Thursday, May 9, 2013

Maeve's Birth Story

"And she'd had lucky eyes and a high heart,
And wisdom that caught fire like the dried flax,
At need, and made her beautiful and fierce,
Sudden and laughing."
-The Old Age of Queen Maeve, William Butler Yeats

It is Mother's Day and I am finally ready to share this story, I find myself wishing (as I often do) that I was still a journaling sort. Five months have passed since Maeve's birth, and though there are hundreds of pictures (thanks to her camera-addicted father), she has barely a page written in her baby book. There are so many moments that blur together and that the fog of my nursing, sleep-deprived brain can't dredge up in the correct sequence, but what follows is an imperfect account of my first labor and the birth of my third child, Maeve Luisa.
the belly, 42 weeks

 I'd never dilated more than a fingertip with either of my boys, who were born at 41 and 40 weeks respectively, and I'd never had very consistent contractions, so I did not expect to dilate before labor with this pregnancy. Still, it still felt horrible to finally consent to the pelvic exam and membrane stripping at 40 weeks and have nothing happening. I walked and walked and walked some more; through the fountains of Scottsdale, all over the neighborhood, at the Tempe arts festival, the Botanic Garden...

 My mother arrived two days before the 42 week mark. She had been certain there would be a baby to help care for by then, but instead she was greeted by two kids with the flu and two parents haggard from sick and sleepless nights (and all that walking...) But, with her arrival my worry over the kids' security was finally put to rest. They loved my Mom, were comfortable with her, and she knew the routine. No need to shunt them from one neighbor to the next, they could continue their usual routine at home and in school. So, on Sunday, December 2nd, at 42 weeks and 1 day, with everything on the "to do before baby comes" list completed, I finally went into labor.

The contractions had been coming intermittently all day. I'm not sure what I expected them to be like, but I was surprised how similar to menstrual cramps they felt. We had gone to the Zoo in the morning, mostly to walk, and left when I was starting to feel too tired and uncomfortable. By the afternoon it was clear that I was in early labor, I was having steady surges every ten minutes or so, though they only lasted for 30 seconds. My mom and Nat played with the kids while I tried to rest and walk and used the bathroom constantly. By the time the kids were heading to bed things were picking up. I set up my birthing ball in the living room and put in the a Coupling DVD.My Mom, Nat and I watched a few episodes but I couldn't focus on it. I actually ended up using none of the video or music I'd assembled for labor; I found it distracted me from getting through each contraction.

Nat called our doula around 11pm and she was there within the half hour. My contractions were steady as a train, at least a minute long, 4-6 minutes apart. We went for a long walk around the neighborhood and they picked up in intensity, so we camped out in the bedroom, alternating between the birthing ball and the bed. From 1 am to 3:30am the labor was hard; steady. I took each contraction as an opportunity to remind myself to let go. With each surge in pressure and pain, I'd catch myself tightening up, and for the rest of the surge I'd work at breathing relaxation back into my body. Anne and Nat took turns resting and putting pressure on my sacrum.The baby was also working like heck to get out of that damned ROT position; I could feel her grinding and pushing with each contraction; her movements were sometimes more uncomfortable than my own muscles. And then, around 3 am, I heard my mother get out of bed, go into the kids bathroom, and throw up. Crap. My labor began to shut down. We all decided to get some rest, drop the kids off at school, and head to the midwife for my already scheduled 9am appointment.

The midwife was was worried. We had already ordered a foley induction for the next morning, but she decided that a biophysical profile (BPP) would be helpful at this point just to make sure the baby was fine. Anne headed home and Nat and I discussed the pros and cons of heading to the hospital. We decided to try to rest first and check on my Mom, who was feeling okay. I tried to nap, failed, showered, and by 12:30pm we checked in for the monitoring.

The hospital was intense. We waited for over an hour before being checked into triage. The nurses were shocked at my dates, at the fact that I was attempting a TOLA2C. The nurse who took my vitals had some very unwarranted advice about the risk to my baby if she was as big as she was looking to be. The NST portion of the BPP was good; baby was active, reactive, pretending to breath, but big. The fluid wasn't as great (but we were looking at a 42 week old fetus and placenta!) Altogether we scored a 5, and the offer of admission to the hospital. Hmmm. "Could we go think about it and get our stuff?" "Uh, no, you need to be admitted." "Well, we don't have our stuff, so I think we'll just do that first." "Why don't we check you in and your husband can get your stuff?" We did actually have our "stuff" out in the car, but that wasn't the real point, now was it? The real point was that my OB had told me nevereverdonotever show up at the hospital before I was in transition. And here I was, barely contracting, and very early labor, about to be admitted.

But the flip side of it was that it was now 3:30pm. My kids were home from school; my mother was in our house with them. Would I be more comfortable laboring at home with the sickly hellions, or alone in a quiet room at the hospital? Could I get my doctor to let them just leave me alone for the night and still get the foley bulb in the morning? Yes. Could I sneak some hospital fries and watch t.v and just veg out for a bit before hitting this labor thing again? Sure. Was I at 42 weeks 2 days and the end of my rope? Definitely. So I was admitted.

Goal for today? Supermom. (from my my first c-section baby)
And everyone left me alone. Seriously. After eating some dinner and waiting for the labor room I got my heparin lock put in by a very sweet nurse (who was also very VBAC and natural childbirth supportive), then got my vitals checked by a not-as-sweet nurse who, after hearing my situation and my goals, said they were ready to have an operating room available whenever I wanted one and then pretty much ignored me. Which was good, because not much was happening. We watch some t.v., tried to rest (and failed), talked briefly with my OB who was getting ready to deliver in the next room, He was fine with waiting the night to see what happened. And by 7:30 the contractions began to pick up again, 1 minute long, 5-7 minutes apart.

In the middle of one of these contractions, as I was breathing my long breaths and Nat was pushing on my back, an extremely high-stress, high-energy OB from the high-risk obstetrics group burst into the room and began to freak out. I truly wish I had recorded what she said, because it was straight out crazy. She told me that they "didn't do this" ("this" being letting women be pregnant until their baby decided it was time to come out, apparently), that I was putting my baby at risk, myself at risk, that it was against hospital protocol and procedure, and that she understood that my doctor was a low-key guy, but he hadn't okayed this with the high risk team (he had actually gone to bat for me quite firmly), that we weren't in Africa (no clue what she was going for with that comment.) She couldn't believe we hadn't gotten a weight estimate done yet and wanted to order an ultrasound right away.  My husband, a very quiet man by nature, was incredulous as well as speechless, and so, in the throes of labor, I stood up for myself. It was awesome. And terrifying, because she was basically threatening to kick me out of the hospital if I didn't consent to a c-section right then and there. But I told her that I wasn't into being threatened or scared into another surgery, that a TOLAC was important to me, that both of the patients were thriving and healthy, and that we had plenty of evidence to back our stance (she asked me for authors and reference numbers...seriously.) I told her I appreciated her expertise, I was glad she was there to help us should things get rough, that I was sure she had plenty of reasons for her concern, but that she didn't need to worry about me right now. By the end of the conversation she was less psycho, but still said that she was going to run it by the head of obstetrics and order an ultrasound. Luckily, my OB played interference and we never saw her again.

on the one birthing ball the hospital had
And so I was left to labor. LABOR! It was rough. At 2am Anne was back with us, with her magical hands. In the early morning the contractions became too intense to talk through. I was most comfortable on my left side, but no one let me stay there for long. I lunged, sat on the ball, used the peanut ball, hung my leg off the bed to get the baby to turn, walked and walked some more. I made the wireless monitor fall off at least 32 times. I began to lose some mucous plug. At 9am I finally consented to being checked and was almost 2 cm. After 36 hours of off-and-on contractions. I was totally defeated, but rallied to try the birthing tub and we made the long trip down the hall. The tub felt good, but it was also way too hot and the monitor kept slipping off. Anne kept me supplied with cool washcloths, Nat got in with me and I hung on to him, riding each contraction like a wave.
in the tub

Then my blood pressure started to rise. I felt awful. They made me get out of the tub and stumble slowly back to the room. The contractions out of the tub were insane. I was so wiped that I was falling asleep in between them, only to wake up in agony and try quickly to get on top of the pain. My focus was slipping; I couldn't ride the contractions well and I wasn't coping. I kept apologizing for not being able to handle them, trying to explain how they felt as I caught my breath in between. But the "in between" was getting shorter and shorter.I felt like a crazy person. I was still changing positions in the bed, but Anne ased me to try a squat/lunge on the floor in an effort to get the baby to turn. Standing made the contractions so intense in my back that I dropped to the floor, and as soon as it was over, climbed onto the bed on my hands and knees. The next few contractions were all in my back and it was excruciating. I started to dry heave and whined for relief; for sleep.I think I mentioned demerol, and Anne suggested another cervical check before deciding what to do. I think she thought I might be approaching transition, but I was only at 3cm. I asked for an epidural and no one argued.
epidural nap


I've since read a lot about cervical scarring, and I think that must have been what was going on with me, beyond the tricky positioning of my baby's huge head. I don't regret getting the epidural at all. It allowed me to rest and my body was relaxed enough to dilate at a more rapid pace (rapid for me, anyway) I do regret that I didn't know to ask for a "walking" epidural. The medication settled on my left side and I couldn't move or lift that leg at all, which didn't help for positioning, though Anne and Nat valiantly helped to shift me from side to side each time there was a blip in the baby's heart rate.

I napped from 5pm-7pm At 7:30 I was at 5cm. But then my blood pressure started to rise again, and an hour later the baby's heart rate began to drop and then disappeared. The wireless monitor was tricky, but not that tricky, and suddenly we were all in panic mode. They thought they had her back on, but then thought it was my heartrate they were tracking. One nurse sternly told me to relax to lower my heartrate so they could find hers. They administered oxygen at 10:20 and began to prep the OR. I remember saying something to Nat like "let's hope she's okay" as they wheeled me out and his response wasn't too reassuring; we were both scared. But as we got out the door they had her tracking again. I seriously considered asking to turn around. In the OR, the surgeon on call said "well, they look good now, we still doing this?" and no one said a word. It is the one moment I regret in the entire process. But, then again, I was strapped to an operating table without any of my support team, a pretty powerless position (they finally remembered to let Nat in right before they began operating.)  And the baby was clearly stressed, who knew what would happen during the second stage. After all these weeks of trying to get into a good position, she was still having to work too hard. It was time to let go.

My doctor is a speedy driver and he was on hand to assist in the delivery. Maeve Luisa entered the world at 10:52pm December 4, 2012. She was 8 lbs, 10 oz, 21 inches long, with a 15 inch head circumference, covered in meconium and flaky skin, and pissed as heck to have been stuck in my body for so long. They let me see her right away, and kept her in the OR as long as I was there. I nursed right away in recovery and she wasn't bathed for the first couple days (to help with bonding.) All in all it was a very respectful and gentle process.









She nursed like her brothers before her, which is to say, like a barracuda, but had no patience for the 2 days it took my milk to come in. She is our 3rd ginger baby; firey, smiley, smart, and a great communicator. Most importantly, we are excellent and contented partners in the bonding dance, thanks to all those labor hormones!

nursing in recovery

in awe and ready to hold her





My recovery was long, and my abs are wrecked for sure.  But I'm thinking a 4th kid might not be so bad...maybe a HBA3C this time?

(that's for my husband)

at 2 months









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