Wednesday, October 15, 2014

Wesley's Birth Story

If you've read this post, then you know the back story of the weeks leading up to Wesley's birth.  The very short version is, we cancelled an induction that was scheduled for 5 am on 9/23. 

On that very day, 9/23, I was in the car about to pull out of my driveway to take my daughter to the zoo and meet up with friends.  It was about 10:15.  My phone rang and it was the doctor's office.  The doctor personally called me to let me know that my 24 hour urine sample I had supplied the day before came back elevated.  It was 320, and anything above 300 is considered preeclampsia.  She told me that she thought I should go to the hospital.  At this point, it became clear that I should not put off inducing any longer. So, I called my mother in law to pick up Noelle, called my friends to call off the zoo trip, called my husband, the get the picture.

I got to the hospital around 12.  The doctor at the hospital that day came in to talk with me.  She explained that because I was a second time mom, she felt that the induction would go pretty fast.  She also said something that was a tad bit concerning.  She said that once they saw some cervical change, they would break my water.  It was odd to me that every doctor I spoke with, including our favorite who I really trust, had mentioned at one point or another that they really favor breaking water fairly early to augment labor. I really didn't see the need to break the water, just for the sake of breaking it.  Perhaps if I was stuck in labor or something, I would see that as a helpful intervention, but not "just because." Luckily, I have enough experience declining things I don't want, and the practice being respectful, that I wasn't too worried. I had even asked the doctor I saw the day before if there was any risk in waiting longer to break it, and she said no.  It just struck me as odd that they all seemed so gung ho on breaking water.  I think they are just very goal oriented and figure that the goal is to have a baby and just want to facilitate whatever is going to make that happen on the speedier side.  It was definitely a moment that I was reminded once again on the importance of asking questions and being an active partner with your birth team, no matter how much you like and trust your caregiver.  One positive was that when I arrived at the hospital, no one even asked to do a cervical check!  The doctor just went with the cervical check I had the day before.  I was 2 centimeters dilated.  I had forgotten to ask about the rest of the info, but knew that I was a lot more favorable than I had been the week before. 

By 1 pm I was hooked up to the pitocin which they started on 2 ml/u, with a plan to increase it by 2 ml/u every 30 minutes until I established a pattern of contractions every 2-3 minutes.  My nurses also said that once a good pattern got established we could stop the pitocin so I could use the tub if I wanted.  A little while later the doctor came in to check on me again.  She was hoping by that point that I would be "pretty uncomfortable" which would indicate to her that it would be a good time to do a check and maybe break my water.  Fortunately, I think I was just at the very beginning of getting "uncomfortable" but must have still been acting like I wasn't uncomfortable because she said based on her observations she didn't think it was time yet.  That was fine by me!  She explained that she may be leaving the hospital campus for a bit, but that the nurses would call her when I hit active labor and also reassured me that there are always residents in the building in the unlikely event that she wasn't there.  During this time I was staying mostly in bed, on my left side, so that I could try to get some rest and preserve energy for hard labor.  I had my Earth Mama Angel Baby Labor Companion relaxation tracks going.  I started to really need to breath through the contractions.  At this point I called our doula to ask if I should continue to try to rest, or if I should be moving.  Her recommendation was to try some different positions to see if it changed the labor at all.  She said that unless I was getting deep rest, moving would be better.  We hung up the phone with the plan that I would try some different positions and call her if things continued to pick up.

I decided to sit on the birthing ball for a while.  My wonderful nurse helped me get all set up and also got a heating pad going as I was starting to feel the contractions spread all the way around my back, like a band around my lower abdomen.  I had many strong contractions that continued to get more intense.  Phil tried to tell me that he felt like he should call our doula to come.  Apparently, I was in denial because I was convinced that I wasn't far enough along.  Finally, I felt myself get pretty serious and told him to call her.

Shortly after he hung up the phone, things got really intense.  I was moaning a lot louder, had a good bit of rectal pressure, and felt a HUGE sense of relief every time the contraction ended.   I was still on the ball, with the hospital tray table in front of me, and Phil sitting across from me holding my hands.  Between contractions he talked in a really calm voice about our vacation to Mackinac Island earlier in the summer.  I couldn't focus at all on what he was saying, but found his voice so very soothing. 

I started to really feel like I needed to get up and move, but didn't really know how to.  I also thought that I should try going to the bathroom.  I told Phil to get my nurse in the room.  She said that I could try to go to the bathroom.  I remember starting to feel a little panicky at this time, but I was still very calm on the outside.  I felt like going to the bathroom was going to be a huge feat and I felt at a loss about how to go about it.  Everything just seemed so hard.  When I stood up, I felt a huge bulge between my legs.  I remember very clearly saying in a shocked voice "I think I need to be checked".  So, instead of trying to go to the bathroom, I got on the bed.  While the nurse was getting her gloves on, I felt more pressure and saw her look on the bed and do a double take.  I said to her "am I ok? Is everything ok."  She started to get very busy, but said "oh! Everything is just great!"  As it turns out, my bag of waters was protruding out of me still intact!  I think around this time it broke spontaneouly as well.  She said that she was going to call my doctor.  Then she checked me and said that I was at 8 centimeters dilated.  She got even busier and began frantically (but not in a nervous way) calling other people and saying that I was very close to delivery.  She said that the backup would need to come, because my doctor was not on the campus. 

The next several minutes were a blur.  One unfortunate thing was I was laying completely flat on my back since I had only gotten on the bed for a cervical check.  Also, things were moving so quickly that there wasn't a lot of time to get into a good position for pushing.  This probably would have been helped if we had called the doula sooner, but she was still in route at this point.  I remember saying that I needed to push and Phil encouraging me to do so, but the nurse encouraging me not to.  I think she knew that this baby was coming very quickly and she was trying to get the rest of the team in the room.

Eventually, 3 residents came running into the room.  I was definitely pushing at this point.  I remember thinking that I was in such an awful position, however, it actually didn't feel awful.  I just knew from all my reading and classes that laying flat on your back was not ideal.  Phil tried to see if we could get the squat bar up, but everyone in the room just looked at him strangely, because apparently there was most definitely not enough time for that.  He settled on moving the bed up a little and asked my nurse to hold one leg back while he held the other.  It was still far from ideal, but was an improvement.  I think I pushed maybe 2 or 3 times, and all of a sudden I felt my little baby being born.  I heard crying IMMEDIATELY! The nurse said "ok dad, tell her what it is" and he exclaimed "it's a boy!"  He was put on my chest immediately and I said "oh Wesley!" and he stayed there for a long while. He had come out rapidly and in an absolutely perfect position, which was amazing given the not so great position I was laying in.  I absolutely credit the chiropractic care I had throughout the whole pregnancy for keeping me in such good allignment to birth in, even in a suboptimal position.  Phil was awesome and when the resident went to cut the cord, he said "oh we are delaying that."  After it stopped pulsing, we said we were ready for Phil to cut it.  It seemed like only a few minutes until my placenta came out. The hospital did a great job of delaying all the routine procedures.  Wesley was on my chest and nursing for a good hour and a half before he was weighed and got his vitamin k shot.  He weighed in at a healthy 8 pounds, 2 ounces and 21 inches long.  And much of that happened when it did simply because I needed to get up and go to the bathroom and get ready to transfer to the postpartum room.

And now for the comedic part of the story.  I had a second degree tear, and it wasn't long before the residents began to repair it.  I'm not exactly sure how long the residents have been doing this, but they definitely seemed a bit unsure about what they were doing during the repair.  This sounds awful, but it was actually really funny and something I am still laughing about daily, 3 weeks later.  I  heard things like "what about over here" and "thats not part of the tear, it's just like that" and "oh, she doesn't have an epidural" after they had neglected to sufficiently numb the area.  It also felt like there were 20 hands in my vagina, with random finger poking that I simply could not understand why it was happening.  During this time, my doula finally arrived.  Imagine her surprise to see me holding my baby, being stitched up, since to her knowledge I was just laboring on the ball when we had called her to come!  I just progressed SO quickly!  Given the goofy nature of how the repair was going, I was glad to have the doula there.  She stood by my side while Phil started making calls, and helped hold my leg back since they were having trouble getting the stirrup properly positioned.  All of this was going on with my sweet Wesley on my chest. 

Later, Phil made me belly laugh (which HURTS after giving birth, by the way!) by referring to the residents as the three stooges.  That is COMPLETELY what it felt like in that room.  It is even funnier because earlier during the pregnancy, Phil sent me this comic.  I was initially baffled by it and didn't find it nearly as hilarious as he did.  But after this experience, it is absolutely appropriate and HILARIOUS.

Wesley's birth was so incredible!  I am so glad that I decided to go without an epidural.  I felt so normal and completely amazing right after.  It was such a stark contrast to how I felt after Noelle's birth.  I would still love to go into labor on my own some day, but it's safe to say that this induction was pretty great.  It was just 3 hours and 40 minutes of being hooked up to pitocin.  The highest they ever had to dose it at was 6 ml/u which is pretty much just a whiff.  I'm also so very thankful that my preeclampsia was very mild and that I did not need to be treated with magnesium.  Phil was amazing.  Completely amazing.  He took such an active role in the birth, and is such a loving husband and father.  I can't imagine not having him at my side.  Wesley was born on September 23rd, 2014.  It also would have been Grandma Gert's 103rd birthday.  Grandma lived with our whole family from the time I was 1 year old until she died in 2006, so her birthday has always been a special day in our home.  I'm overjoyed that Wesley gets to share this special day with her. 

The weeks leading up to Wesley's birth

It is so very hard to believe just how much my views on childbirth have changed. It's funny to go back and read Noelle's birth story, which you can find here. 

The weeks leading up to Wesley's birth are such an important part of the story, that I can't put it all in one post.  This one will focus on weeks 38-40, and I will write about the actual birth in a separate post.

Around week 38, my blood pressure started to go up.  This was very similar to what had happened with Noelle at the end of pregnancy, it was just happening a week early.  My blood pressure that day was 140/82.  Nothing to warrant immediate induction, but we did need to keep a close watch on it.  I tried to chalk that reading up to inaccuracy.  I had just carried my sleeping toddler in from the car, layed her on the waiting room couch, then transferred her once again to the chair in the room where the blood pressure was taken, all while she remained totally asleep!  This meant my blood pressure was taken on my right arm, while standing up, after having just carried 30 pounds of sleeping toddler around.

Unfortunately, my blood pressure was high again at 39 weeks.  This time 140/90.  The doctor I saw was the same doctor who delivered Noelle.  He once again mentioned needing to keep an eye on things, and wanted me to come in 3 days later for a biophysical profile (an ultrasound that looks at various criteria to judge the health of the baby), and he also wanted me to get bloodwork done that day to check liver and kidney function.

When I came back for the biophysical profile, my blood pressure was up once again.  It was 150/90.  Bad news.  The good news was that my bloodwork had come back great and the ultrasound was perfect.  In addition, none of my urine screenings indicated that there was protein in it.  This meant that I had gestational hypertension, but not preeclampsia.  The doctor I saw that day was a new doctor at the practice.  Her recommendation was to induce that day or the next.  She said that even though I didn't have preeclampsia right then, my blood pressure put me at risk for developing, and that those risks outweighed the risks of induction.  Major bummer.  We asked a lot of questions.  I explained that I had been monitoring my blood pressure at home, and that many of the readings were totally normal.  At this time, I consented to a cervical check to see if I was favorable for induction.  I wasn't.  I was maybe a fingertip dilated, not very effaced, and cervix was mid position.  I also asked if stopping work and taking it easy in an effort to lower my blood pressure would help.  She said that it may help, but that I was still at risk for developing preeclampsia.  We asked for time to think about the decision and she told us to call her and let her know our decision either way.

After a long lunch (with a lot of tears) with my husband, and a long phone conversation with our doula, we decided to not induce that day (it was a Thursday) so that I could at least try to get some rest, but we were still on the fence about inducing on Friday.  We called and explained to the doctor that we were still making up our minds about a Friday induction.  It was 4:15 and I asked what we should do if we could not make the decision until after 5.  She told us we could call the on call line and speak with the on call doctor, who fortunately, was the doctor who we had seen the first time my blood pressure started to rise and who we have a lot of trust in.  I called and spoke with him, which was a great decision.  He said that the doctor I had seen earlier that day, was absolutely correct in her recommendation from a text book standpoint.  However, he felt confident in me waiting until Monday because he was familiar with me, and this was all deja vu from Noelle, and because he "had been doing this forever."  He also felt that all the current testing I had done indicated that I would likely be fine for the weekend.  He suggested I call the office the next day to schedule either a Sunday night or Monday morning induction.

The next day, I called the office as instructed and asked to schedule an induction.  The nurse got back to me and said that there were no spots left for Sunday or Monday, so I was scheduled for Tuesday, 9/23, at 5 am.  In addition, I had another biophysical profile and office visit scheduled for Monday and they wanted me to collect my urine for 24 hours.  This was a really telling moment for me.  I "needed" to induce ASAP, but only if it was convenient for the hospital?

When we went in for the office visit, my blood pressure was a reassuring 130/82!  Not perfect, but much better!  In addition, my ultrasound once again looked perfect. I was 40 weeks and 3 days.  I saw the same doctor who had recommended induction the previous week.  I explained how I had tried to schedule for that day, but was put off until the next morning.  We had another discussion with her about whether it was necessary to induce.  Her recommendation was the same as before.  Even though my blood pressure was better, and everything still looked good,  she told me that I "still had the disease".  She was referring to gestational hypertension.  It was not her most tactful moment.  In addition, I was dilated to a 2 this time, and was a lot more favorable for induction! She also told me that I had the advantage of being a second time mom.  My risk for the induction not working and needing a csection was very low. While this was all phenomenal news, we still didn't want to induce when everything was looking good, even a little better than the week before.  Much to that doctor's dismay, we decided to cancel the next day's induction and scheduled another biophysical profile and office visit for Thursday.  That visit was also scheduled with a different doctor, the one who I have already referred to as knowing me better, and that we have a lot of trust in.

These weeks were really an emotional roller coaster.  It was really difficult to decide whether or not to go against the official medical advice to induce.  I really had to trust my intuition, which was telling me that I was healthy and that I could hold off.  But there's always that little voice saying "what if" and being scared that I could never forgive myself if something did go wrong.  I also HATE conflict, or even the threat of making someone unhappy.  While that one doctor did have a moment or two of not being tactful, I never felt like she didn't truly want the best for me.  I understood her perspective from a medical standpoint.  The chance of delivering a healthy baby with a favorable induction at 40 weeks and 4 days was high.  While there was a good chance that I wouldn't develop preeclampsia, the risk was still higher and preeclampsia can develop quickly.  However, the medical standpoint didn't take into consideration how difficult my last induction was.  I was really pretty sick after Noelle's birth.  I passed out in the bathroom, I was extremely weak, and I definitely did not have the amazing feeling that I heard a lot of people talk about after having a natural birth.  In my mind, these were risks to inducing that I had to at least consider.   It took a lot of prayer, talking with Phil, and talking to our doula, and going with my gut.  I think a lot of people would have made the decision to induce a lot earlier, and I think for a lot of them, that would have been the right decision for them.  But for us, we decided to hold off still longer.