Sunday, May 18, 2014

Lucky, A Birth Story in Two Parts (II)

There is this medical myth that second births are faster and easier.  In the grand scheme of things, yes, this one was "faster" but I would never call it easier.  I shared his brother's birth story earlier and now this one for comparison.

I realised as I was writing this that while I use nicknames for my boys, I had not selected one to use for my husband.  To make things simple, I'm using his STEAM handle which fans of the series "Song of Ice and Fire" (or watchers of HBO's Game of Thrones) will recognize.  Just to add to our nerd-score, my handle happens to be the reply.

Nerdy names aside, here is my second birth story:

On the Wednesday before my second little boy was born I had my regular OB visit and discussed my on-going issues with labor being unproductive and the signs of muscle damage in my hips and lower body as well as the continued stress on my kidneys making me weaker.  I was still at just under 5cm according to my OB when he checked and swept membranes again, sending me home with instructions to keep up the walking and allowing me to try anything and everything if it could help break my water or get things moving.

That night, just as we were all settling in to bed for some rest, my water decided to break.  After having to mop up the mess all over the bed and struggling into clothes without waking the sleeping nearly three-year-old it was time to go. I left Valar home with the sleeping toddler and had my mother drive me in with a plan for her to trade with him and watch the little boy once they confirmed this was the real thing.
We arrived at a little before 11:30 at the hospital, meaning I knew we would be having a baby on Beltane (Mday Day for those not familiar with year wheel celebrations). After navigating the world's worst parking garage and improper signage, we the triage department for the maternity ward as my contractions increased from an annoying cramping to drastic squeezing of my innards, making me sure that we made the right call about it.  The nurses hooked me to the monitor and we all watched my contractions at a steady 5 minutes apart and about a full minute long with a healthy dose of "Why am I doing this again!?!"  

And so it went until the attending arrived.  She nicely watched my contractions, asked what made me think my water broke, looked thoroughly squeamish when I mentioned that I was being intimate when it happened - did she not know how the baby got in there to start with - and said she wanted to do an exam.  After finding fluid she said she still doubted my membranes had ruptured because many women mistake loss of bladder control for their water breaking.  I assured her it was not my bladder, but she seemed to have a low opinion of my ability to tell the difference.

Then she went a step farther in being thoroughly inadequate in her diagnosis by saying I was just over 3cm, then seeing that their own hospital OBs had been the ones to do my last exam she said she'd leave it to what he had stated.  At that point she informed me that while they could see I was indeed having contractions and feeling something distinct, she felt I was not really in labor yet or only the very early stages if this was labor.

Curbing the urge to hop off the bed and throttle her as she told me I was not even in labor while mid-contraction... I asked her to simply humor me and she agreed to let me wait a while and see if the contractions did indeed progress things.  My desire to kill reduced greatly once she had exited the room and the nurses were again commenting that from everything they could see in my monitors, this was indeed labor.  Unfortunately, when two hours later I had only progressed a tiny amount that same attending tried to send me home because she did not feel it was safe to follow the advice of the supervising doctor from my OB's office about giving me pain medication and a sleep aid to allow my body some rest before needing to work even harder while pushing.

About the point that I was struggling to pull on my pants while trying not to scream from contractions every three minutes, my husband wisely dragged in another nurse in the midst of their shift change and explained that if they were serious about discharging me he wanted both a wheel chair to bring me to the car and the name and number of the best person to call while filing malpractice against the hospital for their behavior.  At this point the nurse, now with the fear of legal action, went back out and returned with another nurse and MY doctor as he had just come in for the day shift.  He assured me that he was not allowing them to send me home, pointing out that had the girl called him as directed he would have told her to admit me and do the transfer from the triage section into a progressed delivery room so that he could have a more experienced doctor doing the care until he arrived.

I was then moved from the initial room to a delivery room with a birthing tub, yoga ball, and far more comfortable bed to rest between what was now a routine of contractions every three minutes. My new nurse assisted us over and assigned husband to run a warm bath in the birth tub as I had expressed in my birth plan how that was the preferred location for my labor.  After another check from a doctor with more than half a brain we were vindicated with the news there was just a pin-prick hole and the baby was pressed tight against it but that they would open it a tad more once I was ready to move to the tub so things could progress.

Having had such an easy first labor, it was a shock to my system when we could hear an audible crack as the bones in my hips and spine suffered with each contraction.  After getting in the tub with my first son, there was such relief and quick progression.  It was exactly what I needed to relax, to allow the steady ebb and flow of contractions in waves, and to reduce the pressure from all the weight and muscle movement.  But unfortunately there is one saying about pregnancy and birth that IS very true… “Every birth is different.” 

Valar puts up with much of my complaining.  He's held my hand through two long pregnancies, and I adore that he has learned to read me so well over our years and can see when a migraine is coming or I need a break because the long term damage to my knees is getting to me. But when even he finally had to excuse himself to go have a cigarette and even cry a little to shake off the concern from my whimpering and howling at the pain in my spine and legs... it is fair to say that something was very wrong.

I would have stayed longer in the water if the intensity and frequency of these contractions hadn't been causing me to slip down into the tub as I started to pass out. The bed was safest this time and I'm thankful for it. Once there, it was easier to focus on breathing and using my mind to overcome the pain.

I asked for something first just to reduce the edge and make it tolerable to ride out without being so aware of how badly my bones were grinding and the least amount of interference with the baby's heart rate. That worked for perhaps ten minutes before I was back to having to bite a pillow to stop the howling and my body fought itself.

Finally it was my nurse who called in the attending and told him point blank that even she was uncomfortable with the level of pain I was putting myself through after all our other complications this pregnancy. He stayed to watch through two contractions before telling me he felt it was time to do something to both push the progression (fourteen hours of active labor at that point and only a single centimeter) and reduce my suffering. Within a few minutes the team was setting up for an epidural even knowing my scoliosis might be problematic.

I am thankful the anesthesiologist was so skilled and steady, placing her line even as my body decided to challenge her with only a two minute window between contractions that lasted nearly as long. After that it was so much calmer. I was quiet and mentally unclouded enough for us to sit and discuss with the doctor about all our options which lead to a safe, healthy birth for our little hobbit baby.  By sixteen hours of labor, I was exhausted mentally and physically.  I wanted it to all just be over. Valar wanted it to be over. Even the doctors must have wanted it to be over as they willingly listened to my concerns and questions if a c-section would be needed based on heart rate for myself and the baby.

My doctors listened kindly, agreed to see how soon there would be a surgical room open as we all felt the baby had been stressed enough and my body was beginning to suffer too.  As they left the nurse reminded us to call for her right away if I felt any change as I had just reached 7cm and with my eldest, all that was required for me to move from there through transition and into birth was the "effort" of standing up after a trip to the toilet.  It took perhaps ten minutes for me to ask Valar to call the nurse back in as I felt a touch of pressure.

I wish I'd been holding my camera at the moment she lifted the blanket to look.  The jaw drop and look of shock told me more than her rush to the room phone to call in my attending.  It was time and Valar just smiled and took his place next to me, holding my hand and grinning.  Since the epidural was doing a good job of dulling the contractions, I was able to resist the urge to push until the were all prepared.  This time took far more pushing as he was much larger, but as they lifted our little boy onto my chest and he opened his big blue eyes for the first time, I was so happy just to make it through all the challenges of this pregnancy and birth.

Epidural is not a dirty word.  Pitocin, though I feel it is used too frequently, is not a dangerous chemical.  In my case, these were the tools that lead us to another calm birth rather than a dash to the operating room or another baby born on a bathroom floor. I may have had to request pain medication and required the use of Pitocin to alter the progress this time around, but I am very happy to know it was possible at all.

Our mutual recovery from this experience has been much slower physically.  I required stitches which I promptly managed to rip open upon getting home and returning to being Mommy to a toddler and never stopping for long.  I had bruising at the spot where my epidural was placed and where one of my IV lines had blown during the first attempt at pain management with Nubain while in labor.  Over all, things have been slow but no more problematic than any fatigued life with a new baby.

The little Hobbit Baby did require a short trip to the hospital's NICU on his second night as he had tried to inhale while still in the birth canal and swallowed fluid and blood.  His lungs required a round of oxygen therapy and antibiotics to fend off infection.  He is on a vitamin D supplement to combat jaundice and steadily gaining weight perfectly.

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