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.


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