Tuesday, June 14, 2011

Pregnancy #2 Alia's Birth Story

I looked forward to labor with confidence. I felt like I knew what to expect. What small desire I possessed to labor un-medicated with baby one grew into a real vocalized and written goal.

I bought relaxation music and a miniature CD player to bring to the hospital. I invested in a few essential oils such as lavender and chamomile to aid in aromatherapy. Late at night while my husband worked his graveyard shift I practiced abdominal breathing and mental labor simulations. I continued to make prenatal toning exercises part of regular routine.

As my due date approached the certified nurse midwives confirmed that baby number two was in the anterior occiput position, the most favorable position for birthing. My confidence waxed strong.

Early on the morning of November 30th I could tell I was getting closer but these contractions were nowhere near as intense as the contractions I recalled from labor number one.

We walked around the block hoping to speed up the timing a little bit I was sleepless and tired and wanted to get this show on the road.

Walking seemed to be the trusty trick to accelerating labor contractions. Most of the time I could continue walking through the contractions which is a definite indicator that I have some work to do. A few times I stopped and hung my body weight upon my husband in a bear hug. It felt good to have him support my back.

When we got home I desperately wanted to sleep but my body engaged in a serious work. I soaked in my tub with the jets on my back once more.

We called Julie, the certified nurse midwife on duty and informed her that we were on our way to the hospital. Contractions were four minutes apart, but there it wasn’t urgent. We loaded the car with our previously packed hospital bag, CD player, throw-up bowl, birth plan, and infant car seat. This time the drive seemed much more tolerable than with baby number one.

As soon as we arrived at the nurse’s station in the Labor and Delivery unit I wondered if I were really in labor at all anymore. I felt good. In fact, I couldn’t recall a contraction in the last ten minutes. What I didn’t realize is that sometimes the excitement of going to the hospital can release endorphins that temporarily stop the labor process.

The nurse showed us to triage where they handed me a hospital gown and instructed me to lay on the observation bed. A nurse strapped the external fetal monitors to my abdomen and began measuring contractions.

The labor and delivery nurse performed a cervical exam and announced two and a half centimeters dilated and 75% effaced. I looked to see if her hands were big. Nope. They were average.

A little after 7:00a.m. the nurse assigned us to our own room. We set up our CD player, dimmed the lights and I pulled out my essential oils. The nurse looked at me and said, “You aren’t planning to go natural are you?”

I nodded and handed her my birth plan.

“Great!” she sighed with irritation. It would have been helpful if you’d shown us this when you checked into the hospital. We could have assigned you to a room with a tub. Now it’s too late. All of our inductions have arrived. Let me see if I can find someone willing to swap you rooms.”

I felt burdensome and didn’t want to cause problems. I looked to my husband for input.

Neil shrugged his shoulders with indifference.

I hated the thought of forcing someone out of their room. Not to mention walking through the hallway in a hospital gown with an open back and lugging all of our belongings around.

“Do I need a room with a tub?” I queried.

The nurse seemed impatient. “Nobody goes natural without the tub. If you want a room with a tub you need to make up your mind now so that I can arrange for someone to switch rooms with you.”

I looked back at Neil. “Do you think we should switch rooms?”

Neil shook his head. “Let’s just stay here.”

The nurse asked, “Last chance, are you sure?”

“Yes.” I nodded my head but doubted our decision.

I labored for another hour un-medicated. Neil fell asleep in a rocking chair while I stayed on my hands and knees rocking to alleviate the pressure of the baby’s head on my back.

The nurse came in and asked, “How are we doing in here. Are you ready for the epidural yet?”

I shook my head. “I think I’m okay.”

The nurse looked surprised. “Maybe labor stopped.” She suggested. “Let’s put the monitors back on you and see what’s happening. Come climb back on the bed.”

I would prefer to be anywhere in labor but on a hospital bed; especially if it meant lying on my back. Lying on my back in the supine position increased the pressure on my lower back significantly. Contractions seemed manageable when I moved around and shifted positions.

The monitors beeped and the indicator on the graph climbed and spiked representing the intensity of my contraction. The pressure of the bands felt restrictive and aggravating.

The nurse watched the graph and nodded. “You’re still contracting.” Let’s take a look at your dilation.”

Now the rough part. I needed to scoot down low toward the foot of the bed for a cervical exam.

The nurse waited for the contraction to end but by this point in labor my contractions were much closer together and upon having her fingers perform the exam, I immediately started contracting again.

The nurse removed her hand from the birth canal and pulled the latex glove from the wrist until it was inside out.

The labor and delivery nurse looked at me sternly. “You’re 7 centimeters. You don’t have a tub. You’re going to need the epidural. The anesthesiologist is in the room next door. When he finishes there he’s leaving and you’ll miss your chance if you don’t get it now. Do want me to go grab him.”

My first thought, Really? Seven centimeters, this isn’t as bad as I thought it was going to be. But with her words came a mist of doubt. She must know something I didn’t.

In a less than confident voice I managed, “That’s okay, I think we’ll be fine.”

The nurse didn’t back down, “Listen, I’ve never seen anyone make it through transition without the tub. I’ll send him in as soon as he’s done next door.”

The nurse exited. I knelt down and leaned forward on a birthing ball preparing for my next contraction. I looked over at Neil still slumbering in the chair. I placed my hand on his knee and wiggled it a little to wake him gently.

“Neil, what do you think we should do?”

He grunted, “About what?”

“About the epidural.”

He looked annoyed. “I don’t care. Get if you want. She said you can’t do it without the tub, do you want to risk it?”

I felt betrayed. I stared at him in silence. Why didn’t anyone think I could labor un-medicated. I made it this far without any complaint. Did everyone think I was being difficult? I felt completely alone and vulnerable.

“Well let’s try some of these oils, their supposed to really assist with relaxation. Will you rub this one on my feet?”

Neil opened his eyes again, “I don’t know how to apply essential oils. I’m trying to sleep.” His tone expressed fatigue and irritation.


My eyes stung as I fought back the urge to cry. I stood up and walked over to the bed with my back to him. I leaned on the bed for support.

Neil sighed heavily and raised from the chair for the first time since we arrived. “Where is it?”

I handed him the oil. He let a few drops drip into his palm and then massaged them into my foot while I lay on my side on the bed. He dropped my foot in frustration.

“This is disgusting. You have dust all over your feet from walking barefoot on the hospital foor. Now the oil is turning it into sludge on the soles of your feet.”

“I’m sorry.” Embarrassment and hurt surfaced. In retrospect I’m not sure which emotion dominated. But it was clear that I was annoying the nurse and now I was annoying my husband.

Neil walked back to the rocker and plopped down trying to get comfortable when the nurse re-entered with the anesthesiologist. I don’t recall his name so I’ll refer to him as Dr. Smooth hereafter.

“Dr. Smooth this is Mr. and Mrs. Rasmussen. Mrs. Rasmussen hasn’t decided if she’d like an epidural or not. She’s afraid that she won’t achieve her birth plan goals if she gets an epidural. What advice do you have for Mrs. Rasmussen?”

Dr. Smooth smiled at me with kind eyes. “It’s good to meet you Mrs. Rasmussen. My you have big beautiful brown eyes. Do you mind me asking the origin of your ethnic background?”

“My mother’s family immigrated from Italy in 1938.” Maybe women are just suckers for praise, but this man felt like my new best friend.

“Well that explains it.” He nodded jovially. “Mrs. Rasmussen what’s your first name?”

“Becky” I replied.

“Becky? I once had a girl friend named Becky. She didn’t have beautiful brown eyes like you, if I remember correctly they were green. But she was pretty all the same. I’ve liked the name ever since.”

“Becky, why don’t you lay down on your side for just a moment ,here. I’m going to hand you this clip board with a few forms and we’re going to talk about your concerns okay?”

What could it hurt to talk? Labor pains were surging deeper into my core and this Dr. Smooth provided the best company and the best distraction thus far.

“Becky, I want you to imagine for a minute that your tooth is aching. The throb is deep. Pain is searing up into your sinus cavity. Your head is aching. Your jaw is sensitive to touch. You schedule a dentist appointment and discover that a large molar is cracked and rotting all the way around the nerve. The only way to save the tooth is to proceed with a root canal. Would you do it?”

I imagined myself in the dental chair feeling the throbbing tooth with pain emanating from my uterus. “Of course!”

Dr. Smooth continued, “You’re a smart girl, Becky.”

Now let’s imagine that the dentist suggests the administration of local anesthetic to numb that area of the mouth. He’s concerned for your oral health and wants to ensure you hold perfectly still during the procedure. Would you do that for him?”

“Yes.”

Dr. Smooth walked around to my back side. “You would? That would be a silly thing to feel guilty for, wouldn’t it?” He placed his hand on my back and said, “This will feel just a little bit cold. We’re just washing you with some antiseptic. So you think you could live with yourself if you accepted a little bit of anesthesia?”

“Yes.” His line of thinking made sense, but it didn’t ring true somewhere inside me.

“That’s right, Becky. You’re a good girl, there’s nothing to feel guilty about. You deserve to be comfortable. Just write your name on that line right there giving us consent to help you.”

I felt trapped in a strange sort of way. My heart wanted to resist his instructions but my conscience told me it would be improper to waste this polite man’s time by refusing his services.

I signed the document.

“There you go, sweetheart. That’s all there is to it. Now curl up nice and tight for me. Hold perfectly still. You’re going to feel the tiniest prick.”

Dr. Smooth inserted the local anesthetic between the two vertebrae following it by the larger needle.

He inserted the epidural catheter forming a loop and taping it to my back. “Wallaah!” He pronounced. “You’re among. That wasn’t so bad was it.”

Dr. Smooth winked at me and shook my husband’s hand. “You take good care of her, you hear?”

My husband cleared his throat, “Will do.”

Doctor Smooth left and the nurse looked satisfied. Neil looked satisfied. Why didn’t I feel satisfied?

A few minutes later, my C.N.M. Julie O’Neil arrived. “How are we doing in here? It sounds like you’re getting closer?” Julie smiled brightly. “It looks like you just got an epidural. How are you feeling?”

Julie pulled a chair by my bedside. Do you want to watch some T.V.?

“Sure.”

Julie and I laughed and talked while Neil snoozed in rocker. Every few minutes Julie looked at the external fetal monitor screen. She recommended we place bets on the height and weight of the baby. Julie really brightened my spirits. I felt so thankful to enjoy her company.

When an hour passed, she recommended we find out what was happening inside.

By now it was 9:30a.m. and I could hardly keep my eyes open.

Julie performed a cervical exam and said, “Good news. It’s time to push. I’ll be right back with some assistance.”

I sat up a bit and called to Neil, “Hey, babe. It’s time to push.”

I started to cry. I think it was the fatigue. “I’m too tired. I can’t do this. I just want to sleep.”

Julie re-entered the room. “I heard that. I promise you we’ll let you sleep as soon as you’re done. This won’t take long at all.”

The nurse and Neil helped me pull my legs back into the assisted squat position. I started to protest. “I don’t want to. I’m too…”

My uterus contracted and the urge to push overcame me. I held on to my legs that were being supported by Neil and the nurse and heaved, “I need to push.”

Julie laughed, “I guess you had it in you after all.” Her shoulder length blond hair fell in her face as she tried to get a better view of my perineum.

“Shoot, I forgot a scrunchy.”

When the contraction ended I lowered my legs and rested. I pulled the pony tail out of my hair and said, “Here you can use mine.”

Julie smiled, “Are you sure?” She removed her gloves and accepted the scrunchy. She pulled her hair into a tight pony tail and put new gloves on her hands.

The resting period lasted longer than I anticipated. The pushing stage is also known as the second stage of labor. In this stage contractions are usually further apart allowing the laboring mother to regroup.

Another contraction began. I inhaled deeply pulled back my legs and began exhaling ever so slowly through three long breaths as I bore down.

Twenty minutes (two contractions) later baby number two arrived. She looked beautiful with a mass of thick black wet hair.

Julie said, “You wanted this baby wiped down and wrapped in a blanket, right?”

I nodded appreciative of her recollection of my birth plan.

It took approximately one minute before they handed me my new baby girl and it was love at first sight.

I didn’t communicate my feelings very openly to Neil about his role as coach. I let the feeling of abandonment and disappointment fester inside. I silently held it against him for over a year.

Analysis

-Minor forms of induction can cause latent or long unproductive labors

-Your healthcare professional knows more than you do; even if you don’t like what they have to say.

-The consequence of home induction methods may be more than you bargained for.

In my case it wasn’t worth it.

-It’s best to present your birth plan at admittance and request a room that accommodates your goals.

-Just because your partner loves you the most, it doesn’t mean he’ll be your best coach. Your coach should care about your goals as much as you do. Consider your mom, friend, sister, or a doula.

-The power of suggestion is REAL

-Normal vaginal delivery is less painful than back labor

-The urge to push can be recognized with an epidural anesthetic.

Delving Deeper

Was the birth of baby number two a failure? I didn’t meet my goal. I knew I could deliver baby number two without an episiotomy so on the second birth I focused on my desire to labor un-medicated.

This is a difficult question to answer. At the time I felt like I failed. I lamented a missed opportunity. I felt jipped out of the full experience. I thought my coach failed me.

Over a year later I realized this wasn’t about the failure of a birth plan. It ran much deeper. We as a team we failed to communicate and create a cohesive game plan. The birth itself was a success story with a happy mom, healthy baby, and a much better beginning.

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