Saturday, February 14, 2015

The birth story of Rowan

From the time I was a little girl, I always dreamed about being a mother. I knew I wanted lots of babies, and could not wait to be pregnant, to give birth, to breastfeed. As a teen, I decided that when I did eventually have babies, I wanted to try natural childbirth. I imagined labor often, and thought I would be good at it--I wanted to try at least! 

The journey to motherhood was more difficult than I had imagined, but after two miscarriages and many months attempting to conceive again, we finally had a successful pregnancy. I began thinking and planning about birth early on--still sure that I wanted to try a natural birth. But, at 27 weeks when my water broke unexpectedly and I was told that due to baby being breech, I would need a c-section, my plans were quickly changed. I spent five weeks on bedrest trying to keep baby girl in as long as possible, and that gave me time to accept the need for a c-section and change my heart so that a safe delivery was all that mattered. When the time came, my surgery went smoothly, recovery was as good as could be hoped, and our daughter Adelyn Piper, though early, was healthy.

When I visited my doctor for my post partum appointment, I immediately asked about future births and whether I'd be a good candidate for a VBAC. I was told that was definitely an option, and I again began to dream of the birth I wanted. After another miscarriage and surgery to correct a uterine septum that was the culprit of the losses and complications, I became pregnant again 13 months after Adelyn's birth, and again began researching and learning about VBAC information so that I could optimize my chances for success. I tried not to worry about the fact that baby girl #2 was persistently breech, but as time went on, it began to be more concerning that she was not going to turn. After trying everything possible to turn her, I finally had to accept that once again, I was going to require a c-section for her birth. I knew that just like last time, the most important thing was a healthy baby and healthy me, but it was still very disappointing. Ella Kathryn was born healthy on her due date, and once again, my surgery and recovery went very well.

When I became pregnant again 13 months later, I knew I wasn't ready to give up on my dream, and that I was willing to give it my all one more time even if it meant being disappointed yet again. I began chiropractic adjustments early, switched providers to a practice of midwives very open to vba2c candidates, and picked out a doula who couldn't wait to cheer me on towards my goal. The pregnancy was my least eventful one of all, with no bleeding for the first time in 6 pregnancies, normal morning sickness, aches and pains, but no complications.

In the final weeks, baby girl #3 turned head down with plenty of time to spare--the first BIG hurdle was crossed, and my hopes were way up! I spent all of my time swirling on an exercise ball, doing pelvic tilts, watching birth videos, and reading birth stories. I was nervous, but so excited and loving the anticipation. I couldn't wait to find out how it would happen--would my water break? Slow and steady progression of contractions? Fast and unexpected?

At 39 weeks, I had my cervix checked during my appointment, and was bummed (though not surprised) to find out that I was "closed tight", but 50% effaced. I had been told previously that my cervix had scar tissue on it, and we weren't sure if that would interfere with dilation, so I was nervous that my due date would come and I would still be unfavorable for induction, and would be forced to schedule a third c-section. I had been using Evening Primrose Oil, Red Raspberry Tea, and for weeks to prepare my body as much as possible, but really struggled to trust that my body would know what to do in the right time, and so I spent a lot of time worrying and praying and trying to wait patiently.

Every night for a couple of weeks, I had contractions every 8-10 minutes that were painless, but consistent, and I tried not to get my hopes up each night as I timed them. I stayed up late each night, watching birth videos and eating popcorn and OJ (which is why I gained more weight than I had hoped)...Finally, a few days before my due date, I felt a few that were different--more painful, engaging different muscles, more intense...and I thought maybe something was beginning to happen. At 39+5, I finally had a day without heartburn. I told my husband (and Facebook) that we were going to Moe's for dinner and I was going to eat SO MUCH. Several comments on my FB post were accounts of Mexican food preceding labor, but since Eggplant Parmesan had already failed me, I didn't have much hope. I knew it would taste good and that was enough for me, so I went and did some serious eating. Afterwards, we went to church for our small group, then headed home where for the first night in a while, I didn't bother doing any hip circles or pelvic tilts, didn't drink any tea, and just hung out until bedtime.

 I went to bed with the usual pattern of contractions, but woke up a few hours later to painful, much more intense contractions that I immediately knew were the real thing. I got out of bed at 3am and went to time the contractions, finding them to be about 6-7 minutes apart. I woke up my husband (Nathan) and called my doula (Jerri-Anne) to let her know, but told her I thought I had some time and not to come just yet. I wanted to get in the shower and see what would happen to the contractions, and to gather my thoughts before letting things start rolling. Plus that's what always happens in birth stories, so it seemed like the right thing to do.

Pretty quickly after getting into the shower, I realized I was not going to be able to sit and relax and buy some time, but that things were progressing in intensity and I wanted Jerri-Anne sooner than later. I got out and messaged her on Facebook, still trying not to admit I was really antsy, but she picked up on it and quickly said she was on her way. Once she arrived, she sat with me and timed my contractions, and when 6am came, I called my mom to come get my girls ready to leave with her once they woke up. She came soon and the girls got up and snuggled me for a few minutes and had breakfast, and then Jerri-Anne suggested we all go for a walk to see what would happen to my contractions. We headed outside and began the circle around the neighborhood, I'm sure looking like quite a little parade at 7am.

As we walked, I very quickly had a contraction, but was able to walk and talk through it. A minute later, the next one came and I had to slow down a bit, but still kept moving. One more minute and another contraction came, and this one had me stopped in my tracks. They were painful, but still manageable, and I was trying to stay as relaxed as possible and wait for Jerri-Anne to tell me what to do next. After two laps and many stops, she told me the contractions were really close and she thought we should head inside and call my midwife, and I was pretty relieved to hear that suggestion.

I called and was thrilled when my favorite midwife, Meg, answered and told me to head on in, and that she would be there all day and all night. She had been the one I saw at 39 weeks and had spoken to on the phone about my options for passing my due date, and I had let her know my intent to try induction before consenting to a c-section. She had been very supportive and encouraging, so I was thankful that she would be there, already familiar with my goals and wishes.

My mom got the girls loaded up and I kissed them goodbye, and started gathering up our things,  mentally kicking myself for not packing and preparing in advance. I felt a sudden sense of urgency to get going, so we left pretty quickly to make the hour drive to the hospital (and totally forgot to bring any outfits for baby girl, including the one both of her sisters had worn home from the hospital that I hoped she would fit into as well!).

I had been nauseous ever since waking up, but Jerri-Anne and Nathan both were encouraging me to find something I could eat before getting to the hospital. I had tried some cold diced peaches with no luck, but finally settled on a smoothie, so we found a Panera on our way and pulled in, Nathan promising to hurry as he went inside. Jerri-Anne was already at the hospital, and after a lot of really painful contractions, we finally pulled in to the parking deck. As I got out of the car, another contraction hit me and brought tears to my eyes, and while holding on to the side of the car and breathing, I saw a lady watching me with a sympathetic smile. I realized I was REALLY in labor and about to have a baby, and I had to work to collect myself and stay focused. The walk from the parking deck to the hospital entrance seemed very long, and I had to stop several times to breathe, but finally we arrived and headed up to check in.

Once we got in to a triage room, I finally threw up all of the smoothie I had managed to drink, and tossed the rest in the trash. Meg knocked on the door around 11am, and as she walked in, my water broke. We joked about how she had made it happen just with her presence, but that I was definitely staying now no matter how far progressed I was. I told her I hoped to be a 12 because I was ready for action. She laughed and called me an overachiever, and then checked me, her face quickly showing that I was far from a 12. In fact, I was a 1. Baby was low, cervix was soft, but I was only 1/10th of the way done. Ouch. She told me that she could feel the scar tissue on my cervix holding it shut like purse strings, and she tried to break it loose and hoped that I would see some progress from that. She also noted that my fluid had very slight meconium staining, which meant when the time came to push, the NICU team would come in and in the event baby girl was not immediately crying, she would have to go to the warmer to get suctioned and evaluated by them instead of on my chest. I was not at all happy to hear that, as the biggest thing I felt I had missed by having c-sections was that first moment of having my girls straight into my arms, skin to skin, and able to breastfeed immediately. I wanted that moment SO much and was hoping I was not going to lose out on it again.

We got moved to a labor room and met our nurse for the rest of the shift--Michele. She was nice and we quickly got a good vibe from her, so conversation flowed easily between us all as she got things set up in my room. While Nathan and Jerri-Anne got my essential oil diffuser set up and some oils going (Thieves for germs and Orange for mood and energy), I went to the bathroom before getting in bed, and took a moment to collect my thoughts. I was not able to get a room with a tub as I had hoped, but was thankful for wireless, waterproof monitors available, so Michele got me outfitted with one and then had me get in bed so she could start my IV and run the antibiotics needed because of my GBS+ status. I think I vomited again somewhere in that time frame, and Jerri-Anne sat by my head with a barf bag and tried to distract me while the IV got started. Laying on my back quickly made my contractions harder to deal with, and I felt my ability to cope beginning to slip away. I started thinking about an epidural, but kept telling myself "just don't say it out loud...if you say it, it will happen". Jerri-Anne had asked me weeks before if I wanted some type of code word in place for if I was asking for an epidural so she could discern if I really wanted it or needed her to talk me out of it, and I had told her no, that if I asked for it, I would mean it 100%.

After a few minutes of trying to stay distracted and beginning to struggle, the anesthesiologist came in to talk with me and go over the options available to me. I knew this hospital was one of very few in the US that offered Nitrous Oxide, and I had planned to let that be my "last resort" option to help get through transition or pushing, but yet, at a measly 1cm, I was having such intense contractions every 2 minutes or so, and quickly losing steam, so I asked to go ahead and start trying the Nitrous. Even as I asked, in my head I was thinking "just give in, tell them to start setting up the epidural..." but I was determined to hold out a little longer. I had said all along that even though I wanted to try to go drug-free, that if my labor was very long and got super intense early on, I wouldn't hesitate to use the epi when the time came, as the VBA2C was more important to me than the natural labor goal, and I wanted to have the strength and energy to push well.

The Nitrous machine was brought in and I was instructed how to use it, and began trying to take nice deep breaths into the mask at the onset of each contraction so that it would hit me by the time the pain peaked. It only took a couple of contractions for me to find that I was feeling absolutely no relief from the gas, and I was beginning to get frantic during contractions, losing control of my breathing and gasping and crying instead. Jerri-Anne stayed right by my head, holding the barf bag as I continued to throw up off and on, and doing her best to calm me down and help me breathe. Nathan was on my other side, holding my hand or rubbing my back and encouraging me to breathe slower and relax. After a few more contractions, Jerri-Anne told him to go ahead and go get some lunch and take a break, and soon after he left, I finally broke down and told her I wanted the epidural, I was sure, I didn't need to wait for him to come was time. She agreed and went straight to find Michele and let her know, and I was very relieved.

Around 2pm, the anesthesiologist got set up and had everyone leave the room except Michele, and got the epi placed. I warned her that I have scoliosis, and she felt sure she could work around it, but then had trouble getting in the right spot and I could feel that the tube had gone to the right instead of center. She told me to give it a few minutes and just see, but as my right side grew increasingly numb and my left side stayed the same, I knew it was not working as planned. I finally convinced her to retry, and the second time it worked better, although still not affecting my left side as much as right. They got me positioned on my left in hopes of encouraging the medicine to spread that way, and Nathan and Jerri-Anne came back in, followed soon by Meg ready to check on my progress. I told her surely, this time I would be a 12, but once again, not the case. She told me I was still a 1-2, but then she did some serious manipulation of my cervix and finally said "there, now you're a 4--I just broke up all that scar tissue and I think now you'll be on your way quickly".

I was disappointed to still be so far from complete, as I had really thought that I would be closer. Looking back, I do think that I was in transition, but that my cervix was just stuck and unable to join the rest of my body, I was much more relaxed though and able to talk and rest and text updates to friends and family for the next hour or so. Michele told me that in NY, where she was from, VBACs did not exist and that it had been a surprise to her when she moved to NC and began working. She told me that up until a couple years ago, a patient like me would have terrified her, but that she was coming around to the idea of it more and more. Meg checked again and I was a 6, My pain started to creep back in on my left side in one spot, and over the next couple of hours intensified until once again, I was in a great deal of pain and struggling to cope with the contractions. I was checked again around 6:30pm and found to be complete and that baby was very low, but I was feeling no desire to push at all, so she agreed I could wait a bit and labor down and try to push when it felt right.

I was very nervous about pushing, as I felt like I had learned and prepared a lot for the rest of labor, but not at all for this part. Jerri-Anne asked me what I was feeling and I just told her I was nervous, not ready, didn't think I could do it yet. I had heard and read so much about the instinctive urge to push, and breathing the baby out instead of coached pushing, so I thought and hoped if I just waited for that, it would happen easily...

After about two hours, Jerri-Anne started trying to convince me to at least do some bearing down and see what happened. Nathan told me later that my temperature was starting to go up and he and Jerri-Anne could see the nurses exchanging looks that said they were getting antsy, so Jerri-Anne was afraid they were going to put me on the clock and begin pushing interventions if I didn't get started. I was feeling so tired and almost like I could just fall asleep between contractions if everyone would just leave me alone--I really wanted to just retreat inside myself and tune everything out, but Jerri-Anne kept telling me to try, so I did. I realized soon that not only did I not feel any urge to push, I also could not feel anything happen when I tried to tell my muscles to do so. I asked to try getting on my knees facing the raised head of the bed, and was able to move my legs well enough to get there, but attempts to push that way were still completely unsuccessful.

My pain in the one spot on my left side was becoming unbearable, and I was getting frustrated that I couldn't figure out how to even begin to push. I asked for the anesthesiologist to come try to fix my epidural to see if it would get rid of that pain, but she was unable to do anything about it, much to my dismay. Michele had been replaced by Lesley, who was nice, but less personable, but who wanted to help get pushing going at this point as well. At this point, my heart rate had crept up into the 150s-160s, higher than baby's, and Lesley felt that it was hard to discern on the monitor whose heartbeat was whose, so she insisted on an internal monitor on baby girl's scalp. I had felt strongly that I would not want that to happen except in case of emergency, but at this point didn't have the energy to fight it and just let it happen, knowing it wouldn't be for long. I was feeling pretty awful and sweaty and flushed from having my heart rate so high for so long, so we got out some Ylang Ylang oil and rubbed it on my heart, and thankfully it worked quickly to lower me back down into the 120's-130's.

I got back on my left side and Lesley started talking me through a few contractions to encourage me to push, and I did my best to listen, but still couldn't feel anything at all happening when I tried to push out her fingers, so even though occasionally she and Jerri-Anne would tell me I was doing it right and to keep going the same way, I had no idea what was different and couldn't feel any change, which made me really frustrated. I had a good cry for a minute at one point, and then pulled it back together and decided I had to figure out a way to do it. Nathan was on my left side, and rubbed some Peppermint oil under my nose to help me breathe after I had gotten totally stuffed up from crying, Jerri-Anne was on my right continuing to coach me through each contraction and try to find something that would click.

Finally, even though it didn't feel like I was doing anything right, baby girl's head moved down into sight and Jerri-Anne asked for a mirror so that I could see and hopefully better engage the right muscles that way. I could barely see what they were seeing, so it was much less motivating than I expected. Contractions had spaced out to every 6-8 minutes which was infuriating as I held my right leg up in the air, people surrounding me waiting for the next chance to coach me on... I tried to focus on the song I had planned for months to use during labor to help me stay calm, but found I couldn't get through the second line. Mostly I just stared at the mirror, not entirely happy with how things looked, but glad at least to see that it didn't seem like I was going to poop while pushing, something I had tried to get over fearing but failed.
 Holding my breath long enough to get more than two pushes per contraction was nearly impossible, and I was frustrated when everyone kept telling me to keep going, push again, don't let it out...and I just could. not. do it. I let myself get a little angry off and on, and tried to use it constructively, and then alternated praying and asking for help, pleading for the strength to get through what seemed so impossible at that point.

I kept watching the clock, wondering if I would get her out before midnight, my due date. Every time I looked up, it seemed time was going more and more slowly and I felt like I had been pushing for so long without progress. Finally though, I began to see a little more of her head with each contraction, which finally got me feeling a little more encouraged that I was doing it and COULD do it. Meg started hanging close by, and I knew that once they took out my catheter and called for the NICU team it would mean it was really close, so every contraction I wished for Lesley to say those things. Finally! She said she was going to take the catheter out. I was excited. I still wasn't feeling a lot of sensation that was helpful for pushing, and still feeling a lot of pain, but had figured out how to make my body do what it needed to push effectively. My left eyeball felt like it was going to pop out of my head with each push and was often the thing that made me let up when everyone kept telling me to keep going longer. I told myself surely it wouldn't actually pop out, and tried to ignore it, but the feeling was so intense and impossible to ignore.

Around 10:45pm, I could see almost her entire head, and could see that I was on the verge of tearing. I was focusing very hard on not letting her slip back up in between contractions, and waiting impatiently through the long break between them. I knew it was really time, and finally, Lesley called for the NICU team to head in and get in place. I pushed four times the next contraction--my best pushes yet, and saw even more of her head. It seemed impossible that she wasn't out yet, but I knew the next contraction was IT. Meg told me she wanted me to push her whole body out and not just her head, so when the next contraction came, I gave it every bit of energy that I had, and watched as my baby girl came FLYING out, crying immediately and therefore able to come straight up onto my chest. I instantly felt an intense flood of emotions as I looked at her, and felt the relief that I was done, I had done it, and this was finally the moment I had always wanted. She was big, beautiful, alert, and the feeling of having her in my arms right then was the most incredible thing I had ever experienced. I cried and laughed and looked around in amazement as we dried her off and inspected her, Nathan crying and laughing on my left, and Jerri-Anne on my right. It was 10:57pm, a whole hour and three minutes to spare before her due date.

I got my wishes of letting her cord stop pulsing before clamping it, and then since Nathan didn't want to cut the cord, I asked if I could and happily did--something I had looked forward to for months. Meg informed me that she was delivering the placenta and then pretty immediately needed to get started stitching my tear to try to stop some of the bleeding. I was already nursing happily and didn't mind most of the stitching, but it ended up taking about 90 minutes and towards the end was pretty uncomfortable. I had asked to see my placenta before they took it away, but somewhere in the midst of all the clean up, Lesley knocked it off the bed and it fell on the floor, so I never did get to inspect it.

Baby girl got taken briefly from my arms to get a diaper and weigh in, 8lbs 9oz and 20.5 inches--a good bit bigger than my other girls who were 3lbz 9oz and 7lbs 4oz! We still were undecided on her name for the next few hours, but once we were settled and resting, Jerri-Anne hugged us and congratulated us and headed home, and we got moved over to our post-partum room (after I very nearly passed out in the bathroom), and settled in there for the rest of the night. Somewhere close to morning I finally decided that her name was Rowan Amelia, one of the two names we had been stuck between for several weeks.

Recovery was a bit tougher than I had anticipated, though in many ways better than a c-section. Because of the significant tearing and stitching that I had, I was still in a good bit of pain and had trouble getting up and down from the bed. I also had a very hard time emptying my bladder for the first day and had to be re-catheterized (by a nursing student doing the procedure for her first time, eek!) in order to get relief from a bladder that I felt sure was going to burst any minute. Nursing got off to a good start, and Rowan and I enjoyed snuggling and nursing constantly throughout the rest of our stay and in the early days at home.

I am so very thankful that I found a hospital and midwives open to letting me have the birth I wanted, and that throughout my labor nobody talked about the possibility of a c-section, or made me feel pressured or rushed. I'm thankful for my husband and Jerri-Anne providing wonderful support and encouragement throughout the process, and that everything happened that needed to in order for my delivery to happen. Though most of my birth plan went out the window, I am still very happy with the way things went and know that I worked very hard to experience the hardest, strangest, most intense, and most amazing thing I could have ever imagined. I can't wait to try again and do it even better next time. I definitely think because of the scar tissue making my cervix unable to dilate as my labor got so intense, that I needed the epidural to make it through, but that it also made pushing and recovery a lot harder. I think that next time, without that factor, I am likely looking at a pretty quick labor, and hope that I can give it another shot at no meds.