We had a baby! Our birth story Part 1

We delivered our daughter, Aisling Jane, 4-5 weeks early on June 11, 2013. She was 6 lb 9 oz and 19 1/2 inches long. She stayed in the NICU for 7 days, mainly due to Jaundice that kept her under UV light therapy on 2 separate days.

It's taken me a couple of weeks to get to where I can write out our birth story. I'm very happy with how it all went, though I didn't have a "natural birth" because I was early, the hospital staff were amazing to work with and the meds I received were as close to perfect as I can imagine -- I could feel everything but without the intense crushing, piercing pain of my induced contractions.

Here is our birth story, Part 1.

Disclaimer: There are references to bodily fluids and parts in this story. I am very comfortable with all aspects of my body and its functions, and I hope you are, too. If not, read with caution. :)

Prelude: leading up to Monday afternoon, June 10

The weekend before my delivery was very relaxed without as much exercise as usual because I was generally feeling lazy and under the weather. I attributed my somewhat icky feeling to having gotten the TDaP vaccine on the previous Thursday, which made my shoulder sore. But overall I just felt very generally lazy and sleepy and never had a fever, so I just laid around reading a book all weekend. I do remember laying in bed on Sunday night having a hard time getting comfy, and feeling a strange sharpish pain as I turned over to go to the bathroom, but it went away quickly and I didn’t think much more of it. In retrospect it could have been significant.

Monday morning June 10 was a fairly ordinary morning. I remember getting up and feeling good, and looking in the mirror and thinking I must not have eaten much all weekend, because I looked less full under my ribs and felt less pregnant somehow. I had an 8:30 meeting to rush off to, and the morning was very normal. Baby was moving around and squirming as she usually did each morning, and I even commented to a coworker that it was more fun to feel her movements now that I knew which way she was oriented after my 32-week ultrasound.

Just after I ate lunch, sometime close to noon, I was sitting comfortably at my desk working. I moved to cross my legs, which required some effort as it lifted my belly a little, and suddenly I felt a tiny bit of warm fluid moving where it shouldn’t be. I froze. It did not feel like pee; I had not had a problem with incontinence and I had recently been to the bathroom, so I immediately got suspicious. It was not a gush, it was maybe a few drops; enough to feel but not enough to even get my clothes damp. I went straight to the bathroom and when I sat down on the toilet I heard a little faint trickling sound that I knew wasn’t pee because it took me a while to “let go” when I peed. I looked down and saw clear liquid of different consistency from the toilet water slowly diffusing out. I felt myself and there was thick clear fluid and a little bit of mucous on my fingers.

Now she had my full attention.

I went home (which is literally right across the street from work) and caught some of the trickle in a clean glass to see if it looked like amniotic fluid. It did: it was perfectly clear with tiny particles floating in it which were bits of the vernix that coats the baby and protects her skin. Totally odorless. I decided to call my doctor. I’d been texting Doug all along to let him know what was happening but I told him not to come home, that if anything was happening it would still be a long time before he’d need to be home.

My midwife scheduled me to come in at 4:00pm for an evaluation. I scooted back to the office, finished what I was working on, and sent an email to my boss and coworkers that I needed to head home, but not to be alarmed. When I got home I decided to take a shower before heading to the midwife. BEST DECISION of the week. I couldn’t feel any contractions, the baby was moving around normally, and the tiny trickle of fluid continued.

I drove over to the Dr. at 4:00pm where it was immediately obvious to my midwife Brooke that I was, in fact, leaking amniotic fluid. I had put a washcloth in my underwear, which turned a PH strip blue as soon as she touched it to the damp area. She listened to Baby’s heartbeat, took my blood pressure and temperature (both normal). While I was on the table I had my first little contraction, and soon had a couple more. Brooke said that I needed to go ahead to the hospital (I planned to deliver at UCSF). She wanted me to go straight from her office, but I wanted to run home and pack a bag and meet Doug. While I’d been waiting for 4:00 to roll around I’d read up on “PPROM” (preterm premature rupture of membranes) and learned that if the baby was <34 weeks gestational age, they would try to stop labor; but if it was >34 weeks, they’d let it progress or try to augment it because the risk of infection outweighed the risk of baby not being ready to come into the world. I figured that when I went to the hospital, I wouldn’t be coming out again without having delivered, and I wanted to get my stuff together. Second best decision of the week!

So I texted Doug to get home (he’s about an hour commute away), drove home, and started to pack. The best possible items I packed were a bathrobe, my own pillow, my toothbrush, and a change of clothes with nursing in mind. My little contractions were getting close together, about 5 minutes apart and about a minute long, but they were painless other than being tight and pressing on my bladder. Baby was still squirming as usual and I laid down to wait for Doug. When he got home he threw together a ton of camera stuff, his portable ipod speaker, and a few things to keep him entertained and comfy. We bundled down to the car and off we went.

The drive across town to the hospital was excruciating, and not because of labor. I suddenly had to pee, which was exacerbated by my frequent contractions, and the San Francisco streets are so roughly paved that it felt like we were off-roading. By this time it was 6:30 and traffic was heavy, so we caught every red light and got behind slow turning people, buses, and delivery trucks way too frequently. By the time we got to the hospital I was in urinary agony. Doug let me off at the front entrance while he went to go park. I waddled to the nearest restroom (waddling to keep from peeing and because I could feel the leaking getting worse). As soon as I peed, which was a tremendous relief, everything stopped completely. No more contractions, nothing, nada.

I headed up to the 15^th floor where UCSF Labor & Delivery is located, and was directed straight to the nurse’s station where they were expecting me because my midwife had called. They got me set up in a room, Doug arrived, and the wait began. I was very nervous about how the PPROM would alter my birth plan, which was for as natural a birth as possible, and I was extremely resistant to the thought of induction. I called our Doula, Heather, who we had not even finalized our contract with yet, and she was on her way. We had everything we needed for Baby, but so much logistical work was as yet undone, because we expected at least another 3-4 weeks before delivery. But ‘twas not to be.

Monday Night

The “risk of infection” would become the top term of my labor, as far as the doctors were concerned. Many women whose membrane ruptures prematurely have some sort of infection which causes the rupture, and as soon as the membrane ruptures, that infection can pass to the baby and create complications in labor and afterwards. Therefore, the standard of care for PPROM after 34 weeks is to induce labor and get the baby out as quickly as possible. However, I was quite certain that I did NOT have an infection (a certainty later borne out in the results of all of the tests they performed on me and my baby), and I was absolutely determined to wait for my body to get started naturally even though it certainly meant a long labor.

Once a woman is induced, the clock starts ticking for the baby, because a woman’s own hormones are no longer in control. Far too many inductions end in C-Section, especially in the US, because induction can make a woman’s labor progress very rapidly and put the baby into distress. Inductions also start a “cascade of interventions” which are basically more unnatural actions done to counteract the effects of unnatural practices that began the labor. I knew that I was going to have to balance the “risk of infection” with my own confidence in my body’s ability to give birth to my daughter. I also had no idea how the USCF staff would handle my resistance to what I knew they would recommend, but I’d heard great things about UCSF so I just went ahead with confidence.

As soon as we were settled in our room, the endless parade of new faces began. UCSF is a teaching hospital, so at each 12-hour shift there is one attending M.D. OB, two resident M.D.’s, at least one med student, one nurse who’s assigned to you, and several other nurses who rotate in for your nurse’s breaks. During the day there are midwives on duty, and there are also other doctors who may come introduce themselves, like anesthesiologists, neonatologists, pediatric specialists, etc. Since I met at least 25 new people at each shift change, eventually I stopped trying to remember names and just remembered faces so I’d know whether I’d met someone or not.

Our antenatal (pre-labor) nurse was named Janice, and she would eventually be my labor nurse. She quickly endeared herself to me. Her job was to monitor my vitals and generally take care of me and make sure I was comfortable. She also proved to be a reliable foil for some overly-cautious doctor speculation -- though in no way did she ever contradict a doctor’s advice, her expressions and body language were extremely communicative.

Our team of doctors, residents, med students, etc. for the current shift came and introduced themselves, performed a visual cervical check with a sterile speculum, and also took a few culture swabs to check for infection. I’d never had so many people looking at my crotch at once; suddenly I realized there would probably be even more later when things got serious. Modesty was already out the window, and I decided to let it go completely.

My cervix was still closed and long, as I expected having just started leaking that afternoon with no other symptoms and no time to start labor at all. With PPROM, they try to limit the number of cervical checks to reduce the potential exposure to infection, and this first one was the only “visual” check. I wouldn’t have another check until things really got going, which turned out to be after noon the next day.

The attending OB came in to make some recommendations. She wanted to induce me with Misoprostol right away to get things moving, since it had already been about 8 hours since I started leaking, and standards of care recommended delivery less than 24 hours after membranes rupture. I was VERY resistant to this idea, because our bodies can react very strongly to induction drugs and I wanted my body to at least start to labor on its own without adding drugs just yet. I was also hoping for a natural delivery and drugs would almost certainly bring the pain on to strongly, too fast for me to be able to handle it.

I had to push back very hard on her and tell her that we’d been expecting an early labor (though not quite this early), I’d had an uncomplicated pregnancy up until now, I was having steady contractions before I came into L&D, but I’d now been in my room for several hours being checked in and “informed,” and how was I supposed to walk around and get labor started if people wouldn’t get out of my room, leave me alone, and let me get up and walk. If I’d been 37 weeks instead of 34 I’d still be at home. I did agree to let them give me Penicillin IV since I couldn’t be absolutely certain that there wasn’t an infection, and I am a reasonable person. My doctor agreed to come back in a couple of hours to talk about induction again.

No sooner had she gone than the Neonatologist came in to introduce herself, and then promptly told us that they expected to keep our daughter in the NICU for at least three or four weeks. I almost lost it. I re-stated to this new doctor that our daughter had measured ahead on every ultrasound, I’d had an incredibly uncomplicated pregnancy, and for all we knew our daughter was just ready to be born. Doug came around and sat next to me on the bed like a hero. After some conversation I got the doctor to admit that if our daughter was an absolute preemie superstar, she might get to go home by the following Monday, still almost a week away. This still seemed like an awfully long time, but WAY shorter than three to four weeks.

And now, my adrenaline pumping, there was no way in Hell my labor was going to get started anytime soon. Doug and I got up and started walking the halls.

Our doula Heather arrived and we debriefed her about what was happening. It was so wonderful to see her, a familiar face and calming presence. She was very reassuring and helped me to think thru some of the emotional responses I was having so that the next time the OB came in, I was able to calmly ask for the evidence (research) that warranted inducing me for a 24-hour delivery. She looked it up and came back, saying that honestly there wasn’t much research, the evidence was weak, and the strongest negative outcome (still VERY weak in probability) was cerebral palsey due to fetal distress and infection.

I decided that the likelihood of fetal (and maternal!) distress from a rushed labor and delivery outweighed my fear of the risk of not inducing. I was confident in my body’s ability to at least start contracting by itself again, and decided to wait 4-5 more hours for my own labor to start back up before taking any drugs. Contractions were showing up, faintly, on the monitor, and I wanted to let my body strengthen them.

And with that decision, we let Heather go home to get some sleep and settled in for a long, sleepless night.

Last pregnant belly selfie