Monday, March 12, 2012

Liam's birth story

The entire pregnancy had been a whirl of emotion and hesitancy to bring another baby into our gently balanced home dynamic. Throughout my pregnancy with Liam, I felt like I wished I had just an extra month, a few extra days to spend one on one with Tyler to show him how loved he is. I certainly never imagined that I would be bringing home a baby earlier than my estimated due date of March 25, and neither did my OB, Dr. Dickerson. Because Tyler was a post-due date baby -- only born at 40+3 because of an induction -- we both felt like I would be making it to that 40 week appointment and the Biophysical profile ultrasound.

On February 28, at 36 weeks and two days, I was tested for group B strep and had my first cervical check. My cervix was dilated to 3cm, Dr. Dickerson said. I was so surprised that I said I didn't want to know about position and effacement. Even then, though, I felt like I had 3-4 weeks -- and Dr. Dickerson said he did too, but to be aware that when labor started, it may go quickly.

I met with the Birth Help team that evening and realized how unprepared I really was. I made a long list of to-dos, including packing a labor bag and taking supplements that I'd purchased but hadn't gotten around to taking. Throughout the week I tried to get my mind focused on the impending labor by purchasing some last minute items for the hospital and postpartum period.

On Sunday, March 4, I woke in the early morning to go to the bathroom and went right back to sleep. An hour or so later, I woke again with wet pajamas. I'd had a dream that my water broke and after I woke, I got up to change. It didn't seem as if I was actively leaking fluid, so I went back to bed. When I woke for the morning around 6:30, I told Scott I was leaking fluid but wasn't sure of the origin. I talked to Angela (our doula and also a friend of mine) and told her that I was losing fluid, but didn't think it was amniotic fluid because it wasn't constant -- but that I was fairly certain it wasn't urine. I expressed my concern about going to the hospital before labor started, or even just wasting time if it wasn't amniotic fluid. She advised me to monitor it and we could make a decision later in the day.

All day I leaked here and there. Sometimes a good bit, but most of the time a tiny bit at a time. I was convinced it was something other than amniotic fluid, and even joked with a friend that if I was peeing on myself I'd never make it another three weeks like that!! I began to pack a bag for the labor -- but only because I thought it was a good idea to have it done ahead of time anyway.

Around 3:30pm, I sent Angela a text message to let her know there was no change, but that throughout the day I'd filled several pads. We hosted a small birthday party for a friend's one year old and I enjoyed our guests and all of the food everyone brought over. Around 5, I spoke with Angela who thought we should take a trip to triage to get checked out. We decided I'd wait for our guests to leave and I'd put Tyler to bed. As I read Tyler The I Love You Book, it occurred to me that just maybe I should read him another, in case this was his last moment with me as an only child with his mother. I also felt the urge to go to the hospital and get it over with so we could get back home, though, so I put him in bed and told him how much I loved him.

At this point, I'd still not felt a single contraction.

When we arrived to the hospital, a nurse used a strip to test the fluid and confirmed that it was amniotic. I broke down into tears. I realized that my bag had been broken at least 14 hours. Not many practitioners would be supportive of waiting for further intervention, but I felt comforted in knowing that mine would. When Dr. Dickerson arrived, he assured me that we were on no timeline. I was to take Penicillin through an IV (I had a hep-lock) every 4 hours because we hadn't received my group B strep results, but he said we could continue that way for days. In my head, I knew I didn't have days in me. I knew I'd never be able to stand that much time away from Tyler, and Scott only had two weeks to take from work. I felt comforted knowing that I wouldn't be rushed, but anxious for labor to start.

At 9:25pm, the nurses filled the labor tub. I would not get in for another 16 hours.

Angela recommended some natural induction methods and I was hopeful that I'd be able to get labor moving by nipple stimulation or walking. After walking and pumping and walking and pumping, I'd only felt tiny contractions. It was nearing midnight, so she suggested rest, which did not come easily. I was scared that I wouldn't go into labor by natural induction means, anxious spending my first night away from Tyler in 19 months, and distracted by hospital sounds, vital sign checks and my intermittent IV of Penicillin. I finally requested assistance to sleep, and after an Ambien, slept for about an hour and a half. The rest of the time I stayed in bed and tried to be physically restful, but my mind couldn't stop. I thought of all of the what-if's, all of the not-readies, how much I loved and missed Tyler. I cried when I realized I wouldn't see him the following day. I considered the possibility of cesarean section for failure to progress and thought of the irony -- I'd put effort into planning a natural birth, and I felt it slipping from my hands. But mostly I thought of how I wished I'd read Tyler one extra book, so I ordered him a few on my list for him and I waited for what the morning would bring.

The following morning, at 6:30am, we were at it again, but our natural induction methods weren't making any progress. Dr. Dickerson stripped my membranes and I walked the halls. Still nothing. Some time later, Dr. Dickerson very gently recommended I begin thinking about my feelings about using Pitocin, a drug that I hated during my labor with Tyler. I hated that he was bringing it up, but in my mind I already felt like it was going to happen. I agreed to the intervention and was hooked up to the IV and monitored continuously with a wireless telemetry monitor. I would stay on this monitor (and curse it) for most of my labor.

At 10am, the Pitocin was started. It began coming through my hep-lock at the lowest dose, 2, and was increased by 2 every 15 minutes. The first segment was spent in the labor room on the ball. After the first increase, we hit the hallway. The night before, we were one of three occupied rooms on the labor and delivery floor. Now the rooms were full. Each hallway had an anesthesia cart and I was reminded that although I desired a normal birth, it was no longer the norm. The halls were busy, but not with other laboring women. Nurses and doctors gave us weak smiles and a few made jokes about my fast paced walking. As the contractions got stronger, I remembered Angela telling me it was a good idea to stop, squat, and rock my hips throughout the contraction. I felt silly doing this, but quickly decided I didn't care.

Apparently this moved the telemetry monitor, which lost the baby's heart rate every time I contracted or squatted. Which was every few minutes! Our nurses chased me around the hospital hooking it back up, struggling to get it to stay on. It was a minor annoyance in the beginning -- it didn't feel great but the contractions weren't strong so I didn't mind as much. Later in the labor, I would yell as the monitor was adjusted during a contraction. There is certainly a lot to be said for intermittent monitoring.

As contractions picked up and became stronger, I began to look to Scott and Angela for relief. I spent some time in the ball near the bed, and when I didn't find the comfort I needed, I leaned over the bed while Scott massaged my back with the knobby ball.

With each contraction, I looked to Scott and Angela. It was a relief to know that I didn't have to go though them alone -- that I was being guided though the journey by our doula and being supported by my husband. The contractions were painful but manageable with the comfort measures Angela taught us. I leaned over the bed for counter pressure, rocked on the ball, spent time on my hands and knees in bed. I reminded myself that though difficult, the movement was allowing Liam to make his way down to the birth canal.

Each hour felt like five. I'm not sure if it was because of the challenge of the contractions or if it was the lack of sleep, but I am guessing it was a mixture of both. In birth class, Rene' taught us that having a full bladder could cause more pain during a contraction, so when I felt overwhelmed by a contraction, I tried to get to the bathroom to empty my bladder. I knew that this was something I needed to do every hour, and I really thought hours were passing! Many hours later (which, in reality was only ONE hour later) I found myself rocking on the ball in the shower, begging to get into the tub. Everyone always said that the tub provided such relief, and I felt like I was holding onto that trick for when I really needed it. I was there.

The nurse wanted to check me, and I requested Dr. Dickerson do it instead. I remembered reading in Ina Mae Gaskin's book that a laboring woman's cervix can actually change when she isn't comfortable with the practitioner, and I certainly felt most comfortable with my own doctor making that assessment. Because I declined the nurse's evaluation, though, I had to wait until Dr. Dickerson was available. He came in and was very encouraging -- Laura, you can do this; Laura you are doing great -- get into the tub, I don't need to check you.

But then it happened. And I know it wasn't intentional, but it still happened. I heard Dr. Dickerson mention to the nurses and Angela that he didn't care if I wasn't to 4cm, that I was in labor and the tub wouldn't slow me down. So in my head, I did the math. I'd been in labor for 94 hours (okay, maybe only 3 hours on the Pitocin, but you couldn't have told me then!) and the thought that I may not have dilated even one centimeter crossed my mind. I knew it was a mind game, and I tried to put it out of my head -- but I will always think of this as my first big challenge during my labor. As I got into the tub, I couldn't stop thinking that if I wasn't yet to a 5 or a 6, that I wasn't going to make it. Even though I knew that number didn't mean anything, in that moment it had power over me.

With each contraction, Scott applied counter pressure from outside of the tub. When the contractions became too intense, he hopped in the tub with me to hold me. Angela stayed by my side and Scott applied pressure. At times it felt like what Scott was doing hurt MORE than the contractions, so I would scream for him to stop. When he stopped, I realized I needed him to hold me. I'm sure this was very confusing for him, but he never once complained, never faltered. I told Angela countless times "This is terrible!!" because in that moment, it really was. I felt like my contractions were never ending. I had no concept of time but it didn't feel like I was getting a rest period. In my head, there was a possibility that after all of this, my cervix was unchanged, and I started feeling panicky.

I told Angela that I needed to see Dr. Dickerson. I needed to be checked. She calmly asked why I wanted that information, and I told her I needed it to make a decision. In my head, if I was at 5cm, I could go on. If I wasn't, I needed to rest. I don't know what that meant, but I couldn't stop thinking of how if I got an epidural, I would be stuck in the bed. I didn't want that. But I was tired, worn out, exhausted. Maybe close to delirious.

Angela suggested that instead of being checked, maybe Dr. Dickerson could turn down the Pitocin. THE PITOCIN! I'd forgotten about that! (Mostly. I guess it had just blended in and become part of my reality at that point.) It had to be turned down. Immediately. I looked over at the IV bag and realized it was only on a two. A TWO! How could it hurt so much and only be on a TWO? (At some point, apparently, the Pit was turned down from a 6 to a 2. Thankfully.) I needed it out of my arm immediately (because at this point, the Pit was to blame for my pain and discomfort, of course.) Dr. Dickerson came and we removed the line. He checked me while I was in the tub and told me I my cervix was 8cm dilated and 80% effaced. I couldn't have been more relieved to learn that the torture I was enduring was transition and that it would soon be over. He recommended I leave the tub and labor on the toilet for a while.

There I met the second biggest challenge of my labor. Often described by natural birthing mothers as one of the most intense places to labor, the toilet brought no relief. But it brought progress. Within minutes of laboring there, I began to feel the baby move into the birth canal. I saw my pregnant belly -- usually so high during my pregnancies -- lower as Liam dropped. I felt no relief in between contractions and I was so tired, but Angela continued to encourage me and Scott held me with each pain. Several times I heard the nurses over the intercom before I realized I was unknowingly pulling the emergency chain next to the toilet. Oops! I felt like I couldn't manage the intensity of laboring on the toilet but was unable to walk. Angela said I could return to the tub for relief but the idea of getting there was unimaginable.

At some point, I asked if I could lie in the bed to rest and Angela suggested I stay on my hands and knees, to keep my pelvis open. I remember asking if it was dark or light outside -- I didn't want to know the time, but felt like I could have been laboring through the night and into the next morning, it seemed so long. I just kept saying "I can't --" I was too exhausted to hold myself up, too exhausted to continue, too exhausted to move. With a lot of physical support, I moved from the bathroom to the bed where I was propped up on pillows and Liam's blanket. The one I made him right New Year's Eve -- the one thing I'd done to prepare for our baby boy. As I saw his blanket, I was reminded of why I was doing this. Healthy baby. Lower risk to baby and Mama. Freedom of movement. Breastfeeding success. Bonding.

I needed this birth to recover from my traumatic experience birthing Tyler, the difficulties it brought when establishing our nursing relationship, and I was almost there.

And then...

It just happened.

I had been pushing with each contraction, but not because I thought it was changing anything, because it provided relief. The contractions were still strong, though spaced further apart. I told Angela I needed Dr. Dickerson, and she gently said he would be coming -- but in my mind, I needed him there right away! I knew he would be there to deliver Liam, and in my head, when the doctor appeared the baby would come out. I needed that baby OUT! Angela encouraged me to vocalize through the contractions and I think this is when I vocalized the most. From the corner of my eye, I saw the nurse come in the room and I yelled, "I need to push!" Later, I would laugh about how I heard her quietly call the doctor and say, "She just yelled that she needs to push!" So -- I guess she was listening to me!

When he did enter the room, he calmly said, "Now Laura. I am going to look to see if we can see any change. Sometimes the labia will move and..." and he pulled up the sheet and said, "I NEED GLOVES!" I knew it was happening. We were ready to meet our little boy and I was ready to rest. I pushed with every bit of energy that was left. I remember thinking -- I don't care if I rip my body in half! This baby is coming out! Dr. Dickerson suggested I move my hips, but I was too exhausted. Just as I was saying I couldn't, someone guided them into the position he'd requested for me. A few pushes later, at 3:34pm, Liam Scott was born -- 8 pounds, 9 ounces, 21" long. 14" head circumference. I needed help turning around so I could lie in bed and hold him. The adrenaline from the contractions was gone and I melted into the bed with my boy in my arms.

(Later I was told that it was my "controlled pushing" that prevented vaginal tear. Funny how different my perception was.)

When it stopped pulsing, a very happy Daddy cut the cord. And held his son.

I wasn't the only one who was tired. Liam did not immediately nurse, though with the help of our doula then later our birth photographer, I was able to nurse him twice before we were moved to our Mother/Baby room. Thinking of this brings tears to my eyes because it wasn't so long ago that this happened. (As a side note, Liam "failed" his glucose test, too, but we were never pressured by the hospital to formula feed him. I was successful at nursing him instead. One day I will write the story of Liam's breastfeeding beginning, though it's short and simple.)

Liam's birth, from Pitocin to delivery, was 5 hours and 34 minutes. The longest and most rewarding 5 hours and 34 minutes of my life.

I can't say enough about our natural childbirth experience. It was one of the most amazing and empowering experiences of my life.

Photo credits to Melissa Cannon Photography. I bid on a birth package that Missy so generously donated to Louisiana Natural Birth group thinking that we would be happy if we got one or two family shots after the birth, and that if I wasn't comfortable with having a photographer we would just ask her to stay outside until the delivery. We couldn't have loved Missy more, and we are so thankful for her presence and support at Liam's birth. And of course -- the beautiful keepsake photos.


Court C said...

Oh my, I am anxious to reed the rest!!! How beautiful. When you wrote how it might be the last book you read to Tyler before having Liam, I teared up!! So sweet! I wish I did this with Emilia :)

bethanyp said...

My heart broke when I read what you said about missing Tyler and it being the first night you've ever spent away from him. I've never spent a night away from Jacob either and I'm not looking forward to it at all. I can't wait to read the rest!!

kristin said...

What an amazing birth story Laura! You are an incredibly strong momma:)Thanks so much for sharing!