Saturday, September 21, 2013

The Birth of Laurie Grace

As a disclaimer, this is not a pretty, unicorn and twinkly lights filled birth story. If that's what you're looking for, you should probably look elsewhere. This is a failed VBAC. A CBAC, though I hate that term since I have trouble truly believing that a birth took place. 
 I had been hoping that with a properly positioned baby, that I'd go into labor before my due date. Apparently my body is one that needs to hold on to babies just a little longer. People were shocked to see me at church three days after my due date, and it seemed like everyone wanted to know if I was still pregnant. I actually told one person that I wasn't actually pregnant, I'd just felt left out since for awhile it seemed like all the younger married women were pregnant, so I'd stolen one of the fake bellies from the Motherhood dressing rooms.
On Wednesday, July 10th when I was 40 + 6 weeks, I woke up around 2:30 with fairly strong contractions. They weren't regular and I hadn't been getting a lot of good sleep recently between being overly pregnant and our two year old deciding that this would be a good week to have monsters take up residence under her bed and have her show up to sleep with us in the middle of the night so I decided to sleep. I didn't get a lot of rest, but eventually they petered out and I fell back asleep. I got up to discover that I was losing my mucus plug. I got kind of excited since my water broke with my older daughter within 24 hours, so I was sure it wouldn't be too much longer. I texted my doula to give her a heads up, though admitted that I had no idea if the dose (I lost my mucus plug during the day before I was induced) of cytotec I'd had in the hospital might have been related. I had sporadic contractions off and on all day, but nothing to make me think I was in labor. Contractions again picked up in the wee hours of the morning coming about ten minutes apart before slowing down again. I had a doctor's appointment that morning, and was pleased to discover that I was at 2 cm. In my first pregnancy, I'd only made it to 1 cm by myself so I was feeling kind of proud of myself. Since I was at 41 weeks, he sent me to the hospital for a biophysical profile. Other than it being a time of day when the baby wasn't normally very active which made things take longer, everything looked great. I got a little annoyed by the nurses wanting to know if I was planning a repeat c-section or a VBAC since I doubt there's many people not planning a VBAC who are still pregnant at 41 weeks in a post-cesarean pregnancy, but everyone was nice so I kept my opinions to myself. As I was leaving one of the nurses mentioned that I was having contractions to which I replied, “ I know,” but I was pleased that the monitors were picking them up since I don't think the monitors will pick up Braxton-Hicks contractions.
I started having contractions again in the wee hours of Friday morning. I tried to sleep, but I really couldn't. At one point, I ended up getting in the tub in hopes that it would help me relax. It did, but we have pretty much the tiniest tub that isn't just a shower stall, and while the water helped, it wasn't comfortable enough to just stay there. Contractions weren't regular, but they were pretty much constant coming anywhere from six to ten minutes apart. When my husband left for work, I told him to make sure that he was available by phone just in case. I really thought that it might be the day. Things stayed that way all day. There was a decent amount of time that I wish that we lived close enough to home so I could have sent our daughter to stay with my mother, since I was having contractions often enough that I was worried about scaring her. But I wasn't having regular contractions often enough to warrant asking my doula to come over or to send her to stay with the friends who had offered to watch her while I was in labor. So I dealt as best I could.
During the day I started to realize that I was having trouble dealing with contractions since my body was automatically tensing every time one hit, and I would have to force myself to let go and relax through it. It was almost like my body was expecting Pitocin induced back labor, so the first several seconds were agonizing until I remembered to breathe.
I was still having a lot of mucusy discharge, and on Friday it took on a bloody tinge. I was sure it couldn't be much longer, and that the baby would be born sometime during the weekend. My doula when I talked to her concurred, and that she didn't think I could go much longer like that. Contractions slowed down in the evening to about every fifteen to thirty minutes, and I was able to get a few hours of sleep. They picked back up again in the wee hours of Saturday morning. I was still losing bloody mucus, and after about 36 hours of that I called my OB's office to talk to the person on call since the length of bleeding was starting to worry me a little, especially since my OB had said he wanted to be a little more cautious than usual over vaginal bleeding since I'd had a single layer suture with my first daughter. My doctor's in a solo practice, and he wasn't on call, so I ended up talking to one of the midwives at his back-up practice. Which was slightly ironic since I had wanted to see them but the OBs in that practice won't allow the midwives to attend VBAC deliveries and they're the only midwives in town practicing legally, so if for only a five minute phone call I did get to have midwife care. She told me as long as it was still mostly mucus and wasn't soaking a pad and I wasn't in a lot of pain that it was probably fine, but that if my contractions picked up to four to six minutes apart for at least two hours to go ahead and go to the hospital. Late that afternoon the blood stopped, though I still continued to have mucusy discharge.
I tried to talk my husband into taking our daughter to the church pool party (I assumed the family hosting wouldn't want me in their pool, and contractions every 10 minutes wouldn't make me good company regardless), but he didn't want to leave me. But they could of gone since things continued the same as they had been. We skipped church for the same reasons the next morning. I was starting to get pretty miserable. I didn't think I was ever going to go into active labor. The only relatively comfortable places to sit were on my ball, the toilet, the kitchen chairs, and to a lesser extent the floor. Contractions were practically unbearable on anything soft. We talk to my mom on Skype every day, and after seeing me Sunday night she was begging me to go to the hospital or to at least call my doula to come over since she thought I was further along than I did. (She also kept telling me to breathe which got on my nerves to the point that I snapped at her to quit.) I insisted that it was just more prodomal labor, all they'd do at the hospital would be to send me home, and that there was no point in calling my doula to come over if I wasn't really in labor. But I also told her and my husband I didn't think I could keep on like this much longer, and that despite my desire to never have Pitocin again I was going to ask about possibly inducing labor the next day at my doctor's appointment.
Monday thing continued like they had been with me waking up in the wee hours of the morning. Around 4 I thought about getting in the tub, but then I felt a small amount of liquid. There was a part of me that wondered if it was amniotic fluid, though it didn't last long and wasn't the huge gush like when my water broke the first time, but I decided as a precaution to stay out of the tub since our tub wasn't sterile and I didn't feel like attempting to clean it into that state. My military id expired that day, and we'd planned on going to the DEERS office on Base to get it renewed before my appointment at 10:30. My husband and I talked and decided there was no way I could manage right then, and that we'd try after my doctor's appointment. He left for work, and I set about trying to manage contractions that were starting to get closer together.
I put PBS on for our daughter, and I tried to get myself in a position that I thought that I could manage to make her breakfast. I wasn't particularly hungry, but I knew I probably should eat and got myself a banana. I was sitting down and then getting back up since nothing was particularly comfortable. I was done. I wanted drugs. I knew an epidural would probably be awful, but I didn't think I could keep going. I figured, based off my first labor, that I was probably at 3 maybe 4 cm at most. I fixed my daughter some cereal, and we called my mom on Skype. I was trying to fold laundry while my mom begged me to call my husband to come home. I refused and told her that I was pretty sure I wasn't in active labor, and that he was planning to leave work about 9:30 to come pick us up. And then I started leaking fluid that was definitely amniotic fluid since I couldn't get it to stop. I changed my underwear, and put a pad on to catch the fluid. I told my mom we'd talk to her later, and I started trying to get my daughter's bag together to go stay with friends. I was still sure it was probably too early to go to the hospital, but I also knew that they were going to send me to the hospital when I showed up for my appointment leaking fluid, and it was too late to cancel the appointment. I kept having to stop during contractions, and so about 9 am I called my husband to ask him to come home now so I could have some help. One of his co-workers answered his phone and told me he'd already left. When he got home, he helped me finish getting things together, and we left for my doctor's appointment.
The car ride was torture. I almost think that riding home after the first c-section wasn't as bad as riding in the car in labor. About three miles from the exit we needed to take for my OB's office, I told my husband to just go to the hospital (which is basically across the street from the OB's office) since I wasn't getting back in the car. I called the office, told them that I thought I was leaking amniotic fluid, and that we were going to just go straight to the hospital. They told me that was fine and to go straight to Labor and Delivery. We got to the hospital, and my husband offered to drop me off at the front door. I told him no, to park, and that I'd walk in. Walking was getting difficult, and I had to actually stop twice between the parking lot and the door to wait out a contraction. We checked in at the desk, and they sent us upstairs to Triage. While waiting I started singing some of the Bible verse songs from my daughter's favorite CD. We sang “I can do all things through Christ who strengthens me” and “Whenever I'm afraid, I will trust in You.” I didn't want to scare my daughter, and amazingly singing through contractions with her helped me to relax some. They brought me a gown, and my husband and daughter stepped out of the room so that they could check to see if I actually was leaking fluid. I was, though the nurse said the sac was bulging so much that she couldn't tell how dilated was, and she was going to get someone else to check me, but that they were definitely admitting me. I lied and told them I had started leaking fluid around 9:30 so that they wouldn't be putting me on the clock quite as early. My husband left to take our daughter to the friends who were going to watch her for us, and I texted my doula to tell her I was being admitted. I then called my mom with the same news, and they came back to re-check me. The nurse didn't tell me how dilated I was, and I asked if I could use the bathroom. I had been guzzling water and hadn't urinated in several hours at that point because I had wanted to make sure I could provide a urine sample. Needless to say, I really needed to go. The nurse told me I was pretty far along, and that they couldn't let me go to the bathroom but that she could bring me a bedpan. I freaked. I was right back at my first birth where I was forced to use a bed pan because they wouldn't let me out of bed, I had to ask the nurse to leave since I couldn't pee with her watching me, I wet myself since I wasn't on the thing right which embarrassed me greatly, and then I didn't pee for five or six hours until they inserted the catheter in preparation for surgery. I'd put my mom on speaker, and she started asking to speak to the nurse with plans (as she told me later) to try and explain why I was freaking out. I hung up on her. The nurse then told me that I was at 8cm, and that they couldn't let me have a baby in the bathroom. I was shocked. I stalled at 3 cm the first time, a fact that my first OB pointed out before I fired him as a reason that he wished I'd just give in and schedule a repeat c-section. And I'd done it all on my own. The contractions all of a sudden got much easier to manage. The intensity and frequency didn't change, but my perception did. I agreed to wait on the bathroom until they got me in a room, and texted my doula and husband with the news.
They moved me to a labor room, and my doula got there a few minutes later. The nurse who came in to check me, told me that because I was so far along that my OB had said that he wanted me to have continuous monitoring instead of the intermittent monitoring that we'd agreed on in the office. My doula promised that she'd help me maneuver with the wires so that I wouldn't be stuck in bed, and I agreed. I asked about using the bathroom again and promised that I wouldn't have a toilet baby, and the nurse agreed. They brought the delivery cart in, something that had never happened with my previous birth, and we got down to business laboring. My husband had brought my birth ball inside when he got back to the hospital, and I spent a lot of time sitting on the ball. I was up and down. I went to the bathroom as needed. It wasn't a home birth, but it was much more like I expected labor would be like before my oldest was born. My doula did remind me to breathe through contractions, but ironically it didn't bother me the way it did from my mom. I don't really remember the nurses coming in to bother us, but we didn't need them. 
My OB came by sometime between noon and 1pm to check me. He didn't have an amnio hook so I don't know if it just happened or if he broke it, but when he checked me my water completely broke in a gush. In triage they had been debating if there was meconium, but once it completely broke there was obviously meconium in the fluid and it smelled foul. He said I was at 6, but told me not to worry too much about going backwards when I asked since apparently it's not unusual to lose some dilation once your water breaks if the sac was bulging. Middle of the afternoon, a nurse came in and asked if I wanted to be checked. I consented, and I was back to 7. 
Around 5 o'clock, my OB came back to check on me. I was still at a 7, with the baby still high at a -1 station. He said we had an hour to get her to come down further not my pelvis. He wasn't worried about dilation, since he said that dilation would increase if she was further down. I asked how to get her to come down further, and he said he wasn't sure so he was going to defer to my doula since that was her area of expertise. 
He left, and she kicked things into overdrive. I was squatting as far down as I could by the bed. I was lunging. I was standing with one foot up on a chair. A nurse came in at one point to ask if she could watch what we were doing so she could have ideas for the future. I said it was fine, and then didn't notice her at all. She left at some point,though I'm not sure when. I spent a long time sitting on the toilet with my legs spread wide, and then with one leg up. I was in the bathroom long enough that a nurse cae in to check on us since I'd been off the monitor for about 20 minutes. 
The biggest issue was that as soon as my OB said "c-section" my contractions slowed down immensely. They'd probably been at 1 to 2 minutes apart, and while they didn't stop, they did slow down to more like 5 minutes apart. There really wasn't that much to work with. At one point my doula suggested trying a side lying position. I didn't stay there long since it was very comfortable and made me sleepy, and I had no contractions. 
About 6:30 pm, thirty minutes later than he'd said, my OB came back. He checked me and said, "I'm sorry,there hasn't been any change." I started crying. I asked if there was anything else we could do short of just removing my pelvis. I asked if Pitocin or an epidural might help. I was told no. My contractions were more than adequate, and since I was handling the contractions great an epidural would probably be more likely to cause problems than to help. He left, I cried like a baby, and I called my mother on the phone to tell her I wouldn't be giving birth and that I was scared. For the first time since I was a child, I called her mommy. She stayed on the phone, on speaker, until they came to get me. 
Things started to get real. A nurse came in and hooked up a bag of iv fluids. The anesthesiologist came by to talk to me. I told him how scared I was of the spinal, and how bad it was with Isabelle. He told me he didn't want to put me out since that wasn't good for me or the baby. I said I didn't want a general, I wanted to be awake, but I didn't want to be stabbed for better than half an hour while they hit nerves. And I told him I'd had a panic attack watching a woman have the same sort of nerve pain during a pre-cesarean spinal on television. (As a side note, I quit watching Discovery Health birth shows after that.) I said I thought from looking it up later that they'd used the wrong size needle the first time, but I wasn't sure. All I knew was that I couldn't do that again. He promised me that he wouldn't do that, and continuing like that was completely inappropriate. 
A nurse came into shave me. She had me lay down flat, and then I had a contraction. Flat on your back is the most uncomfortable way to have a contraction,and while I don't know if this normal in that position I couldn't move until the contraction had passed. She was shaving, and when the contraction started my belly moved down. She pushed up on it, and I screamed. The pain was almost as bad as the nerve pain from the first spinal. I was trying to talk,but all that came out was gibberish. My mom was on the phone still,and she said I sounded like a wounded animal. My doula came over to stand on the other side of the bed. She started talking to the nurse, but I couldn't really make our what she was saying. Mama told me later that what she could make out over me screaming was something about couldn't she tell I was having a contraction and to just wait a minute. Whatever she said, it didn't help since the nurse kept right on going. The contraction finally stopped and I lay there panting. 
They brought my husband some clothes to put on, and they came to ask if I'd rather have a wheelchair or a gurney. I asked if I could just walk, but was told no. I chose the wheelchair. A few minutes later they came and got me. I was wheeled down the hall, through the double doors that said authorized personnel only, and into the OR. 
They helped me get on to the table. There was a large digital clock on the wall that said 7:15, and that was determined to be the official start time of the surgery for their paperwork. The anesthesiology team had me sit on the edge of the table, gave me a pillow to hug to my chest, and had me lean over. They stuck me once with a numbing agent, and then a second time to actually administer the spinal. Mercifully, it took in one try without any nerve pain. I don't know if they started with the right size needle, if it was the different position since the first time they had me leaning forward onto a nurse, or just a different person doing it made the difference. All I know was that I wasn't thinking I'd never walk,and it didn't feel like I was on fire.  I thanked the anesthesiologist, and told him I owed them a fruit basket or something. He laughed, and told me I should have come to his hospital the first time, too. My legs started to go numb, and they helped me to lay back on the table. They moved the boards up on the sides for my arms, but didn't strap me down like I was the first time, and they put up the drapes. I was asked if I wanted my tubes tied, and told them no. I said as of right then I didn't want any more children, but that my husband and I hadn't really talked about it, and it really didn't seem like a good time to be making  that kind of decision. They laughed. Apparently Nurse A Contraction Is A Good Time To Do a Bikini Shave hadn't done a good job, and they re-shaved me. It was odd being able to hear the razor, but not feel it. As they were prepping me, the OR staff was discussing who was staying for the next one. Apparently I was c-section number 14 of the day, and there was someone waiting on the OR as soon as I was done. 
They brought my husband in to sit beside me, and they started cutting me open. I'm not sure exactly what drugs they gave me in the spinal, but it wasn't as strong as the fentanyl/marcaine combination I had the first time. It didn't hurt, but I wasn't as numb and could feel pulling and tugging. It was an odd sensation, but I preferred it to the completely numb disconnect of my first "birth." Soon I was hearing the words "time of birth, 19:48," and then I heard the most beautiful sound ever for the first time ever, my daughter's first cries. I missed it the first time since as they pulled her out they said don't let her cry and she didn't cry in the OR, but Laurie cried immediately. They took her to the side, and offered my husband an opportunity to go to where they were set up. Being squeamish he declined, but a few minutes later they brought her to me. And this time there wasn't any desperate reaching while they held her a quarter of an inch out of my reach. My arms were never strapped down, and the nurse placed her in my arms. I probably wasn't really holding her since she was resting on my left shoulder with my arm around her with the nurse still supporting her, and skin-to-skin wasn't an option since they'd (for reasons I'm not 100% on since it wasn't done the first time and I weighed more then) taped from my belly up and over my shoulders, but it was wonderful. I'd only been allowed to brush our older daughter's cheek after my OB said they could unstrap my hand in the OR. I had her for about five minutes. My husband and I both commented on how much she looked like her sister, and he thought she was bigger though I wasn't sure. Then my husband, Laurie, and the nursery team left. I was alone. 
A few minutes later my doula appeared in the doorway. I have never been so happy to see someone. Generally you hire a doula to help with natural childbirth, but not having to be alone while they sewed me back together was wonderful. 
After the surgery, the room seemed to clear. I was moved to a gurney to be taken to recovery. We were getting ready to leave,and a nurse stopped us to ask if I wanted to see the placenta. I did and she brought it over to me. It was amazing! I'd never seen a placenta other than in pictures before. It was slightly greenish (I'm assuming from the meconium) and you could see all the veins in it branching out like roots.  It was larger than I'd expected. I didn't want to eat it or take it home, but I'm glad that I saw it. 
In recovery the nurse told me she was going to call the nursery and see if she was in Well Baby or the NICU. They had taken her to the Well nursery, and they said they'd bring her to me. A few minutes later they rolled in, and they placed my awake baby in my arms. I counted her little fingers. Then I put her to my breast. With my first the hospital didn't allow babies in recovery, so by the time I got to hold her several hours after she was born she was asleep and uninterested. Laurie was alert, and very interested. I'm not sure that she got anything out until later since she seemed at that point to mostly just be licking my nipple, but she took to it right away and my milk came in slightly sooner. My doula gave me a hug, and told me I'd done everything I possibly could have and that she'd come back to check on me the next day. 
While they were sewing me up, they had done her measurements. My husband was right she was bigger. She weighed 9 lbs, 3 oz, and was 19 inches long. After awhile they took her back to the nursery for a little while, and took me to a room. 
It wasn't great, and it definitely wasn't what I was hoping for. This birth story was hard to write. I started it shortly after getting home from the hospital, and it's taken me better than two months to finish. I've cried a lot. That's probably the biggest issue in finishing this since I'd get a little ways and have to stop so I could pull myself back together. It was a better experience. I'm not going to lie and say it was good. Like the first picture with Isabelle, the first picture of me with Laurie that was taken in the OR I don't have that "oh my gosh I just had a baby" face. I just look sad. Working on this I think has helped me to put things in perspective and get it out. I'm proud that I went into labor on my own. The lack of drugs seemed to help. Laurie wasn't jaundiced really at all. At discharge her bilirubin levels were 0.01 which I credit to not being exposed to Pitocin. I wasn't swollen from an insane amount of iv fluids and she was awake, and nursing was so much easier. And despite all the uterine rupture scare tactics associated with VBACs, my OB told me that I had no sign of rupture or even windows in my scar. 
Emotionally I'm doing better than I did the first time, and much to my surprise I'm not emotionally dead. I'm not truly great and the wounds are still fresh, but I'm not a puddle in the floor. It took me weeks to even give myself permission to grieve. And there's a lot to grieve. I didn't give birth. And it wasn't for some definite even Ina May would agree reason, it was for failure to progress. There's a part of me that says "you're a broken failure, why did you even try," though I try not to concentrate on that voice. It's harder than I would have thought to come to terms with the fact that in all likelihood I can't have any more children. There is no way I can walk through the doors of a hospital to be sliced open for the third time, but finding a provider willing to take on someone wanting a VBA2C with no prior vaginal births and both c-sections for failure to progress that takes our insurance will probably be like finding a needle in a haystack. 
I do wonder what went wrong. With my first, in many ways I chalked it up to a badly positioned baby and a horrific induction and it was a fluke. But it's hard to call different circumstances with the exact same outcome a fluke. My mother says her head was just too big. My OB said that things might have been easier if I'd given birth vaginally the first time. I blame myself for sitting on the couch occasionally, eating sweets when I craved them, going to the hospital too soon, and a million other little things. I wonder how much of the problem was just psychological. I didn't want a hospital birth, but Alabama law makes attended home birth illegal. When we went on huge tour, it smelled evil to me. Just like the first time, my contractions slowed down as soon as surgery was mentioned. Knowing I'd spent the pet several days with my contractions slowing down in the evening only to pick up in the wee hours of the morning, I wonder if my body was doing that again and I just needed more time. And knowing I was c-section number 14 of the day with at least one more following me and that the postpartum ward was full while I was there, the cynical part of me wonders if there was pressure to get me out of the LDR room. I just don't know. 

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