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).

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Birth Story Part 1 – The Induction (That Wasn’t)

I finally managed to cobble enough time to get this post written. Since it’s long enough as it is, it’s not the complete birth story (the baby does not actually arrive until the next post).

Before I go further, I should clarify something about dates. All along in this blog, I have been using a due date of June 7th, which is consistent with the date that my fertility clinic gave me. However, my OB has been using a date of June 10th. Since the decision as to when to induce was made by my OB, his due date is the most relevant date for the birth story, so that is why in this post my pregnancy seems to go in reverse.

June 19th  (41w, 2d) – 11AM

Final OB appointment – Dr. says it’s time to induce. I go home and wait for the hospital to call me in once they have resources available, which could happen at any time over the next few days.

Feels like the longest day ever.

June 20th (41w, 3d)

Still no call from the hospital. I start wondering whether they actually know they are supposed to call me, or if I’ve fallen through the cracks and am waiting for nothing. Time slows down even more (did not think it was even possible!).

June 21st (41w, 4d) – 1AM

I am in the bathroom getting ready for bed when my phone rings. Yes, it is really 1AM, and yes, it is really time to go kick things off.

By 2AM, I am in labour and delivery triage getting a cervical check by the resident Dr. As expected, nothing is happening, so I get cervadil gel inserted which is supposed to help ripen my cervix and get it ready for labour. The plan is that once I am dilated enough, they can break my water and we can go from there (assuming I haven’t gone into labour on my own in the meantime).

I am monitored for an hour to make sure baby’s heartbeat looks good, then sent home and told to return in 12 hours to check progress (or sooner if my water breaks, the cervadil falls out, or I go into labour).

June 21st (41w, 4d) – 2PM

I feel mild to moderate cramping in the morning, which gives me hope that the cervadil is working. I can’t believe that this is actually happening! We go back to the hospital for our progress check, however when I describe the sensations I’ve been having to the Dr. in triage, she does not look impressed and says she does not expect that we’ve made much progress. The cervical check confirms her suspicions, so after another hour of fetal monitoring, I am once again sent home and told to return in 12 hours.

June 22nd (41w, 5d) – 1AM

The cervadil falls out an hour early when I go to the bathroom, so I wake my husband up and we walk over to the hospital (after the last visit, we stayed at my mom’s house which is conveniently located right across the street).

On the way into the hospital, we run into the husband of the woman who came in at the same time we did the night before with contractions. She had her baby not too long after we saw them. We also run into a couple from our birthing classes, and the female is having some serious contractions. I’m tired, but otherwise feel perfectly normal. “I’m not in labour, I’m being induced” I offer as explanation as to why I don’t appear to be in pain at all.

We have the cervical check, and once again the verdict is the same – no progress. We’ve done what we can with the cervadil, so the resident Dr. explains that I will now be admitted to the hospital for the next stage in the induction process. After consultation with another Dr., I learn that the next step will involve inserting a foley catheter (a little balloon filled with water that should mechanically expand my cervix), and hooking me up to pitocin, which should bring contractions on.

However, before we can get going, we’re back to waiting for a room to become available, so spend the rest of the night resting in triage.

June 22nd (41w, 5d) – 8AM

Finally at 8AM, we get moved to a room in labour and delivery. The nurse explains what’s going to happen next, and checks some vitals. Shortly after we settle in, my OB pops in to visit, and in his usual blunt way explains where we stand:

“I know you feel like you’ve been at this a while now, but since the cervadil did not work, it’s like you’re starting from scratch – the last few days don’t count.” He then warned that I now had “2 strikes against me”, since I had not gone into labour on my own, and the cervadil did not work, so with continued intervention attempts being required, my chances of ending up with a C section are now about 50/50.

June 22nd (41w, 5d) – 10AM

Just before 10AM, the nurse and Dr. working that day come in to tell that there has been a change of plans:

“We’re not going to start the pitocin right away. Instead, we’re moving you to the high risk unit and only doing the foley catheter for now. We’ll check you in 6 to 8 hours and if nothing has happened yet, we’ll start the pitocin at that point.”

I ask why I’m being moved to high risk, and the answer from the Dr. is: “Frankly, because we need this room.” While this is getting a little too familiar (and not in a good way), I am happy to delay the pitocin, which scares the hell out of me. As it is, I’m already dreading the pain and exhaustion that comes with labour, and all the reading I’ve done has prepared me to expect faster and harder contractions with pitocin than what would happen naturally. So I’m all about taking things slow with the interventions and hoping that the catheter will be enough to get things going.

The foley is put in, and I felt quite crampy right away. We move all of our bags to the room in high risk, and I am given instructions to walk as much as possible to put pressure on my cervix and hopefully speed things along. My husband and I spend quite a bit of time walking around the ward.

June 22nd (41w, 5d) – most of the rest of the day

We are pretty much back to waiting. Periodically, the nurse checks on me to check my vitals and hook me up to the monitor to track the baby’s heart rate and my uterine activity (ideally contractions). Since she sees we’re interested, she shows us how the read the monitor. The top tracing shows the baby’s heart rate, which should fall within a highlighted range, while also jumping around within that range. The bottom tracing shows my uterine activity, and the nurse explains that a contraction would show up as a low, gradual hill pattern. However, all I get is periodic spikes which correspond to the baby kicking me, or otherwise moving around.

At every check the nurse asks me if I am feeling any contractions or cramps, and how much pain I am in. Initially, all I feel is the constant, dull cramping from the catheter. I estimate the pain at 1.5 to 2 out of 10. The nurse is not impressed. As the day goes on, even that pain goes away. Once in a while, I do feel a little crampy, so report this to the nurse, but again, I can tell that 3 (not very painful) crampy moments an hour is not what she is hoping to hear.

Ideally, if everything went according to plan, the catheter would fall out once my cervix was sufficiently dilated, however this is not happening. At some point, my husband goes to get some food, and comes back to report that the couple from our birthing classes who we’d run into in triage the night before had their baby about an hour and half after we saw them.

Not that I’m counting, but both couples who we saw in triage over the last two nights now have their babies, while we continue to wait. I know it’s irrational because we are so close to meeting our baby too, but I have a flashback to that familiar feeling while struggling through infertility: “Why can everyone else have a baby so easily and I can’t?”

June 22nd (41w, 5d) – 8PM

Finally, after about 10 hours, the resident Dr. comes to check on me and confirm that the foley is still in tight. Therefore, once a room becomes available, I will be moved back to labour and delivery to start the pitocin. In the meantime while we wait, she suggests that I tug on the catheter periodically to see if it’s loosened up at all. I do as suggested, but each time, it feels as tight as ever.

June 22nd (41w, 5d) – 11PM

We finally get the word that they are ready for us in labour and delivery, so it’s time to once again change rooms, hopefully for the last time before our baby comes. I’m nervous, but resigned to the fact that I do really need the pitocin to make this happen, and ready for something to finally happen.

To be continued…