Friday, January 9, 2009

The story of River's birth

I should have posted this on River’s birthday. But I’d actually forgotten that our doula put together this birth story. Since I just ran across it, I’ll post it on his 13 month birthday instead.

Here is the story of River’s birth according to our wonderful doula:

Wm’s Birth Story
December 8–9, 2007

Wm had been noticing some encouraging signs that her baby was on the way for several days, and at 2.20 pm on December 8, just a few hours after her pre-natal yoga class, she experienced some contractions. No slow to start labor for Wm: her contractions immediately started at 3 to 5 minutes apart right from the get go. I suggested she tried to take a nap given that no sleep would be forthcoming that night, but it’s pretty hard to actually sleep when you are in early labor with your first baby! She tried to rest as best she could, but when contractions are so close together, it doesn’t give much time to focus on relaxation.

I arrived at 6 pm and could see that Wm was already very uncomfortable during the contractions. She needed to stand to remain comfortable and so we got into a rhythm where she would sit on the sofa with the hot pack underneath her when resting, and then stand every time a contraction came and put her arms round Mark and bury her head in his chest. They stayed like this for an hour, working hard, and I could see how strong Wm was. The tears and laughter perhaps made Wm feel she wasn’t coping well - but showing those emotions in early labor is a sign of great strength and self-awareness, portraying an innate knowledge of the enormous task that lies ahead. They don’t call it labor for nothing!

Shortly after 7 pm, as the contractions became more intense, Wm and Mark decided that it was time to go to the hospital. She knew that she wanted an epidural and so it was not a priority to stay at home for as long as possible. In addition, she was already having enough trouble that the five minute journey to the hospital was very difficult for her. We entered the hospital through the Emergency Entrance which is never a pleasant experience. Nurses kept trying to offer Wm a wheelchair and it was gratifying to see her refuse. First, upright was more comfortable for her, and secondly, a woman in labor is not sick! An aide came down to take us up to Labor and Delivery on the 4th Floor and we settled in to Room 441 with Kathy as our nurse. Wm politely answered all of Kathy’s questions despite being in active labor.

Unfortunately, hospital protocol made it necessary for her to be monitored for 20 minutes, which meant lying on the bed – the most uncomfortable position imaginable for a laboring woman.

At 8 pm Dr H arrived, a young petite woman, gentle and unassuming and with a quiet confidence. She checked Wm and announced that she was 2–3 cm dilated, 90% effaced, and the baby’s head was at -3 station. (To allow passage of the baby, the cervix has to efface from 0 to 100%, dilate from 0 to 10 cm, and the baby has to move down from -4 to +4 station.) This was good steady progress although I suspect Wm had hoped she might be further on after 6 hours of pretty intense labor.

The anesthesiologist was called and we continued working with the relentless contractions, which were not giving Wm any break at all. A nurse came in to insert the IV, which was necessary because of a positive Strep B test, as well as for the epidural, and a bolus of fluid was administered in order to prevent her blood pressure from dropping with the epidural, which is a common side effect of this procedure. Wm, who abhors IV’s because of difficulties in finding a vein, was very stalwart during this procedure and barely flinched as the needle was inserted.

Finally at 9 pm, a somewhat brusque mannered young doctor walked in and announced that she was the anesthesiologist. I don’t think she even told us her name, but proceeded to lecture Wm on the importance of keeping absolutely still during the procedure – not an easy feat when you’re having strong contractions. In no uncertain terms, she told Mark and I to leave and “go get a cup of coffee for 20 minutes”.

So we waited right outside the door, straining to listen to Wm’s reactions. To our dismay, we could hear that she had to go through a couple of very difficult contractions as the needle was being positioned in her back and she was obliged to remain totally immobile. It must have been so difficult for Mark to hear her and not be able to comfort her as he had been doing so beautifully all day. However, 20 minutes later, we were ushered back into the room and found Wm grinning from ear to ear as the epidural worked its magic.

Dr H returned to explain that, contrary to Dr C’s promises, the ubiquitous hospital protocol insisted on continuous fetal monitoring once an epidural had been administered. However, she assured Wm that her interpretation of the monitor was very conservative and she was not about to react immediately to a change in the baby’s heartbeat. Wm had been concerned about continuous monitoring because it encourages too many false positive reactions in the doctors and greatly increases the risk of unnecessary interventions. Dr. H said she would return at 10 pm to check Wm’s progress. So we settled down to a pleasant half hour of chatting and resting as the contractions were now a blip on the monitor screen and no longer an overwhelming sensation for Wm.

At 10 pm Dr H returned and checked Wm to find that she was at 5 cm dilation and the baby had moved down a little to -2 station. This was great progress for only 2 hours of labor. No wonder poor Wm had been having such an intense experience – her labor was moving along very fast. Mark and I, baffled by the pull-out bed, called for Kathy’s help and she showed us how to work the various bits and pieces.

By 10.15 pm, Mark was settled on his pull out bed and I was comfortably installed on the egg crate foam mattress that Mark had ordered on arrival. We switched off the lights and attempted to sleep. Thirty minutes later, three nurses came running into the room, all lights were on and an oxygen mask was swiftly placed over Wm’s face. The nurses had noticed the baby’s heart rate dipping down with each contraction and needed to move Wm onto her other side. We discovered later that the little guy had the cord wrapped round his body and it was getting compressed by the contracting uterus when Wm was in certain positions. Right side lying seemed to work best for the baby.

Kathy examined Wm and announced that she was now 5–6 cm and the baby was even lower. We resumed our dozing until 1.30 am when Kathy returned yet again to examine Wm. Excitedly, she said she thought she was now 10 cm and might be ready to push. This was incredible – to move from 6 to 10 cm in just 2½ hours – I could hardly believe it! Kathy returned with Dr H who also examined Wm and said she was 8 cm, 100% effaced, with the baby at -2 station. Apparently, Kathy’s miscalculation had been due to the bag of waters bulging out into the cervix, which made it difficult to assess dilation. Dr H suggested breaking the waters to “speed things up” but Wm did not want any unnecessary interventions and so they agreed to wait another hour before doing anything. It must have been disappointing to find out you were not as far along as you had thought, but neither Wm nor Mark allowed this news to discourage them.

At 2.45 am Dr H returned and explained that there had been no change. She highly recommended breaking the waters in order to allow the baby to come down further and put more pressure on the cervix. After some discussion, Wm agreed to this procedure and sure enough, as the bag of waters was pierced, the baby’s head immediately moved from 2 to 1 station and rotated into a more favorable position. There was light meconium in the water, which meant that the baby was perhaps a little stressed.
We resumed our napping although Wm was beginning to feel a little discomfort as the baby moved down the birth canal. For some women, the epidural does not numb the lower pelvic region as well as it does the abdominal area, and this unfortunately seemed to be the case for Wm.

At 4.30 am, the doctor returned to check Wm once more and explained that she was almost fully dilated but there was a lip of the cervix still on the posterior edge. This was unusual as most women have an anterior lip to the cervix. Thirty minutes later, the same procedure proved that there was still a lip in the way and Wm was becoming more uncomfortable by the minute. In response to her unease, Mark got off his pull-out bed and came to sit by Wm, holding her hand tightly during each contraction and giving her loving words of encouragement.

At 6.15 am the doctor announced, after the check, that the baby had moved down to 0 station, which explained Wm’s growing discomfort. She said there was still a little bit of posterior cervix left but she suggested that Wm start to push anyway. The pressure of pushing often moves the cervix out of the way. Sure enough, after the first pushing contraction, the cervix disappeared and Wm was set to birth her baby.

Initially, Wm felt discouraged at her pushing efforts. She was exhausted and in pain and convinced herself that she was not doing a good job. This was far from the truth: after the first few learning contractions, she really got into her groove and moved her baby down incredibly fast for a first time Mom. It took her 100 minutes to push her baby out – that’s on the fast side of average for a first baby. This is when I saw Wm’s true colors: pushing was excruciatingly painful for her and yet she mustered up enormous courage and strength to successfully “push through the pain”.

Our lovely nurse Kathy was replaced by Natalie at 7.15 am, who thought that yelling at Wm would be an effective way of getting her to push. This tactic did not work: Wm was doing very well on her own with Mark and I gently encouraging her and she didn’t need a staff sergeant. Now we could see the top of the baby’s head with each contraction and excitement was growing in the room. Dr H, however, was tied up in the ER and Kathy returned to be with us despite no longer being on duty. The baby’s head was crowning, and still no doctor, and I was glad we had two nurses!

Finally, Dr H appeared and she quickly donned her gown and got into position to catch the baby. This was surely the most challenging time of labor for Wm, who urgently wanted to push her baby out, and at the same time was in a lot of pain. With much encouragement from an excited Mark, she gathered up the final ounce of strength and out popped the baby’s head. Dr H had been obliged to cut a small episiotomy to allow for passage of the baby’s head, as the heartbeat was dipping a little and the baby needed to breathe air. It was at this point that we saw the cord wrapped around his body, which Dr H expertly unwrapped and proceeded to cut. With Mark’s tears of joy streaming down his face, and Wm unable to believe what she had accomplished, their beautiful baby boy slipped out into the world. He weighed 8 lbs 10 oz and was 21½ inches long.

While Wm patiently underwent extensive repair of the perineum (that took over two hours), I watched Mark fall hopelessly in love with his son as he cradled him in his arms in the rocking chair. Finally, Wm was able to welcome him into her loving, mothering arms and he nursed lustily for 45 minutes. Thank you so much for allowing me to be a part of this incredible journey into parenthood. Your strength, patience and good sense were inspiring!

Your Doula,
Mrs. wonderful December 12, 2007

Our doula was able to capture the events and details that we were in no position to do. However, she couldn’t capture the emotions that accompanied the events for me.

These were:
-Shortly after labor began – tears.

-By the time I called the doctor and by the time the doula arrived – full crying

-By the time we arrived at the hospital – bawling. I’ll never forget the look the kind security guard gave me, which seemed to be one of great concern and pity.

-After the epidural – end to pain. I was a little nervous but excited and amazed that the baby would soon be there. I knew it would be my last evening as a non-parent. Mark and our doula were able to sleep. I lay there with a head full of excited thoughts, pressing the increase medicine button more frequently as the hours went by.

-When the pain began again – some surprise. I had thought the worst was over. But the doctor said she could give me some topical if it got bad, which reassured me.

-I was very happy with the nurse who was with me for most of the time. When the bitchy nurse joined in during the pushing, I was highly annoyed and pissed. I asked her to please be quiet. Mark concurred. “Really,” he said. “Stop it.” She did.

-When I began to push – bloodbath and pain beyond description. This was especially demoralizing since I’d thought the pain was over. I was also upset that the doctor was not there to give me the promised topical relief. Someone else had a life threatening emergency that night (I think an ectopic pregnancy) so the doctor was with her until River’s head had already emerged.

-When the baby came out – freaked out. It felt like a huge mass of weirdness. No instant love here.

-As I was getting sewed up for two hours – more pain, though not as bad as the labor itself. Hurt and exhaustion. I really didn’t mind that River spent his first two hours with Mark.

-First day or two – Continued pain. Another bloodbath (the toilet filled with blood the first time I tried to go to the bathroom and I had to get patched up again – very scary). Some confusion, wonder, amazement. Sometimes I thought he was very cute, other times he looked pretty ugly to me.

-With time, adjustment and love. I came to love him more quickly and more intensely than I expected to.

Have you posted a birth story? Please share the link.

1 comment:

PsychMamma said...

I love reading birth stories!! Thanks for sharing yours. I also love the name River. :-)

Here's a link to my birth story:

And here's a link for an award for you!