September 12, 2009

birth story, part III

For part I of the story, click here. For part II, here.

Alright, so at the end of the last installment, we were being chauffeured to the hospital by sweet Jenny, the student midwife. It's about seven am, and I've been in hard, active labor for nearly eleven hours but have little to show for it except exhaustion.

We arrived at UW and our midwife Heather took us inside to get checked in. Thankfully, although our midwives aren't directly affiliated with or allowed to practice in any hospitals, they have developed a good rapport with the midwife team at UW and Heather had already contacted them to let them know we were on the way. When we got to the Labor & Delivery floor the nurses knew exactly who we were and we were shown to a room right away.

I was shaking and continuing to have contractions while people were buzzing around doing whatever it is that they do in this scenario. I was getting an IV, someone was taking my vitals, and questions were being fired away at all of us. At one point, the entire team of OB doctors, the anaesthesiologist, and nurses were packed into our room, along with our entourage of three midwives, our doula, and the two of us. It was a full house to say the least, but despite all the attention, it seemed as though nothing was happening. I could feel his frustration and tension as hubby was trying to comfort me, and I know he wanted to tell them all to just get the hell out.

The doctors offered me a Cesarean immediately, which we fiercely rejected. We were there to rest, and then to continue with a natural labor and delivery as if we were still at home. Our birth plans directed these wishes, and our team was there to make sure that we didn't fall victim to the hospital bureaucracy and have our plan derailed.

Although our preparation in our Bradley class had been focused largely on the goal of achieving a fully natural birth, our instructor (and doula) Betsy had also made it very clear that drugs can have a place and may even be useful when they are not abused. In situations like mine, where the baby was poorly positioned but my body was trying to push it out anyway, it can be beneficial to have a short epidural to relax the uterine muscle a bit. The pain relief it provided meant that I got a mental and physical break from the work, and could try to take a nap while my body (hopefully) continued to progress.

It took forever for everything to get arranged and for me to finally receive the relief I was craving. The anaesthesiologist arrived after an incredibly long hour, and administered a combination epidural/spinal block while Gus held my hand and comforted me between my still persistent contractions. With the epidural in place, the UW docs gave me another exam and discovered that I was holding at 7 cm and my cervix was swollen and Baby's head was too, as it was trying to mold to the opening. They also inserted an intrauterine pressure catheter to measure the strength of my contractions during this process.

Since I wasn't able to feel them anymore and epidural has a tendency to decrease the strength of contractions, we opted for a low dose of pitocin to counteract that effect and see if we could encourage my cervix to finish dilating. This was exactly the cycle of interventions that we had wanted to avoid by birthing at home, but we agreed to the plan after we were reassured that the doses would be as low as possible and that the process would be abandoned if there was any evidence that it was causing a negative reaction in the baby.

By this time it was after 9 am, and the attending doctor was recommending a two hour trial. If there was still no change by eleven, she might insist on a c-section. Betsy didn't appreciate the ultimatum or the time limit, and she intervened with the resident and the midwife on our behalf asking them to ensure that any decisions were ultimately left up to us, and that we be provided with evidence and options. Everyone expressed understanding and support of our desire to continue with as natural a birth as possible, and Gus and I were left alone in the room to try to rest while our wonderful nurse Robin continually monitored the Baby and me.

The pitocin dose was increased, but despite that, my contractions had slowed to almost nothing and I was no longer in active labor. Nurse Robin was starting to worry about the baby, as it seemed that even with the weak and spaced out contractions I was having, he wasn't responding well. His heart rate dropped enough that she turned the pitocin off completely by 10 and put an oxygen mask on me to see if that would help. Betsy later told us that Robin was being extra vigilant monitoring us and was careful to act quickly so she could avoid calling in the doctors unnecessarily and hindering our ability to labor as we wanted. Her actions seemed to be working, and the oxygen helped regulate things until 11 when the docs were scheduled to come back in to check on us.

The epidural and spinal block had worn off by that point, and Betsy asked if I thought that I might want to try moving into a hands and knees position and try to work on turning the baby. I agreed, and we enlisted Robin to help organize all my tubes and help us with the fancy adjustable bed. I was on all fours trying some pelvic rocking when the rest of the OB team arrived to do another exam. It turned out that Betsy had carefully orchestrated this scene- hoping that if the team came in and saw me actively engaged rather than just lying there waiting, they would see our persistence and respect our determination. Such a clever and crafty advocate! I'm really glad that she was there with us, as we were too tired and emotionally spent to be looking out for ourselves.

Despite all the efforts, the exam at 11:20 revealed that I was still 7 cm with a swollen cervix, and Baby was straight OP. His heart rate started to plummet during the exam and I could feel the mood of the room change. Robin and the doctors went from casual to alert mode, and then one of them said that there was meconium in my fluid. We knew that fetal distress often led to Baby passing his first bowel movement in utero, and we also knew that this meant it was probably time to accept further intervention. We agreed that the signs were indicating that this baby was not intending to be born vaginally, and our efforts were not likely to change that. His response to everything so far was also not reassuring anyone that he would tolerate more labor. With many tears and much emotion, we finally accepted the plan for Cesarean.

I was wheeled into the operating room just before noon, and was soon joined by Gus, who held my hand and reassured me despite the fact that I know he was a wreck himself. We even had a laugh when the surgeons cut me open and one of them exclaimed "Wow! That's a big baby!" They asked if he wanted to see, and Gus bravely stood up and looked over the drape at 12:25 pm when our son was born. Gus took some photos while they took Lincoln aside to be weighed and cleaned up, and then Gus cut the cord. They brought Lincoln over to me within just a couple of minutes, and put him on my chest so we could get acquainted. We even breastfed a little bit while they were stitching me back up.

Lincoln was swaddled up and placed on my bed to be wheeled back into our room, where Betsy greeted us and we all immediately burst into tears. She couldn't believe how huge he was, as her babies had both been just over five pounds at birth. Our little guy eats babies like hers for breakfast. And follows that up with an hour on the breast! What?

Since Betsy is also a lactation consultant and a La Leche League leader, she helped us get going on Lincoln's first real meal. We unwrapped his swaddle and put him on my chest so we were skin to skin, and let him find the breast instinctively. It's so amazing to watch an infant, just moments old, bob and scoot his way to a nipple and latch himself on. We marveled over our perfect little baby for a while, and then Betsy left us so we could finally try to get some real sleep.

Although the final hours were nothing like what we had imagined they would be, we are lucky to still be able to say that we had a positive birth experience. The time at home was just what we wanted, and the hospital staff was wonderful and respectful of our desires. Add our awesome birth team to that mix, and we are nothing but grateful for the experience. We have a beautiful son and he's thriving. I feel so lucky and blessed to have such an amazing family!

For a selection of photos of Lincoln's birth day, use this invitation link to visit a non-public set on flickr. And don't worry, they're all safe for viewing!