We had a baby! Our birth story part 3 - Baby Aisling arrives!

Late afternoon and evening June 11, 2013

Before I begin, let me just say that I am very happy with the staff at UCSF, even though I didn't follow their advice in every case and actively resisted additional augmentation of my labor. They were extremely polite and professional even as I politely rebelled, and for this I am very thankful. I trusted my own body in balance with standards of care, and because of this I believe that I had a great experience with a very healthy, though premature, baby. I should also say that the epidural I received, with the exception of a short time when I screwed it up, was better than I ever imagined, because I could still feel everything, and I could move around easily. I could stand up unsupported, I could turn over in bed, and my skin had sensation. If I give into another epidural in the future, which I hope I don't, I hope it's exactly the same as this one.

Ok, now for the rest of the story.

During the 30-45 minutes of peaceful rest after I received my epidural, I was still conscious of my contractions, but the sharp peaks of pain were gone. Instead I felt dull cramps where the peaks had been and an increasing pressure low in my pelvis. The pressure built as I rested until it became quite uncomfortable even through the epidural. It felt somewhat like needing to poop but with an unfamiliar sharpness that felt “wrong” somehow (can’t explain how) and a full feeling between and below the lowest part of my front hipbones. About 2 hours after the last check, an hour after my epidural, and as the discomfort was building, I asked to be checked again.

This time when the midwife checked me I was 4 cm dilated and almost 100% effaced, but the midwife felt a small “lip” where my cervix was resisting, and also said that the baby was presenting “sunny side up” or "posterior" with her nose facing my front. Ideally the baby should be facing my tailbone when she was delivered because of the way her neck, shoulders, and body could bend more easily as she passed through the pelvis. I figured that the way she was facing was probably also what was causing the “wrong” feeling as the back of her head mashed against my rectum and sacrum, and her face began to encounter my pubic bone. The midwife said that babies were born that way all the time, but I’d read about the pain, trauma, and difficulty during the pushing phase of a “posterior” presentation.

Once again, and to my dismay, the midwife strongly urged me to let them give me Pitocin. She said it would “organize” my contractions and get things moving faster. It seemed to me that having gone from 2 to 4 cm in 2 hours indicated sufficient “organization,” and that any additional stimulation of my uterus would just keep squeezing my baby’s face into my pubic bone, and possibly lead to trauma to my nether regions during delivery. I wanted time to turn my baby, and I was sure that I could do it.

The midwife settled herself comfortably into a chair to argue with me. I don’t remember what all was said, but I do remember that she calmly repeated herself many times. I’m thankful that my family has always said that I’m so stubborn I’d argue with a fence post, because that’s what it felt like. Mainly she repeated that my contractions needed to be more organized and regular. I observed that my contractions were far more regular than the monitor showed, because I’d watched it many times when it hadn't picked up a contraction I could clearly feel. She even hinted at the “dead baby card” by saying that my baby’s vitals might be concerning because the highs and lows were different than earlier in the morning and last night, which could indicate distress. She didn't push very hard on this one, and I was thankful for my business brain, because I’d been tracking the numbers and there was no difference, and also why would no one have said anything to me about it until the heat of this debate? As far as I was concerned, we were making great progress, baby and I, and I thought I might be able to deliver before midnight without any additional augmentation if the midwife would leave me alone.

Again, I know the midwife was doing her job, and I can see how scared or less argumentative women would just give in and let the staff follow standards of care to chemically augment their labor to get things "back on schedule." As the clock ticked, I found myself getting more and more impatient for her to just go away and let me turn my baby. Finally I just started to politely ignore her (still responding to her questions but not giving into her pressure), and turned over onto my hands and knees. I think the only reason she finally left was because her shift change was approaching and it was clear I wasn't going to give in anytime soon.

When she finally left I was swaying, arching my back, and twisting my hips aggressively to let my baby fall back out of my pelvis, into my belly, so that maybe she could re-enter my pelvis at a different angle. I pictured her slipping slowly back towards my ribcage as I arched my back, pushing my belly toward the bed with my hips and head up. I pictured pulling a cork (her head) from a bottle (my pelvis) as I twisted and rocked my hips with my shoulders and head on the bed and my hips in the air. Every now and then I’d arch my back like a cat and tuck my hips under, picturing her sliding back into my pelvis, hopefully in a new position, then start the process over again. The movement was exhausting, and I’d lie down every now and then on my side, almost on my belly, with the top leg pulled forward, picturing her back sliding around towards my belly button. I could feel her kicking and squirming about as usual, as I worked. My doula Heather was wonderful, rubbing my back, playing white noise sounds like ocean and rainfall on the iPod, and encouraging me.

Over the next hour, the pain in my pelvis started to feel “right.” Again, it’s hard to explain why…but it did. It was almost a pleasurable sensation – almost – or at least in the general direction of pleasure relative to how it felt before. I could feel tingles in my pelvic floor and I remembered the perineal massage that Doug and I had practiced. If I hadn't known how it felt to actually relax the muscles in my pelvic floor because of having done perineal massage, I would never have known that what I was feeling was sensation in the same nerves. Again I was thankful that my epidural wasn't the awful kind where I couldn't feel my legs or move freely, or this story might end differently.

Things get fuzzy here. Time passed quickly as I worked to turn my baby, the hospital staff shift change happened, and I had Janice back as my labor nurse with a new attending doctor and other staff. I was beginning to feel more intense peaks of discomfort as though my contractions were intensifying (though they still weren't showing up regularly on the monitor), and growing pressure in my pelvic floor. I wanted to be checked but for some reason they wouldn't check me. I was beginning to feel an urgency along with the pain. I asked if they weren't going to check me, could they perhaps augment the epidural a teeny bit (I freely admit that I was a wimp about the pain at this point, which was a mistake).

For some reason, they augmented the epidural immediately even though they wouldn't check me. They gave me a bolus and turned up the base level of the drug. Suddenly, I could no longer feel my legs. I couldn't move anymore. I couldn't turn over, I felt like I was sliding off the bed and couldn't stop myself. It was awful, and exactly what I’d heard about the 'usual" epidurals. Several doctors and staff members came in during this time to introduce themselves but didn't acknowledge my gentle suggestions that perhaps the epidural was too strong? I must have shown increasing distress about the fact that I couldn't feel or move my legs, because finally Doug asked me, “would you rather have the pain back?” and I said “YES.” Then he went out into the hall and worked some kind of magic, because they turned the base level of drug down, but it would take at least another hour for the bolus to wear off.

Again, the blessing of a time with no pain (or sensation at all) was that I could rest, and this time I got some actual sleep for about an hour until returning feeling in my legs and body woke me up. This time I was serious, almost frantic, when I spoke up about the pressure in my pelvis, but even Janice didn't believe me! I think at some point she even said, “You don’t act like a woman who needs to push.” I wondered what the hell those women acted like, so I could pull the moves! Instead, staff continued to leisurely introduce themselves to me and ask me questions.

At some point during this time, before or after I rested, I let Janice start me on a Pitocin drip at the very lowest level. I thought I was close to delivering anyway and I couldn't feel a damn thing, plus I knew that Pitocin can be helpful after the baby is delivered to get the uterus to shrink back down and not hemorrhage. So I did finally get a little Pitocin right before I actually delivered.

Finally, after 10:15 p.m. or so, I was almost freaking out about how I felt between my legs. I insisted that I be checked. It took forever for one of the doctors to come in and check me, maybe another 20 or 30 minutes. It was all I could do to hold myself together while she took her everloving time getting her gloves on, etc. When she finally checked me it took about 5 seconds for her to say, “Oh! Well you’re fully dilated and ready to go!”

Probably because my daughter’s head was RIGHT THERE and had been for at least the last hour. Sigh. I was thankful, in the end, that I'd "labored down" and didn't have to push her all the way from my cervix to the real world.

Commotion immediately ensued as the delivery team rushed in and began turning things on, laying out frightening shiny implements on the table nearby, and getting my bed ready for the delivery. I had been laying on my side for some time, and it felt right to me that I deliver that way, so I asked if I could and they said of course.

So they had me slide down to the edge of the bed where they had pulled out a table-like extension. I laid on my right side with my left knee up in the air. They assigned Doug to hold my knee up and steady, where he could see everything and do a job, too. Janice and Heather stood at my other knee, helping to hold it up perpendicular to my body.

When everything seemed ready they asked me to push once, gently, and the top of my daughter’s head appeared. I asked if I could reach down and feel her and they said of course (I had washed and sanitized my hands while they were preparing everything). I could feel a tiny bit of her head right there peeking out, and I asked if I could leave my hand there while I pushed so I could feel how much my pushes were doing. Again, no problem.

This is where the fact that I could feel my own hand touching myself was so important, both because the epidural wasn't too strong anymore, and because they let me touch myself as I labored. If I hadn't been able to, I wouldn't have known the difference between my own body and my daughter’s head and might not have been able to push as effectively.

They asked me to push with the next contraction. As I did, I could feel her moving down in my pelvis and also feel with my hand how much her head was progressing, which wasn't much. So with the next contraction I knew I had to push harder and longer. There was a place in my mind that was terrified of tearing or being cut, but because I could keep my hand on my daughter’s head and push my own perineal tissue back myself, it was easy to calm the fear. At one point I took my hand away to brace myself and really push hard. While I pushed I felt something start to pinch or just feel wrong, and I reached back down. The doctor had been pushing my skin back to help my daughter to crown, but because the doctor wasn't me and couldn't feel what she was doing, she was pushing too much at the top, toward my pubic bone. I remember pushing her hand away and holding that area, then actually pushing my daughter’s head back away from it and holding it there for a few seconds. Then I reached back to the perineum and pushed the skin really hard, harder than the doctor had been, because I could feel that it was fine and not close to tearing. At the same time I pushed with my whole body while relaxing my pelvic floor, and felt my baby's head move a LOT while everybody cheered and encouraged me.

As she crowned, I felt incredibly full and uncomfortable but not in pain. There was an edge of sensation that told me to be careful, but also gave me confidence that I could push harder without tearing. I pushed HARD, pausing a couple of times to catch my breath while trying not to let up the tension in my abdominal muscles and keep my pelvic floor relaxed. It was a weird combination of moves! One more push and her head was born (facing the correct way!). A pause and then another big push delivered the rest of her, which was such a feeling of physical and emotional relief. I did it!

I looked down at Aisling (ASH-ling) for the first time at 11:10 PM after just 10 minutes of pushing. Throughout my labor I had been confident that she was fine, and hoped that she was going to beat all expectations for a 35-week preemie (she did!). Even though she was 5 weeks early, she was not tiny and frail! She was 6 1/2 pounds, bright pinkish purple with lots of vernix, the cheesy looking protective coating. She had an incredibly cone-shaped head where she'd been sitting parked in my birth canal just waiting for me to start pushing while I freaked out and begged to be checked.

The doctors held her up by her middle with her head and limbs hanging down, while stimulating her back, and she gave her first squalls. They weren't super-loud and aggressive, but they were strong and they were there!

They laid my daughter on my belly with the cord still attached so that it could finish delivering the rest of her blood to her body from the placenta. They covered her with a blanket and one of the pediatric nurses was rubbing her vigorously to stimulate her. I remember that I kept lifting the edge of the blanket to look at her face and the nurse kept pushing it back down saying that she needed to keep warm. I couldn't understand how she could lose that much heat out of her face, which I very much wanted to see. I put my finger in Aisling’s fist and felt her squeeze it as she breathed and squalled on my belly.

After about 4 minutes, her cord was finished pulsing. Doug cut the cord and they whisked her over to the incubator area in the room to work on her. Doug followed with his camera, and stayed with her for the rest of the night while they worked on me. I delivered the placenta easily, and the doctors looked hard for any tearing. There was none. The only abrasion they could find was at the front where I had felt something pinching and pushed the doctor’s hand away.

I kept looking wistfully over to the team in the corner working with my baby. Tears were streaming down my face because I wanted to be with her so badly. Heather stood by me and rubbed my neck and said the kindest things. I was so thankful to have her there. They wheeled Aisling by my bed in the incubator – she needed to go to the NICU for some time with the CPAP machine to help her lungs inflate fully. Lungs are the last thing to develop and she needed some support, which was to be expected. I was heartbroken though, because I wanted to spend a little more time with her, and because I was so full of birth hormones!

Heather stayed with me after they took her away. The next hour is pretty fuzzy in my head but I wasn't sleepy; I was desperate to see my baby and know how she was doing. I said goodbye to Heather as Janice got ready to wheel me to the NICU to see my baby.

Aisling Jane was 6 lb 9 oz and 19 ½ inches long. She spent 6 full days in the NICU, mainly due to jaundice that kept her under lights on two separate days. I’ll tell that story in the next post, and hopefully get back to blogging more regularly soon!

Thank you for following our story! I’d love to hear your birth stories, too.

We had a baby! Our birth story Part 2

Tuesday morning and early afternoon, June 11

After walking the halls for a short while, I realized how tired I was. I hadn’t slept well the night before and I was certain that I wouldn’t be delivering anytime soon. So we returned to our room to rest. While Doug slept soundly on the pull-out chair/bed beside my bed, I tried unsuccessfully to get some rest. I’d agreed to revisit the idea of induction at 3am. Until then, I alternated lying quietly trying to sleep with doing deep lunges and squats and moving my hips to stimulate contractions.

My contractions had returned: they were steadily getting more regular and stronger, but they were still completely painless, so I knew I wasn’t making much real progress. I decided to go ahead and take the first dose of Misoprostol at 3am, knowing it would take a while to have its effect. The second dose would be scheduled for 7a.m., and a possible third dose at 11a.m. I could refuse any of the doses if I chose.

Between 3 and 7 a.m. I felt the contractions continue to get stronger and more regular but they were just barely crampy and I still couldn’t feel anything at all happening in my pelvis, where things were supposed to be moving as the contractions pulled my cervix open.

The hospital shift changed at 7a.m. so there was a whole new set of faces to meet, and they moved us into an actual Labor and Delivery room. It was so spacious and comfortable, with an incredible view of the whole city, a larger bathroom with a tub, an area full of equipment for the baby when it was delivered, and a large area for me to labor. It also had a “birthing ball” which is just a large exercise ball to sit on and rock and help me open my pelvis during contractions, and other amenities. Doug set up our music player and got himself settled in the corner by the window. I took my second dose of Misoprostol – my contractions were about 5 minutes apart, about a minute long, and felt like menstrual cramps with a purpose, which was nice. I was still chatty, texting my family, talking to the various new staff who introduced themselves, and I ate breakfast (because eating is no longer prohibited during labor at UCSF, thank God) – eggs, sausage, and a bit of toast.

When 11a.m. rolled around the nurse decided not to give me my third dose of Misoprostol because my contractions were closer together than the recommendations for continuing the dose of that drug. At this point they wanted to start me on Pitocin but I refused. I was listening carefully to my body and could now feel the contractions getting harder and stronger, more intense and closer together. There was also beginning to be some good pressure and pain in my pelvis and cervix. To add Pitocin, I felt, would take me too quickly into unbearable pain and I still wanted to try for a totally natural birth.

The midwife on duty was rather pushy in her way about this; her style of being pushy meant that she would stay in the room and calmly explain (over and over again) why they wanted to give me Pitocin (“risk of infection,” “we need to make your contractions regular and stronger,” “the baby could go into distress if labor goes on too long”) without truly listening to any of the reasons I gave for wanting to hold off (I am not afraid of infection, my contractions are getting stronger and more regular, the baby’s vitals have been perfectly regular, and I don’t want an epidural but I know I’ll need one with Pitocin). Just as with the doctor the night before, I finally had to look her in the eye and say something like, “You have informed me, and I am choosing not to proceed with your recommendation. Thank you.” It was stressful to have to object so strongly and directly, even though I have a pretty strong personality and she was being very polite, and I can see why women frequently don’t feel able to stand up for themselves and instead just go along. So she finally left and let me labor.

Contractions were continuing to ramp quickly in intensity, and I texted Heather, my Doula, that she should probably head over soon because I would need her help soon in managing the pain. I had a deep inner worry that I didn’t express to Doug or Heather, and that I barely admitted to myself. I’d read about Misoprostol before and I knew that it could make contractions unbearable all by itself, because it interferes with a woman’s own balance of hormonal signals that are controlling labor. I had refused Pitocin because I knew it would make me progress faster than I could handle – because now I was actually worried, deep inside my mind, that I was already progressing faster than I could handle. Had my water broken 4 weeks further along, I would have been laboring naturally at home all this time; I probably would have slept all night, and my own hormones would be in control and gradually working me toward birth slowly and naturally. But instead I now hadn’t slept at all in 36 hours, and I was feeling it. The contractions were now like Charlie horses in my belly and steadily intensifying.

By the time Heather arrived, I was having Doug help me to get through each contraction by pressing strongly on my hips from behind while I sat and bounced on a birthing ball. I could now feel every contraction deep in my pelvis and sacrum, as well as my belly. When I’d stand up off the birthing ball, I could feel where my pelvis was flexing and opening and creaking. During contractions I could feel a tingle, like electricity, deep inside me that would radiate up my back. Occasionally I’d feel a snapping or popping feeling deep inside, too, like the feeling when a stretch goes deep and pulls a muscle. These feelings were almost certainly my cervix beginning to dilate and efface and the ligaments in my pelvis relaxing, but I could tell that it wasn’t happening fast.

I don’t remember everything that Heather did, because by the time she arrived I was very focused inward during contractions, but everything she did helped. She had essential oils and helped to direct Doug and give me ideas for different positions.

I labored for about an hour after Heather arrived when we decided I should get into the tub for a while. The pain was now quite intense with contractions coming faster than every three minutes. I was officially at the point when I thought, “why do women do this?!” and “I don’t think I will ever do this again,” but I was still handling it well.

The tub felt so nice. I was sweating and they’d made the tub tepid. Heather put a cool rag on my forehead and there was a lovely mint smell from her essential oils. She and Doug lowered the lights and turned on a hypnosis track and sat with me in the bathroom while I breathed through each contraction. The waves were so intense. I fell asleep between them but they were coming very close together so I wasn’t getting any real respite. Somewhere deep inside me, my devious conscious mind raised the niggling thought that some women went for pain relief right about now, and I could, too. But I pushed that thought back down without letting it be more than a fleeting image. I probably had 15-20 contractions in the hour I was in the tub. Suddenly I became aware that I was getting very cold. I remember Heather saying that they could add some warm water but all I could think of was how comfortable it would be to get dry and warm and wrapped in blankets and lay on the bed.

Getting out of the tub, dried off, and dressed was complicated by my contractions, the IV lock in my hand, and the monitor I was wearing (I had to wear a monitor once they induced me, which restricted my mobility somewhat). Just as I’d get going on action like putting underwear on, a contraction wave would come and require me to focus. This was somewhat distressing…I was so sleepy…and that inner part of my mind raised the image of rest and pain relief once again. But again I pushed past it.

At last I was dressed in dry underwear, gown, and bathrobe with a new dry elastic band for the monitor, and I could climb into the dry warm bed with blankets piled on top of me. But the comfort of warmth was ruined by the contraction waves that were continuing to get more and more intense, along with growing pressure in my pelvis as my cervix continued to change. I changed positions several times to try to find the best way to bear them, with no real difference. A third time, I thought about the potential for pain relief. I was dreading each new contraction and not getting much rest between them. I decided to ask for nitrous oxide, which is an option that only a few US hospitals provide.

It took a couple of contractions before they could set up the nitrous oxide mask. The peaks were rising very quickly and approaching my pain threshold, and I had begun to vocalize and moan loudly during each one. Then they gave me the mask and told me to start breathing into it before each contraction and to stop once it had peaked. Almost immediately I realized that I couldn’t use the gas. It smelled sickly sweet and warm and it made me nauseous almost immediately. The warmth and closeness of the mask also made me feel suffocated and claustrophobic somehow, which was unbearable when added to the pain of each contraction. The polite part of me felt so bad that I’d asked them to set up the gas and then couldn’t use it.

About this time Heather offered to let me use her TENS unit. She placed electrodes on my lower back and gave me the controller, which let me apply a distracting electrical current to my back muscles during contractions. The purpose is to supply a sensation and stimulate nerves to reduce local pain. It was actually helpful, and I wished I’d begun to use it sooner. I sat thru a few more strong contractions, moaning loudly which also seemed to help, as I could feel things changing inside me. I suddenly had to go to the bathroom, where I found blood on the toilet paper. Hurrah! I announced it to the room: this meant changes were really happening!

But when I sat back down on the toilet, I experienced two intense waves right on top of each other before I could even pee. I turned my mind inward again and did an assessment of my body. I somehow knew that things were not very far along, and I estimated that there would be at least another 5-7 hours of this crushing, aching, piercing pain, and then I would transition, which would be even worse, and then I would labor down and push my daughter out, which could possibly be awful too, especially if I was even more exhausted. I realized that I was fighting the contractions, dreading them, and that my exhaustion was undermining my determination.

I came out of the bathroom, had another 2-3 awful contractions while leaning on Doug, and then I just broke down. It seemed very sudden to Doug and Heather because up until then I’d apparently not shown much of my inner struggle on the surface. I was so tired and rather upset with myself, but most of all I was in pain and I was crying as I asked for an epidural. They wanted to check my cervix first, which was more agony as I waited through another couple of contractions. When they checked me at about 2:30 p.m. I was 90% effaced (cervix thinned out) but only 2 cm dilated. I was not at all surprised, having assessed my own body and knowing that it had much more work to do. The team tried to get me to consider narcotics, but I was done messing around and I firmly requested an epidural.

In retrospect, thinking about how quickly my contractions went from cramps to Charlie horses to crushing stabbing pain, I’m even more assured that refusing Pitocin was the right call for me. Later in the evening it proved completely unnecessary. I’m also certain that the Misoprostol that started my labor is what caused the pain to escalate quickly beyond my ability to bear it. My contractions were coming very fast and hard for having made so little progress in my cervix, and the pain was just draining my energy even more. Baby’s vitals were still trucking right along, though, and I was assured that she was holding up well.

Without going into much detail, I signed the release forms and got my epidural between 3 and 4 p.m. It took the anesthesiology team a long time to place it, which meant I was sitting on the edge of the bed, bent over leaning on Doug and moaning, through 10-15 intense contractions. Sitting bent over is a terrible position and made the pain even more intense. I remember looking up at Doug and seeing tears streaming down his face. He just couldn’t bear to see me in this much pain. Somewhere deep inside me, his tears of empathy made me love him even more, which may not be something many women feel during the peak intense pain of their labors. He was and is a wonderful partner in the worst of times.

Finally the tubes were placed and I felt my feet getting warm, then my legs began to tingle, and finally the intensity of each contraction began to subside as the drug took effect. As the pain receded, the tidal wave of exhaustion rushed past it and washed over me. I was so sleepy. They dimmed the lights to let me get some rest, and I closed my eyes.