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.
No comments:
Post a Comment