Tuesday, October 20, 2009

How I Became a Natural Childbirth Mommy

Childbirth is an extremely emotional topic. I would wager it is at least as emotional as politics and religion. For one thing, it is one of pinnacle events in a woman's life. For another, there are so many contradicting philosophies surrounding childbirth. Births come in about a million flavors. You have your hospital births, some induced, some cesarean, many naturally occurring, and most with many medical procedures and mechanisms utilized to ensure the safety of baby and Mom. Then you have your birthing centers, some of which are equipped with sanitized tubs for water laboring/birthing, etc. Then you have your home births, which occasionally occur in tubs, and which involve either certified nurse midwives, lay midwives, or no midwife. If these aren't enough flavors to throw into the mix, you have the occasional, but extremely exciting sounding car birth (where only a select few are assisted by someone trained in the medical profession).

Then there are the varieties of caregivers, and they too are impossible to categorize very simply. You see, there are obstetricians who favor a great deal of intervention (in their minds - insurance), OB's who feel strongly about only very specified intervention, certified nurse midwives (CNMs) who will only deliver in hospitals - some of them very intervention minded and others more "supervision/intervention when needed" minded, and then there are CNMs who advocate home births. They too are prepared to intervene, but tend to put off interventions until it is clearly necessary. And somewhere in that mix are other care practitioners who may wear one of the above titles, but who may function in more moderate territory.

Finally, there are different approaches to childbirth. There are women who expect childbirth to be difficult work and are happy to have any assistance, intervention, or pain-relief that can ease the experience. There are others who don't look forward to labor at all and want it to be as easy and painless a procedure as possible. Then there are women who are anxious to have a bit of control over the situation, but are happy to have strong guidance of and intervention into their labor and delivery. THEN (have we had enough "then"s?) there are the women who are determined to be very active in all of the decision making connected to their labor. And FINALLY, there are the "die-hards" who are determined to make all of the decisions. These poor ladies are often not well thought of. Many people imagine them having unassisted home-births and expect that they will make headlines such as "Mommy and Baby Lost in Home Delivery" (or something else completely awful).

Does not all this exhaust you? It does me. At 26, when I first learned that I was pregnant with my oldest child, I had no idea what I wanted. I had seen plenty of movies with women heaving and moaning and screaming in what seemed liked a perpetual contraction, and when I thought of childbirth, I had two emotions - confusion and fear. I had heard from plenty of moms that it was indescribably painful. Pain medication in childbirth sounded like one of those angelic pharmaceuticals that rescued women from the anguish of hell. I heard about big babies - 8 pounds or more! Wow! I heard about tearing, episiotomies, birthing pools, more tearing, babies in distress, etc. The issue was huge, and I did the first thing that made sense at the moment. I bought a book - What to Expect When You're Expecting. I mean, here should lie all of the information I would need to make the best decisions regarding prenatal care and childbirth, right?

The next thing I did was call a relative for suggestions on who my care provider should be. My sweet relative mentioned the family practitioner who delivered her baby (oh that I had known to take that reference, because that terrific man actually delivered my second baby!). I gently asserted that I felt strongly about having an obstetrician. (I actually didn't feel strongly about it. An obstetrician just sounded good at the moment).

Well, with very little research or consideration, I took the first OB name she threw out and scheduled with him right away. After two visits, however, I tearfully realized that I wanted a more "first-time mom friendly" environment. This first OB seemed rushed and to the point and didn't take the time to explain things as I wanted. I was also moderately-ill up until 20 weeks, and I wanted more sympathy than he was offering. So I took the next suggestion that was thrown at me, and this time I ended up with three very highly qualified OB's in a beautiful new office. Their bedside manner seemed great as far as I could tell. Joke nicknames like "baby-meister" were tossed around. One doctor suggested that if I needed to take a couple of Flinstone vitamins as prenatals during the sick stage, I should beware of saying "Yabba-Dabba Doo!" Oh, they were darling. And their credentials looked great. Well trained, highly qualified, very skilled in the cesarean, forceps, vacuum extraction. They were sensitive to the pains and discomforts of pregnancy with in-office B6 shots and kind, friendly nurses to take phone-calls whenever. They even enjoyed starting you out at your first visit with a short, free ultrasound. And after every visit, you got a delicious chocolate. I loved my check-ups, and it seemed clear that whichever of the three I ended up delivering with, I'd be in good hands.

There were only two problems with these obstetricians, and I didn't really understand the problems until I was pregnant with my second child three years later. First, they had a sign in their office that said something a little like this: "We are very concerned about the safety of our patients and their babies. For this reason, if you would like a birth-contract, doula assisted, or Bradley birth, please let us know so that we can transfer your care elsewhere." My husband noticed this sign at our first visit to the office, and he thought it was great. He had heard some negative things about intense, naturally-geared women and about doulas, and he had already formed a strong opinion against them. He liked the doctors for asserting themselves so. I can honestly say that I think that sign is great. I don't like the attitude connected to it, but being upfront can save time and grief for a woman who really pays attention to it.

I'd like to re-translate the sign, however, to explain what these doctors were really saying. It should have gone a little something like this: "We each attended medical school for many years and have all delivered lots of babies. So let's make one thing really clear - We're the experts. Please don't bring someone into the room who might interfere with our doctoring, like a doula. Please don't ask us to sign a contract trying to respect your birth wish lists. And please don't try to disagree with us on when and how your baby should be born. We're the experts. That's why you're here, right?" In other words, these doctors were pretty determined to call all of the shots on your delivery.

The second problem with these doctors (which was really a tenet of the first problem) was that they do not feel the need to discuss things with you. They tell you what will happen instead of discussing options with you. You do not have the option of declining a test, a shot, or a procedure. This wasn't very clear during the prenatal visits. It only became clear after the birth of my baby, and even then it was years later before I really understood how controlling they had been.

The only way to illustrate this is to just describe the labor, so here goes. At 39 1/2 weeks, I went in for my routine check-up. In the previous week, one OB had declared that my cervix was dilated to at least two centimeters. "Hurray," I had thought. That's hopeful! But when the next OB checked my cervix, he said that I was dilated to no more than 1 or 1 1/2. By this time, I was huge and exhausted. Having started pregnancy at 160 pounds (ish), I now weighed 225 pounds. I had educated myself so poorly on appropriate nutrition and had already been such a big eater that, once my pregnancy sickness ended at 20 weeks (when I had already gained a good 20 pounds), I went nuts and did not exercise much at all. I felt terrible. It was obvious that I was carrying a good sized baby (who turned out to be 9'3"), and big babies are not a happy thing in obstetrics. Of course, I happen to be 5'9" tall and have a large bone structure. So, a big baby, while not a thrilling idea, shouldn't have made anyone panic. But with this practice, over 9 pounds is not okay. After the OB at this 39 week check-up gave me a quick ultrasound to make sure the baby wasn't breach, he said, "Well, let's have another look." Then came a cervical check that was much more painful than the first. He said, "No, you're still the same, but let's send you in for a non-stress test. If you fail, then we'll just induce you." Not to my surprise, I had started bleeding after that 2nd cervical check. I learned/realized later that what the doctor had done was strip my cervical membranes. Usually, when doctors do something like this, they discuss it with the patient first.

I passed my non-stress test with flying colors and moped home with my husband feeling very forlorn that I wasn't going to be induced or something. I felt so huge and terrible, and I just wanted my ginormous baby out of my body. Then the strangest thing started happening - I kept wetting myself. Except, I wasn't peeing. After at least 3 0r 4 hours of noticing liquid every time I leaned forward or backward, I became confident that my waters had started leaking. I spoke to the OB on call (a different one from that day's check-up), and he declared that if my water had broken, then it would be gushing down my leg. My husband and I had taken a one day class (offered through their practice) where the nurse mentioned that occasionally the waters only leak, and then it is as if the baby acts as a stopper. So instead of gushing, you just having some dripping of fluid as you move around. He advised me to go to the triage at the hospital to be checked and confirm the fluid. My husband and I headed over to the hospital, and I was checked for leaking. Unfortunately, the paper which nurses use to identify amniotic fluid (which turns blue at the presence of fluid) shows the same reaction to blood, and I was still bleeding slightly. So it was near impossible for the nurse to confidently identify the fluid and confirm that my waters were leaking. I was certain however about the fluid as I continued to leak and leak in the hospital, and the doctor decided to have me admitted and wait to see if I began laboring. So I was placed in a bed, given an IV, hooked up to fetal monitoring, had my temperature taken and dilation checked (just 2 centimeters), and then I sat and watched Dave Letterman with my husband.

Now I had read in a magazine that epidurals can slow down labor and hinder pushing somewhat, so I hoped that with my background in theatre and my previous training with relaxation and yoga, etc., I'd just instinctively be able to relax my way through contractions. The thing was, I had not yet been able to identify contractions. I had been told during the non-stress test that I was having contractions (1 every 5-7 minutes), but I had been sure that it was just my baby stretching or something. I didn't realize that those "Braxton Hicks" were actually beginning contractions. I had been having them on and off for weeks.

At about 11:00 PM, Dr. G (my on-call OB) called and said that if my body didn't kick in with the real contractions by midnight, the nurse would start administering Pitocin to induce labor. I said okay and thought, "Please, body, get to work." I had heard horror stories about Pitocin making labor more painful than it naturally would be. At about 11:30, I felt my first natural, strong contraction. It was something like a deep, burning menstrual cramp, and I had no idea how to react to it. I was suddenly afraid and declared to my husband that I wanted my epidural. While the anesthesiologist was placing the needle and tube for my epidural, I felt two or three more contractions like the first, and I was grateful for the upcoming pain relief. Then I laid back and felt my legs slowly start to numb and become very warm. My first thought was that the relief was sweet. My second was,"How long will I have to lay here like this?"

The nurse added the Pitocin to my IV at midnight, and my husband and I started the long wait. The room started to feel pretty chilly, so I asked my husband to turn the heat up. This continued for the next hour until the room was 80 degrees, I was covered in blankets, and the nurse came in wondering why it suddenly felt like furnace. She decided to check my temperature again, and I was running a 102 degree fever. After a phone call, the nurse added anti-fever meds and anti-biotics to my IV. I had some ice chips, my husband video recorded me (speaking in slurring, drunken tongues), and he and I continued to play the waiting game. I was catheterized, so I didn't need a potty break, but I wanted to move onto my side. I couldn't move my warm legs, though. I didn't enjoy it. I felt nauseated. The nurse continued to check my dilation, adjusted my Pitocin up and down as was necessary ("You've had a couple of big ones there. Let's make sure that uterus doesn't overdo it...") I threw up a couple of times, and then I just laid there, waiting to get to 10 centimeters. There was nothing good on TV, and I wasn't interested in a movie or anything. I slept a little and laid there a lot. My husband got me ice-chips as I requested, caught my vomit in a little container, and slept the rest of the time. I must've dozed off after a few hours, because when I woke up it was about 7:00 AM and I was at 10 centimeters.

I was also extremely nauseated and started throwing up large quantities of bile. When I was done vomiting, the nurse placed my legs in stirrups and pointed out to my husband that our daughter had a lot of hair on her head. This was cool for them. I had stopped administering the epidural medicine sometime in the early morning and hadn't administered in a while. I wanted to feel my contractions so that I could push better. I could feel pressure, and I hoped it would help me push. The nurse removed my catheter and coached me on some practice pushes. I had no idea what I was doing. I was supposed to pull my legs back, but I couldn't feel my legs to control them. I couldn't feel my other lower muscles. I could only feel pressure from my uterus.

For the first 20-30 minutes I kept thinking, "Where's Dr. G? Isn't he supposed to be here?" I didn't understand that the doctor wouldn't be there during the whole pushing stage. They knew better than I did that I was not going to have my baby within that first 30 minutes.

The next part is really just a blur. My husband and I had made the mistake of giving our phone number out to family members and announcing the induction. During the next hour, my mother repeatedly called and the nurses told her to call back later. Dr. G arrived, and suddenly the room was full of people telling me to push. I pushed as best as I could imagine, though I still couldn't feel my legs and my arms were exhausted as they tried to pull the legs back. I could only feel the pressure of the contractions and then I'd scrunch up my whole body. I'm sure I did a terrible job. I had no idea if the baby was crowning or what until my husband started to say, "She's almost here." I pushed when told, and after my pushing had hit an hour, the doctor told my husband that he was going to vacuum extract the baby. During this time, I was still running a slight fever and my IV was flowing so fast that it was leaking down my arm. The doctor performed an episiotomy, hooked up the vacuum, and pulled my baby out on the next push. I tore all the way to the rectum, but it was over. She was here, and that was all I thought of.

She was beautiful and big and red. She also had a little mechonium (Baby's first bowel movement) on her body, and they wanted to make sure she was okay, so after they held her up to show her to me (sorry, Mom, no holding her yet), they took her to the nursery for some oxygen and a bath. My husband asked if he could go too, and I laid there satisfied to be done. Then the phone rang, and this time I took the call from my mom. While I chattered away on the phone, my doctor pulled on the cord and removed the placenta (mostly intact) and started to stitch up my 4th degree laceration. By the time I got off the phone with my mother, Dr. G was gone. Then it hit me that I was in a lot of pain. The epidural tube was removed, the IV was removed, and I was alone with a very young, well-intentioned nurse who started to push hard onto my belly. Then the worst pain began. I was so shocked that I cried out with each push. I was apparently bleeding quite a bit, and the nurse kept responding with exclamations like, "Wow, that clot was bigger than my fist!" (This didn't help.) The room was bright, but the lines in my vision started getting really fuzzy, and I KNEW that I needed to use the bathroom. I tried to ask her to help me to the toilet. I kept repeating myself, but she kept saying, "What? I don't understand you." My speech was very slurred, I guess. This time, however, it wasn't the drugs. It was the pain.

Hesitantly, the nurse helped to lift my huge body while I hobbled to the toilet, and I sat down and tried to release the urine from the bladder. I couldn't feel my muscles to release anything. I just watched the blood drip, and I could feel the stitches tug as I sat on the toilet. I could tell that the nurse was terrified with me sitting there. When I stood up, she moved me to an inflatable-ring in a wheel-chair, brought me down to the recovery level, and delivered me to my new nurse. I had no idea what was happening or where I was going.

The recovery nurse helped me into my new bed and gently touched my abdomen, and I cried out again in pain. I started pleading with her, "Please don't bring me the baby. I'm so afraid I'll drop her. I can't hold her yet." She leaned forward and kindly explained to me that my bladder was full, and she was going to catheterize me and get me some better pain medication. When she catheterized me, the bag filled up with a quart of urine (which is apparently a lot). The nurse called the doctor and got me some Percocet. After receiving my new wonder drug (which I continued taking for more than a week), I closed my eyes in the dim room and drifted off to sleep for at least 3 or 4 hours. When I awoke, I felt like a different person. David and I then happily requested that our baby be brought to us, and I got to hold her for the first time. She was very beautiful and big. And pretty sleepy.

Over the next several weeks, I had a difficult recovery. Recovery is always hard for first time moms, but I learned that a 4th degree laceration (when the patient tears all the from the vagina to the rectum) is a serious issue and is difficult to recover from. I had no idea what I was doing with nursing, and our daughter was very tired and didn't latch for the first day. When she finally did latch on the second day, I didn't care that it was a painful, poor latch. I was just relieved that she was nursing. We encountered many difficulties over the next several weeks, including yeast in my milk ducts, and by 6 weeks, she had finished being hungry after feedings. I had begun to offer supplemental bottles when I learned that she was only gaining about 1-2 ounces per week in the first month (it should be at least 3-7 ounces per week). When she learned that she didn't have to be hungry, she refused the breast entirely in favor of the bottle (smarty-pants!!). At 8 weeks post-partum, I was still bleeding, and the doctor discovered that, upon delivering my placenta for me, he had left some placental remains in my uterus. He plucked it out and got me an ultrasound to make sure there was nothing else remaining. (Incidentally, placental remains in the uterus can hinder milk supply, as the body is a little confused and still thinks it might be pregnant).

So, that was my first labor. I think it was terrible, but the true is that a lot of what I experienced is somewhat common. For the next three years, I shared my labor experiences like a great sports story. I was irritated when friends or family criticized my doctors or the hospital where I delivered. I felt like someone was telling me that I couldn't make a good choice for myself. What did they know? I considered myself terribly unlucky. It was only when I started taking a Bradley class almost 3 years later that I realized how little my labor complications had to do with luck.

Well, mommy duties are calling, but in the next post, I will share about my realizations about this labor and the care-givers. I will also share my transition to being an enthusiastic "natural" mommy.

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