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.

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