Monday, July 20, 2009

So What the Hell Did Happen?

Sorry, this is so long. Read only if you're remotely interested in labour and birth stories.

I started out telling this story through the Grace in Small Things lists because it was very, very important to me to remember the good in what happened, the best thing being Mack, of course. It would have been so easy to sink in a deep depression after. I needed to maintain some perspective. But now it's time to talk about the other side.

Except, I'm not sure I really understand exactly what happened. Even my doulas and my doctor seem confused. I wanted a natural birth. I expected a natural birth. I planned and prepared for a natural birth. I would have even considered a home birth if it were allowed and if it weren't my first pregnancy. Let's just say I was almost religious about making this as natural as possible.

I wanted to do most of my labouring at home and accordingly, I worked mostly in the comfort of my own living room. See The Birth: Hours 1-12. I didn't even call the doulas over until perhaps about 20 hours in, around 8PM Tuesday night. That's when things started to get promisingly intense. With their help, I got to a point where contractions were three minutes apart. Sonya-the-Doula (who is also a fully qualified midwife) says she was confident in her assessment that it was a good time to get to the hospital. In other words, none of us feel like we jumped the gun.

So it came as a complete shock when in Triage we were told I wasn't quite three centimeters. I decided I wanted to stay because I was convinced things would change quickly and I didn't want to move. It was too disruptive. I guess the staff saw enough of a change - I was quite effaced - that they let me stay. I got to work in Triage as a parade of women beside me were administered induction drugs and sent home.

Finally they moved us into the labour and delivery room. Sonya knew to ask for Room 4 - it's the best - and they ran a bath for me. I laboured for a few more hours, seemingly effectively. But around 5 AM they checked me again and I was still only 3 1/2 - 4 centimeters. Dr. Baby Doctor suggested an epidural. I was so against it I even cried. Wasn't this the first step on that roller coaster of interventions I'd been warned about? I announced that under no circumstances did I want to end up in a c-section. But everyone made good counter arguments. Even the doulas seemed to agree that since I had been labouring for over 24 hours, the epidural might help me rest and actually speed things up. It was worth a try.

Unfortunately, for the next few hours I had to suffer the ministrations of a 4th year Nursing student. I am going to be a Nursing student so I want to be sympathetic. But I was really tired by this point and she was iffy at best in her technique and her knowledge. The blood pressure machine was clearly not working but she insisted on fiddling with it hour after hour. She checked my vitals every 15 minutes, but it took her 10 minutes to do it, which left five minutes for both contractions and recuperation, the former still coming about every three minutes. In other words, the situation really sucked to labour in.

Still, I tried to ignore everything, opting for warrior like focus and energy. I felt I could do it if I simply believed I could. I worked and worked, breathed and breathed, meditating the baby down. Trevor says that at one point, around Hour 29, we could hear another woman pushing, screaming, then a whole bunch of cheering as a baby screamed out its arrival. He says my head dropped to my chest and I just started to cry softly.

The epidural took two hours to administer, thanks to various blood work that had to be ordered and Student Nurse's mangling of my IV. But when it was finally in, Trev went home to rest, leaving me in the care of the doulas. Again, I didn't sleep much because of all of the checks and of course the contractions. But at least they were more manageable with the epidural and they seemed to stay consistent.

Except, when they checked me again around Hour 36, I was still only four centimeters. I can't tell you how disheartening this was. When the nurse shift switched, the new nurse suggested Pitosin. I declined. No way. They let me work for a couple more hours but when it was clear that no progress was being made, the nurse decided to make her argument again. She seemed to resent that I wanted to talk to Dr. Baby Doctor about it. Then she actually kicked my doulas out of the room and cornered Trevor and me in the bathroom, demanding to know why I was so scared of Pitosin. She thought she was helping, I know she did. But she was completely wrong about the situation. I wasn't being unfairly influenced; in fact, I was the hard-headed holdout. It was actually my level-headed doula, Sonya, who successfully convinced me that Pitosin might be a reasonable next step. It was clear I was quickly losing the marathon and we needed to change one of the factors.

So they administered the Pitosin and yes, things definitely got intense. Ooh, Pitosin contractions suck. But I still managed to maintain my breathing. Trevor says I seemed invigorated, even, because I really believed this would start happening. I mean, I had gone further down the intervention road than I ever thought I would, so why wouldn't it? The nurse also seemed to have had a change of heart and become a little gentler. She said she was very confident that I'd made progress - maybe 6 to 7 centimeters - and while I wouldn't have the baby on her shift, I'd definitely be having it soon. She wished us luck before she left.

I laboured for several hours and the sun set on another day. Trevor says he was napping in the lounge when the other doula, Erin, came to get him because Dr. Baby Doctor had said the "C" word to me, and I appeared to be losing it. He came into the room and found me hyperventilating. Dr. Baby Doctor was trying to explain that the previous nurse had been mistaken, I was still maybe only achieving a tight five centimeters and I clearly wasn't progressing. "Let's put it this way," Dr. Baby Doctor said, "I've delivered three babies tonight. Every one of those women came in after you."

To say I became hysterical is to understate it. This was the lowest point of the entire labour and it happened around Hour 46.

But Dr. Baby Doctor agreed to give me two more hours. He said the baby hadn't dropped at all, but it also seemed to be transverse and if I tried a few different things, maybe we could turn it. So for the next two hours, Sonya, Erin and I tried different techniques, like labouring in a front-facing deep squat. What we didn't know at the time was that Mac was actually occipital posterior and that the squat never would have worked. In fact, it simply made labouring more torturous, adding pressure to what was now back labour intensified by induction drugs. When Dr. Baby Doctor returned in two plus hours later, there was still no progress. The baby wasn't moving down and worse, my cervix had started to swell with the pressure. Essentially I was going backwards.

Completely defeated, I remember looking at Sonya and saying, "I just can't do this anymore. It's time." She nodded and Dr. Baby Doctor and the new, incredibly competent Nurse Rose put things into motion. And the c-section, birth and recovery basically went as described below in GiST. While certainly not ideal, it also wasn't that traumatic. In fact, I hate to admit that the c-section actually came as a total relief by this point. I felt guilty about that.

So what went wrong? Well, Sonya describes there being three elements to a successful labour environment:
1. Power. This describes the contractions and how powerful and effective they are.
2. Passenger. Is the baby in the right place, facing the right way, dropping effectively, holding up under the stress?
3. Passage. Is the cervix responding?

She said I had strikes against me in all three categories. In retrospect, it doesn't seem like we could have made it happen any other way. She even suggested that had I tried for a home birth, there's no saying it wouldn't have ended up the exact same way. But I'm so grateful that my doctor let me try for as long as he did. I'm so glad that Sonya and Erin gave me such considerate and measured advice the whole time. I'm so glad that Trevor was there. He kept me from falling off a precipice.

And I’m so glad that I have let go of religion just long enough to forgive myself and move on. Otherwise I would have ruined this beautiful first week with my new baby. I'm not off the natural birth bandwagon, but let's just say I've made some adjustments to my opinions.

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Anonymous angdesj ~ 1:09 PM

I am at work crying as I read this....we lived the same experience!! At the end of it when they got me to walk around they failed to lock the wheels on my bed and dropped me on my tailbone.....its still injured.

As I mentioned before, it sucks, but we will take on anything for our children. I look back now and still have no idea how I made it through the first few months...couldn't lay on my front due to c-section nor my back because of my tailbone injury (which they accused me of lying about, even though three nurses had to lift me in a gurney back on to my bed). I had the perfect toddler, lol, 9lbs 12ounces as it sounds like you did.

I would go through it all again knowing I would have a healthy child again. Some aren't near as lucky, maybe that is the price we pay for being so fortunate.  

Blogger notquiteawake ~ 7:37 PM

You are a very strong person and I'm extremely proud of you.  

Blogger bstockton ~ 7:40 AM

I think the one thing missing from the pre-natal classes and the mid-wife experience was preparing for a C-section. We were told the stats about how many births were C-sections, but since we were informed parents with a mid-wife we never really thought it would happen to us. In an effort to be natural-birth-positive it's like no one really wants to talk about C-section for fear of losing confidence.

I'm not sure what the rules are in Saskatchewan, but in Ontario once the doctors take over the mid-wives aren't really allowed in the process anymore. Because of this and lots of other reasons and history, there is an adversarial relationship between mid-wives and the doctors. I think this makes the mid-wives reluctant to acknowledge the real possibility of C-section, and reluctant to talk about handing things over to the doctors because at that point they really have no idea what will happen because the doctors do whatever they feel like, and it can take all different forms and attitudes.

I will say that our second experience at a different hospital with different doctors was a much better one, but of course that's part of the problem: once you're turned over to the doctors, you get whoever is on duty. It seems you had both a baby doctor and a mid-wife, we had a mid-wife and whoever was on duty at the hospital at that time. The first time it was kind of like we drew 'the hangin' judge'.

I feel like I didn't express that completely correctly, but that's the gist.  

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