Thursday, March 24, 2011

My Second Son's Birth

Even though you essentially know the end, I hope that you'll consent to enjoy the ride on this one nonetheless. Maybe it's kind of like watching "Apollo 13," where you know they get home safely, but you're still on edge watching it, wondering how in the world they manage it. Well, I love hearing birth stories, and I love telling my birth stories, and I love "Apollo 13," so let's see what happens.

As you'll recall, I was due December 31 but was having problems with high blood pressure throughout the month of December. On December 16, a Tuesday (also my grandmother's birthday, though that is fairly irrelevant), not only was my blood pressure once again stubbornly high, but there was +1 protein in my urine. Figurative alarm bells went off. I was once again sent to have labs drawn and go down to the hospital to be monitored. Sigh.

Having done this a week and a half prior, I figured surely everything would be fine again. I called my neighbor to see if she could watch my son while I made my way down to the hospital to be checked out, assuming that I'd be back in a few hours. I called my husband and told him not to bother coming with me this time, since there wasn't any point in his missing more work to watch me lie in the L&D triage room for 90 minutes again.

I went home and packed a few things to take with me in case I was there a little longer than anticipated, then made my way to the hospital. Once there, the four L&D triage rooms were all in use, so I got to wait in an office with a couple of nurses while we waited for a triage room to open up. There was no sense of urgency in my case, really, and I kind of enjoyed the behind-the-scenes peek at what the nurses were doing when they weren't in the patient rooms. This was a little after 3:00 P.M. on Tuesday.

When one of the other women was sent home (as I hoped to be in a few hours), I was put into a triage room and hooked up to a blood pressure cuff and fetal monitors again. I was having regular contractions, though I couldn't feel them, really, and my blood pressure Would Not Come Down. A nurse-midwife came in and did an internal check to see if my cervix was dilated at all. Upon finding that I was about 4cm dilated already, she declared "this baby is coming tonight! Let's get him out."

Er... What?!

First of all, my husband was 45 minutes away, my son had only very temporary childcare, we were not expecting to have a baby just yet, and, wait, I was only 38 weeks! I still had two weeks to prepare! My mom would be there in a week. She was supposed to stay with my son. What were we to do?!

Well, I called my husband, of course, and told him of the change of plans. They intended to induce with Pitocin and were still quite willing to allow me my trial of labor and VBAC attempt. But, as mentioned in the previous post, I knew that a Pitocin induction would increase my risk of c-section. I decided to delay any other interventions as long as I possibly could, hoping that would help me avoid the dreaded repeat c-section.

We decided the only possible course of action was for my husband to bring our son with him to the hospital. As difficult as it would be for me to have him there with me while I labored, and as problematic it would be that my husband would have to mind our son instead of being totally there with me in the labor and delivery, we couldn't think of anyone else we could call upon who would be able to take our son overnight. My mom was supposed to be there!

They got me set up in an L&D room while my husband picked up our son from daycare and drove down to the hospital. I was hooked up to an IV for fluids and Pitocin, and they also said I'd need to be on magnesium to help prevent seizures due to my blood pressure. The problem with magnesium is that is is a muscle relaxant, also used to stop preterm labor! So they would have to balance the magnesium and the Pitocin carefully to make sure labor didn't stop while still ensuring I had adequate protection from the risks of preeclampsia.

Another problem with magnesium is that it can cause you to retain fluids dangerously, so they would have to very carefully monitor my fluid intake and output while I was on it. This sounded inconvenient.

The biggest problem with magnesium, though, is that, as a relaxant, I would be unsteady on my feet, and weak, and possibly unable to control my muscles, and unable to properly care for a baby as long as I was on it. This meant I would not be allowed to be alone in the room with the new baby until I was able to come off the mag, which was the absolute biggest concern I had. Come hell or highwater, whether I needed a c-section in the end or not, I was going to breastfeed! And if I couldn't room-in with the baby, how was I to start a successful breastfeeding relationship? I was quite upset by this news, but still determined to make it work somehow.

My husband arrived with our son. He had the foresight to bring PJs, books, blankie, pacifier, and snacks for the little guy, who was very well-behaved and charmed everyone with his sweet nature, general cuteness, and amazing red curls. The nurses started taking bets on whether the new baby would have such gorgeous hair, too.

My son's being there meant that I was a little distracted from this whole labor business. I tried to remember to change positions, did not request pain relief, and got up to pee when I had to. I was quite surprised to find, however, that I was feeling almost no pain at all, despite the use of Pitocin. I was contracting nicely, and my cervix was opening, and everything that was supposed to happen was happening, but where was the pain? It was nice, but surprising.

I was very concerned about frightening my son if I were to need to yell, so I tried only to hum quietly when the contractions became stronger. My husband took him out of the room when the doctor came in to break my waters. She had trouble getting slack in the amniotic sac because the baby's head was pressed right up against the cervix. He was excited to come, unlike his reluctant brother! She eventually popped the bag, and my waters came gushing out.

Then the pain started. I felt those contractions like a vise clamping down on my abdomen. It was crazy. When I had to yell, we had my son and husband yell along with me. He thought it was a great game (ah, two-year-olds).

I had made some calls to friends and relatives to give them the news before things got really intense. One of these calls was to my rabbi and his wife. My rabbi's wife called back wondering where my son was during all of this. I told her he was with us. She said she'd arrange for someone to come and get him and bring him to her house for the night. I was so relieved. I couldn't imagine what we were going to do with him when things got really heated. I wasn't sure I wanted him to witness the birth, but I also wanted my husband to be there with me!

A friend came to the hospital, and my husband met him outside, switched the car seat to the friend's car, and sent our wonderful child off to a bewildering night's stay with the rabbi. We learned later that he cried a good bit of the way back north, but that our friend was able to sing to him and calm him (G-d bless him!). We also learned later that our son wouldn't sleep alone, so he ended up sleeping in the rabbi's bed the whole night! (It should be noted here that, at the time, the rabbi and his wife had three small children, the youngest of whom was exactly the same age as our son, and they were expecting their fourth child within the next few weeks!)

My husband came back, and the relief of not having to worry about our son meant that I was experiencing fully the insanity of Pitocin-induced contractions. I remember one of the nurses saying that they needed to increase my Pitocin, and the other one saying she didn't want to do it because she had been at a uterine rupture. I was so happy that she had said that in my hearing! How reassuring! But they did increase the Pitocin, and I couldn't bear it anymore. I was 6cm dilated, which I thought was a pretty good accomplishment right there. I asked for the epidural, and they sent for the nurse anesthetist.

They had me get up to go pee one last time before the epidural. I have my timeline a bit mixed up here (oddly enough), but I think my husband had taken our son outside right about the time I asked for the epidural, so that our son wouldn't be able to watch them do that. I'm not exactly sure when he got picked up and taken back to the rabbi's house, but it was not long after.

While in the bathroom, the contractions starting coming one after another. It felt like one didn't even end before the next one began. I couldn't believe the torture. I could barely walk back to the bed, and when I got there, I started throwing up. The nurse said not to worry, that I was just in transition and it would pass.


In the five minutes I had taken to pee, I had gone from 6cm to transition! Wow!

The nurse anesthetist was there, and he was able to do the epidural despite my shaking, nausea, and general incoherence. The epidural was perfect. It took away the pain but not all of the sensation. I could still move my legs, and I could still feel that I was having contractions, but it didn't hurt anymore. It was amazing.

Though I was fully dilated, they said I didn't have to start pushing right away. The baby was fine, and he could labor down on his own for a while so I didn't exhaust myself pushing when I didn't need to. This was new to me, since the minute I had reached 10cm with our first son's birth, they immediately had me start pushing. I liked this new way better! I was able to rest a bit, kind of drowsy and groggy. It was a little after midnight by then, I think, on Wednesday the 17th. I had been in labor for a little over 6 hours. Right there, I was already amazed by the contrast with my first labor, which took over a day to get to this point!

Finally, they said I really did have to start pushing. He had come down to +2 all on his own (what a guy!), but he needed help to come the rest of the way. (This also is in contrast to my first labor, where the little boy wouldn't even come out of the cervix - he was stuck at -1 station the entire time I pushed!) I protested, enjoying my relaxation, but they set up the table for delivery and called for the doctor. He wasn't going to come out if I didn't do a little work!

The epidural was such that I was able to feel the need to push on my own. So I pushed, and he came down a little. I pushed, and he came down a little more. I pushed and pushed, and he kept coming almost out, then sliding back in. After about half an hour of this (during which there was a fair amount of "I can't do this!" and "I don't want to push anymore!" whining out of me, as is apparently how I react to hard labor (haha!)), the doctor said he really was just about there, but my perineum wasn't stretching quite enough, and he kept springing back. She said probably just a little cut would let him slide right out. Now, an episiotomy was my second worst fear in childbirth, but if it meant all of this would be over, and I would have my baby in my arms, I was willing to do it. It was far less traumatic than a c-section!

A little cut, a few more pushes, and out he slid, a gorgeous, little, bald baby boy, at 1:19 A.M., after only about 7 hours of labor and 39 minutes of pushing. I had done it! He was here! I could not believe it. I couldn't! The placenta slid out a few minutes later, to my surprise. In fact, I distinctly remember saying, "What was that?!" and my husband reporting that it had been the placenta. For some reason, I had thought I'd have to work harder to get that out. They took the baby to be cleaned, diapered, Apgar-ed, weighed and measured - he was only 7lbs., 6oz., almost two pounds lighter than his older brother had been! - then brought him to me quite quickly and put him on my chest for his first breastfeeding. I had no idea how to hold him, and the doctor was still down below doing... something. I put him to the breast. He latched on and sucked. I held him and held him and held him and he nursed and nursed and nursed, and I knew this was how it was supposed to be.

First of all, tending to him took my mind off my other end, where the doctor was working busily stitching me up. Apparently, I was bleeding quite heavily (so what else is new?), and she was trying to get the bleeding stopped along with sewing up the episiotomy and so on. It was not particularly pleasant, but I had a very pleasant distraction!

I ended up staying in the L&D room for about four hours, and the new baby lay on my chest, nursing, the whole time. They were looking for a room on the maternity floor for me, and they were also still monitoring my blood pressure. It started to come down, and stayed down, and they decided they could take me off the magnesium and instead give me oral phenobarbitol, an anti-hypertensive, instead. Hooray!! No fluids monitoring! No fall hazard! I could keep baby with me.

All my dreams had come true.

This time, the hospital stay isn't that important. I will complain only a little, that since this was my second baby, they apparently assumed I knew how to breastfeed and didn't bother to send me anyone for help. At one point during the first day, while I was nursing him for the umpteenth time, a nurse came in to check my IV, saw me trying to figure out how to hold him, and gave me the one tip that solved almost all of my problems. "Turn him toward you," she said, "and make sure his ear, shoulder, and hip are all in a line." Voila!

He nursed almost nonstop, pretty much every hour for up to 45 minutes at a time. I didn't care. I wasn't going to let him go. I was going to nurse this baby. It was going to work!

I recovered quickly and was able to go home Thursday afternoon, not even 48 hours after giving birth. What a difference! I was on iron supplements, because, as it turned out, I again lost quite a bit of blood, although I had tolerated it well and didn't require a transfusion this time. No one told me, this time, that I couldn't make milk because I was busy making blood. No one told me to pump eight times a day. No one told me any of that nonsense that had so discouraged me the first time. (No one gave me any good advice at first, either, except that one nurse, but I had done lots of reading by then and had a pretty good idea of what was going on.)

I am thrilled to report that I breastfed him exclusively for the first six months of his life, then added solids but continued to nurse rather frequently well past his first birthday, then continued to nurse a few times a day until about a month after he turned two. At that point, I was ready to wean, because I was pregnant again! (And I was also ready to start sleeping through the night, but that's a post for another day!)

I was also able to express and donate a fair amount of breastmilk to a couple of other mothers in need of some extra milk. I also occasionally gave a few ounces to my older son to drink, when he was sick or had sores in his mouth, because I firmly believed (and still do) that it helped him recover faster. I felt like I was finally able to give him a little bit of what I had always wished I could have given him.

I don't think I can describe how good it felt to not only be able to nurse my own son, but to have enough excess milk to help out other babies, too. It was this that convinced me that I most likely would have had plenty of milk for my first son, as well, had I just started nursing and continued to nurse right from the beginning. As you read, the circumstances were such that it was not all that simple, but I was reassured that I would have no trouble nursing future babies. And I am so looking forward to nursing this new little one whenever he or she is ready to appear, and however he or she comes into the world. Of course, I'm dedicated to another vaginal birth!

And that brings us to the present, and why I'm writing this blog, and how I know as much as I do, and why I want to share it with everyone!

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