Thursday, October 24, 2013

My Fourth Birth!

I started out my fourth pregnancy confident. I knew my body could grow and birth healthy babies in a healthy way. I knew the "rules" of pregnancy and childbirth, breastfeeding and infant care. I found myself quite laid back about the whole process.

Until I neared the end. I was due October 22 (also my oldest son's birthday!), and we had moved to a town that is usually very quiet and relaxed, except one weekend a year, the Pumpkin Festival, when something on the order of 200,000 people flock over the hill on the one-lane, one road to the coast to...look at big pumpkins and explore the street fair (at least, that was my impression of it). The traffic makes it nearly impossible to take the most direct route to the other side of the hills, where the hospital is. We could still get out if we needed to, but it could take a while (possibly over an hour). This year, the Pumpkin Festival was October 19 and 20, and there was a very good chance, based on my history, that I could go into labor that weekend and that my labor would be short enough to be a nail-biter on that long way around.

We had also arranged for my mother-in-law to fly in from Israel a few days before my due date, hoping she would arrive before the baby so she could stay with the other kids when we went to the hospital and then to help out after the birth.

At my 38-week visit with my OB, we both felt it was reasonably likely that I would have the baby quite soon. I was 3cm dilated already (not terribly unusual in someone who's been pregnant before) and experiencing strong (but not painful) contractions. Panicked, I spent the evening arranging with the neighbors to help with backup childcare in case baby decided to make his appearance.

But labor did not start. We got through another week, Pumpkin Festival weekend loomed, but at least it looked like my mother-in-law would be there in time after all. At my 39-week appointment that Wednesday, October 16, my OB and I decided to play it safe and try not to stir anything up. Thursday, my mother-in-law indeed arrived, and still I remained pregnant. Saturday, Pumkpin Festival day one, came, bright and sunny, and we went for a walk down to the main road to see the traffic, which was about as spectacular as promised. The walk turned into a leisurely day near the harbor, where we went to a pumpkin patch, had a panini, and enjoyed a sunny day without labor.

We found a pumpkin to match my belly.

Sunday was gray and cold, and still labor-less. If we could just make it through the day, it would be "safe," travel-wise, to have the baby. And boy was I ready. I'd been uncomfortable for weeks, with pain in my pelvis from the pressure of his head every time I stood up. I was big and ponderous. I was ready for this baby.

But I had a nagging fear that the baby was not positioned well. He was head down, but I worried that he was posterior (OP), meaning the back of his head (occiput) was toward my back, rather than the more ideal anterior position (OA), in which the back of the head is toward the mother's front. It is easier for the baby's head to make it under the pubic bone in the OA position, because the occiput is the smallest point on the head and helps to make way for the rest of the skull. As well, this position allows him to flex his neck and point his chin down to his chest to better fit under the pubic bone, rather than having to tilt his head awkwardly backward. OP babies are more likely to get "stuck," cause more damage as they come out, or even be unable to drop completely into the pelvis and require a c-section. Also, a baby in a less-than-ideal position can cause labor to stall or be slow to start. I was afraid the reason I was having so many contractions that weren't building into labor was because he was malpositioned.

So, naturally, I worried. I had worried for weeks about his position, and consulted the Spinning Babies website for ideas on getting him to turn. I half-heartedly tried one of the exercises (getting into an inclined, upside-down position for 30 seconds a day), and I spent time trying to open my pelvis by getting on my hands and knees and into a modified Child's Pose, hoping to give him the space he needed to turn.

Traffic wasn't bad Sunday morning, and we decided to see what all the fuss was about at this Festival, so we drove down to the town. We walked around for several hours, exploring. I was in a fair amount of pain by the time we started back to our car, underwhelmed and kind of cold.

N carves a pumpkin with S's supervision

Within a few hours of returning home from the Festival, my contractions, which had for weeks been strong but not painful, picked up in intensity, if not frequency. Every 10 to 20 minutes, sometimes with as long as 30 minutes in between, I would have a contraction I would label as painful, if not stop-me-in-my-tracks agony. Also, contractions that infrequent that did not build into more couldn't be called labor. We ate dinner. We put the kids to bed. I thought maybe, just maybe, this was the night. He had kindly waited until Sunday night, as requested. But would these contractions build into something more or fade away?

I discussed with my husband what we should do. I didn't feel an urgency to get to the hospital, but I wasn't sure whether we wanted to try to encourage labor along or get some sleep. Around 10:00, I said I'd like to take a walk and see whether that made a difference. If not, I would try to go to bed. If so, we could hop in the car.

We took a half-hour walk around the neighborhood with no appreciable effect on the contractions. They were still no closer than 10 minutes apart, and some of them were hardly painful. I never had to stop walking or talking to breathe through one. At 11:00, I called L&D at the hospital to ask what they thought. She said she couldn't give me advice over the phone and that we could come in if we wanted, but at 10 minutes apart, we were likely to be sent home. I explained that we were about 35 minutes away and couldn't be going back and forth. She suggested I wait an hour and see if there was any change, then call back if we were planning to come in so they could prepare a room and get ready for our arrival. I thought that was reasonable and said we would do that.

After another half-hour or so, I thought I may as well try to get some sleep. If I was having the baby soon, it might be nice not to have been up all night. I laid down in bed, but with every contraction (still about 10 minutes apart), I found I needed to get up on my hands and knees until it passed. And I certainly couldn't sleep through them. When I finally had two in the space of six minutes around 12:40 a.m., we said let's do it. I called to let the hospital know we were on our way, gathered some stuff to take with us, let my mother-in-law know we were leaving, and hit the road.

There was no traffic, and my contractions kindly picked up as we drove, to the point that I was concerned my water would break in the car. I figured I still had a few hours until delivery, judging from the spacing of the contractions and comparing to my third birth. Having contractions in the car is so much worse, too, because I didn't have the option to move around to find the most comfortable pose for riding out the pain. At home, I had been going on hands and knees with each contraction, and reclining in the front seat of the car was about the least comfortable position I could think of during each painful minute.

We got to the hospital a little after 1:00 a.m. and dashed through the ER to wander the maze of hallways until we found the birth center. The nurses were ready for us and got us into the room as I continued to contract frequently. I changed into a hospital gown, went over my birth preferences with the nurse, and had my cervix checked. I was 5cm, and it was about 1:30 in the morning. She had them call my doctor and started taking my medical history, getting an IV started just in case I needed fluids, Pitocin, or other meds. She attempted to get my blood pressure, but the contractions came faster and stronger, and every time she tried to get a read, I was in the middle of another one! My blood pressure was measuring a little high (really?!), which concerned her.

Are we having fun yet?

She continued to attempt to get my medical history, while I continued to have contractions reasonably close together. I had a chance to catch my breath in between, but after about half an hour, I found I was shivering and shaking and felt nauseous, all hallmarks of transition for me, but I didn't make the connection. After all I was 5cm only half an hour before, and I hadn't even gotten up to walk around, hadn't used the shower, hadn't done any of the things I'd intended to during my labor to help it along.

My "contraction face."


We noticed the baby's heart rate dropped slightly with each contraction but recovered just as quickly, so no one seemed concerned. I joked that he didn't like the contractions any more than I did.

My doctor arrived, got the story, and said she'd be back in a few minutes. I'd finally had enough of reclining in the bed and decided to at least go back to the more comfortable hands-and-knees position. Once there, I just stayed that way, my hands at the very top of the bed, my knees resting flat. They offered to raise the head of the bed so it was practically vertical. I found this to be perfect, dug my hands into the top of the cushion, and rode out each wave. My water broke with a pop, and I realized that my feet were in the danger zone. Ew. But I was locked into this position. I couldn't imagine trying to move again, even to turn around and squat like I'd planned.

At 2:13 a.m., about 45 minutes after first having my cervix checked, my doctor wanted to check again. It seemed everyone around me realized I was ready to deliver, even though I was certain there should be a few hours left of this labor. She checked me as I knelt, and, sure enough, I was complete. What?! "You can push whenever you want to," she declared. 

Let's do this!

With the next contraction, I bore down for all I was worth. I yelled until I was hoarse. I felt like nothing happened. My muscles were jelly, my stomach was weak, and still I pushed. I screamed "GET OUT!" I could feel his head against the pubic bone. I was so scared he was stuck. I had to push harder. I had to get him out. "GET OUT! GET OUT!" I shouted at him (I still feel bad that the first thing my new baby heard was me yelling at him). I'll go ahead and admit it, here, that I pooped, too. Pushing is pushing. They asked if I wanted to get the squat bar and turn around, but I was certain I couldn't move. My arms and legs were locked in place. I was delivering in that awkward position whether that's what I'd intended or not. I said, "If it's okay with you, it's okay with me," when the doctor asked if I was happy where I was. She said it was fine with her. I had the fleeting disappointment that I wouldn't be able to see him born - that was something I'd wanted this time around - but I knew I couldn't move. We were doing this, and we were doing this here and now. "GET OUT!" I screamed again, and then felt like I was out of power. "I can't do it," I said. "I can't." Three nurses, a doctor, and my husband assured me I could, that he was almost out. Another push, and I could feel his head straining against my perineum. I could feel the burn, the pressure, the stretch. "Let him stretch you. He's almost here," the doctor said. Then, "I see a face!" Another push, and he was through! I collapsed forward onto my arms, exhausted, but I still couldn't move, locked on my knees as I was.

Time of birth: 2:31 a.m. We'd been at the hospital for just over an hour.

I had wanted immediate skin-to-skin and delayed cord cutting, which they had said was fine. But he didn't cry right away and apparently was more purple than they liked. His cord was around his neck loosely, which they were able to unwrap, but they needed to take him to the warmer for stimulation to get him breathing. By the time I was able to turn myself over and recline against the bed, they had whisked him away, and the doctor was pulling gently on the cut cord to encourage the placenta to deliver. That, I got to see. The baby, I couldn't. My husband stood guard over him as he let out a lovely wail and pinked up nicely. They weighed him and measured him, then, finally, they brought him to me. He wasn't rooting, but he had a good suck reflex, and after a couple of tries and a bit of coaxing, we got him latched and sucking nicely. His Apgars came in at 9 and 9. A perfect baby boy, with a head of thin but noticeable black hair. Black?! We're a family of gingers!

Okay, okay, I'm crying. Where's my mommy?!

Because of my history of hemorrhage, they gave me Pitocin to help my uterus clamp down. They also massaged my belly - hard - OW - to encourage it to contract and to make sure there were no large clots or excessive bleeding. Once the bleeding slowed, my doctor was able to assess the damage. Surprisingly, and thankfully, I had but two skidmarks and a 1st-degree tear that needed just one stitch! SO much better than an episiotomy, and much easier than I'd hoped.

I asked the doctor if he'd been OP or OA, and she had to do some mental gymnastics, since I'd been facing backward. Since his face had been toward her, that meant he was indeed OA. I don't know if my prenatal attempts had encouraged him to turn or if he'd turned during labor, but I'm certain that listening to my body and finding the most comfortable - if incredibly awkward - position for laboring made everything go so smoothly.

This hospital's birth center was nice, because we didn't have to move rooms after delivery. The nurse sent me to pee while they converted the bed and cleaned up the room. This room would also serve as my postpartum room for recovery and care. They brought in a bassinet for the baby and put a mattress pad on the bed, changed the linens, and, voila!

The nurse said how she loved natural deliveries, because the babies were always so much more alert, and mom was ambulatory. I could barely walk with a midsection of jelly, but I also felt an incredible sense of accomplishment, and quite a bit of shock, at the speed and relative ease of the delivery.

My main wish for this birth had been that it would be drama-free. No side-of-the-road delivery, no unassisted bathtub birth, no complications or hemorrhaging or surgery or NICU admissions. Just get to the hospital and have the baby. Well, we took that one rather literally, didn't we?

Welcome, Baby Boy #4! 
Born 10/21/13 at 2:31 a.m.
8 lbs., 6oz.
20" long
14.5" head

I'll write about our hospital stay in another post. We had a bit of an interesting time after all, and I got to put my CLEC training to work...for myself!

2 comments:

  1. Wonderful!!! Congratulations!!!

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  2. I had my #3 in a similar position (hands-and-knees on the hospital bed with the head of it at a right angle to the rest of it). What works, works! Congratulations - I love hearing birth stories like yours.

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