Tuesday, October 27, 2009

My Second Bradley Birth, well sort of...

I say "well sort of" because, in my mind, a Bradley birth is more than just unmedicated birth. It is relaxed, more comfortable birth. It's a really wonderful experience, and I fully admit that I wish I could share the Bradley gospel with all women, because it is such a blessing to not have to fear labor and be in terrible pain. I said "sort of" because baby #3's labor wasn't as comfortable and relaxed as baby #2's labor was. His birth, however, was at least as surprising.

By the way, I'm reading the Hypnobirthing book right now, and it's pretty amazing too. I've noticed so far that the main difference between Bradley and Hypnobirthing is that Bradley tends to be a little more comprehensive and inclusive of diet, exercise, education on medical interventions and their risks and benefits, etc. It's a little more medical minded, and hypnobirthing tries to be a little more natural minded. So far hypnobirthing seems to be mainly about the birthing event, but that's not to bag on the book. It's extremely positive and has already helped me start to feel better and have more faith in my next labor, and I'm only halfway through it!

The biggest reason I am about to share this experience, even though it's not a very relaxing one, is that if an induction becomes necessary for your baby's safety, it is still possible to have a good, healthy labor without an epidural. I say this because when I was pregnant with Mr. Handsome and had not yet experienced childbirth without medication, I was uncertain if I'd be able to ever endure a Pitocin induced labor. From my third labor I now know that, while there is a difference in the pace of contractions and the environment in the labor room (more anxiety than is ideal), the contractions don't actually get any stronger than your strongest natural contractions. A woman can still relax through those powerful contractions and give birth to her baby without feeling the need for an epidural. Isn't that good news?

Here's my story:

After a normal, low-risk, healthy pregnancy, I went to my 39 week check-up with my two rowdy kids in tow. There was a male midwife in training joining the regular midwife, but that didn't bother me. He just happened to have been there when I had my strep-B swab a few weeks before (how nice), so I didn't care that he was there to hear a heartbeat. To our surprise, the heartbeat was low - around 90ish (when it should be around 120). I had noticed some slowing in the baby's movements, but he had still consistently moved pretty frequently throughout the day. It had also become difficult to take the time to count movements since I was chasing after my other kids, and summer vacation had just begun. Anyway, the midwife suggested that I have a non-stress test (aka NST) in their office for an hour or two. It was disappointing, but I will admit that I had been very anxious for several weeks now. Mr. Handsome's birth was often running through my mind, and I was practically convinced that something would not be quite right again. I still wonder if this was self-fulfilling prophecy.

During the NST, the heartrate was not steadily low, but there were variables in the heartrate. It would look great for a few minutes, and then there would be a small drop, and then it would be great again for a few more minutes, and then drop again, and so on. It went back and forth like this. After a rather stressful, uncomfortable hour of watching the varying heartrate (as well as watching my children ransack the room I was in and calling my husband for help), the midwife on call asked me to go to the hospital for an extended NST.

My husband met up with me, we got our kids to his parents, and he and I grabbed dinner before getting to the hospital for my NST. I found a good comfortable position, and this time our baby looked great. No variables for two whole hours. The midwife on call came in, said that everything looked good and he was obviously a healthy guy, but advised that we should check again in a day or two and pray that our baby would come sooner. She speculated that there might be something going on with his cord.

Two days later, we packed our bag in case we had to be induced, got our kids to my husband's parents, bought a birthday cake and OJ for after the delivery, and went to the hospital with mixed feelings. I wanted the baby here and safe and was anxious to birth him, but I wanted him to be healthy and fine and not need an induction. Again I didn't want to have an unmanagable labor, and I feared that if I was induced with Pitocin then the contractions would become more than I could relax through, and I might give in. As a reminder, I didn't want to risk another fever or slowing down a labor or having difficulties pushing the baby out - especially if he was struggling.

I picked the best position I could find and settled in with my husband for the NST. There were variables the whole time. After about 45 minutes or an hour, the little guy did a pretty interesting stretch, and his heart-rate dropped down to 90 again. David and I looked at each other - was that him or me that the monitor picked up? I still don't know, but it was enough to get me checked in for the night. I was not happy. I was as concerned as everyone, but I wanted my body to just get to work. I had a feeling that once my body got going that it would progress fast. And I was afraid of the Pitocin.

I had the blessing of two midwives that evening - midwives J and M. I was grateful, because though M was more experienced and confident, J was a little nicer and more helpful to me. She also had longer fingers. (This is a good thing for cervical checks). I got changed, got my monitor and IV (IV always come with Pitocin induction - that's how they give it to you), and got my cervix checked. I was at 5 centimeters. (Good body. Now why hadn't you started yet, silly?) It was at least a good start. With it being my 3rd baby, no epidural planned, having gone unmedicated before, a great coach/birth partner, and two supportive midwives, things looked good.

For the first hour my contractions felt only like Braxton Hicks, nothing more. But they were steady, and they were a start. During the second hour they increased the Pitocin. The contractions became more powerful, but I could still move around easily. I got up and down to use the bathroom a few times, and the rest of the time I spent on my side breathing deeply. During the third hour, the deep back-pain started and the contractions increased in strength. Midwife J functioned almost as a free doula by pushing on my back during those contractions and being a second support person with my husband. I felt very grateful for both of them.

The progress between the hours was very fast, and there was tension in the room as the baby's heartrate continued to have his variables. Though if I understand correctly, they were more frequent than at the start. During the final 30 minutes of dilation, the contractions had peaked in strength, and it was hard not to vocalize during each contraction. My husband was my hero, holding my leg up for me during each contraction (it helped - I couldn't have a pillow propping it up, because the monitor was right where a pillow would've been). I can't say full out that the surges in my abdomen were painful, but the back-pain was very strong. I was so grateful to still have midwife J pushing on and massaging my back during these contractions.

Suddenly I felt something like a water-balloon popping inside me, and I knew that my bag of waters had broken. We checked and the midwife confirmed it. There was a little mechonium in the fluid, but "not much" reassured midwife M. I asked if I could have a bath. I guess our baby's variables had become consistent enough that they didn't feel good about a bath. Instead they checked my cervix, and midwife J thought at first that I was at a full 10. "Do you feel an urge to push?" No, was my answer, but I wanted to push. They decided to let me try pushing. Then midwife M checked my cervix. It turned out that there was a lip on the cervix.

Okay, only a woman who has had a lip on the cervix knows this one. The contractions are no worse. It's just that, if you are anxious to start pushing instead of waiting a little longer for it to just go away, then what the midwife needs to do is push on the lip while Mom pushes with the contraction. It hurts.

It took two tries to get the lip out of the way, and the second time I literally grabbed midwife M's wrist as she pushed on the lip because it hurt so much (she backed up and suggested that we recollect ourselves). But the lip was gone. I declared that I wanted a mirror, and they propped one right up where I could see it. This was it. Time to push him out. Here he comes.

Except he didn't come as I pushed. This made me more tense. I pushed and did my best, but I was frustrated that he wasn't there. At this point, the room was filling up with people, including Dr. P, one of the nice OB's connected to the midwife practice. At the time, I wasn't thrilled to see him, but it was good that he was there just in case he was needed.

They realized that the baby was posterior and that was why he wasn't emerging. Midwife M was about to turn the baby, but then she said, "No, let's have Dr. P do it instead." I didn't know what to expect in having the baby turned. More pain? How much more? Dr. P walked up with his gloved hand, and midwife M said, "Don't push on this next one." I took a deep breath, didn't push, Dr. P barely reached inside with two fingers, turned his hand, and the baby was turned. I hardly felt a thing. Wow. That guy had magic hands.

For the next 10 minutes the pushes were more successful, and I could see the baby's head emerging. Now here's a challenge in labor that is really unavoidable, but can hurt more in unmedicated labor. Crowning and birth requires stretching. The slower and more gentle the birthing, the easier the stretching and the better it is for both mom and baby. Unfortunately, I had two problems. One, having so much scar tissue from my first labor tear, my body can only stretch so far. Two, once our baby was crowning, his heart-rate dropped and didn't come back up. It didn't stop, but it had dropped. At this point, an oxygen mask was placed on my face.

I was tired. It was after 1:00 AM, and this labor had been more stressful and hurt more than my last labor. I had been humbled by the pain. I was also staring at a mirror where, as I had pushed during the less productive phase, large amounts of brown fluid were coming out. Mechonium fluid meant serious distress to me. And there my body was during the crowning, looking as if it might tear apart as I tried to get this baby out. I was not fully present, to be honest. I was tired, confused, afraid of tearing, and feeling the tugging, stinging pain of crowning.

As I previously mentioned, midwife M approached me and said, "If he's not out on the next push, we'll have to perform an episiotomy." I had been such a bad patient, I felt. I had resisted everyone's advice, and I wanted it clear that I would comply of course. Then I heard the exchange that midwife M had with the doctor where she explained that I'd had a 4th degree laceration before. I realized that I was wearing an oxygen mask and I heard the heart-beat, steady but slow. I felt the next contraction, and this time I really pushed. He still didn't come out, so I kept pushing after the contraction and suddenly he slipped out.

What happened next was almost comical if it hadn't been so scary. Midwife J, who was waiting to receive the baby, reached out and caught him, and her eyes unconsciously widened as she started to unwrap the baby. His cord was tied in 4 different directions - around one arm, two or three times around the neck, around the opposite arm, and around his waist. What had he been doing???? It was amazing that he had only variables in his heartrate. He was completely white, long and slender, and very still. The cord was quickly cut and he was transferred to the incubator and table for examination.

My husband and I were so sure that, if the baby was still with us, he must've breathed the fluid. How could he not have? As the cord continued to come out of my body, we all stared in shock at a tight knot - technically referred to as a true knot. Our little Rambo had not only wrapped himself every which way, but somewhere along the line, he had swam a knot into his cord. What on earth?! Everyone was amazed and grateful that he was out and safer. Knots, if baby gets too big and isn't born soon enough, can mean the very worst, which I won't even say. You know what I mean, though.

People asked me how I was, and I could only stare over at the table. The baby was moving slowly. "Is he okay?" I kept asking. "Did he breath it?" There was very little relief at this point. My husband approached the doctor examining the baby and asked if the baby had aspirated the mechonium. He answered that he was unsure. The baby sounded a little funny, but not very bad. "Let's get him some IV's" and they could tell then.

I told my husband that he could go with the baby, but he was kind and stayed with me. I don't know if it's because he knew that I needed him or because he didn't want to be without me. I delivered the placenta shortly after the baby was born, and then the midwives stitched me up. I completely stopped liking midwife M at this point. She was giving midwife J pointers on a cool way to stitch me, and it felt like I laid there for at least 30-45 minutes shivering to death. I did need a couple of shots of local anesthetic since I'd had none until then. The stitching ended, and I was transferred to the recovery room. Just before or after I was transferred, we were informed that the baby hadn't aspirated the fluid. It was such a miracle to us! He just needed one more IV, and then he'd be good to stay with us.

Hope had returned, but I was humbled. Though Mr. Handsome had aspirated the mechonium in labor #2, the labor itself had mostly gone so well that I had left the hospital almost cocky. It wasn't really an "I'm so cool for going natural" thing. Actually, it was more of a "It's too bad more women don't give this a chance" thing. This time, however, with all of the fear and anxiety, the power, speed, and discomfort of this 3rd labor, the pain with the lip on the cervix, and the whole hour of pushing, I was humbled. Grateful, but humbled. Incidentally, I could walk, but I couldn't pee just yet. :) Too much local anesthetic, I guess.

Two and a half hours after our labor, the final miracle of Mr. Rambo's birth came - he was with us and doing just fine - at 2 1/2 hours! With my daughter, I wasn't ready to hold her until at least 4 hours after birth. With Mr. Handsome, I didn't even hold him until the next day. I nursed Mr. Rambo, and we both held him lots. He was so cute, and we were so happy and humbled to have him. It was a truly blessed event. He had a little jaundice during his second week, but I nursed him a ton, it passed, and there was no hospitalization necessary. His birth weight was 8'1" - a skinny dude in our family, but by the time he was 3 or 4 days old, he was 9'1". That was more like it.

He is such a cutie! He is also completely busy and completely exhausting when he's awake. He is just about 17 months old now, and I cannot leave him in a room for more than a minute unattended, or disaster occurs. He certainly keeps me on my toes (or humbled if I'm not). Of course, I'm 24 weeks pregnant, 35 years old, and have never been pregnant with such a young toddler. But it's all good. We are truly blessed.

Am I glad I skipped the epidural on this one? Well, to be honest, with how he was doing when I was on the Pitocin, I don't know if they would have even let me have one had I asked. I wonder if that's saying something. But I am glad that I didn't have one. Again, my recovery was better, I eluded the episiotomy again and my tearing was less (this time only 1st degree), and I was able to push him out unassisted once he was positioned right. I have a feeling that, had I opted for the epidural, our scary vaginal birth would have turned into a c-section. And I'm grateful it didn't have to. Again, he probably would have been in similar condition, but I wouldn't have been in such good shape.

Needless to say, I'm grateful and humbled that we were in such good hands and that all ended well. Now it's time to be grateful, let go of the fear, and send our little girl positive messages to come safely and peacefully into the world. :) And I'll encourage her to put off passing stools, knitting, or Chinese jump-rope experiments for later. Much later.

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