staring at the monitor announces to me I am having a contraction. "Jenny, you are having a contraction now." Yes, I am aware. You could ask me.

After an hour or so of this game, the nurses decided I would be a good candidate for a new fancy wireless monitor. They disconnected the belts and taped this gizmo to my belly that had a central piece with five contacts taped to different areas. I wish I took a picture of it, but I did not. The idea is that you can move freely and the different contacts will still pick up contractions and heartbeats without the mother having to placate the machine.

The first nurse attached the wireless monitor to me and turned it on. Nothing happened. She asked for assistance from a second nurse. Nothing happened. They called for help at the nurse's station. More nurses came in to tinker with the machine. They changed the battery. They reset it. They turned it off and on. At the height of the fiddling, there were five nurses gathered around the computer screen trying to get the receiver to work, while I had my contractions, unnoticed, beside them. Finally a miracle! The wireless monitor started communicating with the computer. Hurrah.

Directly after this hubbub, a med tech came in the room to set up the delivery supply table. She explained they set everything up early so no one has to wait if baby comes faster than expected. She was an older lady and chatty. Not chatty in a good way. After the monitor excitement, my mother felt need to explain to the med tech that my father likes watching the monitors because he is good with numbers. The med tech assumed he was an accountant. No, an engineer. Oh, an engineer! What kind of engineer? A structural engineer! She begins to explain the structural foundation problems in her house. Her son's house? Somebody's house. She kept talking. Daddy kept answering. I kept having contractions in the bed every five minutes while some stranger nattered on for free advice. This went on for much longer than I preferred. It was one of those moments where I noted the ridiculousness of being in active labor while a random hospital employee shoots the breeze with my parents about a totally irrelevant subject.

Perhaps sensing my agitation after all the extra people exited the room, the older nurse suggested that I get out of bed and sit on a birthing ball. The fancy wireless number stopped working (because they can only to get it to work for an hour before it dies?) and I was back on the belts. After a little bit of time, they disconnected the monitors and I was free for awhile. I sat on the ball, contracted every five minutes, and scrolled Facebook while chewing ice. Grace read. Dave and my parents shuffled out for food. An hour passed. They turned the monitors back on for 20-30 minutes. I contracted every five minutes or so. They shut off the monitors again. Another hour passed. I was annoyed at how long this was taking. It was lame. The temporary adrenaline of the morning wore away into the monotony of slow progression. The previous evening's lack of sleep had caught up to me and I was intensely sleepy.

At 1:30 it was decided I needed to be checked for a status update. Back into bed. Almost 6, 90% effaced. Sigh. All those contractions and I was still not as far along as I usually am before labor even starts. I was vocally discouraged. The nurse started talking to me about nipple stimulation. I just stared at her. She said I had to be be rechecked in an hour. I decided what I really needed was a nap. I announced my intentions, shifted onto my left side, and slowly relaxed into a horizontal position as the bed was flattened beneath me.

WHOA!!! I bellowed as I flailed like an overturned insect, clawing to be set aright. The newbie nurse Sam immediately sought to bring me succor. "Do you need an epidural?" she asked. "I need to sit up!" I snapped back. Horizontal was a bad, bad idea. The bed was moved all the way back up. Pillows were arranged to support my upright position and I settled in to rest.

Since I was still contracting every five minutes, I never went to sleep. I kept my eyes closed and relaxed as best as I could. It was the best nap you could imagine while not actually sleeping and still having contractions. Contraction. Five minutes of psuedo-sleep. Contraction. Five minutes of psuedo-sleep. It really wasn't half bad. An hour passed.

It was again time to see how the progression was coming. 7cm, still 90%. Argh. The nurses started talking to me about pitocin. No. No. No. Pitocin means constant monitoring and IVs and limited positions and defeat. I declined. I got another talk about nipple stimulation. Sigh. Surely something would shake loose soon. I updated some people on FB and a friend remarked that she couldn't believe I was still posting at 7cm. But really, nothing much was happening. One contraction every five minutes. That's it. 30 seconds of pain; 4:30 of nothing. I could hardly believe that 6.5 hours into the day, there was still no baby in sight. They said they'd check again in 30 minutes.

Over the course of those 30 minutes, all of a sudden my contractions were getting much stronger. Not necessarily closer together, but noticeably and significantly more painful. And then maybe closer. Then the bellwether sign that always announces my hour is at hand: I had to pee. It was decided that my parents would step in the hallway, the nurse would check dilation again, I would go to the potty, and then Grace would decide where she wanted to ride out the rest of the way. After everyone cleared out, the nurse announced I was between 8 and 9 and 100%. Finally. Finally. Finally. 

As I got out of bed to shuffle to the bathroom, I could feel the intensity of labor cascading down on me. I preemptively tell the nurse not to worry because I am not going to deliver on the toilet. She said she had never had that happen with a patient and wasn't going to worry about it until it did. See, I knew she was a newbie. I had multiple contractions walking across the room. I had several contractions on the toilet. I had contractions walking to the sink to wash my hands. I laughed that I was washing my hands. I am not a barbarian! I had contractions shuffling back towards the bed. I made it to the bed and just leaned on it, unable to climb up, waiting for the wave to crash. I caught my breath and looked up at Grace sitting on the couch. I told her that she could stay or she could leave, but the time to decide was now. She thought a moment and decided she would go.

I climbed back into the bed. It was about 10 minutes after 3. My parents came back in to confirm it was time for them to go. The nurse left. My parents left. Grace left. Dave announced he had to go to the bathroom and he also left. I was left entirely alone. I swallowed a bit of panic while facing transition all by myself. I hoped someone would decide to return before the baby came. It felt like an eternity. It was probably more like ten minutes. I draped myself over the left rail of the bed and onto the side table, contracted, and waited.

This position was how Dave found me when he returned from the bathroom. He was alarmed. "What's wrong?!" he exclaimed. "I'm having a contraction!" "Do I need to get the nurse?" "Not yet, but soon." Soon came fast. I started to feel pushy. Dave rushed out and got the nurse. She returned and declared me fully dilated. I already knew that. She said she would page my doctor.

After a few minutes the nurse returned, concerned because my doctor was not returning her page. She tried to text and still had nothing. She was barely concealing her anxiety. She explained all this to me while pulling her phone out to make a direct phone call. In a moment that crystallized why I drove an hour into Nashville for the entire pregnancy even though it was an enormous pain in the rear, when the nurse began dialing the number, my doctor walked into the room. Never underestimate the value of a doctor who knows your birthing history. My doctor said as soon as she was notified I was between 8-9, she immediately started making her way to the hospital because she knew I'd be ready to go by the time she got here. (Her office is a longish walk away.)  The time was now somewhere between 320 and 330.

The bed was broken down while my doctor gowned up. She never took her eye off me while the old phrase don't push echoed about. In the middle of her process, she asked the nurse, who was standing aways back, if she had finished dressing. The nurse answered yes and didn't move. That was a hint, newbie nurse, to get a bit closer. I could feel both my waning ability to hold back and my doctor's nervous hurry. I knew. She knew. The nurse did not seem to know. As they finished getting ready, my daily iron pill alarm on my phone sounded. It was now 3:30. I reached over and shut it off.

Finally everything was set in order and they turned towards me and my contorted position. I was still, essentially, draped over the side of the bed sitting almost straight up.. The time for finding an optimal birthing position had passed. That moment came and left when I was by myself. I really couldn't move anymore. The nurse popped open the stirrups and instructed me to put my right foot in the right stirrup. I told her I wasn't going to do that. She tried again. Put your foot in the stirrup. No. All of my coping ability hinged on staying compact. I was not about to give it up in order to please the newbie nurse. She looked stumped at my stubborn refusal. My doctor was only mildly concerned my hips didn't have enough expansion room. She suggested that Dave and the nurse basically pick me up, shift me, and hold the entire weight of my legs. I said it sounded fine to me. The nurse looked...concerned. Dave grabbed one leg, the nurse grabbed the other, and they shifted my weight off my hips. I squared up a little, but was still heavily leaning left, and they stood there, each holding the dead weight of a leg in a bent, non-stirrupy position. I win. Ha!

Finally the moment arrived. I was given the all clear and didn't have to fight myself any longer. 1,2,3,4...   Crap. I forgot to tell the nurse not to count at me. Too late now. I am pushing. She is counting. I am ignoring. I give one long push. A second long push. Maybe a third? I don't remember now. I barely recognized that the baby was crowning. I just had to make the agony stop. Usually after the head is delivered, there is a slight abatement where I can catch my breath. Not this time. Her head emerged and I just kept pushing. I felt each shoulder bump out, one at a time. I don't ever recall being able to distinctly identify the shoulders, but there they were and she was fully delivered. It was 3:40pm. It's a girl: Eleanor Clare.

They immediately put her on my chest and I let her lay there, soaking up her familiar foreignness. After a few minutes, I latched her on to nurse and she took it like a champ. But then it seemed almost immediately, they moved her to examining table to wipe her up and weigh her while I delivered the placenta. It seemed unbelievably fast. They hooked up the pitocin IV right after birth so maybe it kicked in almost immediately. Surely the doctor didn't pull on the cord? I wasn't paying enough attention to know for sure. Anyway, the placenta seemed to come really fast. Out it came and they almost immediately dropped it into a bio-hazard box before I could even mention I'd like to take a look. I love to give it the long stare in order to accuse it of the misery it caused me. I did get a glimpse, but that's it. Oh well. (I have one in the freezer if I really want to look at one. Snert.) With the placenta out, time for the stitches. Even though I was pushing full bore for approximately five minutes, I only had a first degree tear and maybe three stitches. Not terrible. My doctor told me the cord had been loosely wrapped once around baby's neck, but she didn't anticipate any trouble. Time for the glorious icepack. My doctor congratulated me and said she was proud of me.

Baby weighed 7lbs 4oz and they laid her back on my chest. As they finished cleaning up and putting away, Dave went to get Grace out of the waiting room. This is the moment she got up early to see. It took a lot longer to arrive than anyone had anticipated. Grace is beaming and the four of us huddle together. We can't take our eyes off this baby.

The medical personnel leave the room. I notice that baby has a lot of mucus. She didn't exactly get properly squeezed on the way out. I latch her onto nurse. Her latch is great. She is nursing like gangbusters. I notice her nose seems clogged. Is her color weird? It's always so hard to tell. I am looking at her hard. Is she turning purple? Or is that just a lusty red? Hmmm. Something seems off. I look away and stare out the window at downtown for a few seconds. I look back down at her. Nope. This is not normal. This baby is definitely turning blue. It's been about 30 minutes since birth.

I tell Dave to get the nurse. I unlatch her and she begins to mew. He returns with half of the staff in labor and delivery. I learned that when a baby turns blue, nurses use the word 'dusky' a lot. No one wants to say blue. A nurse takes her from me and the baby begins to scream. This pleases the nurse greatly. She continues to intentionally annoy her to continue the crying. She is pinking back up.They immediately decide she needs to be suctioned. After she is suctioned, everything seems normal. NICU is called as a precaution. They descend immediately. I keep saying immediately, but I am not sure how else to describe what happened. It was a well-oiled and fast moving machine. NICU comes in and declares there is nothing for them to do because everything needed is already done. They will recheck her in an hour as another precaution. Then they hand me back my baby.



During this series of events, Grace's eyes are as big as saucers. All of the preceeding is happening in the background while I turn my attention to Grace to tell her what's happening and to reassure her. It sounds very scary, and it was definitely unnerving, but it was also very apparent that the baby's nose was full of gunk and she had yet to learn that if she just opened her mouth, she could breathe normally. So I tell Grace it is normal for a baby to be full of mucus and that she was born so fast that it didn't get pushed out in the regular way. Grace seemed to be accepting of the explanation. But still, she was happy when we had our baby back. So was I.



Since we had to wait for NICU to give us the second all clear before we could head to our regular room, we had a gloriously relaxing time. My parents eventually wandered in. And happily, my MIL got all the kids up to the hospital very quickly. We were all reunited and talked and laughed and cooed over our new baby. We stayed in L&D for over two hours after birth. It's the first time I have not felt rushed at the hospital.

Soon NICU cleared us again and it was time to move upstairs. My newbie nurse Sam accompanied me into the bathroom for the glamour portion of childbirth. She was hilarious. She couldn't get over how fast everything happened. She couldn't believe I didn't have an epidural. She kept telling me I was amazing. She had never seen anything quite like it. I have mentioned her quite a bit through this retelling but she didn't annoy or upset me, if I gave that impression. It was just very obvious to me that she didn't have experience with my kind of labor. She has to learn somehow. She was effusive with praise and amazement. She wanted to do a good job and support me, even if she didn't quite know how.



And that is how we came to have five children after seven long, boring hours of labor and then one exciting hour. I'm sorry it took five months to tell you.




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