Birth Story Part 2 – the Delivery

Picking up where the previous post left off….

June 22nd (41w, 5d) – 11PM

After lots of waiting around the last few days, once we get moved back to labour and delivery to start the pitocin, things start to move quickly. As soon as we get into the room, the mood feels electric and purposeful, and there is a real sense that this is going to be it, and that the baby would be coming soon.

I am pleased to find that the nurse assigned to me is the same nurse who I met in triage the night before and really liked. She also remembers me, and I am really happy to have her on my team. Since the idea of the pitocin still freaks me out, I mention to her that I will want an epidural sooner rather than later, and she reassures me that I can have it at any time.

I’d been monitored for the baby’s heartbeat and contractions every few hours since being admitted, but now that the pitocin was going to be administered, I would be constantly hooked up to the monitor. I was Group B strep positive, so in addition to the monitor, I got an IV put in to administer an antibiotic to clear up the infection, and protect the baby from contracting it.

June 22nd (41w, 5d) – shortly after 11PM

The nurse hooks me up to the monitor, which immediately shows that I am having a contraction! I am feeling a little crampy in my lower pelvis, but it does not feel anything like what I expected a contraction to be. “Are you sure it’s a contraction?” I ask the nurse.

She feels the top of my uterus, and since it is really hard, she confirms that it is, in fact a contraction.  The news of an actual contraction, even before the pitocin is administered is a good sign. There is a festive, celebratory feeling in the air, however it is short lived.

The nurse frowns at the monitor. “That’s not good.” We learn that once the contraction was over, the baby’s heart rate took a dip. The nurse explains that while it is not unusual (and okay) for a baby’s heart rate to dip during a contraction, a dip right after is not a good sign as it means that the baby is not handling labour well. So, we watch to see if the same thing happens with the next contraction.

The nurse is pleased to see that the next contraction does not end with a dip in baby’s heart rate, however, before we can relax, the heart rate goes flat. As I mentioned in my last post, the baby’s heart rate should be within a certain range, and also fluctuating within the range (with peaks and valleys). In our case, while the baby’s heart rate is still within range, there is very little change from beat to beat. Instead of seeing peaks and valleys, you don’t have to be standing very far back to see a flat line.

A flat heart rate tracing could mean one of two things: either the baby was resting/sleeping, or he just was not doing well anymore and needed to come out sooner rather than later. So, the first step was to try to “wake” him up.

June 22nd (41w, 5d) – waking up baby

I remember seeing the flat pattern once earlier in the day. That time, the nurse had said the baby was probably resting, and sure enough once I ate something, the baby almost immediately “woke up” and started moving around. So, now we would once again try to wake the baby up.

First I have some sweet apple juice. Nothing.

Then the Dr. (who, along with a resident are in and out of the room this whole time) tries to irritate the baby to perk up by moving my stomach around. Still nothing.

Next, the resident finally manages to pull out the foley in case it is bothering the baby. And still nothing.

While the baby has generally been very active, I realize that this whole time I had not felt him move at all.

At this point, the Dr. starts talking C section if continued monitoring shows no change. From the conversation between the Dr., resident and nurse I find out that of everyone on the very busy labour and delivery ward, they are most concerned about us, and one other patient. In a matter of hours we’d gone from super low priority to highest priority.

The nurse continues to watch the monitor, which continues to show no change. I’d been lying on my left side this entire time, so she suggests maybe if I move to my right side, we might see some improved activity. I move over to my right, but as soon as I do, the baby’s heart rate plummets. Upon seeing this, the nurse yells for me to turn back to my left, and thankfully once I do, the heart rate goes back to its familiar flat pattern.

The Dr. and resident come running into the room. “What just happened there?” The nurse explains the change in position, and the Dr. tells me to stay on my left side.

June 22nd (41w, 5d) – getting ready for decision time

I am not totally sure of the exact sequence of events, or how long any of this takes, but several things happen now:

  1. The Dr. explains that she does not like what she is seeing. She is going to do a C section on another patient, and if there has been no change in the baby’s heart rate by the time she comes out, we will be going straight to a C section too.
  2. The nurse suggests that since I had indicated that I’d prefer an epidural early in the labour process, we may as well get one going now. Even though I am not yet in labour, I would need one if we end up doing the C section, and as this is looking more and more likely, getting an epidural now would shorten the prep time later.
  3. The Dr. says to stop the pitocin as she does not want anything to happen while she is in the operating room doing the earlier C section. I am not clear on when exactly the pitocin was started, but it is now stopped.

June 23rd (41w, 6d) –  sometime after midnight

The resident anesthesiologist comes in to administer the epidural. He asks me if I am a runner, which I find very flattering. I explain that I did not run during pregnancy, but did run on and off before that (though I do find it hard to identify as a “runner” given that I usually did not have a regular routine, and do not run very far or very fast). He explains that he could tell from my muscular back (!).

I feel an icy river trickle down my back as the epidural goes in. It is some time before I feel any effect, but eventually I do start to feel some tingling in my feet. I then start to feel colder. I know from my reading that feeling cold is a very common side effect from epidural (seen in about 50% of cases). I mention to the nurse that I am feeling colder, and she confirms that this is nothing to worry about. She asks if I want a blanket, but I am fine without. We’re in the middle of  a heatwave, and even with the air conditioning going, it has been over a week since I’ve felt anything but slightly warm to unbearably hot. So, the cooler temperature is welcome.

However, after about a minute I feel like I’m freezing and start shivering uncontrollably. My muscles tense up really tight with every shiver. I tell the nurse that I’ve changed my mind about the blanket, and she immediately brings me 2 blankets that have been warmed up, which feel wonderful when she places them on me. I am soon cold again, and have my husband rub my muscles to warm them up and cut down on the shivering.

The nurse continues to watch the monitor, which shows no real change from before. Finally, she says “I’m not a Dr., so keep in mind that this is just my opinion, but I think you should prepare yourself for a C section. We haven’t seen any improvement, so when the Dr. comes out of the operating room, I expect she’ll want to do a C section on you.”

June 23rd (41w, 6d) – sometime after 1AM

The other C section is over, and the Dr. and resident come into my room. The Dr. tells me that she was watching a read out of my monitor while she was in the earlier C section, and that based on what she saw she’d already made up her mind that we weren’t going to wait any longer. They wheel me to the operating room, and my husband goes to change into scrubs.

There are about a million people in the OR. This is a teaching hospital, and every person in the OR has a resident or student with them. By now, I recognize many of the faces, and most of the others come up to me to introduce themselves.

The prep seems to take forever. I listen to the conversations, and watch my monitor screen. Overall, the mood does not feel frantic or panicked, which gives me comfort. At one point, I hear someone ask the Dr. if this is an emergency procedure. “It’s urgent” the Dr. says.

This spooks me a bit, and I keep watching the monitor. At some point, the Dr. comes to talk to me. She explains that she has no idea why the baby’s heart rate is doing what it’s doing, but that it is not a good sign, which is why she wants to get him out sooner rather than later. She then tells me that if everything is fine, I will hear the baby cry when he is born. If I don’t hear anything, things are not good.

After what seems like forever, my husband shows up and stands by my head. I am happy that he is finally with me again. I am still shivering, but also start to feel very hot on my face. Someone takes my temperature and notes that I have a fever. I can’t believe that part of me still feels freezing cold, and yet I have a fever.

The prep continues. The resident anesthesiologist tests my level of sensation by pricking me, first in places where I am not numbed, then in places where I should feel no pain. Eventually, it gets to the point where I can’t even tell he’s touching me. I hear voices counting in unison, as various staff check that they have all their instruments ready.

I keep watching the monitor. The heart rate continues to be flat, but it is now also a bit above the desired range.

Finally, they start cutting into me. There is a curtain hanging down just below my chest so I can’t actually see what is going on, but I know what is happening. Again, this stage seems to take forever.

And then, the baby is out. I don’t remember at what point I realize this, because he does not cry. The Dr. says “Oh, goodness” when he comes out – and not in a good way. (I don’t actually remember hearing the Dr. say that – my husband tells me about it afterwards. He claims we talked about it right afterwards, but either I totally blocked it out, or I was so focused on listening for the cry that I did not hear it). I see a group of 4 or 5 people move from my lower body to the corner of the room. My baby is somewhere in the middle of them, but I can’t see him. More importantly though, I still don’t hear him.

The resident anesthesiologist is up by my head, opposite my husband. “Everything’s fine. Your baby’s okay” he says. “But he’s not crying. He’s supposed to cry.” I answer. “It’s okay, that’s what all those people are there for” he replies, pointing to the corner of the room.

And then, I hear it! My baby cries out an angry cry. Shortly afterwards, someone asks if my husband wants to cut the cord. Based on how squeamish he is, and our earlier conversations, I am sure he doesn’t, so am surprised when he says he does and bounds right over to the corner of the room. When he comes back, I say “I can’t believe you cut the cord!”. He replies “I just wanted to see him”. And then he pulls out our camera, and I get my first look at our baby boy. His mouth is open wide in a wail, and he has several wires coming out of him, but he’s perfect and he’s all ours! We are finally parents.

To be continued (tying up some loose ends).