Friday, July 31, 2009

You Ask and I Deliver

I know you've been anxiously awaiting the detailed story of Kate's birth. Why is it that so many women just love this stuff? Perhaps because it's the female equivalent of tales of going into battle. Well, suit up in your pink armor and grab your ruffled sword, cuz here we go!

(Or perhaps put on your gauntlet? Made of hospital bracelets?)

Not exactly the sort of bracelet most people mean for a "push present... Seriously, at some point it actually starts to impede movement!

Kate's Birth Story

Because of Kate's two vessel cord, my doc wanted to induce me a little early. As a pregnancy goes longer, there is the risk that the placenta begins to deteriorate and the baby's supply of nutrients suffers. With a two vessel cord, that's even riskier. She suggested we target an induction at 39 weeks.

So the day after I hit 39 weeks I had an induction appointment for 7am, but I got a call the day before asking to move me up to 6am. After a little coordinating with our babysitter for Claire and Scott, we rescheduled for 6am. So bright and early the next morning, our friend came over to our house to stay with the kids until they woke up after which she took them over to her house for the day.

Now I know that you're not supposed to eat right before your induction, but no one explicitly told me this. One of the forms I was given said that I should ask my doctor about this. Oops! guess I "forgot." "Ignorance" is bliss. I had a light breakfast before we headed to the hospital because I remember being SO hungry while in the hospital with Claire and Scott.

After giving them my info and getting into a gown, the first and arguably worst, order of business was my IV. I hate needles, but only because I have had SO MANY bad experiences. In the past I've tried to donate blood and it usually went something like this. Force fluids for 24 hours beforehand. Show up and have multiple nurses look quizzically at my arms trying to find a vein. Have the first attempt get painfully flubbed. Have the second attempt in my other arm be painful the whole time and end with me just STOPPING bleeding. Like I hit the time limit they allow and I've stopped filling the bag without having donated enough for them to use. Then I have to have M help me do everything for the next 24 hours because BOTH my arms are bruised and in pain. So M made me stop even trying to donate blood anymore. I just don't have good veins AT ALL. With both Claire and Scott my IV was in my hand and quite uncomfortable. With Claire it was in my right hand, and so a big pain when trying to do pretty much anything. And with Scott, it was in my left hand, but it hurt like crazy and made my whole hand cold when they sped up the flow to get more fluids in me so I could get my epidural. I hated that it held up my pain relief! I guess I only have obviously usable veins in my hands. This time there really was only one they could use in my right hand, and it was kinda tricky anyway because they said it was "crooked." And after telling my experiences, they tried very hard NOT to put it in my hand, which I appreciated. The first try was in my wrist just below my thumb on my right hand. It didn't work, but it sure hurt! After some wiggling that made me squirm and break out in a sweat, they gave up. Then the nurse called a different nurse. She tried in my inner forearm on my left arm and same thing. OUCH! I had bruises and tenderness from those failed IV attempts for longer than I had pain from delivery:

Yes, those are my arms. And, no, I am not a hairy man, I swear.

Finally they got a great IV just below the crook of my right arm. It didn't really hurt and it ended up not being uncomfortable to bend my arm like I feared. The only drawback was that anytime I bent my arm, the flow would stop and the machines would beep at me. But if not bending my arm was the price I had to pay to get that epidural sooner rather than later, then sign me up and call me the girl with the stick straight arm jutting out.

Once my IV was in place, they told me my doctor was going to come break my water. Enter M to fulfill his role as my advocate. His primary job this time around was to make sure I got my epidural, fast. In my last two labors, the common factor in what made me unable to easily handle my contractions was my water being broken. So M was under strict orders to NOT let them break my water unless I had an epidural. Fortunately, they had already been getting those IV fluids flowing because they knew I was going to want one, so all I had to do was keep making sure I didn't bend my arm! I conceded to let them break my water as long as the epidural was truly "on it's way." When my water was broken, I was still at about 2cm like I had been since my appointment 2 weeks before. My water was broken at 7:14am and that marked the official beginning of my induction. Pitocin was started either just before or just after my water was broken, I don't remember which.

A couple minutes later, the anesthesiologist showed up for my epidural. The epidural went very smoothly (WAY better than getting my IV!) and as I sat hunched over while he finished up my epidural, I was just beginning to feel guilty about getting an epidural before I had even felt a contraction when I felt one and right off the bat, it was pretty uncomfortable. So perfect timing. I felt a few uncomfortable contractions and then the epidural kicked in and I only felt a sort of tightening occasionally when the contractions came.

After laying down for a few minutes with my epidural, my blood pressure monitor started beeping at us. It was taking my blood pressure every 2 minutes as the epidural came into effect, and the numbers were too low. This might have been okay, except along with it Kate's heart rate was dropping when I had a contraction. They like to see “variability” in the heart rate in response to contractions, but they prefer the baby's heart rate to go up and not down. So something had to be done. First try was to have me tilt over to my left side for improved blood flow for Kate. That wasn't enough, so then I had to lay completely on my left side. In the meantime, the anesthesiologist was contacted about my blood pressure. When my blood pressure continued to be too low and continued to cause annoying chimes from the blood pressure machine, it was decided that they needed to give me drugs to raise my blood pressure. What does low mean, you might be asking? I was measuring numbers like 78/28. So you know, almost deadish. I always have low blood pressure (like it's not unheard of for me to measure at 88/56), but this was really something special. Two doses of ephedrine later, my blood pressure was finally reaching acceptable numbers (meaning the systolic was USUALLY over 90 and the diastolic was usually over 40).

Just then the anesthesiologist checked in on me, but since my blood pressure was okay again, he merely suggested that I lay on my right side for a change or my epidural would get lop-sided. So my nurse tried having me lay on my right side. No go. Apparently Kate's heart rate really just didn't like me on my right side. This fit with what I'd seen the whole pregnancy. I can't even count how many times throughout the pregnancy I remember different medical people commenting things like, “This baby just doesn't like you laying flat on your back.” Or, “Let's have you lay on your left side,” followed by, “Much better!”

Now that things had settled down a little, I told my nurse that I really had to pee. Things had been so crazy that she had forgotten to get a catheter in me. We took care of that and she said it was a good thing too because my bladder could have kept Niagra Falls going for quite some time. No wonder I could feel it through the epidural! The nurse suspected it had been impeding labor. Before that I had been checked and was dilated to a 4 or maybe 5. But things REALLY picked up after my bladder wasn't full!

Since I was stuck laying completely on my left side, my epidural did get VERY lop-sided. I could wiggle my toes on my right foot and almost felt like I could have walked on it. It only felt a little tingly to me. My left leg on the other hand was COMPLETE dead weight. I couldn't move it AT ALL. I don't know if it was related to my uneven epidural, but as the blood pressure situation was resolving itself and my bladder was finally empty, I started feeling those contractions more and more until finally they were genuinely hurting again. Because I was hurting again, the nurse checked me at I think it was somewhere around 9:15am-9:30am and said I was dilated to a 7 or maybe even 8. So the anesthesiologist was brought back in and re-dosed my epidural. The nurse told him that this was basically my “delivery dose.” The re-dosed epidural took awhile to help and those contractions were pretty intense. I was even having to use breathing exercises. Imagine that, labor being, like, hard or something!

Those breathing exercises were especially interesting to do when I ended up with an oxygen mask on. This has happened in all three of my deliveries because the babies have reached a point where their heartbeats weren't that fabulous and the nurses know the baby is headed through the most taxing part where they are actually pushed out. So, feeling like Darth Vader having a panic attack, I laid there.

Then the nurse told me to tell her if I got the urge to push. After only a couple minutes, I told her I was feeling “different,” like there was a lot of “pressure.” But it also kinda wasn't hurting as much and I wasn't sure if it was just the epidural redose taking effect or what. I was checked and I was ALMOST to a 10. The nurse told me again to tell her if I got the urge to push. Well, with the very next contraction, I had the urge to push. She checked me after that and it was no longer about dilation because she immediately said, “Oh yes, there's the baby's head, and there's her ear.” So then I had to resist the urge to push while my doctor showed up and they put down all the sterile drapes.

Up until they took the oxygen mask off and actually wanted me to push, I had easily felt every contraction and the accompanying urge to push. At first things were going okay, but after the first or second push, I couldn't really feel it anymore. I knew what I needed to do, but the urge was gone. Figures. The worst part was that it was hard for me to tell exaclty WHEN the contractions were so I wasn't sure WHEN to push. I had to have the nurses tell me and I could tell they were confused because before I hadn't needed that. I guess the epidural finally kicked in all the way! I was probably pushing for maybe 10-15 minutes total.

Toward the end, things kinda stalled and Kate's heartbeat wasn't looking so great and my doctor said that if I didn't get her out on the next push we'd have to use the vaccuum. That motivated me a little throw caution about not pushing with my upper body and such to the wind. The nurse thought that's what got Kate out, but I think it was that at the same time, they had me change position slightly to lay less propped up sitting and more laying on my back. The change of angle seemed like it got things unstuck and I could feel to push better.

Kate's head was delivered and they suctioned her mouth and then while her shoulders were being delivered, Kate cried a little. Before she was even all the way out, so cute! Although, I hope that isn't a portent of an impatient personality! The official time was 10:30am, so just over 3 hours from start to finish. I'll take it.

Then when things died down M went with her to get cleaned up while I was stuck waiting for my epidural to wear off. My right leg felt great, but that left leg, UGH. They needed the delivery room, so they kept checking if I felt like I could move. I kept telling them sorry but I don't have feeling back in my left leg even though my right leg felt fine. I think they didn't believe me despite my explanation about having to lie on my left leg the whole time. Then they would try to have me move my left leg and when I couldn't budge it AT ALL without help, THEN they believed me. It ended up taking FOREVER for me to get feeling back in that leg. They moved me to a postpartum room LONG before I had something more than dead weight attached to my hip.

So I ended up ordering lunch in the LDR room. How great is that? I didn't even have to miss a meal! In fact, had I wanted to, I could have ordered a 2nd BREAKFAST based on the time!

My poor nurse was SO busy dealing with my quick labor and low blood pressure that she hadn't had a chance to sneak out and use the restroom or eat her breakfast! It's so true. Though it wasn't exactly scary, we were kept on our toes. There was just no “down time” during my labor. I had brought along things to kill time, but a time with “nothing going on” never presented itself!

When I called my mom a little before 11am she was in the car on her way to a tennis game. After I said hello, she asked me to hold on a second. I could just tell because of that and the way she was talking that she thought I was just calling with an update. She came back on the phone and said, “So you're at the hospital.” She thought I was just letting her know how things were going during some down time. So when I told her, “We had Kate,” the surprise in her voice was priceless!


azufelt said...

Yeah! Love that! I had that same EXACT left-leg dead weight problem, it was terrible. And of course had to stay in LDR for like 5+ extra hours becasue of it. Oh well, the price we pay to be more comfortable through the process, right?

I have to be there at 5 a.m. next week, and so I am hoping to get it all underway sooner, and have a morning baby also... we'll see. Mine have all been afternoon babies, being induction has never started until after 9.

And I totally love the way your mom reacted on the phone, that's SO how my family would respond too, completely priceless!!

Congrats again on a smooth delivery and beautiful little girl!!

Ralphie said...

I love a good labor story! Very well done my friend.

Kristen Joy said...

I love hospital food. I love being taken care of in the hospital. I love surprising people with quick labors.

brook said...

that's probably the most hilarious story i have ever read...maybe having a child (SOME day...) wont be that bad after all? plus, since i'm a phlebotomist, i can just put my own IV in haha...yeah right! but still, i'm sorry you had to deal with incompetent IV-putter-in-ers.
glad she's here!
and too bad you don't have a recording of your mom's voice....that would have been priceless (well, duh, for everything else there was mastercard)

Corinda said...

Thanks for sharing your war story. I'm glad it went so much faster this time. And I totally agree that not knowing when your contractions are coming to push is highly annoying, if not unbearable.