Wednesday, November 19, 2008

Uli's Birth Story: Labor & Birth

After the version, I continued to have ‘practice’ contractions regularly. By Monday afternoon, the contractions were beginning to be a bit stronger. At one point we were at Woodman’s grocery, and I had to hold onto the cart as we walked because the pains were noticeably more intense. I knew that typical ‘practice’ contractions can generally be walked-off (vs. ‘real’ contractions which may intensify with movement), and these didn’t seem to be going anywhere, but still, nothing was conclusive (they didn’t seem to be coming in any kind of regular pattern nor did I need to actually stop and concentrate during any of them) so we just continued with our normal routine.

That night we were catching-up on our TiVo (CSI. The real CSI, not the fake NY or Miami ones) when suddenly I felt… warm and wet. My contractions weren’t active at that moment, and I knew that having my membranes break would be statistically improbable, but I checked it out and sure enough: my water had broken. So not only was our baby one of the 5% breech-at-term babies, but she was one of the 4-10% whose bag of waters broke before active labor!

If we’d still been in the running for a vaginal birth, I would have just gone to bed to rest up, and we would have waited up to three days for the labor contractions to start. However, since homebirth was no longer in the cards for us (the midwives could lose their insurance if they were to catch breech babies—I really feel it is unfair that insurance decides these things for us instead of our own heads & hearts!), we called the birth center for the midwife on-call—turned out it was Mary, the midwife who’d initially realized that Uli had turned in utero.  Mary, all pro-active as she is, had already called Meriter that afternoon to check-in with the on-call surgeon, and had learned that this particular doctor was one who wouldn’t let us attempt a breech delivery regardless of how far along in labor I might be when arriving. So, since the hospital gets all crazy about membranes being broken, Mary recommended that we go into the hospital sooner rather than later, to save us the additional complication of the surgeon considering us an emergency (for which they might decide to put me totally under rather than waiting for the spinal, etc.).

Mary came by our house around 9pm and had me verify (with a type of litmus paper) that my water had indeed broken. Sure enough, the paper turned dark blue/green (indicating a different ph than usual vaginal fluids), and so we knew that this was really happening!  We printed out our birth plan (typed up just then—and sketchy as can be), packed a bag, said goodbye to Emily and the dogs, and off we went. It was kind of eerie, driving off, knowing that when we returned it’d be with a baby in the carseat. We were totally calm—no need to rush when I wasn’t even in pain or anything—and it was also kind of sad. I’d so so wanted to deliver at home. I’d so wanted to avoid the situation we were now calmly driving toward.

We arrived at Meriter at about 9:30pm. They took me up to Triage in a rickety old wheelchair; seriously, that thing should have been out of commission—if you leaned in the left arm-rest, it crumpled under your weight!  The maternity ward nurses wanted to re-verify that my water had broken (wouldn’t take Mary’s word for it, even though she’s a nurse too and my primary provider…) so they did a swab test. And omg, it HURT. Honestly, I’d say that the stupid swab was the most painful part of having Uli. The nurse apologized and said that only very rarely does a woman complain that the test hurts (which is understandable—all it entails is a Q-tip, a swab of the fluid and then they check that out under the microscope) but let me tell you, when it hurts, for whatever combination of sensitive tissue and hormones or whatever, it hurts BIG-time. And of course their hurtful test showed that my water had broken. Just like the non-painful external test I’d already taken (just sayin’).

I was given a hospital gown, and then we waited some more. I was really super thirsty but had left my water bottle in the car (stupid, stupid me!) so Justin asked the nurse to bring me some water; they refused for fear I would aspirate during surgery (which, IMO, is ridiculous. I was having a spinal, not a tube down my throat. And even if I were being put under, if I’d been in a car accident and had just stuffed my face with McDonald’s they’d still put me under and not worry all that much about the minute risks of aspiration). But anyway, no water by mouth for me, so they hooked up an IV and offered ice chips. :p   And then we waited some more...

Finally, at about 1:00am, they walked me into the OR. They had me sit on the edge of the bed and a nurse held my hands and told me to squeeze her fingers while the anesthesiologist put in the spinal. That was probably the most terrifying moment—Justin hadn’t been allowed into the room yet, the nurse who was telling me it’d be OK and was holding my hand was a nurse who I’d found kind of rude back in Triage and so wasn’t especially comforted by her, and I was really really worried that the spinal would hurt. They kept saying that it’d be like a bee sting—and I’d just had a bee sting this past spring and those things can smart like nothing else!  The room’s lights were so bright, everyone’s faces were covered by masks, the equipment in those rooms is overwhelming—all sorts of beeping and flashing—and it suddenly struck me that I was having a cesarean. I was about to have my baby plucked out of me. Me, who was a homebirther at heart. The situation became very real and very frightening all of a sudden. 

But that was all in a few seconds. The next thing you know, the anesthesiologist was telling me that my lower-half would be getting really warm and then would go numb—and indeed it was! I hadn’t felt the needle go in at all. I could feel them laying me onto the table, but I couldn't really "feel" it. Pressure, but not actual touch. Next, they inserted the catheter (oh, how I’ve afraid I’ve always been of catheters! I’d cancelled a urologist appointment once because they were planning on catheterizing me and I just couldn’t stand the thought of it) but, with the spinal in effect, I couldn't feel it at all. Justin was finally allowed in, all gowned up. They erected a barrier between Justin and me and my lower body, and started swabbing the iodine.

Before you knew it, they told Justin to stand up so he could see the baby as she was pulled out—we'd specifically requested that Justin announce the sex of the baby to me, since we didn't know what it was. And she was a girl! They took her over to another part of the OR to check her out, and Justin went with her and snapped a few pictures. I could hear her crying, but couldn't see her.

While Justin was with the baby, I developed HORRIBLE shoulder pain. Intense. I felt like I could barely breathe, like my chest was collapsing. I'd read about this sensation--that it was caused by air entering my abdominal cavity and putting pressure inside my body where I wasn't used to it. I tried to just breath through it, but I could barely talk, it hurt so badly, so the anesthesiologist put some Demerol into my IV. Instant relief. But also, instant sleepy, drawly, out-of-it-ness too.

Justin was able to bring the baby (as yet unnamed) up to my head about then, and I was able to touch her with one of my hands. She was so precious, alert, and had a lot of blonde hair. And her extra little nubbin of a thumb (polydactyl). She was just beautiful, and I wished I could hold her (though, I was struggling to see her and communicate with Justin, now that the Demerol was in my system).

After what seemed like forever, they finally had me sewn up (the surgeon had stitched the uterus, but was then called away to an emergency so a resident finished stitching my abdomen) and we were wheeled into Recovery. Mary met us there (she hadn't been allowed in the OR) and she helped me unwrap the baby and I held Uli skin to skin. We tried some nursing; Baby was interested, but we couldn't get her to latch, so she just nuzzled. We were brought up to the 6th floor and given a room where Justin had his own bed. I had a machine that allowed me to self-medicate via IV (but not overdose) and the catheter stayed in until Wednesday afternoon.


And they left us alone together for the first time--our family of three.

Tuesday, November 18, 2008

Prologue to Uli's Birth Story: the Version

 I’ve e-mailed and talked about pieces of the Version and Birth stories to people, but haven’t put everything together in one place yet; so, for the purpose of Blog-i-ness, here goes:

We went in for the External Cephalic Version (“version”) on Friday, Oct 24th. As you probably know, in a typical version the mother takes a uterine relaxant so her muscles are as pliable as possible; then an OB attempts to wrestle the breech baby to a vertex position by pushing hard on the uterus/abdomen, ‘grabbing hold’ of the baby’s head and butt, and forcing the baby to turn.

Best case scenario for a version: baby turns, mom gets to go home, waits to go into labor as normal, and vaginally delivers a head-first baby. Worst: during the version, the placenta is ripped from the uterine wall, or the umbilical cord gets kinked or torn, or the stress of the pushing causes the baby’s heart rate to drop—any of which would mean an emergency c-section right then and there. 

Versions work better the earlier they’re performed, so that I was going in at 39 weeks wasn’t ideal. But, although the risks involved a c-section and the version wasn’t a sure thing, a caesarean was in my future anyway if the version didn’t succeed, so we figured it was worth a shot.

Before the procedure that Friday, the hospital required another very detailed ultrasound;  they rechecked fluid levels, looked for fetal abnormalities, checked to see where the placenta was, etc. My midwives tried to advocate a quicker scan (they knew how adamantly against them Justin and I are), but the techs were insistent and went ahead. And they found all was well with the baby (no surprises there! We'd been healthy the whole pregnancy and had good nutrition).

Justin and my attempts to turn Baby had apparently done something, because she was now in a Complex breech position (one of the feet had dropped down). The OBs thought this new position might be a good thing, making it easier for them to turn her.

The OBs began to tell us what they intended to do for my version:
(1)    Hook me up to an IV,
(2)    Give me a spinal
(3)    Attempt the version, and
(4)    Prepare for an emergency c-section.

Um.... NOT what I had understood what that day’s procedure would be!!  I wanted to stay as far away from narcotics and other pain medications as I could get since drug like those have a history of affecting a fetus’ heart rate; with the OBs pushing on the baby like they would need to, the risk of ‘needing’ an immediate c-section increased with the use of additional medications. So I explained that I'd heard about the uterine relaxant rather than a full-out spinal. They acknowledged that that had been the standard procedure, but said that new research shows that since the version is so painful, even with the uterine relaxant medication most women can't relax well enough to allow the OBs to give the version a good try, and so they prefer to move directly to giving the patient a spinal so they're totally numb.

I had learned enough from my Bradley classes that you must know about risks, weigh pros and cons, and advocate for yourself if you’re uncomfortable with any supposedly required medical procedures, so I found the guts (and really, it doesn’t sound like much, but when you have three doctors standing in front of you telling you “This is what we do. Comply!” it takes something deep inside you to challenge even a portion of what they’re saying) to tell them I wanted to try it with just the relaxant first, and that I'd consider the spinal if my tenseness interfered with their ability to do the version.  I could tell they thought I was making an odd request, but they agreed to try it my way first.

They repeated that it would really hurt, and I should be prepared to have the spinal.  I repeated that I understood but that I was serious about trying to avoid the spinal if at all possible. Then, the OBs said they'd still only do the version in the OR, because (1) they liked the narrow surgical table, and (2) because they really figured I'd cave once they started the procedure and would need the spinal. 

I was taken to Triage and two doctors from Anesthesia came in to start my IV. Since I really didn't intend on having/needing the spinal nor a c-section right then, I asked that they give me a port (is it called a hep-lock?) instead. They appeared surprised by my request, but they agreed. 

It was about this time that Aszani from the Madison Birth Center arrived; she was there to support us and provide medical advice as my primary care giver, if necessary. She was shocked that the OBs had wanted to give me a spinal for the version and agreed with our decision to try the procedure with the least medication possible.

Eventually, into the OR we all went. Blinding bright lights at first, which they kindly turned off. There were two OBs attempting the version, one on either side of me, pushing and pulling the baby’s head/butt. And yes, it hurt. A lot. But having my support people right there with me helped tremendously. I was on my back for the procedure, but Justin and Aszani were able to hold my hands (my arms were free, since I didn’t have the IV) and they rubbed my head and breastbone, and reminded me to relax my glutes and my pelvic floor. It really really helped, having those verbal reminders to relax specific muscle groups. And I vocalized a bit, which helped me relax as well.

The docs gave it a vigorous attempt, using even their elbows to dig into me and try and push the baby around, but after 45 mins, they decided to give up—it wasn't working. Baby had moved back into a Frank breech and was refusing to let them move it any more than transverse.

I thought that they'd try the spinal next, since they’d been so adamant about it initially, and so was surprised to hear them say that they weren’t going to bother. They said it wasn't me who was the problem--that I was relaxing perfectly (thank you Bradley Classes!)--it was the baby. Baby just wasn't interested in moving for us. It was great to hear the primary OB say that the statistics on 'needing' to use the spinal obviously weren't based on studies with women like me, who knew how to purposefully relax. But as nice as that was to my self esteem (is there a merit badge for Relaxation?) it was obviously very disappointing that they were giving up when I felt like I could take more.

Back to Triage I went, to recover. And here's where I forgot what I'd learned in Bradley class... I was distracted because I was shaking quite a bit (a side effect of the muscle relaxant), and was dressed in just a horrible hospital gown (I should have brought my own gown! And some warm socks—the hospital is COLD!) and was under their strange little hospital blankets (not much more than a sheet) when they decided to give me some fluids. Via IV with the port they’d placed in my hand. I let the nurse hook me up before I thought about it (I mean, now that there wasn’t the risk of emergency surgery, why not just drink some water?) Then, I started contracting, so they wanted me to lie in bed longer than the hour they'd initially told me to rest, so we just hung out, waiting... Eventually, when the contractions weren't getting worse and they were talking about letting me get up, I thought: "You know, I could really use a potty break about now. And why am I in bed when I should be up trying to walk off these contractions to see if they’ll stop?"  And sure enough, once they took out the IV and I used the restroom and walked around a bit, the contractions totally stopped. I could have been outta there at least 60 mins earlier if I’d just remembered to avoid IVs (and the limitations they put on movement).

So. I found myself at home that evening with big bruises on my stomach. Bruised seriously enough that I couldn’t try the Webster technique again (hurt waaayyy too much to balance on the blocks Justin needed me to lay on to do the adjustment). Instead, Justin and I focused on tilting and moxa, and I slept a lot.

The OBs wanted us to set up a time for a c-section that next week, but I was convinced that giving our baby as much time as she needed in the womb was the best choice (whether or not she turned) and that some squeezing of labor is beneficial to a baby, so we planned to wait until I actually went into labor before we went into the hospital for a cesarean.

Friday, October 24, 2008

[More] troubles

Breech. We’re breech.

Here I was, thinking it was just the dogs and cats who were being naughty, but it was Squish too.

We went in for our prenatal on Weds, and for the first time the midwives weren’t so sure about Squish’s position. They strongly recommended an ultrasound. These are not the type of practitioners to require invasive procedures if they really don’t think they’re necessary, so when I hemmed and hawed about setting up an appt for Monday and they countered and said it’d be a “mistake” to wait, well, I took them at their word. We went in yesterday afternoon. And sure enough--Squish is a frank breech (head-up with feet straight up next to his/her head).

This was the second time we’ve been to Meriter’s sonography department, and neither time has been happy. The first time (miscarriage) was much much worse, and I keep telling myself that. At least this time our baby has a healthy heartbeat and they could see his/her little face and s/he seemed happy. Just upside down.

So. Breech. What now? We met with Anastasia from MBC last night to talk over our options. The birth center doesn’t officially catch breech babies (because of insurance risks). There is some leniency with home births (it’d be legal) but it’s their official policy at this time not to catch ‘em on purpose (if one snuck in there, that’d be one thing. But we know about this one now. Mary (one of the midwives) has caught several breeches when she practiced in Africa, and she seemed more willing to consider attending a home breech... But neither Anastasia nor Aszani would agree to it at this time.

So officially, our options are to try everything to encourage the baby to turn. This includes:

~Laying head-down on an ironing board 3 times a day, 15 mins a time, to move the baby up out of my pelvis and hopefully let him rotate back to head-down when I start walking around.
~Putting cold packs on the top of my uterus and a heating pad on my lower, which might get the baby to move its head away from the cold. (Note: I tried this last night before going to sleep, and Squish did NOT LIKE the COLD. But still didn’t turn...)
~Webster Technique. A chiropractic adjustment that Justin doesn’t put his faith in, but that some people say works wonders. It’s supposed to loosen-up your pelvis, balance it out, and encourage the baby to move up and out of it so that gravity can draw that noggin down.
~Playing a tape of my voice from earphones positioned near my pubic bone, hopefully drawing the baby down there to listen. Or having Justin read Squish a story or something from down there.
~Moxibustion. Which is burning incense (mugwort) while stimulating acupuncture points on either side of my little toes with the incense wands. Sounds a little crazy to me, but there’s data to support it. Maybe crazy-people data, I’m not sure, but it can’t hurt so is worth a shot.
~Visualization. Positive thinking and just plain asking Squish to turn, “seeing” Squish turn, believing Squish will turn.

And finally:
~ECV (external cephalic version). They (either an OB or my midwife--I’m not sure who) will manually try and wrestle Squish into a head-down position by pushing on my stomach and the baby and twisting the baby down. The procedure has good results earlier in pregnancy (34-37 weeks, I think) but not so great at this point (39 and 3/7).  We’ve scheduled this procedure for 2pm this afternoon. There are risks with it, risks that the others above don’t have (so I hope they work and we don’t have to do the ECV!), but we’ll try it. Risks:  cord gets tangled around baby resulting in emergency c-section; placenta is ripped off of the uterine wall resulting in emergency c-section; baby’s stressed-out because s/he’s being pushed on so hard and starts to get irregular heartbeat/dying resulting in an emergency c-section.        ....So, it’s not the ideal thing, really. But it’s either try it now or not at all because later the baby will certainly be too big for it to work.

OK, off to get dressed and go into work for an hour to wrap-up my Friday business, and then it’s back home to start our baby-spinning routine. Wish us luck.

Sunday, October 12, 2008

Where do I come up with this stuff?

“If you don’t know your options, you don’t have any.” ~Diana Korte & Roberta Scaer, A Good Birth, A Safe Birth

I betcha think I just pull all my birthing ideas out of my hat, right? But no, I really did some research! I suppose it began back when I was still a teenager, reading some of my mom’s books. Other ideas are from ‘official’ sources such as peer reviewed journals and things (Justin has those stats--they vary from epidural info to swaddling to bottle feeding) and the rest has either come from books from the library, birthing videos, or other women who have been ‘in the trenches,’ so to speak, and write in their blogs.

And of course, there were my Bradley classes! For our Bradley childbirth classes, our main ‘text’ was Susan McCutcheon’s Natural Childbirth the Bradley Way. We also had our workbooks and a LOT of supplemental information gathered from various journals and studies by our instructor, Betsy. I enjoyed reading McCutcheon, though I was grateful for the additional info Betsy brought us; it really fleshed-out the classes and gave us a LOT of choices to think about. Very empowering.

Another book I’ve just finished reading (borrowed from the library): The Thinking Woman’s Guide to a Better Birth by Henci Goer So good! Comprehensive information on cesareans, breech births, induction of labor (stripping of membranes, Pitocin, and breaking of waters), food & water during labor, electronic fetal monitoring, slow labor, epidurals and narcotics, episiotomies, OBs vs. midwives vs. family practitioners, doulas, place of birth (home vs. freestanding birthing center vs. hospital). I was impressed by the studies noted and the lists of ‘pros’ and ‘cons’ to various procedures and methods. And not a difficult read at all--the sections are short and to the point.

And a read suggested by one of my midwives: Birthing from Within: An Extra-Ordinary Guide to Childbirth Preparation by Pam England, CNM, MA & Rob Horowitz, PhD. England’s book focuses on having healing births--births that not only calm your fears about parenthood, but can issue-in a strength via a successful rite of passage. England suggests that women are often told to ignore their feelings of nervousness about an upcoming labor or to set-aside their disappointment after a traumatic or ill-handled birth, with people telling a mother that ‘all that matters is that you have a healthy baby.’ She counters this idea, saying that the birth experience itself is such a powerful one that its place at the beginning of motherhood should be recognized for its importance. Far more important, she gives example, than the wedding is at the beginning of marriage. Yet, how often do you hear brides bemoaning some calamity during their ceremony or reception, and people lend their ear and understand how upsetting it was? Compared to how often a woman might say her birth wasn’t what she’d hoped for, yet the listeners brush off her concerns, telling her to ignore that disappointment or despair--just focus on the baby? All too common, even in my limited experience.

Birthing from Within calmed many of my fears about how my birth should or should not be (according to my own jittery mind) and included some good exercises about pain management. It has many ideas (many of them via visual arts media) on how women and their partners can explore their fears about childbirth, includes information about how best to avoid the all-too-common ‘necessary’ un-necessary medical interventions, and suggests healing rituals and paths to restoration after unsatisfying births.

And for blogs: check out Joy’s blog, Breast and Belly (now called Housefairy). I started reading it about 4 or 5 months ago, when Joy was pregnant with her 5th child and planning a home birth. She then decided upon a last minute elective cesarean instead, and her more recent posts, while fewer and further between--not surprising since she’s been recovering from major surgery, nursing an infant, and caring for 4 other children--are so honest they grip you and really make you think. Check her out--and go back through her archives a few months--the journey she’s chronicled is so interesting that it well worth the digging.

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