Friday, May 8, 2009

Jonah's Birth by Jen

My son was due on May 5th, a day before our wedding anniversary. I had no expectation that he would be out by then. He was our first child, and first children may very well come a couple weeks after their due date.

I was planning on having a water birth at our hospital’s birthing center. I saw an OB/midwife group that very much trusted nature to take her course, and they were in no rush to induce labor. They did, however, schedule biweekly non-stress tests to keep an eye on things. I have scoliosis and a funky musculoskeletal system, and knew my son was posterior. I was using the rebozo technique to turn him at home, and inserting evening primrose oil at my midwife’s suggestion to try and help soften my cervix.

I had a great NST on Monday, my due date. I would go out and walk a little bit, as much as I could. I have a chronic pain syndrome that flared up during pregnancy and restricted my mobility, to the point where my husband had to help to dress and bathe me. Thursday rolled around, and my usually active son seemed much quieter than usual. I did kick counts, and I just couldn’t tell if he was even moving or not. I drank some cold water, ate a snack, had a Sprite, and lay on my left side for a while in the evening. He moved a couple times, but was definitely not the wild child he generally had been. I considered calling the on-call midwife, but decided to just keep my NST appointment in the morning.

I was shocked to wake up the next morning and find I had slept the whole night through for the first time in nearly 5 months. My son hadn’t woken me with his kicking. I drank another Sprite and had a carb-filled meal before my morning appointment. I was relieved when the midwife found his heartbeat, but it was very flat. We tried all the usual tricks to get him to be more lively, but when I lay in that chair waiting for him to move so I could push the button they gave me to mark his movements on the monitoring strip, I knew something was wrong. My son was not himself, and it filled me with fear.

The midwife felt he was just quieting down in anticipation of labor, but my intuition told me differently. She ordered a biophysical profile for 3PM, just so I wouldn’t worry all weekend, and scheduled me to see the OB for another NST on Monday. I called my husband to go with me to the test, and we stopped at home to get the hospital bag and eat something. Yet again, I had a big meal and a pop, hoping to sugar him up so he would move for us.

I thought perhaps his fluid might be low, but I wasn’t prepared for our son to flunk the test as much as he did. He did not move once- not even a twitch. He scored a 4/10. I’ve worked as a labor and delivery nurse, and knew exactly what would happen. The tech left the room to talk to the doctor, and I turned to my husband and said, “They’re sending us to the hospital now.” And so they did.

On the way there, I called my mother to come to the hospital, worried they would have to get him out, and wanting to be sure someone would be with me and someone with my son the whole time, in case he had some distress. We had no idea why he was not moving.

We arrived in Triage at 7PM. The triage nurse said the doctor reading the BPP had estimated our son’s weight at 10 lbs. She and the midwife felt my belly and laughed, saying, “That kid isn’t 10 lbs!” The OB on-call as backup agreed. They felt giving the vaginal route we desired a shot would be fine, and we would watch our son to make sure he tolerated everything. My cervix was firm and high, only 1 cm dilated, and we decided that using the mechanical means of a foley catheter bulb would be less risky to our already distressed son than a chemical ripening agent.

My midwife inserted the catheter, which would stay in up to 12 hours until it dilated my cervix enough to fall out on its own, and I nearly passed out. Stimulating our son’s scalp made him make one big turn- and suddenly he was himself again, kicking and wriggling as usual. His heartrate suddenly changed from flat to a textbook-perfect one.

I had never planned on an IV or fetal monitor, but suddenly I had them, and wanted to have them. I was terrified he would stop moving again- or even die. We had called our doula Eileen on the way to the hospital, but she was at another birth, and we fully expected the process to take a very long time. The foley insertion had jump-started my labor and I was contracting every 4 minutes, but it was no problem for me. My pain level was consistently high during my pregnancy, and the only way I could tell I was contracting was by feeling my abdomen harden, or looking at the monitor. What I couldn’t stand was the hospital bed. It was too uncomfortable to sleep in. I accepted an offer from the nurse to take a sleep aid, and had maybe 3-4 hours fitful sleep, waking up to watch the monitor and reassure myself by my son’s movements.

In the morning, our doula arrived. The birth she had attended had finally happened at 5AM, and she was exhausted. She took a catnap on the floor of our room, and we walked the halls a bit. At 11AM, the foley bulb fell out while I was relaxing in the shower. Our midwife Margie checked me and I was 5 centimeters. I had lunch, and they started Pitocin. She offered to break my water, which is pretty routine in the hospital, and I declined. I felt strongly that my son already had issues and needed that extra cushion. Margie respected my wishes without problem.

Before too long, I was contracting every 2 minutes. My son was posterior. Eileen offered to put counter-pressure on my back during every contraction, and honestly, I couldn’t tell her when I was having one. It was just like the intense, neverending pain I would feel from my illness, and I usually dealt with that by rocking, listening to music, and trying to daydream myself in another place.

Saturday is a blur for me. The rocking chair was uncomfortable. I couldn’t move far because the FHM did not have telemetry. I wanted to soak in the bath, but taking the monitors off for more than a couple minutes was not appropriate to my son’s situation. I listen to Johnny Cash sing “Folsom Prison Blues” over and over. I remember zoning out in a daydream and hearing a nurse ask my husband and doula if I was unconscious because I didn’t fuss or cry or make any noise at all, and my doula telling her I was just a hypnobirthing mom. I remember wondering what all those laboring patients I had were whining about, because it was totally doable. At dinnertime, I was starving and could smell food. I made my husband sneak chicken fingers and fries from the cafeteria and wolfed them down. My midwife came in a few times and had me try a few positions to get my son to turn. I did them, and he didn’t budge.

At 9PM, Margie came in again and checked me. I was STILL 5 cm. It was so disappointing, I wanted to cry. She and my doula decided it was his posterior positioning, and wanted me to lie WAY over on my left side. I hadn’t been able to lie completely on my left side for more than a brief time for over a decade, because of my crooked back. I tried, and the pain this time was not tolerable. I didn’t cry out, but I told them I wouldn’t be able to do it for long. Both ladies felt he wasn’t going to move down unless I could stay on my side for a long time. I decided on an epidural, so I could tolerate the positioning better, and crank the Pitocin to the maximum, since it was ¾ maxed for most of the day. It was a tough decision to make, but since he had been looking so great on the monitor, I decided it was our best shot at helping him come out. It was in by 10PM.

Once on my side, my son didn’t care for that position either. The night nurse increased the Pitocin, and then had to decrease it due to late decelerations of his heartbeat. I spent most of the night with an oxygen mask and fluids bolusing through me. I declined to have my water broken multiple times. I was never pressured to do so, just given the option. My husband and Eileen turned me every hour or so, and cat-napped on the floor next to me. None of us slept. I watched my son’s heartrate all night, reaching for the call-light every time it would have a big dip. I stared at the infant warmer in the room, feeling a dread come over me, and feeling I would never see him in it.

In the morning, Margie came once again and checked me. Still just 5 cm. The OB on-call and Margie had never mentioned a c-section ever. Not even at this time. I know most OBs I had worked with would have taken me to the OR as soon as we came into triage, or at least after it had been a few hours without progression. I was tearful and told her I had a bad feeling. She again offered to break my water to help move things along. I requested we just go to the OR. My doula encouraged me to heed my intuition, and my husband was supportive. I was never pressured or even offered to have one. That, as well as every other decision, came from me.

My son Jonah was born on Mother’s Day, and my grandmother’s birthday, the first baby born at the hospital that day. 8 lbs 2oz, and 19.5 inches. He had a double nuchal cord and a placenta high in the fundus of my uterus. The cord was stretched as taut as could be between the placenta and his neck. The OB needed the vacuum extractor to pry him out, and he was limp and dusky. The neonatal practitioner worked on him for a couple minutes and he finally pinked up and started crying, peeing on his nurse. His cord, we assume, had been wrapped a 3rd time when he stopped moving, his distress likely from cord compression. The OB told us that my instincts were right, and if we had broken his water, we would have likely had an emergency c-section instead of the unplanned but less scary one we had. I feel very lucky to still have a living child, because I know from my work experience that when a baby stops moving, it is often because they have died. My birth was nothing what I had planned, but because my desires were honored and respected, I don’t feel traumatized by it at all. In fact, my husband and I both agree that we had a great birth- an adventurous one, no doubt- but a great one.

Jen's first son was born on Mother's Day. Jonah weighed 8 lbs, 2oz and was 19.5 inches long.

1 comment:

Devon said...

He is so sweet! Thank for sharing this:)