...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.
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***