Tuesday, January 13, 2015

She's Here!! (8 days late...)

Short version: 12 hours labor, epidural, baby sunny side up, 45 minutes of pushing, born 3:44 pm. 8 pounds 14 ounces. Pictures to come shortly once I get them off the camera. 

Long version: 

(Seriously don't read it if you don't want to know about my cervix. You've been warned!)
This whole delivery was bizarrely parallel to my first, but with far better outcome for me, and less trauma to everyone.

Friday the 9th I was a week overdue. I was sore and exhausted and beyond done being pregnant, and I felt like the only way I was ever going to start labor was for my water to break. I had my 41 week appointment that morning, and we'd scheduled a 42 week check for the following Thursday and induction for Friday the 16th.

Fun aside: January 10th was the inspection resolution deadline for our house, so we knew we were going to have to sign some things that day (thankfully, electronically).

We went to bed at about 11 on Friday night, I was timing contractions and noting that they’d been every about 7 minutes for a couple days (whee). I woke up at 3:30am on January 10th with a decently intense and painful contraction, but didn’t really think anything of it because honestly that was sort of the norm by that point at 41 weeks 1 day pregnant. I peed and came back to bed at 3:38. A few minutes later I had another contraction, this time accompanied by a rather enormous gush all over the bed. I woke C up with my exclamation of “Ohmygod, my water just broke!” and continued to gush all over my side of the bed while he went and grabbed every available towel in the bathroom. I tried to go back to sleep for a little while, but the contractions were immediately so painful and intense that I was already having to focus through the pain and really work to let them accomplish what they were doing, rather than tense up. I had to resort to making “Aaahhh” sounds and trying to stay open and relaxed starting almost immediately. At about 4 I gave up trying to get back to sleep, and we left for the hospital 45 minutes away at a little after 5am. Turns out that 45 minutes to the hospital, even with no traffic at all (yay Saturday morning?) REALLY sucks when you are in active labor like that. I tried to eat and drink a little but threw up pretty fast, and I decided that I hated every bump in every road, and every red light was out to make me miserable.

We pulled up to the hospital and C went and got me a wheelchair, and they directed us to the Mother and Baby unit, where the nurse immediately sent us to triage (in my head I said “Are you fucking kidding me? Triage? Really?” but once the nurse there saw the puddle between my feet and how much I was actually in labor, she brought me to a labor/delivery room. We were set up and I was being monitored by 6am. Because Dee's delivery had been only about 30 minutes after my water broke, we thought that maybe this one would be quick too, so by about 7am the room was set up. They monitored me for a little while and started the IV antibiotics because I was Group B Strep positive. I also got an ultrasound to verify that baby was head down, which was apparently hospital procedure even though I’d had an ultrasound the day before to check fluid levels and had already verified that she was head down. I was 5cm dilated, and having very frequent and very painful contractions. I was doing my absolute best to surrender to them and let my body work but my hips and low back were feeling every ounce of pain, and my pelvis was objecting mightily (I had symphysis pubis dysplasia/SPD for the last 8ish weeks of my pregnancy). The jetted bathtub became my best friend for about an hour.  The tub had jets labeled “feet” but which hit my hips absolutely perfectly to ease the pain and give his hands a rest. C helped me out at around 8am. I was feeling pushy and they checked me again. 7cm.

I was put back on the monitor (UGH) and they noticed that the baby’s heart rate was not doing well with my intense contractions. I was really, really thirsty, but because I’d been throwing up I just asked for ice chips to chew on. Around 9am they put in an internal monitor (poor girl has scratches and a scab from it still 3 days later) to keep better track of her heart rate. I also got an oxygen mask around this time. I was able to labor on my knees in a supported kneeling position, which felt good but C still had to use strong pressure on my hips and low back with every contraction. At every 2-3 minutes, he really didn’t get any breaks. Because of the internal monitor, I could not go back in the tub. During this time, the OB noted that the baby seemed to be OP(occiput posterior)/OT (occiput transverse) which explained the back labor and lack of dilation. I needed to hold C’s hand very hard while I was focusing on trying to let contractions happen without letting my body push, even though the baby’s head was pushing against my back and rectum which makes pushing happen. I spent a LOT of this time visualizing my midwife Mary from when I delivered Dee, making me breathe with her instead of letting my body push before I was fully dilated.

The baby’s heartrate was still not doing well with the contractions, so they did a saline infusion via catheter to add some fluid back around her to try to cushion her a bit (I think this was around 9:30). This worked somewhat. The OB on call did mention that if her heart rate continued to be this slow we would be facing an emergency C-section in about 30 minutes; as soon as she said that, Little Cat C’s heart rate sped right back up. While we had expressed our wishes to do this med-free, the nurse could see how much pain I was in and how tense I was, and the fact that I had not dilated any further for two hours despite the frequency and intensity of contractions and my changing positions. She asked if I thought I might want to consider an epidural, just in case that allowed my body to relax and dilate. I immediately went back in my head to J's delivery, and how my decision to get an epidural (evidently) made everything so much worse. Knowing, however, that we already had an internal monitor, and the saline infusion catheter, and I would not be getting out of bed and being able to move around much (due to the interventions plus the SPD). C and I talked about it. He told me I was doing an amazing job and that he would support whatever I wanted; I just wanted to cry because I felt like I was spiraling down the disaster trail I’d been down before. I knew, deep down, that I was completely exhausted and would not have the energy to keep breathing through the urge to push for however many hours it would take me to finish dilating. Around 10:30 I told the nurse I wanted an epidural, though I mentioned my previous experience with them and the source of my reluctance.

The anesthesiologist was amazing and had my epidural in place by 11:00. I could still feel the contractions, but they were 75% less painful and suddenly I found that I could deal with them, breathe through them, and allow my muscles to unclench. I never knew that a properly placed/properly executed epidural could work for me. My blood pressure dropped a lot shortly after the epidural was placed, which I guess sometimes happens. The anesthesiologist came back and gave me a shot of fenylephrine, which fixed things. It did still start to wear off around 3:00, but that was fine with me (that part is coming up). The nurses and doctors noted some meconium in the fluid at around this point, and the baby’s heart rate was still dropping with the contractions even though I was no longer crawling out of my skin with each one. The OB suggested giving me a dose of terbutaline in my IV, to help relax my uterus and give the baby (and me) a break for a little bit. They assured me that it would only be for about 30 minutes, and the contractions would pick back up again (which they did). It worked beautifully, and once I was laying on my right side Little Cat C’s heart rate started cooperating again. I also got to nap for about 2 hours. I was dimly aware of contractions picking back up, and C told me he could tell because I changed my breathing with each one. At around 1:00 or so I woke up and noticed that the contractions were definitely picking up in intensity. I could feel that I needed to poop, and mentioned it to the nurse. She checked me and said that my cervix was softer, and the baby had moved down more, but I was still only at 7cm. The OB said to start pitocin to help the contractions work to move down this OT/OP baby. We did try putting a big peanut ball between my knees to open my pelvis and help the baby turn, but that didn’t really work. The pit definitely did it’s job, and I went back to sleep for a little bit between contractions. My heartrate started going up pretty high, and they noticed I was running a fever (another side effect of the epidural, apparently, because it went away completely a few hours after delivery and I never felt ill at all). I was finally making dilation progress, and actually felt the baby move down during one contraction, but had a very swollen lip of cervix left. They had me try pushing with a contraction to see if they could move it out of the way, but the baby really didn’t tolerate that very well, and it didn’t work. I still kept flashing back to during J’s delivery where I also had a lip of cervix that would just not move. They decided it would be best if I just kept letting the pitocin help (they never had to turn it up very high, I only needed a little bit of a push from it) and we’d check again in a little while.

At around 2:30 I was *FINALLY* at 9cm, but still had the lip of cervix; at about 3 I was complete and started pushing. The OB was absolutely awesome and was able to actually push the little bit of cervix out of the way *and* turn the baby’s head as I pushed (side note: I really should look up who the OB was because I cannot remember her name). If you’ve given birth vaginally before, you are probably familiar with the ring of fire which generally accompanies a baby’s head as it comes out, and it vanishes as soon as the head/shoulders are through I had this VERY mildly with Dee, and very briefly. Well... I had it the entire 45 minutes it took to push Little Cat C and her chubby little body out. I am so, so grateful that the doctor had such strong hands that she was able to turn Little Cat C as she was born. We were unable to delay cord clamping for very long, because she did not cry beyond a couple gurgles when she was born. C cut the cord and the NICU team took the baby over to the warming bed. The OB noted that she was a big baby, probably about 8 pounds. They worked on getting Little Cat C to breathe for what seemed like an eternity. I have no idea what her APGAR scores were. She never cried. I never noticed anything particular about my other babies crying but Cecilia’s lack of crying was awful. I’m getting teary just remembering. I finally asked if she was okay, and they assured me that she was but they were just trying to get her lungs a little more open. The nurses and OBs working on me had me deliver the placenta and did all the usual fun things (no real tears though, surprisingly! Just a teeny little papercut sized thing that didn’t warrant stitching). I did finally get to hold my baby after they did what they so pleasantly termed a “sweep” of my uterus. Yeah. That was horrid. I never again wish to have anyone’s hand inside my uterus, but apparently it was necessary as I was bleeding pretty badly and actually did have clots that were preventing things from properly clamping down. Turns out I had a postpartum hemorrhage, but “only” lost about 750ml (half of what I lost after J was born).

Little Cat C was born at 3:44 pm on January 10, 2015. She weighed 8 pounds, 14 ounces, and was 20 inches long. My reaction to her weight may have been “HOLY GOD, she’s almost 9 pounds?!” She ate for an HOUR after she was handed to me for the first time. Contrary to Dee’s prediction, she never pooped on me. She has so far been very easy and relaxed; having a chubby baby is pretty different! We don’t have to wake her for feedings, and I’ve never brought a baby home that was already too big for newborn clothing items.

Things I have learned? Baby position is VERY important to ease of delivery. My two OP babies both resulted in epidurals, internal monitors, back labor (though J’s was by far worse), and lots and lots of pushing (almost 3 hours with J, 45 minutes with Little Cat C), and longer labors (though Little Cat C's was almost exactly 12 hours, just like Dee, had she *not* been OP/OT it would have been significantly shorter), in addition to postpartum hemorrhages (though this could have been from other things, like the pitocin/epidural/long ass transition) and a bruised tailbone. 

Recovering from the SPD is not really that pleasant. My pelvis doesn't feel properly connected to itself, and I'm just waiting for things to settle a bit more before getting an adjustment which I think will help a lot. I *can* walk pretty well though, which is awesome, and more than I could do before delivery!

Also, epidurals are not the devil. They *can* work perfectly if they are placed perfectly, though I still metabolized the drug faster than normal. Mine did make my face really itchy for a while, which was weird.

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