Friday, April 13, 2007

Roan's Birth Story - Chapter 2: A Hard Day's Night

Once the smoke had cleared and our home was once again deemed inhabitable, Jen, Micah, Josefa, the two dogs, the 26-foot moving van, and I returned home. Soon my mom arrived on a flight from Houston. At this point I badly needed to be alone with my coach and get some help focusing on working through this labor. Everyone went downstairs to the basement to give us some space.

At this point my contractions were still about 5 or 6 minutes apart but were growing in intensity. I took a warm bath, Arwen checked in with our midwife, Neko, and she suggested we take a walk in the fading afternoon light. I was feeling pretty uncomfortable by this point and having a hard time focusing after all the day's excitement. Arwen took me by one arm and I grabbed a trekking pole in the other and we headed very slowly out the door. I was moving at an absolutely glacial pace. I only made it 2 or 3 blocks before feeling wiped out and needing to get back home.

On the slow walk back I thought I felt - but wasn't sure - a tiny trickle of water breaking. I was hoping to put off the moment of my water breaking for as long as possible. Because I was GBS positive, the hospital would require that I head to the hospital as soon as it broke to begin a course of antibiotics and prevent infection. And at that point, the clock would start ticking, giving me no more than 24 hours to get that baby out.

Once we got back Jen brought up a nice healthy dinner of homemade minestrone soup and hearty bread. Where just a day or two before I could gobble down spicy, rich foods with enthusiasm I now found my tummy very sensitive. I ate what I could, which wasn't much, and Arwen turned on a movie to distract me, Stranger Than Fiction with Will Farell.

We only got about 15 minutes into the movie before all hell broke loose. Contractions started coming every two minutes apart with a nearly unbearable intensity. I couldn't sit down any longer; I was hanging off of Arwen with my arms around his neck, moaning, when all of a sudden in a gush my water broke. Looking back we realized that the little trickle I had felt earlier was probably indeed amniotic fluid, and its release, even in a small quantity, got things kicked up to the next level.

So now began the mad dash around the house to pack all the last minute odds and ends into the car, phone Neko and let her know we were on our way, load ourselves into the car, and head out. It's a short ride to the hospital from our house, but I assure you I felt every bump and pothole along the way. My mom and Josefa rode to the hospital with us, and my mom rubbed my shoulders the whole way.

We got the car parked, up the elevator and into The Baby Place. I had a hard time answering the lady's questions at the front desk, and at one point I asked to borrow her trash can because I was pretty sure I was about to spew. They ushered me into an exam room in a wheelchair to check my dilation, and to my surprise I was already at 5 centimeters. "We're already halfway there!" Arwen encouraged me. "I'm gonna barf," I replied, and next thing you know I was wearing and standing in the hearty minestrone soup from earlier.

They got us settled into a Labor & Delivery room, which are really nice at St. Joe's. They have wood floors, dimmable lights, and - most importantly - a huge jacuzzi tub. They hooked me up to a fetal monitor and dosed me with antibiotics for about half an hour. At this point I felt a new burst of energy. I was ready for this challenge. We walked the halls, did the hula dance that's supposed to help the baby turn and move, and sat and laid over the birthing ball we brought with us.

Things kept progressing well for a while. Over the next few hours I continued to dilate at a steady pace; about a centimeter every hour and a half to two hours. Although the contractions continued to be strong, my mind had had time to adjust to them by this point and I was able to deal with them. Arwen kept reminding me to "moo" - making low moaning noises is supposed to help you relax (and make you laugh). Things were going swimmingly.

Then around 8 centimeters I hit a wall. All of a sudden I began to experience such intense pain in my back I felt like I was losing my mind. It wasn't just every few minutes when a contraction hit either; it was an excruciating, sustained pain that came to an even more intense crescendo with each contraction. Neko explained that this was "back labor" - caused when the baby is rotated face up instead of face down. (This is different than a breech birth, where the baby is head up/ feet down. Roan was head down but rotated the wrong way.)

I completely lost my composure now. I was moaning and crying, thinking that if there were any women laboring in the rooms next door they probably would be wondering if I was dying in here. It hurt so bad I couldn't think or breathe or do anything other than beg Arwen to rub my back furiously and not stop. Even now when I think back on that intense pain it brings tears to my eyes.

Maybe if we had made some different choices at this point the ultimate outcome might have been different. I try not to second guess it; I don't have any regrets. But I do realize now that this pain was so intense that it completely stopped me in my tracks in terms of being able to put into practice the training we'd had for situations just like this. There was no way I could get up out of that bed and move, much less get on all fours, arch my back and roll over - one of the most effective techniques for getting a baby to rotate properly.

Instead I stayed put for hours, blubbering and begging for the pain to stop, wearing out Arwen's arms and shoulders from massaging me. The midwife checked me again and found that not only was I still stuck at 8 cm, but I also had some swelling on my cervix, which would make it even harder for the baby to navigate into the birth canal. We would have to do something about the swelling in order to get this baby out.

So Neko drew a bath for me and got the jacuzzi jets going. I could barely make it across the room to get into the tub, and once I got in the water wasn't nearly hot enough to do much for my back. They won't let you go above 100* for the safety of the baby. I was in a very bad state at this point. Arwen was encouraging me the whole way. I know it was hard for him to see me in so much pain. I stayed in the bath for a while, at least until I reached a semi-calm resignation to the misery I was in.

Before long it was time for the midwife to check me again. Much to our chagrin she found that I was still just at 8 cm and the swelling on my cervix had not improved at all. She gently suggested that I consider trying some Pitocin, an IV drug that intensifies contractions. I started crying at this point, because I felt there was no way I could handle contractions of even more intensity without the help of pain medication. Or, she suggested, if I could muster the will to get out of bed, we could try walking the halls for the next 30 minutes and see if that helped things progress at all. She left Arwen and me alone for a few minutes to talk about our options.

I started begging for some drugs. "I just can't do this. There's no way. This is f-----g torture." He knew that just about everyone going through natural childbirth reaches this point. He didn't want to see me get so far and then give up. "Ok honey, for the next 30 minutes you are going to listen to me. You're going to try what I say. After that we'll do whatever you want. Just give me 30 more minutes." He wanted me to get up and walk the halls with him. I tried to explain that that was a physical impossibility, but he wasn't having it. "Come on honey. We only have 30 minutes left. You can do this."

It wasn't pretty. I felt sorry for the nurses, doctors and other patients who had the misfortune of encountering my poor pitiful self in that hallway. I was not exactly a rousing endorsement of natural childbirth. I was crying, moaning, hanging on Arwen, my sister and my mom. I was in a pitiful state, but I was doing it. We walked up one hall and back, and when Arwen asked if I wanted to get back into our room, I said no, we still had a few minutes left, let's walk the other hallway.

When our 30 minutes were up Neko found our efforts had paid off. I was still swollen, but had dilated to 9.5 centimeters. She also said the baby had rotated some. We were almost there. But the midwife still felt it was necessary to start a Pitocin drip to get us the last bit of the way. Again I started crying because I didn't want to take pain meds, but I also didn't want to suffer even more intense contractions. "Just try it for a few minutes," Arwen said, "and if it's too much you can have all the pain relief you want."

So they started the Pitocin drip sans epidural, and to tell the truth it really wasn't that bad. I guess Roan had rotated enough that she wasn't putting as much intense pressure on my back. By this time it was the wee hours of Monday morning, and it was time for a shift change at the hospital. It was time for Neko to go home and another midwife, Christi, to come on duty. The midwives at St. Joe's are in a group practice, and we'd had the pleasure of working with both Neko and Christi during my pregnancy. In fact, they were two of my favorite midwives, so I felt lucky to have them both.

Christi found before long that the Pitocin had done its job and gotten me to 10 centimeters. My cervix was still swollen, however, so I couldn't start pushing yet. Even though I had managed to take some Pitocin without an epidural, she suggested I consider going ahead and getting the epidural so they could really crank up the Pitocin all the way. I didn't even have to say anything to that suggestion; she could tell by the expression on my face that this would be a very disappointing turn of events. "Well, before we do that, let me try one more thing," she said.

She started pushing hard on my cervix, and when contractions would come she had me push. It only took a few minutes, and she had gotten the baby's head past the cervix, into the birth canal and ready for pushing. "How did those last couple of pushes feel? Do you think you could keep pushing?" she asked. "I get to push now?!" I was ecstatic. I felt like I could push as hard and as long as necessary; I could see the light at the end of the tunnel. In a few minutes this baby would be in my arms.

Well, that's what I thought anyway. They set up a mirror so I could watch my progress. As each contraction came, Christi directed me in how to push most effectively. At this point we invited my mom, Josefa and Jen into the delivery room. It's not what I expected at all; I had thought I'd feel more comfortable with family around in the early stages and want my privacy at this point. As it turned out, I wanted to be alone with Arwen in the beginning stages to get my head straight after the bomb scare, and now in this last stage I was comfortable with the pain I was experiencing, excited about being so close to the end, and wanting to share this magical moment with them.

Arwen and Jen were by my side throughout the whole pushing process. It seemed like we were making good progress. Before I knew it two hours had passed. They kept me on a fetal monitor continuously throughout this time, and were amazed that the baby showed no signs of stress.

I knew from our Bradley training that most women complete the pushing stage somewhere between 20 minutes and 2 hours. I wasn't discouraged at all when we hit the 2 hour mark; I felt like I could keep going forever. What I didn't know at this point was that although Roan had rotated, she had only come 90* instead of the full 180*. This position is called Occipit Transverse. And apparently babies don't come out this way.

Christi let me keep pushing for another hour. By this time we could see the baby's head appear during each push, and then recede again after the contraction. The baby had had a couple of minor heart decelerations and was beginning to show some signs of stress. At that point Christi said she'd need to get the opinion of a doctor as to whether we could keep going. I was still feeling completely optimistic at this point though; I had every confidence that I could do this. The doctor came in - a young Asian woman - and took a look. She didn't mince words.

"We are looking at a possible forceps delivery right now. Actually the baby is not even far enough down the birth canal to use forceps, and forceps are going to be very uncomfortable for someone who has not had any pain relief." She explained that the baby was turned Occipit Transverse or "OT". As we would come to find out days later from another midwife, in the time before C-sections, the outcome for OT babies who failed to make the final turn was grim: both mother and baby died. The doctor offered, "I can give you another half hour to push as hard as you can, to see if you can get her into position for the forceps. Otherwise we are looking at a C-section delivery."

I heard the words she said but inside my head I scoffed. Not only will I get this baby in forceps range in the next 30 minutes, I will be holding her in my arms by then. Forceps schmorceps.

Well it didn't exactly go the way I thought. When she next came back, I had pushed some of my biggest, hardest pushes. With each effort everyone in the delivery room - Arwen, Jen, the moms, the midwife and the nurse - shouted encouragement. "You can do this!" "Push that baby out!" "You're almost there!" It sounded like the sidelines at a highschool football game. Despite all our best efforts however, when the doc returned she found the baby had not moved one bit. All of a sudden the reality of where we were hit me.

She explained that the anaesthesiologist would be coming in to talk with me before they wheeled me into the OR. The nurse handed Arwen the familiar blue paper scrubs, hat, booties and mask. He looked a little defeated and scared. Avoiding a C-section had been my preeminent goal in preparing for this labor. Now I was facing my biggest fear.

Strangely though, a sense of calm and grace came over me. I had felt so loved and supported throughout my labor. I had been surrounded by people who cared about me and honored my choices. The midwives and nurses had honored my desire for natural childbirth, not pressuring me with drugs and giving me every opportunity to make things work. Niether of the moms ever said one discouraging word. And I had the world's best coach who was there with me every step of the way, without whom I would never have made it to that point.

I grabbed Arwen's hand in my right and Jen's hand in my left and gave them a squeeze. I said through teary eyes, "Even though this isn't what I had hoped for, I think we all have a lot to be proud of. I want to thank you all for the incredible support you've given throughout this birth. In a little while our baby will be here, and that is all that matters."

Despite my best efforts, a natural childbirth just wasn't in the cards for me. But that's why we decided to have this baby in a hospital; now that medical intervention was clearly necessary, we knew we'd have the best care available. I felt like I had done all I could, and now I was in good hands.

Coming soon: the next and final chapter in Roan's birth story...


Anonymous said...

I hate that you had to suffer so much but know the final product was well worth the effort. I could hardly read the chapter without wincing. You are brave & strong & had a wonderful team with you.Good work. Love to all.GGD

Anonymous said...

seriously, not that jough would want me to tell everybody (but its tender so i will anyway), you moved both of us to a couple of teardrops. yall are an amazing couple and we are so luck to have yall as friends. I am glad everything turned out ok - Roan is beautiful!
heart- jough and sarah

Anonymous said...

Jough and Sarah aren't the only ones who were moved to tears! I am so proud of you all!

Love you,

Heather Marie said...

You guys are so sweet. I figured compared to the bomb scare, chapter 2 would be anti climactic!

Anonymous said...

What a challenging experience you had--and you came through with courage, strength and grace. I am so glad you had such a great coach and wonderful support team to help you through. A am so proud of you and am even more grateful than ever for beautiful, healthy Roan. I have it on the highest authority (your Dad) that she is perfectly precious. Love you all, Grandma Carolyn