Monday, April 28, 2008

Clara's Birth by Mackenzie

After 5 weeks of bedrest, biweekly NSTs, and a trip to L&D for pre-eclampsia, my OB finally decided we should induce at my 40 week OB appointment. We had a few hours to prepare before we headed to the hospital. Dan and I made a list of what we would need to pack and/or buy. Then, we ate lunch and took a nap. The afternoon went quickly. Before we new it, we had to get packed and eat dinner. On our way to the hospital, thunderstorms began. Wow, was the rain coming down! By the time that we arrived at the hospital at shortly before 8 PM, tornado warnings had been issued for our county. In fact, the hospital was moving everyone ambulatory to the ground floor, and when we got to L&D, we were sent to wait in the hallway. The staff was wheeling all of the laboring women into the hallway as well because all of the LDRs had windows. It was wild to sit there with all of these laboring or recovering women, getting a preview of what I was going to experience.

Finally, we got into our room around 9 PM, when I was supposed to get my first dose of Cervadil. We waited and waited for a nurse to come. Because of all of the chaos surrounding the tornado, it took an hour and 45 minutes for a nurse to find time to get me admitted and insert the medication. In fact, it was close to midnight by the time I got the first dose of Cervadil, and I was supposed to have my 2nd dose at 1 AM! However, I was contracting pretty regularly on my own when the nurse hooked me up to the monitor, so she and the doctor decided to forego the 2nd dose of Cervadil and just head straight to Pitocin at 4 AM.

Dan stayed with me until about 12:30 AM and then went home to let the dogs out and get some sleep. I slept fitfully for a few hours. The contractions were more like cramps and were coming every 2-3 minutes. The big nuisance was the BP cuff. My pressure was high, so I was being monitored more frequently. Gosh, that sucker hurt. I also was showing +2 protein in my urine, so the staff started to get concerned about my pre-eclampsia. As long as I laid on my left side, my BP was fine. But that was the worst way to lay to cope with the contractions. At least I was able to sleep a bit. The nurse had to wake me at 4 AM to put in my IV and start the Pitocin drip. Shortly after, the contractions got a bit more intense, mostly longer, and I had a harder time sleeping. Good thing I brought a good book to keep myself occupied.

Dan got back around 7:30 in the morning. I was feeling fine but my BP was not great. Every time I would get up, it would go up to borderline dangerous. The nurses changed shifts, and my new nurse was GREAT! She had 37 years of experience and was very much like a midwife in her approach. When she first came in, I was sitting on the ball which she encouraged. Then my BP was taken, and it was back to bed. She checked me at the start of the shift, and I only was dilated to 2, although I was almost 75% effaced now. Not a lot of progress for 4 hours on Pitocin.

My OB came to check on my at about 9 AM. I was still at 2, and my BP was HIGH. She asked if I intended to get an epidural, and I answered, "Yes, eventually." She advised that getting the epidural now would help keep my BP down and recommended that we break my water and get the epi so that she wouldn't have to give me magnesium sulfate which could slow down or stop labor. So she broke my water and put an internal monitor on the baby. But it didn't work. And the whole thing was EXTREMELY uncomfortable for me. Afterward, I got up to use the restroom one last time before the epi, and I didn't feel any gushing. Strange.

The nurse anesthetist came in around 9:45 to administer the epidural. She was great at explaining it. I was a bit apprehensive, but she and Jane were wonderful. The worst part was that when she fed the catheter in, she rubbed a nerve, and I had a strong clenching feeling in my lower back. It was awful. But when she moved the catheter, it went away. The epidural taking effect was a very odd feeling. At that point, I didn't really need the relief, so I just got to kinda feel the numbness spread.

Right after the epi, my mom arrived. She'd driven in from PA that morning. I was SO glad to see her. I had been waiting (impatiently) all morning for her to get there. We hung out and chatted and watched tv as the nurses checked on me and moved me from one side to the other every hour to make sure that the epidural was taking effect equally on each side. We watched the contractions on the monitor and watched my blood pressure go up every time I moved from my left side.

At about 11:30, Jane decided she needed to check me again because the contractions hadn't gotten more intense after my water had been broken. She found that my water HADN'T been fully broken and the reason that the internal monitor wasn't working was that it was on my CERVIX, not on the baby. So Jane broke my water and put in the internal monitors for the baby and for contractions. Now it was a lot more fun to watch the contraction monitor because their severity was truly being recorded. Every so often, the nurse would come in and turn up my Pitocin because my contractions would start to "fizzle out". Thank goodness I had the epidural, because I don't want to think what it would have felt like otherwise! Eventually, my Pitocin was just about as high as it would go!!

Dan's parents arrived around lunch time and brought Panera for everyone…except me. I was STARVING at this point, having not eaten anything other than a granola bar since dinner. So I had jello and a popsicle while the rest of them had sandwiches and chips.

By 1 PM or so, I still hadn't made much more progress. So Jane dropped the bottom of the bed so I was laying with my hips slanted toward the floor. Then she propped my top let up on the tray table so I was essentially spread-eagled while lying on my side. She said the spread and the decline would help the baby move down the birth canal and put more pressure on my cervix to help me dilate. I hung out that way till about 4:30. In that time, the OB came to visit again and said that we were making progress, slowly but surely. I think I was maybe close to 100% effaced at this point? I kept telling everyone that I wanted to do whatever it took to deliver vaginally, and they were 100% behind that. Also during this time, I was discouraged and kinda retreated into myself. Everyone else was playing cards and chatting, and I just wanted to read alone.

Finally, the OB came back to check on me at about 4:30. I was FINALLY 5 cm and 100% effaced. She said the next 5 cm should go much more quickly than the first 5. I also started to get a bit more uncomfortable, feeling some pelvic floor pressure. I could feel the contractions, but only as a pressure. Even then, I was having to breathe through them a little bit. So they had the nurse anesthetist re-dose my epidural. That provided relief for most of the pressure. But within little more than an hour, the pressure was back, and it was more intense. D was now sitting next to my bed, and I was really having to concentrate to deal with the discomfort. My mom was there, too, on the other side. D was rubbing my lower back, and I was holding onto the rail of the bed HARD.

During all of this, D's parents returned with dinner from Wendy's for the troops. I couldn't STAND the smell and made them leave the room because I was feeling so nauseated. My mom headed out to the waiting room with them, and D stayed with me. I was crying because I was SO uncomfortable. D's mom offered to stay with me so that he could eat, and I nearly screamed, "NO!" at her. D called the nurse to check me, and I was at 7 cm. In just about an hour! The nurse put my legs down to keep me from dilating quite so quickly and in an effort to help me manage the pressure. And they sent the NA in to re-dose my epi again. By the time the NA got there, I was in a LOT of discomfort. Every time I had a contraction, I felt like I had to hold my insides in. Most of the pressure was rectal, just like you read about—it felt like I needed to have a bowel movement IMMEDIATLEY! I felt some of the same type of pressure vaginally. It didn't HURT, per se, but I was extremely uncomfortable.

It was now just before 7 PM…shift change. My great, midwifey nurse was leaving. What was worse at the time was that the nurses were having their shift change meeting and kept putting me off. That is, until I finally said, "I'm not kidding, I feel like I have to PUSH!" The NA, who was still in the room, RAN to the nurses' station to get my new nurse. She checked me, and sure enough, I was complete. So I went from 5cm to complete in an hour and 20 mintues or so. WE WERE READY TO PUSH!
Oh, did it feel good to push. It relieved the pressure SO MUCH. And yes, you poop during delivery, and no you don't care. Unless your nurse doesn't clean it up and you have to ask her to. Needless to say, I wasn't thrilled with my new nurse. Instead of coaching me on appropriate pushing and doing perineal massage, she was charting on the computer while I was pushing. What made that even more annoying was that she was hiding the contraction monitor, and we needed to see that because the pressure was constant whether I was having a contraction or not. So the only way I knew when to push was that D would watch the monitor and tell me when the contraction had gathered enough steam.

The nurse was thrilled with how well I was pushing and the progress that I was making. She jokingly asked if I had done this before! The baby had a few small decelerations, so I had to wear an oxygen mask. I was exhausted and shaking violently between every contraction, which made me even more tired. D was awesome, helping hold my leg and my shoulders and feeding me ice chips between contractions. He kept telling me what a great job I was doing. We pushed for about an hour, with both D and the nurse telling me what great progress we were taking when all of a sudden the nurse made me stop pushing and paged the desk to call the OB. Later, D said that we had only been seeing a bit of baby's head at the peak of each push, and then baby would recede…but suddenly, a LOT more of baby's head appeared with a big push, and it didn't go back. When the nurse told me I had to wait to finish till my OB got there, I said, "NO! Go find another doctor. Please!" She said it would only be 15 minutes. So I "blew away" the contractions for a bit and then was allowed to give little pushes. It was the longest 15 minutes of my life. Like a little kid in the car on a long trip, I kept asking how much longer I had to wait.

Finally, Dr. R arrived. She was great and positive and very excited. I pushed and pushed and started kinda hyperventilating. I was so, so tired at this point that I couldn't catch my breath between contractions. I was pushing for three 10 counts during each contraction, and the contractions were less that 2 minutes apart. My progress stalled. You could see baby's head, but I was losing the strength to push her out. Dr. R asked if I wanted her to use the vacuum to help me. I knew I needed the assistance. So on the next push, Dr. R attached the vacuum to the top of baby's head, and I pushed with all my might. You should have seen my tiny little OB standing up and pulling all directions on that vacuum with both hands! One more push, and baby's head was out. Oh, did it feel better already! I had to blow away a bit of a contraction, and then I pushed again to get her shoulders out. That was a bit easier!

And finally she was here!! It was 9:10 PM. D cut the cord. He was so funny when Dr. R asked if he wanted to. She barely got the question out, and he practically shouted, "YES!" She cried a little, and they took her straight to the bassinet because she needed to be suctioned. Probably because of the vacuum delivery.

I was so disappointed not have her placed right on my chest, but her daddy ran right over to her and watched the whole time. She never was out of my sight, either. While they cleaned her up, Dr. R put me back together. Mercifully, she had given me a shot of Lidocaine to numb my perineum. I wonder if she knew how badly I was going to tear? It took her as long to stitch me up as it took the nurses to check and clean up the baby. Everyone kept remarking on how big she was, and D and I both noticed her huge hands and feet right away. Someone asked, "What's her name?" D looked at me, and I answered, "Clara." D smiled really big. I had been having second thoughts about her name for a few weeks, but I knew as soon I saw her that it was right.

They finally gave her to me, all bundled up. She was PERFECT! She latched on the first try and did a great job, nursing for quite a while. My mom and D's mom came into the room and met Clara. They were so excited. After she finished nursing, D's dad came in, too. He took a lot of pictures. Then it was time for Clara to go to the nursery.

Unfortunately, the fun didn't stop there. As they nurses were monitoring my vitals after delivery, two causes for concern arose. First, my BP would not stay down. Secondly, I spiked a fever of almost 102 degrees. So, I ended up taking Percoset in addition to the Motrin I requested for the recovery pain. And then I got a migraine. By the time they moved me to my room, I was REALLY out of it. The nurse was giving us instructions, and I couldn't keep my eyes open. I had to keep my IV in to get 3 doses of antibiotics for the fever, and that was pretty uncomfortable. It was now midnight, and I was ready to pass out for a variety of reasons. D left to go home, and they took Clara to the nursery with the promise to bring her in when she was hungry. She nursed for an hour and a half at about 4 a.m. What a trooper!

By morning, I felt SOO much better. I had to have the IV until late afternoon that day to get my last dose of the antibiotics, but other than that, I felt pretty good. The headache was gone, and the pain in my "bottom" was completely bearable. The only outstanding issue was that my BP was still high unless I was laying on my left side. That continued until my discharge, and I was put on BP medication for a week and a half to help it regulate as I recovered.

All in all, it was a long and not uncomplicated labor. It definitely did not turn out the way I expected, and I was a bit disappointed in the experience. But Clara was worth every second of it, and I already can see doing it again in the not too distant future! The good news is that there's no guarantee (or even increased likelihood) that the next time around will be anything like this time.

Clara Louise arrived at 9:10 PM on Wednesday, July 12th after a long induction and labor (beginning 12 midnight 7/11). She is Mackenzie's first child.

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