Well many women who read the account of my first labor would notice much to criticize, and it does not all have to do with the epidural. For one thing, as I pointed out, my doctors were very controlling. Now I will admit that the hour of pushing my daughter was such a blur, and it's possible that Dr. G rushed because he feared the baby was in distress. It would definitely be understandable that having a mother run a fever for over 6 hours might not be good for the baby. But if that was the case, it was not made at all clear to me or to my husband (who was under no influence of drugs and had actually slept a little the night before). All we knew was that the doctor was not satisfied with how I was pushing, and there was no discussion of whether to cut and vacuum or to give me a few more minutes of pushing.
Another naughty OB behavior was when the other OB, Dr. J, stripped my cervical membranes without consulting with me. Stripping the cervix can present many risks, including leaking waters or even occasionally a full-on breaking of the bag of waters. It's an optional procedure that can effectively kick a woman into labor, but it should be a procedure to which informed consent is actually given rather than something snuck up onto a patient.
As far as my hospital care went, many complaints could be made about the nursing staff. Considering I was a first time mom and was receiving a great amount of IV fluids, it was unwise to decatherize me so soon, and the post-partum nurse (the young, well-intentioned one) should have been mindful of that and at least catheterized me again before going at my abdomen the way she did. She was also such a novice and should've considered that a brand new mom in terrible pain might be frightened by hearing so much detail about her loss of blood. (Don't get me wrong - this was at least more disclosure than I'd received much of the morning, but perhaps it was done in an unprofessional and insensitive manner).
I could go on and on. The biggest problem with the entire situation - the prenatal care, the labor, the delivery, and the post-partum care, etc. - was my lack of knowledge. As I previously mentioned, I had purchased and made a valiant effort at reading What to Expect While You're Expecting. The book is difficult to read, though, and is set up in a way that you won't really learn about something unless it occurs to you to look it up and study it. It is also a book that makes a great effort to avoid having an opinion on anything, and so it waters down much of the information. An excellent example of this is the entry on "episiotomy." I'm not sure if a new edition of the book has changed the view (I hope so), but it essentially states that episiotomy assists birthing, prevents tearing, and in order to avoid 3rd and 4th degree tearing, the best option is a "hockey-stick" cut. Now, at the time when my edition was published, "hockey-sticks" might have looked great on paper, but most doctors in my area still wouldn't consider doing them for one very big reason - that's a lot of cutting that might not be necessary. Midline cuts (a small cut straight toward the rectum) might carry a risk of tearing into the rectum, but they were still minimum cutting. Mediolateral (a cut toward the side at an angle) automatically create too much tissue damage, some of which is irreversible. And there is plenty more that I can say about episiotomy, when it's right and when it should be avoided, but it deserves it's own post. At any rate, I did not learn what I now know about episiotomy from What to Expect, I'll tell you that.
So having purchased a slightly useless, difficult to read book (which for some reason made me extra nauseated for my first few months) was the bulk of the my education. The other resources I had were the internet (again a "look it up when it occurs to you" resource), a one-day prenatal class offered through our doctors' office (more of an orientation than a class intended to educate couples), and a lot of intimidating conversations with friends and family. There was so much that I did not understand about pregnancy and labor. It was no wonder that I took poor care of myself during the pregnancy and was terrified of childbirth.
Here's a funny punchline though: Even after my horrible delivery with Dr. G and his practice, upon learning that I was pregnant with my second baby, I returned to the same practice. I had no idea at the time how much a part they had played in my "bad luck" labor.
It was only when my husband, daughter, and I moved into our new house that doors opened for me learning more about natural childbirth. In the years following our daughter's birth, I had many conversations with other moms about labor, and very occasionally I had an exchange with a mom who enjoyed having "Bradley" births with her babies. I knew nothing about Bradley, only that when I met a mom who had experienced a successful Bradley birth, she was extremely enthusiastic about it and would talk your ear off about how great it was (if you let her). When I met my new, very cool neighbor and learned that she had done a Bradley birth, I was very curious. She shared her first birth experience with me, which was very similar to mine with my daughter. Then she shared about her second birth experience after she and her husband had attended a Bradley class together. It wasn't without it's challenges, but the experiences were night and day, and she was so grateful to have been able to birth that way. It peaked my interest big-time. I couldn't ignore the fact that most of the women I met or knew who had planned and prepared unmedicated births were very happy about them, even when the experience wasn't complication free.
The next part of the story is history, as they say. My husband and I arranged for and attended a Bradley class (he was reluctant at first, but soon after enjoyed being so well informed and prepared). I read all of the suggested material, kept a diet log, and did prenatal exercises like crazy. Preparing for natural childbirth became one of my great goals in the coming months and weeks.
The most difficult and sobering part of the journey was the realization that many of my complications in my first labor, delivery, and post-partum were not simply a case of terrible luck. Many of them were the offspring of procedures I had been subjected to or consented to. For example, as I stated, stripping the cervix brings a risk of premature rupture of membranes and possible infection. It might still be the best choice for a woman, but even if the doctor chooses or suggests it, it is not "risk-free." The epidural, which I'd like to discuss/vent about another time, has a risk of a negative reaction (i.e. fever) for some women. The use of antibiotics during labor or afterward with baby brings a risk of yeast over-growth in the milk or thrush infection in the baby's mouth. These procedures are not necessarily bad and are sometimes necessary for a safe delivery, but they always bring risks with them. And women deserve to know about those risks in order to give truly informed consent. I mean no offense to other women when I say that I believe a large percentage of birthing moms are not well-informed on the risks as well as the benefits of medical intervention in childbirth.
After several weeks in the Bradley class, I couldn't NOT think about my labor with my daughter, and when I thought about it I was angry - at my doctors and nurses, at every mom who had ever frightened me away from pursuing natural childbirth, at my husband for shooting it down once when I expressed an interest in natural childbirth, and mostly at myself for not taking control of my pregnancy, taking a good prenatal class (ideally for me, a Bradley class), and having the courage to consider better care-providers. I'm not saying that it was healthy to become so angry at everyone. I just was, and one thing was more clear than anything - if I didn't change doctors soon, I might end up repeating my first labor experience or having one similar to it.
This might sound silly to some people, but one of the biggest things I learned in my class is that the provider is half of the experience. If you are with a provider who understands and respects your desires, communicates well with you, and wants you to be a part of the decision making, you stand a better chance at a positive, safer labor experience regardless of whether you plan to go with or without an epidural. But if your providers are unwilling to consult with you and are willing to take your entire labor into their hands, you could end up the way I did - confused, in terrible pain, and with a difficult recovery.
Okay, some might ask, "But isn't the safety of your baby the most important thing?" Of course it is, and if the safety of my baby was unimportant to me, then I wouldn't be going to a health-care provider and delivering in a hospital at all. Actually, even saying that is somewhat unfair, because I know a few mothers who always birth their babies at home, unless it's medically impossible to do so, and they are very conscientious about the safety of their babies. One of them is a registered nurse who even chooses not have a doctor or midwife at all, and it is her husband who delivers the baby. Sounds crazy? Well I wouldn't feel comfortable doing it, but she is extremely well educated about childbirth, as is he, and they have had at least 1 or 2 excellent home births just this way. The need for an ambulance, midwife, or doctor hasn't arisen and hopefully never will.
This doesn't mean that I'm advocating unassisted home births. I just won't condemn them. For some women, it's the right decision, and it honestly sounds amazing. I just haven't ever felt right about it for myself.
So, back to the issue of a baby's safety - of course it's important. I don't know a single woman who is willing to carry a baby for 9 months just to gamble their safety away like it's nothing. And yet, it is slightly debatable what could be considered a "safer" delivery method/locale. You could definitely argue that a hospital and an OB are the safest - best equipment, highest qualified, etc. During most hospital labors, however, the doctor is not present during the labor and is not visually supervising the patient in their labor. The laboring portion is left in the hands of the labor and delivery nurses on staff, and let's hope they're great! Chances are, however, they are dividing their attention between at least two or more women (especially in Utah county!).
On the other hand, with a lay or nurse midwife, either in a birthing center, hospital, or home birth, the midwife is supervising not only the delivery of the baby but mom's labor. Once it's clear that mom is in labor, the midwife comes to her side. Attending so many labors with typically undivided attention makes for incredibly expert eyes (between experience and training), and, in my opinion, you have the absolute best authority on how the labor is really progressing. The midwife is much more likely to notice if something is not right. She is also more likely to have "seen it all" so to speak, and she'll know if it's a normal part of the unpredictability of childbirth (and if there's anything consistent about childbirth, it's that it's unpredictable), or if it's something that merits medical intervention. Some people panic at the thought that a midwife is not licensed to perform cesarean sections. This might sound like a big red-flag. As one who has delivered with midwives in a fairly complicated delivery, however, I can attest that they are not insensitive to the possible need for cesarean, and they will have a qualified OB in the room during the pushing stage to ensure that a cesarean can be safely performed if necessary. (Happily, in my case, it wasn't necessary! Though that OB had magic hands and turned my posterior baby like a charm!)
Returning to my experience with the Bradley class, at 32 weeks into my 2nd pregnancy, I contacted my Bradley teacher, gave her permission to say "I told you so" (she had warned me against staying with my OB's), and asked for some suggestions. After considering a couple, I decided to try and get the wonderful family practitioner who had delivered my sweet relative's baby years before. He was very popular even as just a family practitioner, but he was only accepting obstetrics patients on certain recommendations. He accepted my reference from my Bradley instructor, and I enjoyed the remainder of my visits very hopeful that everything would go better with this delivery.
I will not go into great detail in this post on the birth of my 2nd child (my first son), but I will say upfront that I did not receive an epidural. My husband and I enjoyed this labor more and felt like active participants. That alone was a blessing and a confirmation that my personality is better suited to unmedicated childbirth. I'm not joking when I relate that my husband actually said to me at one point during the labor, "This is actually a lot more fun." Of course, he was pretty exhausted by the time our son was born, but we both felt good about how our labor went.
I will also be plain and point out that it was not an uncomplicated delivery. I had hoped that a labor free of unnecessary intervention would minimize the complications in the delivery, but there are some things which you cannot prevent - like passing of and aspiration of mechonium. (More on this next time). I will say that, in light of the challenges my handsome boy faced during his first trying hours and days in the real world, I believe that it served him well that he came into the world drug free.
By the way, that same boy is still ridiculously handsome and has a passion for Legos and Wii, which I swear we only let him play on the weekends...
Showing posts with label Bradley. Show all posts
Showing posts with label Bradley. Show all posts
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.
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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