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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Magpie's birth story, part I - the prequel

I've never posted the story of my labor with Magpie and her birth. At first, I was too shell-shocked to process it, let alone write it down, and then I was too sleep-deprived, and then I kept putting it off, and then I returned to work and didn't have a second free anymore...and well, somehow nine months have passed. Ms. Magpie has now been on the "outside" as long as she was on the inside. And it is time to write about how that came to happen.

I was induced for my labor at 39 weeks and 2 days. This is not what I had wanted. During my pregnancy, I had quietly completed a Hynobabies course, with Will at my side; I had ponied up the money to hire an experienced doula; I was going to go through Magpie's labor unmedicated if I could, in a fully equipped hospital but with as little intervention as possible. After so very much intervention to create Ms. Magpie, and so much intervention during the pregnancy itself between the monthly IVIG infusions and the weekly ultrasounds, etcetera, I think I was just done. I was ready for something to go right - without a hitch - and without a thousand medical interventions to make it possible.

Then I was diagnosed with gestational diabetes during my 27th week of pregnancy. It quickly became apparent that I couldn't control my fasting glucose numbers no matter how carefully I watched my diet. My post-prandial numbers were lovely...but my fasting numbers in the morning were creeping steadily upward. I became so afraid of having a "large for gestational age" baby, and therefore so strict with my diet, that I didn't gain a single pound past my 27th week, only gaining 18 pounds the entire pregnancy, despite the recommendation to gain 25-35 pounds as a woman of normal weight at the beginning of pregnancy. When I look back on it, it all seems a bit crazy, but I was determined to try to do the best for this very wanted girl, whom I pictured swimming in sugar, and growing - I was repeatedly warned - ever larger because of it. Because of the rising fasting numbers, I was put on insulin at night, and then when that didn't do the trick, more insulin at night. I started doing twice a week non-stress tests at 30 weeks, soon adding growth scans to the mix once a week. They all looked good, but between the insulin-controlled gestational diabetes, my age of 40, my treatment with lovenox throughout my pregnancy (switched to heparin at the end), and my abysmal reproductive history of six consecutive losses, I was told that waiting to deliver without induction was a no-go.

"All babies are priceless and irreplaceable, but this baby is really priceless and irreplaceable," my OB said to me again and again. And she was right.

I was told that the placenta can start to break down at the end of pregnancy and that this happens faster in women with gestational diabetes. I was told that the risk of stillbirth goes up past 39 weeks for women with insulin controlled gestational diabetes. I was told not to risk it. That as soon as it was safe to deliver, we were delivering. My OB offered me an elective C-section a few times. "You're a primipara; your cervix is long and closed and posterior; this may not go well for you and may be a rough road to delivery."

But I was adamant. I was not going to have a scheduled C-section. I was going to try to do this unmedicated. I was going to give birth vaginally. Surely my body could do something "right." Looking back, it seems that I believed that if I was determined enough, I could make the birth itself turn out the way I wanted. A ridiculous level of persistence and determination had brought me through 7 IVFs and gotten me this far; in my mind it stood to reason that I could persist through a few hours of labor and have the birth I wanted.

So we proceeded ahead with the induction plan. My long and closed and posterior cervix ("not even a fingertip dilated") would be prepped with cervadil and then after 12 hours of cervical ripening, we'd move on to pitocin.

Although cervadil is usually placed at night, I asked to be admitted and have it placed in the morning so that the timing of the pitocin administration would allow me to overlap with the beginning of my OB's call schedule. And so I was admitted on a Monday morning at 10AM. An IV was put in, which stunk, because my veins are a wreck from having chemotherapy in my twenties, and so I tend to have a lot of pain with IVs. And then the cervadil was placed. Apparently they can't lubricate it and they try to place it as high as possible, tucking it behind the neck of the cervix. I'll be honest - it was a bit uncomfortable, but it was in. I was strapped up to all the electronic fetal monitoring equipment. And told to rest. This was impossible, of course, given my adrenalin levels, excitement, and nervousness. On the physical side, the IV, that electronic fetal monitoring equipment (which alarms every time you move), the scratchy gown, and the cruddy delivery room bed whose sheets wouldn't stay on leaving me repeatedly sticking against the vinyl mattress were not exactly conducive to sleep either. I was most definitely awake, but tried to rest.

We were on our way!! Or were we?

To be honest, I didn't feel really much of anything going on.

***To be continued***

Mo

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Two teeth

Here is my beautiful girl at 8 months and change. She's growing up, moment by moment.

I am not entirely comfortable in this blog space but will try to keep posting. Thank you for your thoughts and comments on my previous post. They all helped and I am working to just tolerate the feeling of reduced safety that I have now. And also to be mindful of what I write, to realize that I have a wider audience than I imagined.

I have much to say, about parenting, about trying to balance life as an academic and clinician with being a mom, about what it is like to be here in the world of parenting and babies after being so long in the world of infertility and loss - so long there that I thought getting out of it was impossible.

Much to say on how deeply I desire to do right by this little girl, this oh-so-wanted little girl, and how I often feel completely de-skilled by her, disarmed, at a loss to possibly measure up to the ideals I have for myself ("If only I can get out the other side of these many losses, of this infertility, I will..."). Much to say on how each moment comes and goes so fast (how can this be true already?) that I want to hold on to each one, be mindful, be present - physically and emotionally. How already I sometimes glimpse the little girl emerging from the little baby I gave birth to. And much to say about those times when she looks up now and sees me and smiles, looks at me and her entire being lights up, and I feel so moved to be my best self for her, to be deserving of the trust and faith she has in me.

Found

I've been quiet this past month after receiving a couple of taunting comments from someone on this blog.

Apparently someone from my real life found this blog or someone from the blogosphere stumbled onto my identity, I'm not sure which. I've had real life folks find us before - and in the past this was always handled directly and honestly, with the person contacting me to let me know. I'll admit even in those cases, it felt weird to be found and to know that someone who knew me was reading.

But then I realized that that's the decision I've made as I've gone along - to make this blog real enough and personal enough that if you knew me well, knew our story, you'd recognize it in these pages (how many people in real life do YOU know who have had so many IVF failures and so many miscarriages and now are the proud parents of a tiny little girl?). So if you knew me, even without the photos of Magpie, you'd recognize the story because it's unusual enough. So be it. If I stripped out all the details to make it entirely anonymous, it wouldn't feel real or honest or emotionally true, and therefore, in my book, wouldn't have any point.

But now someone has found us and isn't being on the up and up. Instead they are leaving comments that are sort of....well, menacing. Sort of an "I know who you are!" kind of thing, and putting identifying information about us in the comments. They don't have all this information correct, but the intent is obvious. (They could have, for instance, emailed me at the email address on the blog and told me I had inadvertently posted clues to my identity, but instead they chose to post our identifying information where others might see it.) It's mean, really. Basically, it's a form of bullying.

I'm not sure what the point of this behavior is. Does this person want me to shut down the blog? Are they just plain hateful? Do they not understand that some of us work in professions where it is important that we maintain a sense of confidentiality and anonymity? I'm not sure.

But the sad result is that I haven't felt comfortable posting again. Five years and more than 500 posts, and in effect, I've been silenced. Maybe that was the intent of this person all along? I have no idea.

I'm trying to decide what to do about this space. One thing that would be useful to know as I mull over this is whether this blog has been helpful to you in any way in your own journeys. Did these words and our experience matter or assist you in any way through your own decisions, or your own pain and struggles?

Thanks for your thoughts and sorry for the silence.

Mo


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Sweet potatoes, where have you been all my life?!

Magpie's first venture into solids this weekend was a raging success. Six months old and ready to eat!

At first she wasn't so sure about it...

But very quickly, she decided sweet potatoes were delicious

And fun to spread everywhere in reach!

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