Between contractions, we were still chatting and I would half listen to Que and Stephen talk during each contraction. Around 8:00 p.m, Dr. Bootstaylor poked his head in to say hi. I went to the bathroom and was having some bloody show. I got tired of sitting on the birth ball and perched on the bottom corner of the bed while I ate some grapes. Stephen decided to make a dinner run to Chick-fil-a before things got more intense (with my approval). I leaned over onto the dinner tray trying to utilize forward leaning to help the baby get into the best position for birth. From where I was sitting, I could see the Atlanta cityscape. I started to focus in on a single traffic light, so far away that it was tiny. Red, green, yellow. Red, green, yellow. The room got quiet as I lost interest in conversing. Que provided silent support. Stephen was gone for quite a while (I found out later that they had closed the main entrance, and he had to go through the emergency entrance), and during the time he was gone, my labor shifted from somewhat noticeable to undeniable active labor. I was starting to moan a little during my contractions (one of my favorite ways to cope). When Stephen walked in, I said, "Okay, I'm ready for you to call our moms." Then he said, "Well, actually, they're already here. They're out in the waiting room. Do you want me to call them in?" I wanted a few more minutes, but then I told him to summon the moms. I found out later that they had decided to drive up before it got dark, and had just arrived planning to hang out in the waiting room until Stephen called. As it turned out, the Lord orchestrated that detail perfectly so that when I was ready for them to come, they were already there.
When they walked in, I was leaning over the tray table with my head buried in a pillow. By this time, my eyes were closed and I barely managed to acknowledge their greetings. By about 10:00 p.m, the Pitocin had been turned up to 4, contractions were frequent, and I started throwing up. I would have a pretty intense contraction, coping well through most of it, only to have my coping interrupted two-thirds of the way in by a throw up episode. Que had put some peppermint oil on a paper towel, and my mom was applying cool clothes to my forehead. At one point, I grabbed the peppermint oil towel and wiped my mouth with it (keep in mind, my eyes were still closed). Finally, when I had thrown up so many times that my stomach was totally empty, I stopped.
Around 10:30, I was really feeling the contractions, and I was worried. I knew Pitocin contractions were often harder to handle, but I felt like I was reaching my coping limit, and I wanted to try getting in the water. I knew the only way that could happen was if we were able to completely turn the Pitocin off and for labor to continue without it. I asked to have the midwife come in. Anjli came in and I expressed my desires, so she suggested that we do a cervical exam to make sure that I was progressing before we figured out what to do next. I was 5 cm, and -1 (Yay! Progress!), so she suggested we try turning off the Pitocin and breaking my water. I did not want my water broken. I felt like that had contributed to the fetal distress Nathan experienced during my first induction, and with that experience plus all the research I had done, breaking my water was an option I wanted to use as more of a last resort than an early part of an induction. I told Anjli that I didn't want my water broken, and could we just try turning off the Pitocin first, and to my great relief, she said that absolutely we could do that.
At this point, I was so tired. So, so tired. Like the most aggravating thing about the contractions was that they were keeping me from going to sleep. I started fixating on taking a nap. I just knew that when they turned the Pitocin off, the contractions would stop, I would get to take my nap, and then after a while we would start it back up and finish the process of giving birth. I was laying on my side in the bed at this point, so hopeful. The nurse came in and turned off the Pitocin, and I continued to vocalize through each contraction, just waiting for them to stop. The contractions spaced out just a little bit, but to my great disappointment, they just kept coming. After a while I began to think that, to my great surprise, apparently labor was rolling along on its own, it was not about to stop, and I was not going to get to take a nap before delivering this baby.
Friday, August 30, 2013
Monday, August 12, 2013
Kaitlyn's birth story-Part 5
On the way to the hospital, we drove through Chick-fil-a, where I supplemented my veggie lunch with grilled nuggets since the spicy sausage had not been working for me. Stephen and I talked about how funny it was that despite this being our third child, we had never driven to the hospital in labor. (I had obsessed a lot about when to go to the hospital in labor, considering my previous long labor, distance from the hospital, traffic and fact that this would be my second vaginal birth. Turns out, I didn't have to worry about any of those things.) I was so excited about having the opportunity to start the process of getting the baby born that I didn't feel as nervous about induction as I may have been a week earlier in my pregnancy. I was pretty much willing to do whatever it took to get the baby out. I was also really happy because the midwives on call over the next 48 hours were two of my favorites.
When we arrived at Atlanta Medical, we drove into the parking deck and started circling, looking for a spot. We drove all the way to the top without seeing a spot, looped back down to the previous level, then had to get back on the twirly down ramp to go down another level before we finally found an empty parking place. I was really glad that we weren't trying to find parking with me in labor. We casually walked into the hospital and took the elevator to the maternity floor. We told the lady at the nurses' station that we were here to meet Linda to start an induction, and they sent us out to the waiting area and told us they would come get us. While we were sitting in the waiting room, this man approached us to ask if we were interested in giving blood "while we were waiting." Ugh--no. We're here to have a baby, not to give blood. Sorry. Didn't the big pregnant belly clue you in?
After we had waited a while, Linda came out to the waiting room and told us they had a labor and delivery room that had opened up (Yay! We wouldn't have to start the process in a triage room!) and walked us back to a large, pleasant LDR room with a fabulous view of the Atlanta city skyline. A nurse came in and hooked me up to the fetal heart rate and contraction monitor. I was surprised to see that the itty-bitty, wimpy contractions I had been noticing were actually showing up on the monitor. Another nurse (I had two nurses assigned to me) asked me many questions, including if I knew when my last menstrual period was. I looked at her blankly and told her that was a long time ago, but I told her my due date instead. Finally we finished the Q&A session, and she left the room. After taking a bathroom break, I decided to stand by the bed and try to encourage the contractions with some gravity instead of sitting in the bed. They still didn't hurt, but they were coming in a pretty consistent pattern. Stephen and I waited quietly in the room for about an hour before Linda came back in to do a cervical check in order to decide if my cervix was open enough to place a Foley bulb. She checked my cervix, and then said we wouldn't need a Foley bulb at all. I was 3 centimeters dilated and 80 percent effaced. I was pretty surprised at the progress I had made since the previous day, especially since I had slept well all night, and had not had so much as one painful contraction. Linda said she thought a slow Pitocin drip would likely be enough to get my labor going.
Stephen and I continued to wait. At one point, we heard a woman cry out. I said, "That woman just pushed out her baby--or she's about to get an epidural." A minute later, we heard a baby cry. It was about 4:30 in the afternoon at this point, and I decided to call my doula. I asked her to start heading our way pretty soon so she would be there around the time that they started Pitocin. I told her no hurry, since at this point I didn't even have my IV in, but that it would be good if she could get there in a little while. Linda came by and told us she was about to go off shift, and Anjli would be taking over. Anjli took a minute to discuss the game plan, which was to start Pitocin at a very low dosage and possibly break my water at some point to get labor going. Finally the nurse came in to start my IV. My past experiences with IVs during and after birth have not been good. Not only have they been difficult to place, but they have hurt the entire time they've been in. I was dreading the IV so much that I had actually considered exercising my right to refuse despite Atlanta Medical's policy that all VBAC moms must be at least be hep-locked. Obviously, since I was about to start a Pitocin drip, foregoing the IV was no longer an option. However, I had an entire paragraph in my one page birth plan about the IV placement. I requested that the IV be placed in my left forearm, and that the smallest possible needle be used. The nurse said that could pretty expertly place an IV, and I told her I really didn't care if it took a long time or multiple sticks to get the IV in as long as it didn't continue to hurt once it was in. She took a look at my forearm, declared that my veins looked fine, and got ready with the needle. Two unsuccessful sticks later, she said she could try sticking my left arm again, or we could try to get it into the right forearm. I told her I was fine with it being on the right, as long as it was still in the forearm area. Thankfully, the third stick went in the vein and she was able to secure the IV in my right forearm. While the nurse was making her third attempt at IV placement, my doula walked in.
We did some more waiting, chatting about several random topics before the nurse came in with the Pitocin. It was 6:20 before she had the Pitocin hooked up to the IV machine and started the drip. Before the drip had even been started, Stephen had started asking me when I wanted him to call our moms to come. Our original plan (pre-induction) had been for me to labor at home until I was well into active labor and then have our moms drive to the hospital at the same time we did and meet us there. However, I knew it would be quite a while before labor picked up, and I didn't want a lot of people sitting around staring at me waiting for something to happen, so I decided we would call them once labor had gotten more active and have them drive up then. Stephen asked me multiple times when I wanted him to call our moms to come, and I finally got a little irritated and snapped at him, "I'll tell you when to call them--I need to be at least 5 centimeters!" Shortly after Que (my doula) had arrived, Stephen asked me if I thought he could go down and get a coffee at the Starbucks on the hospital campus. I said that was totally fine; Que was there with me, and even if they started the Pitocin while he was gone, the effects of the drug would not begin that quickly. He got his coffee and had made it back up before the nurse arrived with the Pitocin.
The midwife started me at 2 units of Pitocin (barely a whiff), and the plan was to turn it up very slowly to mimic the natural progression of labor. When I had arrived at the hospital, I had been attached to the standard plugged-in fetal monitor, but I had expressed my interest in using one of the telemetry machines. At that point, the nurse had told me that the units were all in use, but that I could certainly have one as soon as it became available. When Anjli had been in the room to discuss the game plan, she had reiterated to the nurse that I needed to get one of the telemetry units so I could stay mobile, and use movement to facilitate labor. Around the time that the Pitocin was started, the nurse brought in one of the telemetry units and got everything set up. Apart from the cumbersome IV pole, I was free to move about as I pleased. I decided to go out and walk the hall before the contractions really kicked in because I knew that walking was one activity that could really facilitate labor, and I wasn't really sure that I would feel like walking once the contractions really kicked in. Stephen and I walked around the hall that looped the labor floor a couple of times before a nurse at the nurses' station looked at me suspiciously and said, "What's she doing?" I gave her a puzzled look, but kept on walking. We had barely rounded the corner of the hall my room was on before my nurse came to me and said I could not walk out in the hall while on Pitocin; that was against the hospital's policy. I was a little irked at this completely unreasonable policy and continued to pace the hall immediately outside my room for about five more minutes. Then three nurses approached me (both my current nurses plus the nurse who was coming on call and would be my nurse through the night shift), and said that the charge nurse was adamant that I needed to go back in my room--it was a liability risk for the hospital. I decided this was not a hill worth dying on, and returned to my room where I regrouped my efforts to facilitate progress by pulling out my birthing ball to sit on. As I sat on the ball, we all continued to talk, but I started to fade out of the conversation long enough to breathe through my contractions.
When we arrived at Atlanta Medical, we drove into the parking deck and started circling, looking for a spot. We drove all the way to the top without seeing a spot, looped back down to the previous level, then had to get back on the twirly down ramp to go down another level before we finally found an empty parking place. I was really glad that we weren't trying to find parking with me in labor. We casually walked into the hospital and took the elevator to the maternity floor. We told the lady at the nurses' station that we were here to meet Linda to start an induction, and they sent us out to the waiting area and told us they would come get us. While we were sitting in the waiting room, this man approached us to ask if we were interested in giving blood "while we were waiting." Ugh--no. We're here to have a baby, not to give blood. Sorry. Didn't the big pregnant belly clue you in?
After we had waited a while, Linda came out to the waiting room and told us they had a labor and delivery room that had opened up (Yay! We wouldn't have to start the process in a triage room!) and walked us back to a large, pleasant LDR room with a fabulous view of the Atlanta city skyline. A nurse came in and hooked me up to the fetal heart rate and contraction monitor. I was surprised to see that the itty-bitty, wimpy contractions I had been noticing were actually showing up on the monitor. Another nurse (I had two nurses assigned to me) asked me many questions, including if I knew when my last menstrual period was. I looked at her blankly and told her that was a long time ago, but I told her my due date instead. Finally we finished the Q&A session, and she left the room. After taking a bathroom break, I decided to stand by the bed and try to encourage the contractions with some gravity instead of sitting in the bed. They still didn't hurt, but they were coming in a pretty consistent pattern. Stephen and I waited quietly in the room for about an hour before Linda came back in to do a cervical check in order to decide if my cervix was open enough to place a Foley bulb. She checked my cervix, and then said we wouldn't need a Foley bulb at all. I was 3 centimeters dilated and 80 percent effaced. I was pretty surprised at the progress I had made since the previous day, especially since I had slept well all night, and had not had so much as one painful contraction. Linda said she thought a slow Pitocin drip would likely be enough to get my labor going.
Stephen and I continued to wait. At one point, we heard a woman cry out. I said, "That woman just pushed out her baby--or she's about to get an epidural." A minute later, we heard a baby cry. It was about 4:30 in the afternoon at this point, and I decided to call my doula. I asked her to start heading our way pretty soon so she would be there around the time that they started Pitocin. I told her no hurry, since at this point I didn't even have my IV in, but that it would be good if she could get there in a little while. Linda came by and told us she was about to go off shift, and Anjli would be taking over. Anjli took a minute to discuss the game plan, which was to start Pitocin at a very low dosage and possibly break my water at some point to get labor going. Finally the nurse came in to start my IV. My past experiences with IVs during and after birth have not been good. Not only have they been difficult to place, but they have hurt the entire time they've been in. I was dreading the IV so much that I had actually considered exercising my right to refuse despite Atlanta Medical's policy that all VBAC moms must be at least be hep-locked. Obviously, since I was about to start a Pitocin drip, foregoing the IV was no longer an option. However, I had an entire paragraph in my one page birth plan about the IV placement. I requested that the IV be placed in my left forearm, and that the smallest possible needle be used. The nurse said that could pretty expertly place an IV, and I told her I really didn't care if it took a long time or multiple sticks to get the IV in as long as it didn't continue to hurt once it was in. She took a look at my forearm, declared that my veins looked fine, and got ready with the needle. Two unsuccessful sticks later, she said she could try sticking my left arm again, or we could try to get it into the right forearm. I told her I was fine with it being on the right, as long as it was still in the forearm area. Thankfully, the third stick went in the vein and she was able to secure the IV in my right forearm. While the nurse was making her third attempt at IV placement, my doula walked in.
We did some more waiting, chatting about several random topics before the nurse came in with the Pitocin. It was 6:20 before she had the Pitocin hooked up to the IV machine and started the drip. Before the drip had even been started, Stephen had started asking me when I wanted him to call our moms to come. Our original plan (pre-induction) had been for me to labor at home until I was well into active labor and then have our moms drive to the hospital at the same time we did and meet us there. However, I knew it would be quite a while before labor picked up, and I didn't want a lot of people sitting around staring at me waiting for something to happen, so I decided we would call them once labor had gotten more active and have them drive up then. Stephen asked me multiple times when I wanted him to call our moms to come, and I finally got a little irritated and snapped at him, "I'll tell you when to call them--I need to be at least 5 centimeters!" Shortly after Que (my doula) had arrived, Stephen asked me if I thought he could go down and get a coffee at the Starbucks on the hospital campus. I said that was totally fine; Que was there with me, and even if they started the Pitocin while he was gone, the effects of the drug would not begin that quickly. He got his coffee and had made it back up before the nurse arrived with the Pitocin.
The midwife started me at 2 units of Pitocin (barely a whiff), and the plan was to turn it up very slowly to mimic the natural progression of labor. When I had arrived at the hospital, I had been attached to the standard plugged-in fetal monitor, but I had expressed my interest in using one of the telemetry machines. At that point, the nurse had told me that the units were all in use, but that I could certainly have one as soon as it became available. When Anjli had been in the room to discuss the game plan, she had reiterated to the nurse that I needed to get one of the telemetry units so I could stay mobile, and use movement to facilitate labor. Around the time that the Pitocin was started, the nurse brought in one of the telemetry units and got everything set up. Apart from the cumbersome IV pole, I was free to move about as I pleased. I decided to go out and walk the hall before the contractions really kicked in because I knew that walking was one activity that could really facilitate labor, and I wasn't really sure that I would feel like walking once the contractions really kicked in. Stephen and I walked around the hall that looped the labor floor a couple of times before a nurse at the nurses' station looked at me suspiciously and said, "What's she doing?" I gave her a puzzled look, but kept on walking. We had barely rounded the corner of the hall my room was on before my nurse came to me and said I could not walk out in the hall while on Pitocin; that was against the hospital's policy. I was a little irked at this completely unreasonable policy and continued to pace the hall immediately outside my room for about five more minutes. Then three nurses approached me (both my current nurses plus the nurse who was coming on call and would be my nurse through the night shift), and said that the charge nurse was adamant that I needed to go back in my room--it was a liability risk for the hospital. I decided this was not a hill worth dying on, and returned to my room where I regrouped my efforts to facilitate progress by pulling out my birthing ball to sit on. As I sat on the ball, we all continued to talk, but I started to fade out of the conversation long enough to breathe through my contractions.
Thursday, August 8, 2013
Kaitlyn's birth story-Part 4
Because of the gestational diabetes, we had a few additional ultrasounds between 30 and 38 weeks. At my 38 week ultrasound, Dr. Bootstaylor told us we wouldn't need additional ultrasounds unless I went past my due date. Both my previous pregnancies were 42 weeks, so I just smiled and said we'd most likely be back. Although I tried to prepare the basics in case we were surprised by an early delivery, I didn't rush to do anything. I knew that most likely, I would have 4 more weeks to fill with projects. At 38 weeks, I bought a pack of diapers. At 39 weeks, I started packing my hospital bag. At 40 weeks, I had my baby shower. Little by little, we got the crib and cradle up, set up the pack and play, and dug out the baby items we had packed away from the boys. I unpacked the baby gifts and wrote all my thank you notes. I cleaned the house periodically, each time hoping that maybe I would have a baby before it got dirty again.
With Daniel's pregnancy, I had utilized a lot of herbal labor preparers, including a blend called 5W, evening primrose oil, black cohosh extract, and a pregnancy tea. This time, aside from drinking red raspberry leaf tea, and taking a bit of evening primrose oil, I did nothing. I had a few Braxton Hicks, a new experience for me since with both previous pregnancies I did not have any. They were not painful and didn't bother me though. What did bother me was the distinct lack of prelabor signs. I felt great--too great in fact. As my due date came and went, I didn't feel huge and miserable. I felt like I could go on being pregnant for many more weeks. I grew increasingly convinced that I would be pregnant for many more weeks.
At my 41 week appointment, I begged the midwife to strip my membranes. She said they didn't usually strip membranes (because it kicked moms into labor, a reason that seemed unintelligible to me at the time--that's why I wanted her to do it!), but agreed to check me and then decide. She checked me, then said my cervix wasn't open enough to allow the two fingers needed for a membrane sweep. I left with directions for a homeopathic regiment which the midwife said had kicked many moms into labor.
At 41 and a half weeks, I had a non-stress test in the office. The paper in the machine jammed almost immediately, but I didn't notice until about 10 minutes later. The lab tech came in to fix it, but when the midwife checked the strip, the baby showed one deceleration right as the strip began. Because we were one of the last appointments, we were sent over to the hospital to have a longer non-stress test and biophysical profile to check on the baby's well-being. As we sat in the hospital, I anxiously wondered if we were going to have to start an induction immediately. I did not want to be induced, but I confess I was a little excited about possibly meeting this baby sooner rather than later. Kaitlyn looked great on the monitor, and she scored perfectly on the biophysical profile. We left the hospital both disappointed and relieved and went to bed exhausted.
At 42 weeks, we had an appointment with Dr. Bootstaylor for a non-stress test and biophysical profile. After I had passed my due date, I had asked Dr. Bootstaylor at one of our appointments what he thought was the point in pregnancy where further intervention was needed, and he said 44 weeks. My first response was, "NO WAY am I going to go to 44 weeks! That is definitely past my cut off!" I spent a lot of time after hitting the 41 week mark thinking through just how long I was willing to go. I felt comfortable going to at least 42 and a half weeks and maybe 43, but I didn't know exactly when my final cut off would be. The day before my 42 week appointment, still with no signs of labor, I decided what I needed was a plan. If the baby continued to look good, I decided to have the midwife strip my membranes at my appointment Monday and if that didn't kick me into labor, proceed with induction Wednesday. I discussed my plan with Dr. Bootstaylor, and he was on board.
I knew because of my history of 42 week pregnancies that I would likely deliver around the 42 week mark, so I had made that 42 week mark my expected delivery date. I was in great shape mentally all the way to 42 weeks. However, this time around, 42 weeks came--and went, with no baby. I began a slow spiral. I was the permanently pregnant woman. This baby was, in fact, never going to be born--at all. I went nowhere, and saw no one, because I couldn't take any questions about when the baby would be born. I lost interest in my dwindling list of projects. I spent most of my time sitting on the couch, desperately pregnant. I held out hope that the membrane sweep would finally trigger labor, but if that didn't do the trick, I despaired of spontaneous labor ever happening. Sometime Sunday, I decided that Tuesday would, in fact, be a good date for induction. I didn't feel like I would have any regrets about starting an induction at that point, even if it went differently than I had hoped.
I started reworking my birth plan to accommodate induction. I wondered if I would still be able to tolerate labor without pain medication. During my induction with Nathan, the contractions had felt like getting hit by a freight train pretty much from the beginning. They had also caused no change in my cervix at all--for 12 hours. After being told that "sometimes an epidural will relax you and help you dilate" and hearing the discouraging news that I had still made no progress, I had opted for the epidural. My normally very low blood pressure plummeted, and though they were able to stabilize me, they couldn't restart the Pitocin without Nathan's heart rate dipping too much. I ended up in the operating room, having a very much unwanted c-section. Because of this experience, I feared induction. I also knew that, as a VBAC mom, induction carried some additional risks. However, I knew that the midwives at Intown did very slow, gentle inductions, and I knew I wouldn't be okay with a decision to move straight to c-section without at least trying for a vaginal delivery.
I tried to cultivate flexibility in my desires for the impending induction. I thought about how my induced birth would ideally unfold. I wanted to try the Foley bulb (a manual dilater that helps open the cervix to about 3 to 4 centimeters) to ripen my cervix and then have Pitocin to finish the process. I also wanted to attempt to turn off the Pitocin if my labor seemed to be in a good pattern in hopes that I could still utilize water for pain relief. (Hospital policies do not allow labor or birth in the water while a Pitocin drip is being used.) I decided I would still give it my best effort to forgo pain medication, but I would leave the option of an epidural on the table if it became absolutely necessary. I didn't want my water broken, but decided that I would try that as a final measure if needed for progress.
I made my list of questions to ask the midwife at my Monday appointment. Could I still use telemetry (portable fetal monitoring) so I could remain mobile during labor? Were there any restrictions on eating or drinking during an induction? How much IV fluid would be used with the Pitocin? (I was concerned with the swelling that excessive IV fluid could cause, which often makes the initiation of breastfeeding more difficult.) Could I start my induction in the morning? (I don't sleep in hospitals, and because I was expecting the induction to be long, I didn't want to start by losing a night of sleep and potentially miss another night of sleep during the most taxing part of labor.) We spent Monday morning at Dr. Bootstaylor's office having another non-stress test and biophysical profile. The baby continued to look perfect. I told Dr. B that I really wanted to start the induction process the next day. He thought that was a reasonable option. We ate some delicious arepas (Venezuelan food) for lunch, and headed to the midwives office.
I started asking my questions. Yes, I could still use telemetry. No, there were no restrictions. They would not have to use that much IV fluid. They normally start all inductions in the evening, but if I really wanted to, we could begin in the morning. She thought beginning induction the next day was an appropriate decision, but would need to contact the hospital to get us slotted for an induction time. She checked my cervix. I was 1-2 centimeters and 50% effaced. She swept my membranes, and sent us on our way, telling us that she would call us to let us know what she was able to schedule for us. We headed home, dropping by the grocery store to pick up some Paleo approved labor snacks, then stopping on the way to pick up the boys from my mom, and hurried home to finish packing for the next day.
The first thing I did upon walking through the door was check our answering machine to see what time we would need to go up the next day. As the midwife talked, I grew increasingly incredulous. She said that the hospital had no induction slots at any time of the day until Thursday (which would be one day before I was 43 weeks). She mentioned that possibly I could be worked in that night and recommended that I call the on-call midwife to see what she said. I called the on call midwife and left a message, then made a brief phone call to my mom to say that we might be heading back to the hospital right away to start something. The midwife called back shortly. I told her the situation, and she said that there was no way I should come right in; she had four moms currently in labor, one of whom was having twins. However, I guess she heard the desperation in my voice, and she promised to call right away if space opened up. I said I would gladly sleep with the phone and we would come whenever we needed to, even if that was the middle of the night.
I tried unsuccessfully to make the mental shift that I wasn't scheduled to be induced the next day, and while they might be able to work me in, I may have to wait until Thursday to start the process of getting this baby delivered. I had already reached the point of being completely and 100% done with being pregnant, and yet I could do absolutely nothing to change my state. I called my doula and spent about an hour filling her in about the situation, and telling her I was feeling really crazy. I did feel a little better after spilling my guts to an empathetic listener. I did nothing to prepare to go to the hospital. Instead, I half-heartedly watched a movie, and went to bed, feeling depressed that the membrane sweep hadn't worked and I wouldn't be having a baby for a long, long time.
I actually slept well, all things considered, and woke up the next day late feeling pretty rested. Somehow overnight, I had managed to make the mental shift that we weren't going to be able to do anything until Thursday, and, while unhappy, I was resigned to my fate. I had a little bloody mucus over the course of the morning, but dismissed it as a side effect of the membrane sweep. I had warmed up some leftovers from our nearly empty fridge, including a spicy sausage link that was the only meat we had that didn't require cooking. (I hadn't bought anything fresh at the grocery store the previous day because I thought we would be at the hospital having a baby the next day.) I was sitting down to eat when the phone rang. I sprang to answer (as much as a very pregnant lady can spring), and it was the midwife. She said that they had talked about me at the midwives meeting that morning, and why didn't I just come on up and they would work me in, even if they had to start me in a triage room. I, of course, said that was totally fine. She also said to go ahead and have a good lunch and then head up to the hospital.
I hung up the phone, stared blankly at Stephen, and said, a little unbelievingly, "She says to come on now." I started scarfing down bites of my lunch while throwing things into my hospital bags. After a couple of bites of sausage, I couldn't stomach any more of the spiciness, so I finished my veggies, but threw away the rest of the meat. Looking back, it's kind of funny that I still had stuff to do to get ready despite being 42 weeks and 4 days pregnant. I really had given up on having the baby before Thursday, and I was kind of holding out on getting ready until we had our scheduled time. Stephen brought the boys next door to the grandparents.
Finally, we got in the car to head to the hospital to start the induction and finally have our long awaited baby.
With Daniel's pregnancy, I had utilized a lot of herbal labor preparers, including a blend called 5W, evening primrose oil, black cohosh extract, and a pregnancy tea. This time, aside from drinking red raspberry leaf tea, and taking a bit of evening primrose oil, I did nothing. I had a few Braxton Hicks, a new experience for me since with both previous pregnancies I did not have any. They were not painful and didn't bother me though. What did bother me was the distinct lack of prelabor signs. I felt great--too great in fact. As my due date came and went, I didn't feel huge and miserable. I felt like I could go on being pregnant for many more weeks. I grew increasingly convinced that I would be pregnant for many more weeks.
At my 41 week appointment, I begged the midwife to strip my membranes. She said they didn't usually strip membranes (because it kicked moms into labor, a reason that seemed unintelligible to me at the time--that's why I wanted her to do it!), but agreed to check me and then decide. She checked me, then said my cervix wasn't open enough to allow the two fingers needed for a membrane sweep. I left with directions for a homeopathic regiment which the midwife said had kicked many moms into labor.
At 41 and a half weeks, I had a non-stress test in the office. The paper in the machine jammed almost immediately, but I didn't notice until about 10 minutes later. The lab tech came in to fix it, but when the midwife checked the strip, the baby showed one deceleration right as the strip began. Because we were one of the last appointments, we were sent over to the hospital to have a longer non-stress test and biophysical profile to check on the baby's well-being. As we sat in the hospital, I anxiously wondered if we were going to have to start an induction immediately. I did not want to be induced, but I confess I was a little excited about possibly meeting this baby sooner rather than later. Kaitlyn looked great on the monitor, and she scored perfectly on the biophysical profile. We left the hospital both disappointed and relieved and went to bed exhausted.
At 42 weeks, we had an appointment with Dr. Bootstaylor for a non-stress test and biophysical profile. After I had passed my due date, I had asked Dr. Bootstaylor at one of our appointments what he thought was the point in pregnancy where further intervention was needed, and he said 44 weeks. My first response was, "NO WAY am I going to go to 44 weeks! That is definitely past my cut off!" I spent a lot of time after hitting the 41 week mark thinking through just how long I was willing to go. I felt comfortable going to at least 42 and a half weeks and maybe 43, but I didn't know exactly when my final cut off would be. The day before my 42 week appointment, still with no signs of labor, I decided what I needed was a plan. If the baby continued to look good, I decided to have the midwife strip my membranes at my appointment Monday and if that didn't kick me into labor, proceed with induction Wednesday. I discussed my plan with Dr. Bootstaylor, and he was on board.
I knew because of my history of 42 week pregnancies that I would likely deliver around the 42 week mark, so I had made that 42 week mark my expected delivery date. I was in great shape mentally all the way to 42 weeks. However, this time around, 42 weeks came--and went, with no baby. I began a slow spiral. I was the permanently pregnant woman. This baby was, in fact, never going to be born--at all. I went nowhere, and saw no one, because I couldn't take any questions about when the baby would be born. I lost interest in my dwindling list of projects. I spent most of my time sitting on the couch, desperately pregnant. I held out hope that the membrane sweep would finally trigger labor, but if that didn't do the trick, I despaired of spontaneous labor ever happening. Sometime Sunday, I decided that Tuesday would, in fact, be a good date for induction. I didn't feel like I would have any regrets about starting an induction at that point, even if it went differently than I had hoped.
I started reworking my birth plan to accommodate induction. I wondered if I would still be able to tolerate labor without pain medication. During my induction with Nathan, the contractions had felt like getting hit by a freight train pretty much from the beginning. They had also caused no change in my cervix at all--for 12 hours. After being told that "sometimes an epidural will relax you and help you dilate" and hearing the discouraging news that I had still made no progress, I had opted for the epidural. My normally very low blood pressure plummeted, and though they were able to stabilize me, they couldn't restart the Pitocin without Nathan's heart rate dipping too much. I ended up in the operating room, having a very much unwanted c-section. Because of this experience, I feared induction. I also knew that, as a VBAC mom, induction carried some additional risks. However, I knew that the midwives at Intown did very slow, gentle inductions, and I knew I wouldn't be okay with a decision to move straight to c-section without at least trying for a vaginal delivery.
I tried to cultivate flexibility in my desires for the impending induction. I thought about how my induced birth would ideally unfold. I wanted to try the Foley bulb (a manual dilater that helps open the cervix to about 3 to 4 centimeters) to ripen my cervix and then have Pitocin to finish the process. I also wanted to attempt to turn off the Pitocin if my labor seemed to be in a good pattern in hopes that I could still utilize water for pain relief. (Hospital policies do not allow labor or birth in the water while a Pitocin drip is being used.) I decided I would still give it my best effort to forgo pain medication, but I would leave the option of an epidural on the table if it became absolutely necessary. I didn't want my water broken, but decided that I would try that as a final measure if needed for progress.
I made my list of questions to ask the midwife at my Monday appointment. Could I still use telemetry (portable fetal monitoring) so I could remain mobile during labor? Were there any restrictions on eating or drinking during an induction? How much IV fluid would be used with the Pitocin? (I was concerned with the swelling that excessive IV fluid could cause, which often makes the initiation of breastfeeding more difficult.) Could I start my induction in the morning? (I don't sleep in hospitals, and because I was expecting the induction to be long, I didn't want to start by losing a night of sleep and potentially miss another night of sleep during the most taxing part of labor.) We spent Monday morning at Dr. Bootstaylor's office having another non-stress test and biophysical profile. The baby continued to look perfect. I told Dr. B that I really wanted to start the induction process the next day. He thought that was a reasonable option. We ate some delicious arepas (Venezuelan food) for lunch, and headed to the midwives office.
I started asking my questions. Yes, I could still use telemetry. No, there were no restrictions. They would not have to use that much IV fluid. They normally start all inductions in the evening, but if I really wanted to, we could begin in the morning. She thought beginning induction the next day was an appropriate decision, but would need to contact the hospital to get us slotted for an induction time. She checked my cervix. I was 1-2 centimeters and 50% effaced. She swept my membranes, and sent us on our way, telling us that she would call us to let us know what she was able to schedule for us. We headed home, dropping by the grocery store to pick up some Paleo approved labor snacks, then stopping on the way to pick up the boys from my mom, and hurried home to finish packing for the next day.
The first thing I did upon walking through the door was check our answering machine to see what time we would need to go up the next day. As the midwife talked, I grew increasingly incredulous. She said that the hospital had no induction slots at any time of the day until Thursday (which would be one day before I was 43 weeks). She mentioned that possibly I could be worked in that night and recommended that I call the on-call midwife to see what she said. I called the on call midwife and left a message, then made a brief phone call to my mom to say that we might be heading back to the hospital right away to start something. The midwife called back shortly. I told her the situation, and she said that there was no way I should come right in; she had four moms currently in labor, one of whom was having twins. However, I guess she heard the desperation in my voice, and she promised to call right away if space opened up. I said I would gladly sleep with the phone and we would come whenever we needed to, even if that was the middle of the night.
I tried unsuccessfully to make the mental shift that I wasn't scheduled to be induced the next day, and while they might be able to work me in, I may have to wait until Thursday to start the process of getting this baby delivered. I had already reached the point of being completely and 100% done with being pregnant, and yet I could do absolutely nothing to change my state. I called my doula and spent about an hour filling her in about the situation, and telling her I was feeling really crazy. I did feel a little better after spilling my guts to an empathetic listener. I did nothing to prepare to go to the hospital. Instead, I half-heartedly watched a movie, and went to bed, feeling depressed that the membrane sweep hadn't worked and I wouldn't be having a baby for a long, long time.
I actually slept well, all things considered, and woke up the next day late feeling pretty rested. Somehow overnight, I had managed to make the mental shift that we weren't going to be able to do anything until Thursday, and, while unhappy, I was resigned to my fate. I had a little bloody mucus over the course of the morning, but dismissed it as a side effect of the membrane sweep. I had warmed up some leftovers from our nearly empty fridge, including a spicy sausage link that was the only meat we had that didn't require cooking. (I hadn't bought anything fresh at the grocery store the previous day because I thought we would be at the hospital having a baby the next day.) I was sitting down to eat when the phone rang. I sprang to answer (as much as a very pregnant lady can spring), and it was the midwife. She said that they had talked about me at the midwives meeting that morning, and why didn't I just come on up and they would work me in, even if they had to start me in a triage room. I, of course, said that was totally fine. She also said to go ahead and have a good lunch and then head up to the hospital.
I hung up the phone, stared blankly at Stephen, and said, a little unbelievingly, "She says to come on now." I started scarfing down bites of my lunch while throwing things into my hospital bags. After a couple of bites of sausage, I couldn't stomach any more of the spiciness, so I finished my veggies, but threw away the rest of the meat. Looking back, it's kind of funny that I still had stuff to do to get ready despite being 42 weeks and 4 days pregnant. I really had given up on having the baby before Thursday, and I was kind of holding out on getting ready until we had our scheduled time. Stephen brought the boys next door to the grandparents.
Finally, we got in the car to head to the hospital to start the induction and finally have our long awaited baby.
Friday, August 2, 2013
Kaitlyn's birth story-Part 3
This pregnancy has been my most challenging. Not because I had worse
pregnancy symptoms (although the morning sickness phase this time lasted
at least twice as long), but because several things happened in my
family that would have been horribly stressful at any time, but during
pregnancy were just about more than I thought I could cope with. I had
to give up my ideals of a peaceful pregnancy where I got plenty of
sleep, exercised regularly, stayed low stress, and let others take care
of me. Instead, I had broken sleep pretty much every night for the last
six months of my pregnancy, had to stop exercising because my body
couldn't take the physical strain of no sleep and exercise, battled
constant stress plus stress that the baby would be harmed by my high
stress levels, and took care of the various members of my family who
were taken out by a variety of health issues, sometimes all at the same
time.
I did my best to take care of my pregnant self, considering the less than ideal circumstances. I took my prenatal vitamins, ate well, drank lots of water and herb tea, and slept as much as I could. I could feel that the stress had taken it's toll on my body though, so when I didn't pass my glucose screen, I felt convinced that I wouldn't pass the glucose tolerance test either. I wasn't surprised when I got the news that I had failed the GTT. I was referred over to See Baby, Dr. Bootstaylor's office, for gestational diabetes counseling. I went to that first appointment full of questions. "What does this diagnosis mean? How does this affect my VBAC chances? What do I need to do manage the condition?" I learned that I would have to finger prick four times a day to keep an eye on my blood sugar levels. Ick. I would need to have additional ultrasounds at four week intervals to keep an eye on the baby's growth patterns and well-being. To my relief, I learned that if I could control my blood sugar with diet, care during my labor and birth would not be any different than a non-GD mom. Dr. Bootstaylor said he didn't usually recommend induction for GD moms (my main fear, as both my previous babies were born at 42 weeks), and that if I could maintain normal blood sugar levels through diet, my risk levels should be similar to a mom who didn't have gestational diabetes.
I took on the new challenge of managing my blood sugar levels. Fortunately my trusty Paleo diet that I was already following only needed some slight modifications to keep my numbers in line. I completely ignored the recommended GD diet plan I was given that was built around multiple small servings of grains and three cups of milk every day (yuck). I knew that the way I was eating would be better for my blood sugar levels than the carb heavy, food pyramid diet that primarily emphasized portion sizes. I swapped raisins in my oatmeal for raspberries and heavy cream (yum). I figured out I could eat fruit as long as I didn't overdo the quantity in one sitting. My post meal blood sugar numbers were perfect. My fasting numbers hovered around the target mark, sometimes slightly above, sometimes slightly below. I felt sure that my broken sleep was the culprit. Fortunately, Dr. Bootstaylor thought the fasting numbers were acceptable as long as they didn't go any higher.
After I recovered from the initial shock (now I have to worry about GD too?), I had to process that I was now a high risk pregnancy. Being a very granola mama, I worried about what this could mean for my pregnancy and birth. Would I have to take medicine? Would the baby be huge? Would I be forced to have unwanted medical intervention during my birth? Would the baby have low blood sugar after the birth that would necessitate the use of a glucose solution, or worse, formula? Would my start to breastfeeding be compromised? All my pregnancy and birth books didn't reassure me. They droned on endlessly about how less intervention was safe in a low risk pregnancy. What about high risk pregnancy? Was minimal intervention still feasible and safe? My pregnancy reference books devoted, at most, two pages to gestational diabetes. Internet searches mostly proved too alarming to be useful. I saw tons of stories of early inductions and c-sections.
I was increasingly grateful for my care providers as they remained calm and reassuring. The midwives told me that if my blood sugar numbers were good, we could proceed normally with prenatal and birth care. Dr. Bootstaylor continued to tell me after every ultrasound that the baby looked great, and normal. I soaked up the word normal every time I heard it, clinging to the possibility that this roller coaster pregnancy could still be normal and the hope that I could still have a normal birth.
I did my best to take care of my pregnant self, considering the less than ideal circumstances. I took my prenatal vitamins, ate well, drank lots of water and herb tea, and slept as much as I could. I could feel that the stress had taken it's toll on my body though, so when I didn't pass my glucose screen, I felt convinced that I wouldn't pass the glucose tolerance test either. I wasn't surprised when I got the news that I had failed the GTT. I was referred over to See Baby, Dr. Bootstaylor's office, for gestational diabetes counseling. I went to that first appointment full of questions. "What does this diagnosis mean? How does this affect my VBAC chances? What do I need to do manage the condition?" I learned that I would have to finger prick four times a day to keep an eye on my blood sugar levels. Ick. I would need to have additional ultrasounds at four week intervals to keep an eye on the baby's growth patterns and well-being. To my relief, I learned that if I could control my blood sugar with diet, care during my labor and birth would not be any different than a non-GD mom. Dr. Bootstaylor said he didn't usually recommend induction for GD moms (my main fear, as both my previous babies were born at 42 weeks), and that if I could maintain normal blood sugar levels through diet, my risk levels should be similar to a mom who didn't have gestational diabetes.
I took on the new challenge of managing my blood sugar levels. Fortunately my trusty Paleo diet that I was already following only needed some slight modifications to keep my numbers in line. I completely ignored the recommended GD diet plan I was given that was built around multiple small servings of grains and three cups of milk every day (yuck). I knew that the way I was eating would be better for my blood sugar levels than the carb heavy, food pyramid diet that primarily emphasized portion sizes. I swapped raisins in my oatmeal for raspberries and heavy cream (yum). I figured out I could eat fruit as long as I didn't overdo the quantity in one sitting. My post meal blood sugar numbers were perfect. My fasting numbers hovered around the target mark, sometimes slightly above, sometimes slightly below. I felt sure that my broken sleep was the culprit. Fortunately, Dr. Bootstaylor thought the fasting numbers were acceptable as long as they didn't go any higher.
After I recovered from the initial shock (now I have to worry about GD too?), I had to process that I was now a high risk pregnancy. Being a very granola mama, I worried about what this could mean for my pregnancy and birth. Would I have to take medicine? Would the baby be huge? Would I be forced to have unwanted medical intervention during my birth? Would the baby have low blood sugar after the birth that would necessitate the use of a glucose solution, or worse, formula? Would my start to breastfeeding be compromised? All my pregnancy and birth books didn't reassure me. They droned on endlessly about how less intervention was safe in a low risk pregnancy. What about high risk pregnancy? Was minimal intervention still feasible and safe? My pregnancy reference books devoted, at most, two pages to gestational diabetes. Internet searches mostly proved too alarming to be useful. I saw tons of stories of early inductions and c-sections.
I was increasingly grateful for my care providers as they remained calm and reassuring. The midwives told me that if my blood sugar numbers were good, we could proceed normally with prenatal and birth care. Dr. Bootstaylor continued to tell me after every ultrasound that the baby looked great, and normal. I soaked up the word normal every time I heard it, clinging to the possibility that this roller coaster pregnancy could still be normal and the hope that I could still have a normal birth.
Thursday, August 1, 2013
Kaitlyn's birth story-Part 2
I had my first appointment set with the midwives, but I had another
thing on my mind pretty much from the first day that I found out I was
pregnant. My first baby weighed 8 lbs 2 oz. My second baby was 8 lbs 14
oz. I did not want to have another one pound weight jump and deliver a
ten pound baby this time. Stephen and I had been following a modified
Paleo diet before I got pregnant, and I decided I would continue to
follow the same style of eating while pregnant in hopes that I would
deliver a smaller, or at least not bigger baby. I had to make some
modifications, particularly during a very green first trimester. (In
fact, I started having nausea before I had a positive pregnancy test
this pregnancy. When Stephen asked if I was pregnant, I was like, "no
way, it would be way too early to be nauseated anyway." Little did I
know, he was right.) I ate a Chick-fil-a sandwich one day. Another day I
had a slice of pizza. Although at the time, they sounded like the only
possibly palatable food, I felt so terrible after eating them that I
immediately went back to completely abstaining from all foods containing
wheat. First trimester nausea minus crackers and other starchy soothers
was interesting to say the least. Beef, which I craved with both of my
boy pregnancies, was nauseating. I couldn't eat it, cook with it, or
think about it without wanting to immediately throw up. I ate a lot of
gluten free oatmeal (a departure from Paleo's no grains mantra),
smoothies, and dairy to round out my chicken and veggies.
As my pregnancy progressed, I grew, if anything, even stricter with my diet. I ignored multiple chip cravings, and made sugar a very rare treat. Once I was diagnosed with gestational diabetes (more on this later), I cut way back on my carbs. No more french fries--ever. No sweets. I kept my rice and potato portions tiny. I snacked on nuts, fruit, cheese, and the occasional popcorn. During the last fourteen weeks of my pregnancy, I gained a total of two pounds. The midwives, bless them, didn't ever comment on my lack of weight gain. All told, I gained twenty pounds during the entire pregnancy, about half of my gains with the boys (36 and 38 pounds, respectively). Yet I still fought anxiety over the baby's weight, especially after I had to stop my exercise program during the second trimester (due to way too little sleep and way too much life stress taking a toll on my already waning pregnant energy), and after I had an ultrasound at 38 weeks that estimated the baby's weight to be 7 lb 14 oz. I had a mini meltdown after that appointment. I remember Stephen trying to talk me down as I said, with panic on my face, "If she gains half a pound a week for the next 4 weeks, she'll be ten pounds when she's born!"
Apart from my giant baby fears, I felt great on my strict pregnancy diet. I credit my diet for helping me get through five enormously stressful months of life crises that happened right as I was second and third trimester pregnant. I never felt huge, despite going way past my due date. I had sufficient energy to cope with the demands of three skin infections (in my eczema son) that kept me up all night long. I had next to no heartburn, which was a persistent issue during my previous two pregnancies. My skin looked great. I never crossed over to that "I'm too giant for even my biggest maternity shirt" phase. Even if the baby had been big, it would have been worth staying the course on my diet just to dodge so many of the normal pregnancy complaints.
Oh, and when she was born? Eight pounds, one ounce. My smallest baby yet. In a postdates, gestational diabetic mom. I felt like all my efforts had been validated. And, two weeks out from her birth, I don't look pregnant! A little extra padding for sure, but I'm sure I'll be able to lose it on whole, Paleo foods, especially once I can start exercising again!
As my pregnancy progressed, I grew, if anything, even stricter with my diet. I ignored multiple chip cravings, and made sugar a very rare treat. Once I was diagnosed with gestational diabetes (more on this later), I cut way back on my carbs. No more french fries--ever. No sweets. I kept my rice and potato portions tiny. I snacked on nuts, fruit, cheese, and the occasional popcorn. During the last fourteen weeks of my pregnancy, I gained a total of two pounds. The midwives, bless them, didn't ever comment on my lack of weight gain. All told, I gained twenty pounds during the entire pregnancy, about half of my gains with the boys (36 and 38 pounds, respectively). Yet I still fought anxiety over the baby's weight, especially after I had to stop my exercise program during the second trimester (due to way too little sleep and way too much life stress taking a toll on my already waning pregnant energy), and after I had an ultrasound at 38 weeks that estimated the baby's weight to be 7 lb 14 oz. I had a mini meltdown after that appointment. I remember Stephen trying to talk me down as I said, with panic on my face, "If she gains half a pound a week for the next 4 weeks, she'll be ten pounds when she's born!"
Apart from my giant baby fears, I felt great on my strict pregnancy diet. I credit my diet for helping me get through five enormously stressful months of life crises that happened right as I was second and third trimester pregnant. I never felt huge, despite going way past my due date. I had sufficient energy to cope with the demands of three skin infections (in my eczema son) that kept me up all night long. I had next to no heartburn, which was a persistent issue during my previous two pregnancies. My skin looked great. I never crossed over to that "I'm too giant for even my biggest maternity shirt" phase. Even if the baby had been big, it would have been worth staying the course on my diet just to dodge so many of the normal pregnancy complaints.
Oh, and when she was born? Eight pounds, one ounce. My smallest baby yet. In a postdates, gestational diabetic mom. I felt like all my efforts had been validated. And, two weeks out from her birth, I don't look pregnant! A little extra padding for sure, but I'm sure I'll be able to lose it on whole, Paleo foods, especially once I can start exercising again!
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