Saturday, January 18, 2014

The birth story



Little man is 3 weeks old today.  Seems like if I don't get this birth story written soon, it may never happen.

Read at your own risk (menfolk).  As with any birth story, there is talk of potentially icky things.

Prologue
For those of you what may not know my back story, this was my third birth.  My first birth, 4 years ago, ended in an emergency c-section after 2.5 hours of pushing.  The OB who performed the c-section later referred to it as "Vaginal birth with C-section".  You can read about it here and here.  I spent the next 3 years blaming myself for the c-section, thinking I wasn't pushing effectively because I got an epidural.

So for my next birth, 1.5 years ago, I planned very carefully.  I decided I wanted a VBAC, and was told I was a good candidate for it.  I switched to a small practice with an exceptionally good VBAC success rate.  I hired a doula.  I had the birth I wanted in the beginning, arriving at the hospital 8 cm dilated.  I didn't get an epidural.  At first.  But after an hour-and-a-half of pushing, I was shaking so badly I knew I wasn't effectively pushing, and ended up with an epidural.  This was ultimately a good decision.  After 2 more hours of pushing, she was born.  But not without a lot of drama that very nearly resulted in a repeat c-section.  It was almost exactly like my first birth.  With that experience, I forgave myself for my first birth and moved on.  Recovery was better than the first birth, but a VBAC was not the magic bullet I had hoped for.  The full story of Greta's birth can be found here.

And then this guy.  I spent the last few months of pregnancy facing great indecision on whether or not to have a scheduled c-section.  Although a lot of the midwives were fond of telling me this birth would be totally different because I'd done it once, what they did not seem to recall is that they'd told me the same thing last time.  I was so very close to a c-section last time.  If this guy was a bit bigger?  Or later term and under greater distress?  I knew my chance of a c-section was fairly high, despite what many of the midwives told me.  I did have one who had a frank discussion with me, and said "It's clear you don't have easy births, and whatever you decide is entirely understandable."  It was so nice to have someone acknowledge that (and she ended up being the midwife who was at Teddy's birth).

I ended up deciding to go for the VBAC, because I just couldn't bring myself to not even try.  I knew I'd jump to a c-section fairly quickly if it looked like I was heading that way, though I also knew it'd be a hard labor no matter what.  I don't have easy labors.  That's how it is.

I stumbled on this article a few days before my due date.  I have a tendency to search the scholarly literature when I'm in late pregnancy.  It is a nice review of the VBAC research, and points out the interesting statistic that women who have an emergency c-section after they have fully dilated have only a 13% VBAC success rate in a subsequent pregnancy.  Seriously.  This made me feel like a little bit of a rock star for Greta's birth, but also made me wonder why I was told I was an "excellent candidate" for a VBAC.

That's quite a prologue.  Now for the actual story.

Chapter 1
(Don't worry, there's only one chapter.)

With my first two births, I felt totally euphoric before birth began.  So of course I expected the same sensation to precede my third birth.  There were a couple times, in the weeks leading up to my due date, that I was convinced I was about to go into labor.  I did not.

The night before I actually went into labor I was feeling anything but euphoric.  We had some friends over for dinner and I was feeling borderline antisocial.  Perhaps it's because I had such a rough late pregnancy this time.  I thought I had a rough time the last two times, but it was nothing compared to this.  I was tired, I was sore, I was very, very over it.   As everyone is at 40 weeks & 1 day.  But still.

Hubs and I crawled into bed at a very reasonable 10 p.m on December 27th, the day after my due date.  He often works nights and weekends but had had a very normal schedule since early December, and it was nice to have him home.  My mom had arrived a week earlier, so everything was in place.  But I felt that all eyes were on me, waiting for something to happen.  This was the very reason I had not had any family in town for earlier births, but this time we really needed someone to watch the girls when I went to the hospital.

Anyway.  I couldn't sleep.  I had been having trouble sleeping in general, but this time I really couldn't sleep.  I tossed and turned until 2 a.m., trying to not wake up hubs.  I played Candy Crush on my phone, which has been very good at putting me to sleep.  For that matter, I finally beat Candy Crush. I also read the entire internet.  All of it.  At 2 a.m., after beating Candy Crush, I finally got out of bed.  I felt very hot so I took my temperature. 99 degrees.  I googled whether a slight fever is an indicator of impending labor.  It is, along with every other symptom known to man.  I went downstairs and got an apple and some juice.

I sat on the couch and stared at the Christmas tree.  I was glad I had not had him before Christmas, because I got to enjoy a wonderful Christmas with the girls.  But now I was ready.  I wondered if I felt a contraction, but I had wondered that many times over the past couple days.  The day before, at my midwife appointment, I had been 1.5 cm dilated.  I got back in bed at 2:15 or 2:30 and finally fell asleep.

At 3:00 a.m. I was woken up by a contraction.  With my previous births I'd woken up after a night of sleep with contractions, so I always wondered if they came on gradually.  This time, they clearly came on pretty suddenly.  I timed the next several; 5 to 7 minutes apart, about a minute long.  The pain brought back memories of labor.  When I'd gone into labor before I'd felt energized and excited.  Yes, they hurt, but things were happening!  Baby was almost here!  This time, I felt very much that I didn't want to do this.  I wanted to quit.  This was going to be hard.

By 3:30 I gave up on sleep and got out of bed.  I finished packing my hospital bag, and put absurd things like makeup in there.  Hubs woke up and asked me what I was doing, and I explained I was in labor.  I don't think he believed me at first.  My contractions had gotten rather weird; 2-5 minutes apart but very short.  After everything was packed hubs convinced me to get back in bed and try to sleep.  He was being remarkably sweet, not at all annoyed by being woken up.  He watched me for a bit, and when I had a contraction he smiled "Ahhh.... that looks like a real contraction."  I was glad at that moment that he'd been through this before and he knew what we were in for.  He held my hand and half-dozed while I laid there.  The contractions returned to normal, about 7-8 minutes apart, 1 minute long.

At 4:45 I got out of bed.  I had some peanut butter toast and at some point decided they were getting worse.  I did not want to wait so long this time to go to the hospital.  I knew my labors progress fairly quickly (apart from the pushing part) and I wanted to be settled into our room before things got too rough.  So I called the midwife at 5:30.  She had just gotten back from the hospital and I felt bad waking her up, since her shift was done at 8:00.  She encouraged me to labor at home for a bit, but I decided to head in at 6:00.  It was time.  I did not want to do this, and I just wanted to check things off the list that had to get done.  The biggest hurdle in front of me was transitioning into the hospital.  On the drive to the hospital hubs was jazzed.  Cracking jokes.  I tried to play along.  I informed him I fully planned to get an epidural.  My head was not in this.  I was tired.  I just wanted to be done.

We arrived at the hospital and I was thankful to be able to walk myself.  To not be screaming in pain in the entry way.  I was also thankful that I had some tough contractions on the way so that I didn't look like a faker.  I got settled in my room.  Answered their questions.  Abided by their poking and prodding, which I would not have been able to do if I'd waited.  When they finally checked me I was 4 cm.  That seemed like a good number, and I was glad we had come when we did.

I was finally able to get in the tub.  The midwife arrived.  She was one of my favorites, very kind and patient.  After watching me for a while she agreed I had come at the right time.  Everyone was encouraging me to get up and move.  I couldn't help feeling they just didn't get it.  I'm fine right where I am. I am enduring, I want to be left to endure.  Getting up and moving requires energy I just don't have.  They seemed to think that I was stalling, but when they finally convinced me to get out of the tub and check me at 8:00, I was dilated to 6 "stretchy to 7".  It was then that I decided I needed an epidural.  I had already decided it, really, but that was the time.

The midwife clearly felt I was making a bad decision.  She was borderline pushy in trying to dissuade me from getting an epidural.  In my first two births I would have appreciated this.  This time, though, I knew something she did not seem to remember.  I knew I still had a long haul in front of me.  I knew that early labor goes fast but pushing does not.  I was nowhere near the end.  I was exhausted.  An epidural would allow me to rest and save my energy for the pushing phase.  At 9:00 the epidural was in and the new midwife had come on.  When they checked me right after, I was 9.5 cm dilated.  So I had sat still during transition while they inserted a giant needle in my back.  Go me.  The anesthesiologist was a borderline D-bag, but he did a superb job.  It took away the pain but I could still move my legs.  It was exactly what I needed.

I was finally able to get some rest.  I was feeling absolutely delirious from exhaustion.   At 11:00 Teddy was still rather high up, and they made the decision to break my water (something that had happened spontaneously in my first two births.)  He immediately started having some heart rate issues, so they had me turn on my side until his heart rate returned to normal.  This was bringing back memories of my past two births.  The midwife made the decision to allow me to "labor down", since his heart rate was good and the epidural was in, which means that I just laid there and allowed my body to do the work.  I didn't push to try to speed things along.  At noon they had me try pushing, because he was coming down so slowly, but not much came of it and his heart rate dipped down again.  So I laid there and napped some more.  I don't remember what station I was at what time, but I slowly made progress.  The midwife suspected, as did I, that once pushing really began his heart rate would suffer, just like my last births, so she let him get as far as possible before I had to start pushing.  Sometime around 2:30 I mentioned that I was starting to feel the urge to push.  I could feel the contractions, they just weren't particularly painful.  I could also feel all my pelvic muscles.  Like I said, the ideal epidural.

By 3:00 everything was in place.  I started to push, and he made some progress.  At some point, he got rather stuck, and the midwife later told me that she watched as his head slowly turned with each contraction, until he was finally able to push past a bone.  She said it was very weird to see.  I wore out pretty quickly and his heart rate was really suffering, dipping down very low.  The midwife decided to call in the NICU team, "just in case", as well as the on-call OB.  Luckily for me, the OB in the hospital that day happened to be the OB from the clinic I go to, and the same one who was at Greta's birth.  She remembered Greta's birth and this was following suit.  I started to wonder if I was close to a c-section, but they didn't seem to think so.  Finally, the OB told me I had one more chance to push him out or she'd try the vacuum.  He came out on that push.

But of course, the drama wasn't over.  He was very blue.  I'm not sure if I'll ever forget the mental image of how blue he was, and he wasn't crying.  Hubs didn't even cut the cord, they just snipped it and moved him to the warming table.  It seemed like forever until he cried, and I was sobbing, very scared.  The midwife was working on getting the placenta out, and massaging my uterus, and she seemed to think I was in pain while in fact I was just listening for crying.  His birth hadn't been nearly as scary as MJ and Greta's, and yet here he was not breathing.  Finally, I heard him cry.  Hubs later told me it was about 80 seconds before he took a breath.

And then he was fine.  He "pinked right up" and nursed pretty well.  He was 9 lb 5 oz, with a 15" noggin (that puts him in the 93rd percentile).  I had a second-degree tear but apparently not very deep.  Although I was sore, I was able to get up and walk right after (the epidural had apparently worn out).  I made the mistake of feeling "down there" and it all felt like I would imagine someone's face would after getting beaten up.  But by the next morning everything felt pretty normal.

Three days later I was walking around the Mall of America like a normal person (except that I was at the Mall of America 3 days post-partum, making me definitely not normal).  It was a phenomenally easy recovery compared to my other two.  It dawned on me, for the first time, how much of a woman's first couple months can be dictated by the birth itself.  That women who have an easy birth are not even in the same hemisphere when discussing those first weeks (or even months) with a new baby.  Because the way I felt, and my capabilities, were worlds away from my first birth experience, and probably still a world away from my second birth experience.  I was so thankful for my midwife, and for her appreciation for how my body worked, and how I birth.  She read my chart and knew what to expect, and she wasn't impatient.  She later told me she had to keep catching herself when she felt like maybe I should start pushing, and remind herself to let me go as long as possible before pushing.  And she was right.

All in all, I'm really glad this was my last birth.  Pregnancy and birth is not a magical time for me.  I love newborns, I do fine as a postpartum gal, but the precursor is only something to be endured.  I'm so thankful for modern medicine, and for this beautiful, healthy baby boy.

1 comment:

  1. I have heard a few times about third time mama's just knowing what they need and understanding more intuitively how the birth is going to go... in spite of what the midwives/OBs think/say.

    And I echo the idea that a woman's postpartum experience is greatly colored by the birth. In retrospect I had some rough recovery stuff both times (mostly from blood loss), but especially the second time and yet I had a hard time cutting myself slack because it seemed like so many other women were able to get up and go and move on with life. I"m hopeful to be quick to recover this third time around, but at least I'm planning and preparing for another 5-6 weeks of major weakness. Thanks for sharing your story!

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