Wednesday, May 27, 2009

Detailed Birthing Story Part II: Ah, Labor...

Below is Part II of my detailed birthing story. You can check out a shorter version here, and Part I of the detailed story here.

Birthing Story Part II: Ah, Labor

April 15, 2009, 4am-11am

When we step through the elevator doors, we are greeted by an empty waiting room, followed by an empty front desk. We recall during our tour of the Labor and Delivery floor, the nurse informing us that at night, there may be no one sitting at the desk, and to be sure to call out for someone, so we do this. A woman comes to the desk and we give her my name. “Oh, yes, Dr. T. has called you in already and you have pre-registered, so you’re all set. Lucy will show you to your room.”

Lucy, our night nurse, opens a door and tells me to follow her. She asks some questions about my water breaking and I inform her I am 100% positive it has broken. Since this happened two hours earlier, I still am very uncomfortable and relieved to find my way into my room quickly.

My labor and delivery room is very large, and every room is private. There is a bed in one area, a baby warmer in another, several chairs, many wooden cabinets, hard wood floors, large windows, and a bathroom. Immediately, I am given a gown and told to change in the bathroom, where Lucy confirms yes, my “membranes” have definitely “ruptured.” She helps me to the bed, attempts to make me comfortable, asks some medical questions, draws some blood, and places a fetal monitor around my belly, and a blood pressure band around my arm.

By now, our doula, Laura, has joined us in our room. It feels nice to have another person in the room to support us. It is around 4:30am at this point, and I am thirsty. I foolishly did not drink before I entered the hospital. I ask the nurse if I can have some water and she looks at me with a mocking smile. “Honey, has anyone told you how things work in the hospital?”

I am annoyed she responds like this, but through my contractions, I tell her, I am aware I cannot eat, but I am just asking for water. Noticing my doula sitting with her birthing ball, she asks if I have a birthing plan. I tell her, yes, I have “birthing preferences.”

“What I tell women who bring in birthing plans is to right away, toss them out the window.”

I remain soft-spoken and kind. “My birthing preferences are not very extreme. My doctor’s seen them and said they’re very reasonable. It’s less than one page.”

She goes on to inform me how I cannot drink, I cannot eat, I must stay on the fetal monitor and if I need to go to the bathroom, I must inform her, so she can unhook the monitor (she is not happy later when Mike or Laura unhooks something to allow me to get up). I am not happy at how my experience is beginning, but I do accept the ice chips they allow, which conveniently melt into, God forbid, water, and I have a few bites of a sherbet-like treat which they also allow.

Lucy confirms I am in labor, having real contractions very frequently, from less than 1 minute to approximately 3 minutes apart, but inconsistently. A resident doctor comes in soon after and informs me I am 2 cm dilated. I am disappointed I am not further along than this. She asks me on a scale of 1 to 10, with 1 being regular menstrual cramping pain, and 10 being excruciating pain, where my pain level is. I tell her perhaps at a level 2 at this point. I want to leave plenty of room for things to get worse!

Lucy tells me to relax and wait. It may be a while.

As Mike is unpacking a few of our belongings, I see the cord blood banking kit. I mention to the nurse how we are banking the cord blood and she says, “You should have told me that sooner. I have to draw your maternal blood for it and I could have done that when I drew your blood when you first came in. But I’ll do it again now.”

“Well, it was listed on my birthing preferences sheet, so see—there was a point to having it!”

She nods good naturedly, “That’s true. Okay, let me see your birthing plan.”

I tell her I call it simply “birthing preferences” not a plan, and she says she likes this terminology and will use it herself. She looks at my preferences, agrees they are reasonable, and says she will make a copy and put it in my chart. She seems much less uptight now, and even tells me, “If your water hadn’t broken and you’d labored at home for the early stages, then you could have drunk and eaten as much as you’d liked. I’m sorry that you had to come in this early…I could tell you that I would never know if you ate or drank when I’m not in the room, but…”

I take this as a sign that she is more sympathetic than she originally portrayed.

For the next few hours, I labor in the room. Mike and Laura are supportive as I use my yogic experience to breathe through each contraction. We gossip about the nurse, they fill my ice chip cup with water as I request, we talk about the surreal quality of what is happening, and watch as the sun rises above the city.

Around 6:30am, my OB stops by. He has a surgery this morning so I am lucky enough to be able to see him several times. When he enters the room, I feel so much joy to see a familiar face. He is kind, he is knowledgeable, and he is not only my doctor, but I feel he is my advocate. He examines me and says I am still at 2cm, even though my contractions now feel much more painful. “But you’re still smiling!” he observes as I rest between contractions.

“I wasn’t a minute ago!”

He tells Lucy that I do not need to be on the fetal monitor constantly, and that I should be able to walk around if I feel like it (which is written on my birthing preferences). I ask him if I can drink water and he quickly gives me a canned explanation of why hospitals do not allow laboring women to drink or eat—a higher risk of asphyxiation if one throws up etc. but then he tells me I may drink water if I’d like. “Just take small sips. Don’t guzzle it.”

After he leaves, I feel more empowered and more comfortable in the hospital. I am so grateful that he has spoken up for my wishes and the nurses will not question him. They are small wishes, but at the moment, they feel enormous, and I feel grateful.

At 7am, there is a change of nurses; Lucy leaves and Mary is now my nurse. Mary is a kind Irish woman who goes out of her way to make me comfortable. She brings with her a young blonde student nurse, and she asks me if I am comfortable with her assisting. I say I am fine with her participating.

As my pain is increasing quite rapidly, I decide I’ll take a shower as my first main coping technique. Laura asks our nurse if there is a stool or chair I can have in the shower, and Mary brings a short stool. She also finds an extra towel to place on top of it, which I appreciate and would not have thought of myself.

For the next 45 minutes or so, I labor in the shower. I try sitting on the stool, standing up straight, standing with my hands against the side of the shower. I sit on my knees and put my arms across the stool. I stand over the stool with my hands on it. I try as many positions as I can, and I am in extreme pain.

I breathe deeply through each contraction, close my eyes, and tune out everything else. Mike stands next to the shower and offers me help in any way I want it. He relays messages for me, he prays for me, he changes the temperature of the water to warmer, colder, warmer, colder. I squeeze his hand. I do not want any distractions—something I thought that I would want. I have even brought along dvds of Arrested Development and 30 Rock, thinking watching comedy will help distract the pain of labor. But I do not want to be distracted. I want to focus on nothing but breathing through each contraction and finishing it.

I dread the feeling of the beginning of a contraction because I know it is going to get much worse before it gets better. At the end of each contraction, I feel weak, faint, feverish, sweaty. I feel like I am going to throw up, and I feel like I just have thrown up. I whine to Mike that I am not getting much break between contractions since often one begins just as another is ending. I tell him I am not enjoying this at all and I think I am going to ask for an epidural. He says okay, and asks if I really want one. I say I think I do, but I worry I am not far enough dilated.

After several more contractions, I tell him, yes, I definitely want an epidural. He stands by me through a few more contractions and then he goes out to tell our doula. I feel bad that she will not witness an unmedicated birth, but I know she will support me in whatever decision I make.

Mike returns and helps me out of the shower. I tell him and Laura that I want to make sure I am far enough dilated before getting an epidural, but to find our nurse to get the process started. Mary returns to us, and tells me she will find the resident to check my dilation.

It is approximately 9am when the resident informs me I am almost 5 cm dilated! We are all thrilled that I have dilated this much since the last exam. I feel relieved to have made it to active labor before getting an epidural, as I do not want it to slow down my labor.

The anesthesiologist arrives within 15 minutes, and I follow her instructions implicitly so as to make the procedure move as smoothly and quickly as possible. Mike and Laura are encouraging as I sit still through the uncomfortable process. When it is complete, I start losing the sensation in my feet, then legs, then butt, and soon I feel my uterus harden, but I do not feel pain. “I’m having a contraction now, aren’t I?” I ask, smiling. “I can’t feel the pain!” It is amazing to have this reprieve!

Around 9:30, my OB returns, smiles and says, “So you decided to get the epidural!”

“Yes, I did!” I smile back.

He examines me and informs me I am now 6 cm dilated, so things are progressing quickly. He returns to his office, and will join me later. Then, about 20 minutes after having received the epidural, very soon after my OB has left, I observe that I now can feel my feet.

“That’s normal,” Mary tells me.

Not long after this, I begin to feel my legs, then my butt, and before I know it, I am feeling my contractions again, and they are more intense than before the epidural. “That is not normal,” Mary tells me. I am breathing through each contraction as I was before, closing my eyes, focusing, tuning out my surroundings. Laura tells me to think of the relaxing beach. I visualize the ocean from Mike’s and my babymoon to Antigua and I focus on the waves. I keep telling Mike and Laura that I feel sick and each time, they offer me a pink plastic pan to throw up in, as I am certain I will vomit; I have been certain of this since before even entering labor, as my stomach has always been my weak point, but thankfully, I never end up using it.

I also feel a cold liquid down my back, which is not the mental effect of the drug, but rather an actual liquid leaking. The anesthesiologist returns, apologizes, and fixes whatever the culprit is. However, nothing changes with the pain of my contractions. They are even more intense than before.

Around 10:30, Mary tells me, “I’m going to call the resident to check you out again. You may be dilating so quickly that it’s not working. But you should not be feeling your contractions like this.”

The resident returns and examines me. He is very fast and says, “Well, she’s fully dilated!”

I look at him quizzically. “As in, I’m 10 cm dilated?”

“Yup! You’re ready to go!”

Mary, Laura, Mike and I almost laugh in disbelief. An hour ago, I was 6cm dilated and now I am “ready to go!” My OB was correct in his guess from the previous week that when I do go into active labor, I will most likely dilate very quickly. The resident tells me he will contact Dr. T. who will be here shortly (his office is a few minutes away).

As we wait for my OB to arrive, Mary explains my fast dilation is why the epidural has not worked. I still do not understand this reasoning entirely, but I ask if there is anything they can do to now make it work.

“You don’t want to get anything more at this point, because you want to be able to feel your contractions a little bit when you’re pushing,” Mary tells me.

“Don’t worry—I will definitely feel my contractions!”

“Sometimes, they can ‘top off’ the epidural before you start pushing, but I’m not sure your doctor will have you do that.”

As I wait for my OB to arrive, I begin feeling more excited as I know our son is not far away, more pain from the intense contractions, and more anxiety over the part of labor I have feared the most—pushing.

When Dr. T. arrives, he examines me, then confirms, “Yes, you’re 10 cm dilated!”

He can clearly see that the epidural is not working and he asks if I’d like them to “top it off.” I give him a hearty “yes”, and the nurse calls the anesthesiologist back who administers another small dose.

“Do you feel any relief?” Dr. T. asks me.

“Not really,” I tell him. “Maybe my contractions are shorter?” I am desperate to find something it is helping with. “I don’t know though.”

“Hm,” he says. At this point, I realize there is nothing more anyone is going to be able to do for my pain. I am going to have this baby with no help from medication. Later, one of my friends will joke with me that I failed at having a natural childbirth, and I failed at having a medicated birth! Or conversely, I can view the experience as having a forced-success at the type of birth I’d originally wanted!

My OB walks toward the door and speaks to Mary on his way out. “You can have her start pushing,” he says. “It’s probably going to be a while.” Then he leaves.

Mary comes to my bedside and tells me, “Okay! You’re ready to start pushing!”

“What?” I say. “Can’t I wait a little while?”

“Why would you want to wait, honey?”

“If I wait longer until the baby is more ready, then maybe I won’t have to push for as long?”

“No, your baby is ready. Dr. T. said it’s time for you to start pushing.”

“But I don’t know how to push. I’m really not ready…”

“You’re ready. You can do it,” she encourages me.

Mike and Laura are equally as encouraging. I can sense the utter excitement emanating from my husband—he knows it will be a matter of minutes, or a matter of hours, before we will be holding our baby now. He knows that I am scared, that I am in pain, but he knows that I will get through it—I have to get through it. And I will be healthy and I will be okay. So he is excited. I know these things, as well. And so, I have no choice but to start pushing. Because once I have gotten through the delivery, my pushing and my pain will all be a memory. And the pain and fear a memory holds will not be as bad as the moment.

And so I start pushing. And the next phase begins!


Kat said...

I love the detail that you put into your story! Thank you so much for sharing. I am so happy that, although things didn't go exactly as planned, they turned out really well for you! I also love the idea of "birthing preferences" vs. "birth plan" as well. Very cool!

grandma berta said...

As you said, you know it's ending and you'll have your son for all your hard work. Such a touching story, I smiled and I cried. What a joy!

Monsoon Mama said...

i love it!! i am all weepy again and can't wait for the next chapter in your amazing story. i think it's hilarious that your friend said that you failed at having both a medicated and unmedicated birth... ha ha! but really, you experienced and succeeded at both, and it sounds like getting the break with the epidural got you some valuable rest and extra strength for when you had to push!

and good for you for keeping your cool with the first nurse-- it's not easy to remain calm and friendly when someone's initial reaction is so NOT in line with what you want/were hoping for. i'm glad she came around and finally listened to you!

Mike said...

What an incredible experience the evening was. Tara, thanks again for tracking everything in such detail, I really enjoyed re-living everything. :)

That first nurse was really the only negative memory at the hospital for me. (Not including seeing my own wife in pain, of course..! Though that said, in my mind I always knew the pain was a precursor to birth, and so excitement was a big part of the emotional mix.)

Tara was such a champion...especially during the pushing part...but that's next, so I'll hold off on commenting. :)

BabyDad said...

Funny how the terminology and questions from moms-to-be are all the same from hospital to hospital! Thanks for the story "from the bed".

Mary said...

Thanks so much for sharing your story so eloquently! Sounds like you were very cool and calm - that nurse might have sent me over the edge! I can't wait to meet little Dylan!

Tara M said...

Thanks, guys! It has been fun for me to write it and relive everything! I got the "birthing preferences" from one of my friends here, and thought it was less demanding. I'm glad it helped the nurse come around too! BabyDad--yeah, I'd be curious to hear about it all from the OB perspective too! We can do a play by play--this is the woman, this is the doc...I'm curious what questions are universal. But I'm sure a ton are! I think we often forget them afterward though (unless we talk about them enough to remind ourselves, or write them down). I know I forgot a lot of things until I heard them on the audio Mike recorded of the end of it (not this part--but in part III).

michelmoba said...

another chapter read thru big blobs of hormonal tears & a silly smile. When you asked for the epidural to be topped off I actually screamed to my computer "OH YES!" to chapter III

Tara M said...

hehe--yes, Michel--I was hoping the topping off would work, but alas! It is weird how the pain becomes a pretty cool memory/experience though...