Birth Snapshot: The Epidural

Labortrials got an epidural?!  Oh me oh my.  Yes, friends, I consented (begged for, even) to the bleepin’ epidural.  How did this happen, and how do I feel about it now?  Well . . .

I arrived at the hospital worried that something was wrong.  The labor contractions came fast and painful, and I knew that less than 24 hours previously I was not dilated but a smidge.  I also felt as strange ‘pop’ down there and knew it wasn’t my water, so that in conjunction with the scary contractions (tetanic, perhaps) sent me packing to the hospital quickly.

The OB arrived, checked me, and found me to be 2cm dilated, but the baby was high.  According to the monitor, the baby was not handling the contractions well.  (She was having late decelerations.)  The OB restricted me to laboring on my side; the labor nurse told me I had to relax my body in order to dilate.  The contractions really were more than I could handle with the position restriction.  The OB checked me a few hours later, and I was still stuck at 2cm.  I knew that as soon as I could get an epidural that I needed to have it put in.  There was no way I was going to withstand the contractions, restrict my movement, and relax enough to dilate without pain management.

Interesting that this evening on my twitter feed, I saw @RobinPregnancy’s tweet about epidurals:

Did you ever have an #epidural that didn’t work quite as well as you’d hoped?
http://ow.ly/6ejKI
#pregnancy #About

I had an intrathecal with an epidural placed.  The idea was that the intrathecal could possibly get me through the next several centimeters of dilation more quickly and would wear off.  If and when I wanted the epidural, it would be ready and waiting for me.  The intrathecal improved my quality of life dramatically, and indeed I did progress quickly from 4cm to 8cm dilation.  Then I got stuck at 8cm and for a few hours, so I wanted the epidural.

However, the epidural was slow to work, and when it did, it didn’t provide enough relief.  My labor was not progressing very well, so I was concerned that if the epidural didn’t work and I needed a cesarean, that I’d feel the surgery.  I was terrified, actually.  This caused me to over-react.  The anesthesiologist gave me a bolus of something (yes, it’s horrible that I can’t recall this information), and when that didn’t seem to give me enough pain coverage, I received another bolus of something (nope, can’t remember what that was either).

So, when it came time to push, and thank God I got to that point, I couldn’t feel a darned thing.  I could sense when a contraction was beginning, but that was about it.  I had some sensation in my toes.  I had no idea where my vagina was or how to push.  That was terrible.  My OB was a tremendous labor coach, so he talked me through every contraction . . . every push.

Ideal?  I suppose that depends on how you look at it.  The purist in me says “technically, you had a vaginal birth, but you missed the whole darned thing.“  The practical-ist in me says “honey, if you hadn’t gotten that epidural, who knows if you’d have dilated quick enough for the OB, or if the epidural is what helped calm the baby’s response to the labor contractions (stressed mom can lead to stressed baby), or if you would have outlasted the pain.”  No one made me get an epidural.  I told them on entry that I wasn’t interested, and they left me alone.  I asked for the epidural – it was my request; my choice.

People can be sooooooo judgmental about the use (or refusal) of epidurals.  Read this woman’s story over at Unnecessarean.  Don’t miss the comments which are QUITE polarized.  Given what I’ve been through, you may laugh at my comments.  Would I recommend an epidural to my closest friends and family members?  Yes, with caveats.  Would I recommend my closest friends and family members NOT accept an epidural?  Yes, with caveats.  Would I recommend epidurals for VBACs?  Yes, with caveats.  Is the epidural the beginning of the end in terms of natural childbirth?  Yes and no.  Does the epidural cause a cascade of interventions?  Yes and no.

Yes.

and

No.

Yes, it’s not that simple . . .

Birth Snapshot: Out the Vagina

No, I still haven’t finished my 4th and final daughter’s birth story.  I’ve been too busy and too distracted, and honestly not terribly motivated to share all the gory details.  This is why I’m trying to post these ‘snapshots.’  I wrote about my VBA2C for ICAN’s blog, so if you’re interested, go read that post – it shares a lot of what went ‘wrong’ with the birth.

I’ve never enjoyed one of those ‘perfect births.’  You know – the ones you do hear about in the homebirth community – the candles, the soft music, the water, the privacy.  I’m still left so unsatisfied . . . and yet thankful.

My baby did come out vaginally.  I still don’t know how that happened.  Sheer dumb luck?  God?  A little of both??  In spite of all of the interventions at the hospital, the stress, the loss of my quested homebirth, she came out vaginally.

Praise God!

Browser Buzz

My husband finds it incredibly frustrating that I will keep open a gazillion tabs or browser windows open for days . . . errrr . . . weeks at a time.  Here’s a taste of what’s hanging around my browser these days:

All quality stuff.  Check out a link or five!

Birth snapshot: Two weeks ago today…

Two weeks ago today I was utterly hopeless.  By 1pm I had lost my midwife and pissed off the only medpro that was ‘in charge’ of me.

Two weeks ago today and at this time I should have been getting prepped for a repeat cesarean.  Instead, we called the hospital that morning and called the OB’s office to cancel that surgery.  We felt the surgery was at best premature but more than likely completely unnecessary and scheduled out of medico-legal fear.  The only reason I allowed the scheduling of that surgery was because I didn’t think I’d still be pregnant at 41 weeks and 4 days and didn’t plan on needing an obstetrician anyway!

Two weeks ago today and by this time of day, my husband had called my midwife.  He thought her suggestion to just show up at the hospital on that day (with relatively no labor signs) just to appease the doctor was quite strange.  Little did we know that she no longer felt comfortable helping us at home.  Thank God my husband was able to pull that out of her.  So . . . by this time of day I was that patient who goes against medical advice (AMA) and cancels a scheduled surgery and doesn’t check back in with the OB and doesn’t show up at the hospital during business hours.  And my midwife abandoned me when I needed her and expected her the most.

Two weeks ago today and an hour from now, I took a 2.5oz dose of castor oil that did nothing but make me feel sick to my stomach.  We started getting ready to go to the hospital.  I had no idea what you put in a hospital bag . . . couldn’t remember.  I tried to rest but was restless; tried to sleep but was too wired.  Sleep was way to passive for me at the time – I had walked a big blister onto the bottom of my foot; I had bounced on the ball; I had squatted.  I researched ways to help get my baby better positioned if and when contractions resumed.  I researched post-41-week birth outcomes.  I looked and looked for any justification for a pre-42-week cesarean.  I looked and looked for evidence that stillbirth rates doubled at this point in a healthy pregnancy.

Two weeks ago today . . . by 1:02pm, I had no faith in myself.  I had no faith in my birth community.  I had no faith in my care providers.  And yet I had so much . . . an amazingly supportive husband, my in-laws who dropped their plans and raced up her from Denver to take care of us, my 3 sweet girls, and my cozy happy healthy baby in utero.  Why did it have to be such a hopeless day?

Against All Odds: Gillian, VBA2C

I have neglected to post an announcement about my daughter’s birth.  I was thinking that I would have a birth story ready to post within a few days of her birth, but clearly that is not the case.  Actually, in addition to her birth story, I will be drafting additional posts related to this crazy birth experience and a couple of guest posts for other blogs.  Stay tuned!  For now, here are some stats for your enjoyment, and a picture of my latest love bug.

Gillian, day 2

  • Gillian, born Tuesday, July 12 around 5:30 am
  • 8 lbs, 14 oz
  • 21.5 inches long
  • 15.5 inch head!
  • HARD labor commenced at 7pm on Monday, July 11, about 5 hours after a second dose of castor oil while pumping, at 41w4d gestation, the same day I cancelled the ‘required’ 41.5w cesarean (scheduled for 1:30pm on July 11)
  • About the only thing that was physiologically NORMAL about all of this is that she came out of my vagina and I was not given pitocin (well, not until stage 3)

I must give particular thanks to the women of ICAN and Birth After Cesarean for lifting me up, particularly during the last trimester of this pregnancy.  The last week of my pregnancy was sheer emotional hell, and I wouldn’t have made it through without these networks of amazing women.

Re-Birthing Catherine

Background:  I spend a lot of time mulling over the amazing information on kmom’s Plus Size Pregnancy site.  Today I was drawn to the “Emotional Homework” suggestions found under Increasing the Odds for a Safe and Successful VBA2+C.  I started tearing up and getting a lump in my throat . . . not that it takes much to touch my poor lil feelings these days.

Try ‘rebirthing’ your cesarean births - Although it is often a very emotional exercise, many women find it particularly helpful to recall every detail of their cesarean births, and then later re-script the labor and birth so that it goes the way they would have wanted it to go.  Start by recalling (either verbally or by writing it down) every sensory detail of a prior birth. [ . . . ]  Then, when you feel ready, re-script and re-experience the labor and birth the way you would LIKE it to have gone.  Change whatever needs changing, as small or as big as needs be.  Concentrate particularly on healing things with your child, having the wonderful birth and nurturing time afterwards that so many of us grieve missing.  Write out the storyline of the changed birth so you will have it and review it as needed.

My 2004 birth story (the hind-sight is 20-20 version) is here.  I will say that re-reading my surgical report and going over it with my midwife recently was quite illuminating, and that makes this re-birth process a bit easier on my left brain though my right brain is in agony right now.

Deep breath.  [Contraction]  Ppphhhhhhhhh . . . here we go.

my last belly pic 12/2004!

I went to my 40 week pre-natal appointment with my CNM a day after my guess date passed.  I was a bit disappointed that nothing was going on – very little effacement or dilation, but also wasn’t terribly surprised since I had learned that many first time moms go into their 41st week before natural labor sets in.  All of our family had been in town for Christmas, but the brothers and sisters had to head back out to jobs and school and stuff.  It was just us, our dog, and both sets of parents left in town at this point.  Still we’d both had enough family time, so after a good lunch at one of our favorite burrito places, DH and I left for home ALONE to just chillax.  I think I spent most of the afternoon on the couch sleeping through movies.  DH was gaming on-line.

Later in the day I started getting really sick.  I guess it could have been as early as 6:30pm or as late as 8:30pm, but regardless, I was a sick puppy.  My blood pressure runs a bit low, so vomiting + being on the toilet = passing out for me.  It was a fun game to see if I could finish my business before falling to the floor.  So, I was in and out of bed and the bathroom.  There wasn’t much DH could do for me, and I was so sick that I wasn’t staying remotely hydrated.  And I was contracting (though I hardly even remember that detail).

DH insisted on calling our midwife, and of course she just advised that he do his best to get me hydrated and not to worry about the contractions, because of course, there’s no way that I’d be in labor!  That made sense to me.  I certainly didn’t feel like I was in labor.  I felt sick as a dog, and I was getting sicker and sicker.  After a few more hours of this, DH called the midwife back saying that even if I wasn’t in labor, he was worried about how dehydrated I had become.  (We’re both professional singers, so we’re very conscious about hydration.)

This was after midnight.  He’s scurrying around the house trying to figure out what to put in our hospital bag, and I’m thinking that he’s nuts for trying to take me out of the house in this condition.  I remember not wanting to leave the house.  No, no, no – this is just NOT right.  And how the hell am I supposed to get to the car without passing out, pooping myself, or vomiting everywhere?  Hmmm??  And once I’m in the car, how the hell am I supposed to ride in the car without pooping or vomiting everywhere?  Hmmmmmmm???  Oddly enough (thought I get it now), I stopped getting sick.  I became more aware of the contractions, I guess, but I was more curious about why I had suddenly stopped getting sick!

We arrived at the hospital a few minutes later.  The intake gal wasn’t the slightest bit concerned about me . . . taking her sweet ass time while I’m contracting away and wondering when the next wave of sickness would take over my body.  I didn’t think I could get to L&D on my own, so once DH got back from parking the car, I think he wheeled me away to L&D.  I was kind of excited in a way!

Get to L&D.  Everyone is in slow motion.  They knew that I was on my way, but yeah yeah . . . 1st time mom thinks she’s in labor, yeah right.  They didn’t have a proper L&D room ready for me, so they put me somewhere else for my initial assessment.  It didn’t bother me any.  I was just trying to manage contractions.  So blah blah whatever questions that I couldn’t focus on but DH was mostly able to answer.  Taking their sweet ass time.  They check my cervix and holy moly SHE’S 9 CM DILATED!!!  GET HER MIDWIFE HERE STAT!!!  All hell breaks loose.  It was comical.  They readied a L&D room and transferred me.

So here we go!!!  We get set up in our room and our midwife arrives looking a bit sheepish since she insisted TWICE to my DH that I was NOT in labor.  After confirming that I was 9cm dilated, she offered to break my water to help move things along faster.  I knew that she was just trying to help since I was so sick, but DH reminded her that we were not interested in any unnecessary interventions.  He asked again about my dehydration, and they said the quickest way to remedy this was IV fluids.  It sounded like a good choice even though I was bummed to be connected to tubing that could restrict my movement.

At some point the labor nurse noticed fluid coming out of me.  I think she thought that was amniotic fluid, but no . . . ick, it was from uhhhhmmmmm, somewhere else in the vicinity.  I was a bit embarrassed that I was having diarrhea everywhere, but I knew that in order to bring this baby down, I needed to move and change positions.  For some reason, it seemed logical that I would turn my butt to the room and sort of drape myself over the back of the elevated head of the bed.  That was just a great position for me, even though I was making such a mess.  Thank God for chux pads, people!!!  Anyway, from this position, I was able to sway my hips and bounce like a maniac and still ‘rest’ my head.  Upright positions definitely felt the best and seemed the most productive.

I didn’t ever really ‘hit the wall’ like I had expected because obviously I transitioned either at home or in the car when I was still so sick.  Once I got to the hospital, I was still having diarrhea, but I stopped vomiting thankfully!!  I started feeling pushy, so my midwife examined me again and encouraged me to push.  However, she had me on my side for pushing and was having me push for counts of 10.  This was horrible.  They had to give me oxygen, and the position was excruciatingly painful.  My contractions were one on top of the other even though the stupid monitor was telling them that my contractions were ending.  I hated that damned machine.  I wasn’t making progress.  I was getting tired.  I was frustrated.  I was sick.  I was contracting and grunting and moaning and getting nowhere fast.  My midwife estimated that the baby was stuck at 0 position and not tolerating pushing particularly well.

DH & I thought back on our childbirth education series.  We knew something had to change.  So, I got back into that other strange position of draping myself over the top/back part of the bed and pushed in that position.  The counting to 10 was driving me crazy, and I yelled for everyone to stop.  I just decided to push whenever for however long and see what that did.  I felt my baby girl making her way down.  Eventually, that is.  My midwife wanted me to lie down so she could check the baby’s position, but I didn’t see how I could possibly do that, so she contorted herself and checked me and found that I was +1 or +2 . . . can’t remember.  Aha, progress!  That was all I needed to invigorate me.

Some rights reserved by Travis S.

I do remember wondering when pushing would end.  I thought I recalled reading that 1.5 hours was fairly standard, but I had been pushing for twice as long at least.  However, I was surviving (I think thanks to that bag of fluids), and the baby was now doing better with the pushing.  Hooray!  What seemed like an eternity later . . . eventually resulted in me feeling like my vagina was on fire and going to explode.  Baby was crowning!!  My midwife applied counter pressure to the perineum so I wouldn’t tear and encouraged me to ‘go easy’ with the pushing if possible.  Eventually I couldn’t resist any longer, plus I was tired of the out and in game that the baby was playing.  I pushed really hard – I think I was on all 4s at this point – and her head came out.  Relief.  It feels so much better once the head is out, I can’t even tell you.  A couple more pushes and the shoulders and body were out, and my sticky gooey baby was in my arms.

Many women feel like birthing their babies was a transformative experience.  I am one of those women.  I felt like, if I can do that, I can do anything.

 

Closing in on 39 weeks

image by Ixionx

Man, nothing like a really bad flu bug to just knock your butt down.  I feel miserable.  It started with soft palate irritation and has resulted in me being in bed for 2 days.  I finally took some extra strength Tylenol today, so I’m less achy, but I’m coughing and congested and my head hurts.  I FEEL TERRIBLE!  And I’m cuh-RABB-y!!!!!  (Yes, I know I’m *only* 38+ weeks.)

This is the last thing I need right now when I’m feeling the pressure to get out and walk, have ‘relations’ with my husband, do lots of deep squatting, and other things to remind my body that it wants to go into labor.  Really, it does!  (Yes, I know I’m *only* 38+ weeks.)

My 38 week appointment with Mr. Dr. Hyde was uneventful.  He wanted to check my cervix, and he confirmed what I already knew – that my cervix was posterior and closed up like a little clam.  Since then, I’ve been contracting more, I guess, but nothing spectacular or indicative of immanent labor.  (Yes, I know I’m *only* 38+ weeks.)

Last night I had a horrid dream about my baby not only kicking her way out of my uterus but out the side of my gut.  In my dream I start screaming for my mom to call 911 and then pass out . . . and that’s when I woke up.  I know it was just a dream and that it doesn’t mean anything, but pairing that with being sick has just deflated me.  Now all of a sudden, I can’t imagine lasting in labor.  Not only that, I don’t want to be in pain, and I sure as hell don’t want to in pain for hours and hours.  Maybe I’ve watched too many YouTube birth clips as I’ve laid here in agony?  (Yes, I know I’m *only* 38+ weeks.)

My amazing husband – he said to think of what I’d be telling any woman at 38-39 weeks pregnant who is losing steam and gaining doubt.  He says such fantastic things about birth and trust and intuition; I’m not sure he recognizes how wonderful he is.  All I know is that he’s talked me down off of several ledges.  I’m not quite off the edge this evening, but maybe once I get to feeling better, I’ll regain my trust and faith in myself and in the amazing process God designed for me, my body, and my baby.