Monday, August 12, 2013

Magpie's birth story, part II


...Continued from Part I...

Turns out I wasn’t feeling much happening with my contractions because nothing much was happening. My OB came in to check me that night when she got into the hospital to begin her shift…and I was now exactly 1 fingertip dilated. Hmmmm.

I had spent the day refusing the plans of various residents who wanted to put me on a dextrose drip for my IV (yes, a sugar drip for a diabetic) and then add insulin to control the blood glucose spike that would result. I couldn’t understand why we would create a problem (feed Mo sugar she couldn’t produce enough insulin to process, given the gestational diabetes) so that we could treat it (add insulin). I begged to be able to eat lightly and to just have my blood sugars checked. And since I wasn’t in active (or any) labor yet, I took the liberty of quietly eating some of the things I knew would allow me to control my blood sugar and give me energy for the labor to come. I was supposed to be on a clear liquid diet as soon as I hit the hospital, but all clear liquids are either steeped in sugar (e.g., jello, juice) or have no caloric value at all (e.g., chicken broth). Will wonderfully brought me some greek yogurt and nuts, two things that I knew I could eat just fine without any glucose spikes.  I skipped the various popsicles and Italian ices the nurses kept bringing me. “I’m diabetic this pregnancy,” I kept telling them. “Oh – right – I forgot.” This lack of attention to detail was not confidence inspiring for the road that lay ahead. The OB on call agreed to my management plan and we proceeded to switch to regular saline and checking my blood sugar at regular intervals. 

So I'd been secretively nibbling all along from a stash supplied by Will. Once my OB checked me around 8pm and told me that the cervix was softer and maybe 1cm dilated, she gave me one hour off to "officially" eat. Then we would start the Pitocin. 

But even on the Pitocin, not much was happening. I could see contractions occurring on the monitor but didn’t feel much going on. When the doctor came in overnight to check on me, she said I was not responding well to the Pitocin, even as they continued to up the dosage. Magpie's vitals were fine, but my cervix wasn't budging. I could feel mild contractions, but nothing too uncomfortable. And I was still 1cm dilated. A few hours went on like this before my OB said she wanted to break my waters to “get things moving.”

I was not very into this idea. I knew that once your amniotic sac ruptures, you are on the clock and must deliver within 24 hours. And I didn’t want some arbitrary timetable hanging over me and my uncooperative cervix. Given that I wasn’t responding so favorably to the induction, I made an alternate suggestion.

“How about you discharge me and let me go home until Friday and we try again with the cervadil when you’re back on call?” She gave me a quizzical look. I explained that my cervix did not seem to be responding well. And that once the amniotic sac was ruptured, I knew I had to have the baby within 24 hours (I must have sounded like a lunatic).

“You are not going home; you are here to have this baby, and you are having this baby,” my OB said to me.

Ok, then.

Truth be told, the idea of actually having Magpie, of her actually surviving the birth and coming into existence, wasn’t something I could really imagine. I mean, I knew of course that this was the plan, but emotionally, I was so protected from the fear of another loss that I couldn’t imagine it. We had been terrified to believe that Magpie would be born alive. I didn't focus on the negative either, trying to maintain a zen-like focus on the now, cherising the pregnancy but not assuming there would be a positive outcome. For months, I put off purchasing a crib or any other furniture for the nursery. I hadn't decorated. I hadn't bought any baby clothes or diapers. Nothing. To decorate, or make purchases that assumed a live baby was coming, seemed dangerous. A few weeks before my due date, I finally bought a crib, but I made the retailer promise to refund the money if the baby died. The week of her birth, Will and I and my sister finally began to cautiously prepare the nursery.

So hearing that I was having the baby, this hospital admission, no matter what the state of my cervix, was in a strange way surprising to me.

Once I processed this fact (obvious to everyone but me), I agreed to have my water broken.

Which was easier said than done.

The procedure sounded simple when I had read about it - you put a plastic hook (an amnihook) up through the cervix and nick the amniotic sac, which then empties. Not painful. No big deal. Problem is, the plastic arm on this hook is straight, and my cervix was so not ready for birth that it was still posterior, pointing backwards, not down. So the amnihook needed to bend around the back to enter the cervix, and well...anatomy-wise, this wasn't really happening. So this part of the process, which I thought would be not a big deal, was excruciating. In fact, my heart rate went so high that my doctor had to stop as she was worried that it would imperil Magpie's health. Despite the pain, after about 10 minutes of this torture, the sac was still intact. My OB said she would give me 15 minutes to recover, then try again.

The second try, at 4AM, was just as painful as the first, but she succeeded. My water broke, and was clear. Within minutes the contractions picked up significantly in intensity. And within the hour, I was contracting every 2 minutes, with contractions lasting as long as 1.5 minutes each. I could no longer talk through the contractions. I couldn't walk through the contractions. When one hit, I was lost in it, moaning, ow, ow, ow, ow, ow, ow. It would reach a point where I would think it was unbearable, stay that way, and then begin to back off in intensity. I remember needing to use the restroom, but being afraid of getting caught in a standing position during a contraction. It took so long to move the IV pole and all the wires and disconnect me that it seemed like I was always caught somewhere in the middle of this trip. Or stuck on the toilet in pain and alone, not sure when I would be able to make it back out to the main room. Back at my bed, I tried many different positions: Sitting on a birthing ball draped onto the bed, sitting in bed on my knees leaning against the back of the bed, standing at the side of the bed with my hands on the bed. Nothing was really great, but the ball was probably the most doable. Between contractions I would just deflate, head down, exhausted, sleeping between them even if only a few moments, then wake again with the intensity of the next contraction.

We managed like this for a few hours, but by 7 AM, the contractions were coming one on top of the other with really no break in between. I couldn't think, I couldn't use any of the coping strategies I had learned. Hynobabies? Ha! I was lost in these contractions. And when the pain would ease a bit down from unbearable, another contraction would start. The contractions were overlapping at least half of the time. I started to think I couldn't do this.

At around 8:30AM, my OB stopped by and I asked if we could check how things were progressing, that if I had a long way to go, I might need an epidural. She told me she didn't need to check me. That despite the intensity and frequency of my contractions, I was undoubtedly still in very early labor and had many hours to go, but before we could talk longer, another contraction hit. Ow, ow, ow, ow, ow, ow, my eyes closed, all consuming, who knows how long it lasted. In this state, there is no sense of time. When the contraction was over and I opened my eyes, she was gone.

When the next contraction hit, I commenced vomiting. And with each new contraction, I retched again. I knew I couldn't continue this for another 12 or more hours. This was not doable. I asked my doula to track down my OB and tell her I needed an epidural.

The anesthesiologist came in to consent me and started giving a long and detailed explanation of risks and benefits during a contraction. Seriously? I testily asked her, "Can you please wait a moment?" Once I could think again, I then asked her to talk fast before the next contraction hit. She waited and then tried again. She got a little into her spiel, and I threw up as the next contraction began. In honesty, the only thing I remember her saying is that I would need to sit still on the edge of the bed for 8-10 minutes. I remember telling her that was not possible. She told me it had to be possible. I remember thinking I would try but that there was 0% chance I could do that. Fortunately during the procedure, I had a rare four-minute space between contractions and she got the epidural in on the first try. Compared to everything else, it was no big deal.

Once the epidural was in, my OB returned and checked me. I was 3 cms dilated and 90% effaced. I remember thinking, Wow - after all of this, that's it? Things were not really proceeding well here. But with the epidural in, at least I was more comfortable. For a while it was great. I wasn't in pain, but I still had full control of my legs. I was able to use a bedpan to urinate, which was hugely important to me, as I really didn't want to be catheterized (my main reason for not wanting an epidural, aside from the fear that it would slow my labor, is that I am almost phobic of urinary catheters).

My OB checked me again at 2:45PM. I had progressed to 100% effaced and 4 cm dilated....with a swollen anterior lip. The baby was still very high and not coming down at all, despite very intense and frequent contractions (that thankfully I couldn't feel very much). My doula suggested the baby was malpositioned and we proceeded to have me do a number of rocking exercises to try to get her to drop into a better placement.

I settled into this new rhythm. Surely I could make Magpie descend into a better position. I could have this baby vaginally if I just tried hard enough.

***To be continued***

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12 comments:

  1. OUCH! I'm cringing at the thought of that hook!

    hope you're well otherwise :)

    XXX

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  2. Oh God pitocin induced contractions are the devil. I am having serious flashabacks to our birthstory and it's making me phsyically ill remembering how bad the contractions were.

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  3. Oof. As I may have told you, I remember having sort of the same emotional reaction (though in different circumstances) when, in the hospital for an external version at 37w5d, they told me they could just give me a section that day and send me home with a baby, and I was like, "I am not ready to have a baby!!!" Which, obviously, was ridiculous (the version worked, and they didn't do the section), because -- hello!?

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  4. THis is all sounding very familiar to my labor and delivery. Ugh! I remember how wonderful that epidural felt and how it felt like an eternity to get it. Those contractions are just the worst kind of pain ever! Looking foward to the grand finale.

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  5. Shuddering knowing the worst is to come. Since I never had very strong contractions, I didn't understand the pain that makes you puke until my endometrial biopsy a few months ago. But that only lasted for a few minutes, and I only puked once. You are a champ!

    A little dread knowing the story of your epi failing in the OR, but also looking forward to reading about the first love fest with your beautiful daughter! xoxo

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  6. Me too! flashbacks from the Pitocin contractions, I was delirious. I got epidural and loved it. Reading this, it sounds like you were railroaded a bit by your OB (despite everybody's best intentions), not sure how you feel about that (some people have the opinion "whelp whatever it takes to get a live breathing baby into my arms, others think "I want a healthy baby, but ideally, I would like xyz", neither opinion is correct, just varies by mom), but I'm sorry if you have any residual negative feelings or vulnerabilities about that. Can't wait to read what comes next :)

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  7. I was so angry reading this. They had no business giving you pitocin with an unripe cervix. Just because the cervix was soft, doesn't mean it was in any way ready to dilate.
    I had a similar experience with cervidil (initially), though I was allowed to go to 40 weeks with GD. I had pretty strong contractions all night after they placed the cervidil. This was my second birth and so I remember pretty well what contractions at 5 cm felt like and was certain I was dilating, only to be told after 5 hours of "labour" that I had not progressed 1 iora. Still fingertip dilated, still posterior cervix, still -3 station (actually, I had been told -2 at 36 weeks, so I was really deflated. The new midwife made an adjustment because it turns out it was not placed on the cervix. Two and a half hours later, my baby was born. I almost had her in the bathroom because they didn't believe I was actually in labour as I could not sit still enough for the monitors to pick them up. So it just shows you that contractions on an unripe cervix will do nothing. Once the cervidil was placed correctly, the contractions were effective in causing dilation. They should have at least tried misoprostal before pitocin. I'm guessing you may not have wanted that due to its reputation but I think it would have been warranted in this case. It definitely overstimulated me in my first delivery, so I wanted to try the cervidil first (it took a lot of convincing, let me tell you!)
    I'm glad everything worked out in the end, though I am so sorry you didn't get the birth experience you hoped for.

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  8. By the way Mo, how were your glucose levels after giving birth?
    Unfortunately, 2 months post partum, my 1 hour pp are a little better but my fasting levels are even worse. Was hoping things would return to normal after expelling the placenta but it has not been the case. Maybe once I get rid of this last 30 lbs I have to lose.

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  9. You're so eeeevvviiiillll for posting it in segments, lol. I am more than willing to read a wall of text from you! I'm currently trying to raise money for my first IVF. I really want to cycle late this year after 14 years of infertility. I hope I get as happy an ending as you have!

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  10. Wow. You endured so much. You are a hero. And the docs are evil. I don't know how long I can wait for the next episode. It's thrilling and scary and anger making all at once. I'm so glad I know Magpie is alive and well, because I couldn't stand it otherwise! Hugs to you, mama!

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  11. Mo, I can see how impossible it would have been to mentally conceive that pregnancy = baby. I am glad that you did get a few things the week Magpie was born.
    My only experience of giving birth is also one of being induced, so I can relate to a lot in this segment of your birth story. Drowning in contractions that are one on top of the other. Vomiting. Fun times.
    I'm glad you are writing this out, Mo, and I hope it helps you fully digest and integrate what happened at Magpie's birth. I certainly found that writing it out helped me process all the events surrounding Gummy's birth. Thank you for reading, by the way.

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  12. About to give up on part III, Mo!

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