Wednesday, June 15, 2011

Pregnancy #3 Isaac's Birth Story

The third time is a charm. My weight gain by the end of pregnancy number three totaled 19 pounds. I walked 5-10 miles a day and nourished my body with plenty of fresh fruits, vegetables, folic acid, and whole grains. I ate meat in moderation and limited my sugar and fat intake.

I felt great. My energy levels were terrific and even though my body started producing relaxin a bit early and experiencing the same pains in my ligaments and joints I promised myself I wouldn’t whine. But just in case, I switched to the doctors within the same clinic. I knew they’d be a little more inclined to strip my membranes if I wanted a little pre-labor boost.

I approached labor and delivery with a better idea of what to expect from my body, the hospital staff, and my husband. This time around I wanted a doula.

This upset Neil. He resented my decision to bring a third party to the birth of number three. He felt like I was saying, “You’re not good enough.”

That wasn’t the message I intended. I simply wanted to create an environment that allowed him to fill his role as companion, not birth coach.

At one point he sarcastically said, “I’m not coming. What do you need me for? You have Tina.”

I explained that Tina was not meant as a replacement for him. She planned to support him, give him tips, encourage me, and ward off any medical staff that intended to alter our birth plan unnecessarily. I tried to convey that her purpose was to make his job easier.

Eventually, Neil accepted Tina’s presence as a possible advantage. As we patiently awaited a spontaneous labor or naturally occurring labor I experienced a few false alarms. You’d think that by baby number three you’d recognize labor when it hit. But I learned something new about the uterus in the pregnant anatomy.

Your uterus will never return to its pre-pregnancy condition. Each time your uterus, the hollow organ known as the womb, houses a new fetus it stretches and weakens. It loses muscle tone in the fibrous tissue. In order for the uterus to continue functioning effectively it must get back in shape and prepare and practice for labor. This warm up period manifests itself with Braxtion-Hicks contractions. You experience Braxton-Hicks contractions by the third trimester of your first pregnancy. However, many woman never notice these little abdominal tightening or quickening. Regardless of whether you recognize them or not, they occur regularly.

These Braxton-Hicks or toning contractions begin sooner and become stronger in subsequent pregnancies. The more your uterus is stretched the more work your uterus must do to get back in shape.

Six weeks prior to the delivery of baby number three I experienced my first FALSE LABOR.

My contractions initiated on their own while my Neil and I sat in a movie theatre. I couldn’t help but feel a little excited. I sat content to watch the movie as labor progressed.

When I we returned home I went walking. My uterus tightened while I walked, but not in regular contraction patterns. I couldn’t really tell if it was a contraction or not. Eventually, my uterus relaxed and I resigned that it must not be labor.

I walked the rest of the way home and retired to bed. Laying in my bed my contractions returned strong. At first they only lasted 30 seconds. I timed the contractions. The clocked at 7 minutes from the start of one contraction to the start of the next.

Realizing that 30 seconds isn’t a very serious contraction I ignored the pain as best I could. The contractions continued to progress. Over the next couple hours the length of each contraction increased to 60 and even 90 seconds. The contractions came regularly and steady in the strength. I continued to time the distance between contractions. By this time my contractions were a little more than 4 minutes apart from the start of one contraction to the beginning of the next contraction. My level of discomfort continued to rise.

I wanted Neil to sleep as long as possible so that he would be well rested for the hard part of labor. I quietly left the bedroom and drew a warm bath.

The buoyancy of the water provided welcome relief. When laboring in water the force of gravity is weakened on your muscle groups. I laid back and relaxed. The contractions continued for over an hour, but they eventually became shorter and farther apart. I took catnaps between contractions until I could finally sleep right through the contractions. When I awoke in the tub realizing that my body wasn’t laboring any longer. I climbed out of the tub and went back to bed.

Contractions came and went through the night, but by 6:00a.m. my body didn’t seem very serious about the prospect of labor.

The physical consequence of false labor is pretty harmless. The biggest challenge presented by false labor is the emotional impact on the expectant mother.

Following my first false labor I felt like my life was touch and go. I didn’t want to commit to workshops or projects that might be disrupted by labor. I spent the last four weeks thinking, Today’s the day!

At my routine office visit four days prior to my due date I asked Dr. Saunders to stip my membranes. He agreed. Upon further assessment he learned that my cervix was only a little more than a centimeter dilated. He performed a little sweeping. The effect proved enough stimulation to get me contracting, but not enough to maintain for more than a few hours. My body just wasn’t ready.

My due date came and went. It’s a distressful thing to reach your due date without a baby. There are such negative associations with due dates. When you fail to return a library book on your due date, you’re fined. When you fail to pay a ticket by the due date, you’re held in contempt of court. When you fail to turn in your homework by the due date, you’re academic grade is penalized. My baby was overdue and there wasn’t anyone to punish. Who was responsible for this unjustice? I got whiny. I probably drove my friends and husband crazy. In a particularly weepy moment I cried, “What if I’m pregnant forever? What if my body never goes into labor?”

In case you’re wondering, that won’t happen. Three days later I visited my the obstetric clinic for my weekly exam. Dr. Parker evaluated me and determined that my cervix still meausured once centimeter. My effacement remained the same as well. He refused to strip my membranes advising that my body wasn’t yet ripe and needed a little more time to prepare for a spontaneous labor. Furthermore, he happened to be the doctor on call that night and didn’t particularly care to start a latent labor that would inevitably keep him up all night. He explained that he didn’t mind assisting a laboring mom in the middle of the night when her body chose that time, but if he had a choice he was going to opt out.

I burst into tears asking what I should do. Dr. Parker was the oldest doctor in the partnership and by far the most seasoned in the trade of obstetrics. After delivering more than 14,000 babies hearing the same sob story probably sounded like a high pitched record.

Dr. Parker let me know that one of the other doctors, Dr. Jones was scheduled as the on call doctor for the following day. He explained that Dr. Jones was offering late night exams at a remote clinic in a more rural clinic. With a look of skepticism he checked his watch and said, “It’s 9:00a.m. now. If you can persuade Dr. Jones to see you after 7:00p.m. you could probably labor latently through the night and transition into real labor by midday. Let me see what I can find out. I’ll be right back.”

Hope soared. Valerie, the nurse in attendance winked at me and gave me the thumbs up. When the door closed behind Dr. Parker she said, “You lucked out, darling. Dr. Jones strips membranes aggressively. He’ll get your labor going for sure. But be warned, it’s going to smart!”

Within a few minutes Dr. Parker returned shaking his head as he couldn’t believe he was assisting in such whimsical treatments. Dr. Jones says he’ll see you at 7:30p.m.

I tried not to smile too big. Although I should have been thanking Dr. Parker profusely, I thought he was a mean callous old man for not doing the deed himself.

At 7:30p.m. I met with Dr. Jones at the other clinic. He looked at me with his bright blue eyes and said, “Are you ready for this. If I’m going to do the job, I’m going to do it right. Have you had your membranes stripped before?”

“Yes, with my two previous babies and once last week.”

“Well, I suspect tt this time it’s going to be a little more uncomfortable. But I need you to relax as best as you can.”

Dr. Jones swept his finger along the uterine wall lifting the amniotic sac. He spread his fingers prying my cervical opening.

He smiled, “There we go. Now you’re dilated somewhere between 2 and 3 centimeters. That should send you on your way. Now go home and mow the lawn and see what you can do to encourage some steady uterine activity.”

My uterus cramped in protest. My entire abdomen tightened acknowledging the procedure. Dr. Jones helped me sit upright and bid me farewell.

Just as Dr. Parker predicted I labored latently or unproductively all night. All though I did manage to get some good rest for a few hours. In the morning I walked five miles and piniced at the park with my children. By 4:00p.m. it required concentration to relax during contractions. Between contractions I felt great. We took our children to my sister-in-law’s house and I labored in the tub. Neil called Tina to let her know that I was in early first stage labor and would let her know when active first stage labor began so that she could meet us in the hospital.

We took a walk around the block and my contractions intensified immensely. In fact, I wasn’t sure I could make it home. I hugged Neil hanging my weight on his shoulders.

Neil whispered words of praise into my ears. I felt comforted by the smell of his neck and the familiar sound of his voice.

Once we were home we climbed into the car with our previously packed hospital bag, CD player, and new infant car seat.

As soon as we arrived at the labor and delivery unit I handed the nurse my Birth Plan and said and said this will be an un-medicated childbirth. The nurse smiled and said, “I’m glad you brought that to my attention. We’ll put you down at the end of the hall in Labor & Delivery Room #13. It’s quieter down there out of the way of the bustle. We’ll want to make sure your nurse is Peggy, she’s terrific with natural childbirth. Some of the other nurses just don’t like to deal with it, but Peggy will treat you great and will be a great help.”

This was sounding pretty good.

The nurse showed me to Triage where I changed into my gown and sat on the bed awaiting the fastening of my External Fetal Monitors.

She performed a cervical exam and determined I measured 4.5 centimeters.

Wow! That was my best admittance dilation yet.

The monitors swooshed and whirred with the baby’s heart rate and reporting the peak of a contraction.

“Looks good. Let’s get your Antibiotic IV going so you can get a good block through you and get a heplock. That way you won’t have to be hooked up to the I.V. for the rest of your labor.”

The nurse walked out of Triage. While passing the nurses’ station one of the other nurse’s announced, “Dr. Lawrence says she’ll be on her way in a little while She wants to know how urgent labor feels. She just started nine holes of golf with her son and she’d like to finish if she can. Will you be okay if it takes her an hour to get here?”

I shrugged. “That fine. We’ll just be doing our thing.”

The nurse continued to lead us down the far end of the hallway and showed us to our room. It was a corner room on the third story with natural light creating a warm cozy feeling on two of the four walls. While we set down our belongings the nurse began drawing warm water in the private bathroom.

Our labor and delivery nurse explained, “The temperature of your water is really nice and warm. The tubs are cast iron so they should retain the heat for along time. But if you start getting cold feel free to let some water out and add more warm water. I’ll show your husband around the nurse’s station so you can help yourself to juice, ice, snacks, or anything else you might like. Is there anything I can get you before I go?”

“I’d like a birthing ball if that’s okay.”

She smiled. “Not a problem. I’ll bring that right away.”

I undressed and stepped into the warm tub. The white cast iron tubs at the hospital were not jetted and they weren’t longer or wider than the standard sized bath tub, but they were deeper. This allowed more of my body to relax in the weightlessness of the water.

Neil sat over the toilet seat and made small talk. Enya played in the background. Neil was in a good mood being better rested this time around. He playfully bantered with his dry sense of humor. We laughed between contractions and I closed my eyes and breathed deep abdominal breaths. I concentrated on slow focused exhalations. I imagined myself blowing on an invisible candle flame just enough to make it flicker, but not enough to extinguish the flame.

We enjoyed a beautifully serene quality time together. Eventually, Tina arrived, but didn’t want to interrupt the moment. She stayed in the delivery room while Neil and I laughed and spoke in hushed tones in the bathroom. At one point a contraction began in mid laughter. The physical activity of laughter strained my abdominal muscles. I abruptly stopped laughing, but couldn’t containe my smile. Neil’s ego boosted gaining confidence in his ability to provide adequate support and companionship through labor.

The nurse came came to check my progress. She brought external fetal monitors using telemetry device or battery operated monitors that could be used in the bath tub. She seemed pleased wth the readings and performed a cervical exam while I lounged in the tub.

“You’re progressing. I estimate you’re measuring 7 + centimeters. I’ll call Dr. Lawrence and find out how long it will be before she arrives.”

I closed my eyes and offered a silent prayer, “Dear Farther in Heaven, Thank you for getting me this far. Thank you for sending me Neil. Please stay with me and let my body accept the work its work. Please help me to stay relaxed as the pain intensifies.”

A spirit of gratitude and confidence provided peace. Within minutes my body shifted gears and I felt immense pressure down low. My back pain grew deeper and lower with each contraction.

Relaxation required increased focus. I closed my eyes and concentrated on the notes playing, “Sail away, Sail away.” The music aided my visual imagery as I mentally envisioned myself floating on the shallow shores of Waikiki. I mentally created my personal paradise. The sun shone, the waves lapped, the water sparkled. I felt warm. I focused on the circular warmth emanating from the sun above.

The warmth comforted me. I imagined myself floating closer and closer to the sun basking in its warmth. As the sun came closer, I pictured my cervix opening and expanding its circumference. I let the contractions wrap around me. The enveloped me. I surrendered completely somewhere inside. At times the contractions became powerful enough, I shrank back from the sun in fear that it might burn me.

I continued in this way until the urge to use the bathroom interrupted my concentration. The urgency to get to the toilet overpowered me. I asked Neil to leave the bathroom. I stepped out of the tub and sat on the toilet. The painful sensations down low subsided. The toilet provided welcome counter pressure on my coccyx bone and allowed my perineum tissue to relax completely.

Although I felt better over the toilet, I couldn’t seen to move my bowels. Nothing came. I waited and pushed.

Neil knocked regularly and asked, “Are you okay in there? Are you ready to come out.”

Although I felt okay, I was not willing to get off the toilet. I felt security as I rocked my upper body back and forth while sitting upon the toilet. I couldn’t shake the feeling that I needed to expel something soon.

The nurse returned to the room. I overheard the conversation on the other side of the door.
“Is she still in the tub?”

“No. She said she needed to have a bowel movement. I think she’s still sitting on the toilet.”

“How long has she been sitting on the toilet?”

“Maybe 20 minutes. I checked on her just a couple of minutes ago and she said she was fine but that she didn’t want to leave the toilet.”

The nurse came knocked on the door and said, “Hon, I’m coming into check on you.” She entered exposing my naked pregnant body hunched over the toilet.

“I think you’ve been on the toilet a little too long. You’ve got me concerned. Let’s move you into the room and you can sit on the birth ball. It will give you the same relief without the risk of having a baby in the toilet.”

I stood in my nakedness hoping somebody would hand me a towel or a gown, but too focused on deep abdominal breaths to interrupt my relaxation to ask. I walked across the room where the nurse opened a gown for me to slip my arms through.

She set a clean towel on a birthing ball. “There you go.” I looked at the ball with a contraction vibrating through by core. It seemed that my short walk across the room stepped up the intensity of my contractions significantly.

I stood still afraid to move. No position seemed capable of alleviating the surreal deep pressure.

I felt shifts and movements as though a baby might be rubbing its head against my cervix.

I waited for the contraction to end, but it never really did. Although there was a point where it let up slightly. I bent my knees to sit on the ball but the pressure against my bottom felt alarming. I sat up, exclaiming, “Hot.”

Everyone in the room looked at me startled. That was the first word I’d spoken in quite some time. I felt too much pain to explain the sensation. But there was a hot burning sensation that protested the idea of my sitting on it.

The nurse asked me to sit on the bed and allow her to check my cervix. Feeling like a helpless little girl, afraid to lay on that uncomfortable bed, I said, “I don’t want to.”

The nurse reassured me, “We’ll make it really quick. As soon as you’re done, I promise you can get in any position you want.”

I conceded and sat up on the bed. The pain heightened forcing more pressure in my lower back.

The nurse didn’t seem to require much entrance. “Yep. Just as I thought. You’re done. You’ve got a complete cervix here with a baby ready to come out. I can see lots of hair.”

“Really?” I half laughed with excitement and amazement I’d really done it.

The nurse nodded her head with a smile. “Dr. Lawrence isn’t hear yet, she’s about five minutes away, but Dr. Parker’s here waiting to deliver a baby for a family friend. I’ll walk down the hall and grab him.”

“No. I’d rather wait for Dr. Lawrence.” The nurse looked at me as though I were alien.

“Are you sure? I’m going to go grab him just in case.” She exited the room at a brisk pace.

I carefully scooted off the bed and leaned over the birth ball. The weight of my belly hanging hurt my abdomen, but relieved my back. With my face laying against the towel I saw Dr. Parker rushing into the room followed by our nurse.

“All right, Dr. Parker’s here. Do you want to push?”

“No, thank you.” I shook my head slowly.

“Dr. Parker seemed surprised by my answer.”

“Are you sure?” The nurse queried. “You could be done before Dr. Lawrence arrives.”

“I’ll wait.” I confirmed my decision. What I failed to communicate was that I was still mad at
Dr. Parker for not “helping” me the day before. When I’m angry, with someone I typically withdraw and avoid them. In truth, with as many patients under Dr. Parker’s care, he probably didn’t even remember me. According to the paperwork Dr. Lawrence was my primary caregiver anyway.

Dr. Parker stood in silence for a minute observing the scene. He must have determined that there would be no harm waiting for Dr. Lawrence to arrive.

While I waited for Dr. Lawrence I scanned the room seeking some place or something to provide comfort. I hiccupped incessantly. I felt confused and indecisive. I licked my lips realizing they were dry and chapped. I looked at Tina. “Do you have any chapstick?” She smiled and whipped open a cosmetic bag exposing three types of lip balm, “Would you like mint, pina colada, or cherry ice?”

Under normal circumstances I would have reached for the pina colada. I marched in place delicately as though I were kneading bread with my feet. It felt better to keep moving. If I stopped my instincts told me to lift my feet again like one stepping on hot coals only my feet weren’t the part of my body experiencing discomfort.

I involuntarily released an unusually long burp. I covered my mouth and raised my eyebrows with surprise.

Minutes later Dr. Lawrence entered the room in hospital scrubs. As she dressed in the hospital protective robe and gloves, the nurse advised me to climb on the delivery bed. My feet were cold and I continued hiccupping.

Standing at the foot of the bed Dr. Lawrence assessed the birth canal. “You’ve got a really bulgy bag of waters cushioning the baby’s head. I’m going to slit the membranes and drain the water to minimize the fluid release when you push.”

Dr. Lawrence inserted a tool resembling a crochet hook. The underside of the hook contained a sharp razor like edge designed to penetrate and create a small opening in the bag of waters.

I felt a small amount of pressure release as the membranes ruptured. Water trickled in a steady yet manageable flow. Dr. Lawrence strategically placed towels to absorb the moisture.

“Okay. Relax” Dr. Lawrence instructed.

“Relax?” I looked at her incredulously. I’d been holding a baby inside for the last several minutes and couldn’t conceive of how to reverse my focus.

I took a deep breath through my nostrils filling my lungs all the way into my lower back. I stretched my arms upward and fanned them downward slowly. As I exhaled and slowly and calmly repeated, “I can relax, I can relax, I can relax.”

Dr. Lawrence looked at me like I might be on crack and then turned her attention to my cervix.

“Good. Very good.”

“Now push.” She ordered.

Suddenly I realized this was the scary part. The blood curdling pull your lip over your head part of labor. You’ve heard the terrorizing descriptions of people comparing birth to fitting something the size of a watermelon through an opening the size of a lemon. There was so much pressure along my pelvic floor I didn’t even know where to concentrate my efforts.

I asked, “How?”

Dr. Lawrence tapped her fingers on the tissue crowning over the baby’s head. “Can you feel that?”

“Yes.” I could feel her fingers in sort of a numbed area of my body.

“Focus on that spot right there where my fingers are. Push with all of your strength right there in that spot.”

I pulled my legs back all on my own in a perfect symmetry. The back of the bed angled upward supporting my back. I closed my eyes and heaved with full force. Low grunts emitted from my mouth as I exhaled.

“Wo, wo. Slow it down just a little.” Dr. Lawrence lifted her hand in the stop sign.

I stopped pushing.

“Good. Hold it there for just a second.” I could feel Dr. Lawrence stretching and easing the tissue evenly over my baby’s head.

“Okay, Give me another push in the same place. This time push a little slower.”

I pushed hard, but not my hardest.

“Good. Hold it, hold it, just a little longer. I continued exhaling. My perineum stung, but it didn’t feel nearly as bad as my contractions felt 30 minutes earlier. The tissue stung with a mild irritation or burning as it stretched. As I continued to push I felt a release.

“See the head, dad?” Dr. Lawrence pointed below.

Neil stepped toward the foot of the bed and announced, “You’re almost done, Beck. The head is out.”

“The head is out?” I couldn’t believe it. Pushing wasn’t nearly as bad as I’d expected.

I pushed a third time. The shoulders crept forward forcing the final stretch of the birth canal. I held the push and exhaled low and slow.

Suddenly the rest of the baby’s body exited with a slippery wiggle.

Adrenaline shot through me. I sat up grinning. I scooted back on my bed and set my legs down.

I smiled at Neil, “We did it!”

Neil returned the smile, “No you did. You were amazing!”

My little baby screamed showing off his vocal cords and exercising his new lungs. He continued to scream in complaint of his new surroundings. His shouts continued for nearly twenty minutes. I tried to nurse him, He attempted to latch many times but couldn’t complete a full suction before he opened his mouth to voice complaint about his terrestrial experience.

His little voice cracked. He sounded hoarse. His body shook with angry screams. I nestled him closely and kissed his new little head. I spoke softly to him and welcomed him to the family. His shouts gradually quieted and he took comfort in his first nursing.

During that first hour I walked to the bathroom without assistance. I felt energetic, alive, and on top of the world. Endorphins rushed through my entire body elevating my mood.

After an hour the excitement subsided and I grew sleepy. I fell asleep in a blissful content replaying the experience over and over in my mind.

-Presenting the birth plan upon arrival is like placing your order at a restaurant. It allows everyone to better serve you.

-A helpful labor and delivery nurse or doula greatly enhances the birth environment.

-A well rested husband fully on board with the birth goals is a much better labor support than the alternative.

-If you think you need to poop in labor or if you want to sit on the toilet, it’s probably time to push.

-A woman in transition may not be able or willing to communicate her preferences. Discuss modesty and other possibilities in advance.

-Hiccups and Burping are key indicators of transition.

-Transition not Pushing is the most painful part of labor.

-Pushing feels good. It provides relief and releases the building pressure in the perineum floor.

-No amount of discussion in a prenatal class will prepare you for pushing. Ask for a tutorial if you need one. The medical professional can guide you with their experienced vantage point.

-Pushing un-medicated accelerates the pushing stage of labor. The muscles maintain full control and power.

-Pressure in the perineum acts as a natural anesthetic that numbs the perineum tissue.

-After the shoulders are delivered the birth descent is rapid and involuntary over the rest of the body.

-Delivering a baby un-medicated produces a natural state of euphoria that carries you into motherhood with excitement and optimism.

-There are few things in life that produce the pure satisfaction of accomplishing a challenging goal.

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