Monday, May 31, 2010

365 Days Later...The Birth Story, Part Two: Birth Plan to Plan B

Turned out, baby not so imminent.

We were taken to our Labor and Delivery room, and the nurses set to work starting an IV while I set to work casually mentioning that I, too, am a nurse (oh what kind, you ask? I work in the CVICU…..(pause for dramatic effect)) at every appropriate moment. Nurse Erin was helping my nurse by starting my IV and she missed the first try. “Figures I miss on you, the ICU nurse,” she mumbled, a half-annoyed, half-embarrassed. Word had spread about me already. Not necessarily a good sign that they were warning each other about me, but I felt like the nurses knowing that I was one of them would ensure me a little bit of special treatment, and I would take what I could get.

As they started to hook me up to some fluids, I handed over my birth plan, with the header:
“At this time I would like to have as natural of a birth as possible, free from medication and other medical intervention (i.e. catheterization, episiotomy, vacuum or forceps assisted birth, cesarean section, etc.) unless necessary for fetal or maternal distress. However I have never done this before and I may change my preferences during labor. The most important thing to me is that I give birth to a healthy baby – these are just preferences.”
The nurses agreed not to hook me up to the IV fluids and decided to monitor me at 20 minute intervals, and offered me water and juice. I was so relieved when I was offered juice – I had expected not to be allowed to have anything by mouth (the policy in case of a need for an emergency C-section) and when my blood sugar gets low I become a little edgy, to put it nicely, and, although I had never given birth before, I figured I probably get a little edgy when my entire body is working to expel another human being too, so it was best to have my blood glucose in optimal range. After my initial fetal monitoring period, J and I decided to walk the hallways, trying to help facilitate dilation of my cervix and also to run off some of the nervous energy. We explored the Women’s Center, pacing the hallways at 20 minute intervals – through the Labor and Delivery suites, into the waiting area, and onto the Postpartum unit, with the postpartum nurses encouraging us and giggling each time we yet again passed their nurses’ station, and we played the Sequence board game during the periods I had to sit still and be monitored. I slowly dilated. At 10:30 pm I was at 3 1/2 cm and we made a short video. Eventually I got tired of walking and decided to try to get some rest while I still could. J curled up on a pullout recliner across our large birthing suite. Each time they placed me on the fetal monitor and tocometer we could see that I was having contractions, but, though I could feel my uterus tighten up at times, I had yet to have a painful contraction.

The next time I was checked I was still at 4 cm – I hadn’t progressed any more since the last time I had been checked. My nurse said that Pitocin, a drug that increases contractions, might be a possibility if I didn’t progress at a faster rate. Because my water had broken, my amniotic sac was no longer an impenetrable fortress to protect BB from infection, and I remembered from nursing school that the goal is to deliver a baby within 24 hours from the rupture of membranes to prevent infection. I knew that if I had to go on Pitocin, aspects of my birthing plan would be out the window, as it can make contractions up to three times stronger than they are on own. Pitocin was a hardcore medical intervention, however recognizing the potential of infection with my water broken, I knew that Pitocin probably fell under the “unless necessary for fetal distress” clause of my birthing plan. Sometime around 2 am, my mom arrived after driving 5 hours through the night after a full day of work, bringing energy and excitement. We updated her, and after a while the burst of energy dissipated and I encouraged her to go sleep at our house (a 5 minute drive away) and come back in the morning, promising to call if anything changed. She asked if I was sure, and I told her that I was going to try to get some sleep, so she might as well too.

Once my mom left, I rested and slept fitfully in bed, feeling like I should be moving around to help my labor progress but also feeling tired and like this might be my best chance at sleep for, oh, 3 months or so.

Sometime in the next couple of hours, my nurse’s traded off - my nurse needed to be able to fully attend to a woman actually giving birth and so Erin took over. Bedside manner was not exactly Erin’s forte – she just wasn’t personable, and seemed nervous. The next time I was checked I still wasn’t having any painful contractions and had only dilated 1/2 cm more. The doctor had given orders to start Pitocin, and I obliged. Erin told me that I would have to stay on the monitors now that I was on Pitocin - no more wandering the halls. My biggest fear about labor was that I wouldn’t be able to walk – I felt like walking, activity, was what was going to get me through the pain of the contractions, and I wanted to be able to stand so that gravity was on me and BB’s side, not indifferent to us as it would be if we were lying in bed. This is how indigenous tribal women give birth in the middle of the jungle by themselves - surely there is something to it. Being strapped to the monitors was going to limit my movement. This is one of several reasons that I didn’t want to have an epidural – the thought of contracting while lying in bed with an epidural that may or may not be effective sounded awful, like being trapped – and what if I couldn’t feel my legs? I was terrified of the idea of not being able to sense my lower half at all, of being completely numb. Another reason I didn’t want an epidural.

The Pitocin was infusing and wasn’t having the intended effect – i.e. I remained comfortable with no painful contractions. Erin titrated the Pitocin up and up and eventually maxed it out, and ended up getting doctor’s orders to continue titrating it up past the max dose until effective. I again fitfully slept and rested, and eventually morning arrived. I was allowed to take myself off the monitors to use the restroom, and once they showed me how to arrange the monitors, I moved freely around the room - tired of the bed, Justin and I played some more Sequence while I sat in an armchair.

Around 6 am J’s sister Serene called J – she and J’s mom (BB’s Granacky) had coffee for J (and probably a snack – everyone snuck J snacks when he ran out to the waiting room, and I had told him when I was pregnant that I did not want to know about all the delicious treats he was enjoying while I was only allowed ice chips (and, as it turns out, juice). Apparently she had been up all night too excited to sleep, and they had been there for quite some time. They came back and visited with us, and our friend A showed up sometime in there too – she had driven down from Phoenix bright and early to be there with us.

At 7 am the nurses changed shift, and we got a new nurse, Wendy. Wendy was in her late 50s, and after introducing herself to me, she promptly came up and rubbed my belly and had her own little conversation with BB as though he was already out in the world and not still stuck in my belly, a reality-check that there was an actual person inside of me, soon to be distinct from me. I supplied another copy of my birth plan to Wendy and she read through it. Wendy was charismatic and confident and told us that she was probably the only real supporter of natural birthing that was working that day and that we were lucky she wound up being our nurse. She was quirky and opinionated and she privately told me that all of my visitors might be too distracting and be what was keeping my labor from progressing. She asked if I wanted her to ask them to leave, so I didn’t have to. I quickly told her that I wanted everyone here - I thought the distraction was probably helpful, allowing me to relax and let my body continue laboring, dilating, slow though it may be. But the next time she came in, shortly after the last visit, I felt pressured to try her suggestion, like if I didn’t at least try it I wasn’t being a good mama, so I told everyone I thought they should step out and see if it helped my progression of labor at all.

It didn’t. So I invited everyone back, I’m sure to Wendy’s disdain. But I had so many visitors and, being a social girl, I wanted and enjoyed the company. My mom was back, and told me my sister would be flying in from Washington state that afternoon. Other friends came to visit. Despite the Pitocin going up, up, up, I continued not to have any painful contractions, and at one point Wendy remarked “I have seen about 2 women have a painless labor before”. Sounds good to me!

The morning brought the doctor's back to the hospital, and mid-morning Dr. D came in to check me. I had seen a group of OB doctors, not one doctor, during my pregnancy, so I had only met Dr. D once or twice. She wanted to check me and when she did she quickly announced that I had a forebag. Someone had mentioned a forebag when I had first arrived to the hospital, but I had been checked a couple of times since then and the nurses hadn’t said anything about it. But Dr. D explained that while my water had broken, part of the amniotic sac was still intact, compressed by BB’s head, and that breaking the forebag is the next step in progressing my labor. My desire for an intervention-free labor had been dissipated by the knowledge that the clock was ticking – I knew that BB needed to be born within that 24 hour window and we were already two-thirds of the way into it - the Pitocin was step one and this sounded like it was step two. I agreed to have my water broken, feeling like I should just go with the flow and trust the medical team's plan, since my plan seemed like it was out the window. The doctor set up for the procedure. I felt a tuggy-pricky feeling when she hooked the forebag of my amniotic sac.

My mom and mother-in-law and Serene and A came back in and sat down once Dr. D was done. I felt my contractions quickly grow stronger. Everyone was gabbing with each other when I started to feel a crampy sensation in my lower abdomen. Surprised, I breathed slowly and deeply and tried to focus on relaxing my whole body like the Bradley book had said was so important. The sensation stopped and I glanced at my visitors who seemed oblivious to my sudden silence or the paradigm shift in my labor that had just occurred. A pain-ish sensation, finally, about 19 hours into my labor. A harbinger of what was to come, I realized. My hope for Wendy's miraculous painless labor was forgotten. And before I knew it, another crampy feeling was upon me, this one a little more consuming than the last. I took slow, deep breaths.


  1. Gotta love those birth plans that go out the window! So happy that I have met the end of this story - and that he is so healthy!