Saturday, March 26, 2011

Difficult Birth: Even Trauma Has A Silver Lining

I have written about positive birth stories and called upon women to share theirs with positivity.  I have asked that we stop the fear with our abilities to empower the women around us to have confidence in their bodies and their strength.  My birth story is not a pretty one.  It ended up nothing like I had hoped.  But I want to begin by saying that my story is rare, and while it was everything most of us worry will happen, it is also very unlikely to happen to most women.  Instead, it is proof that any woman has the strength to endure anything and that the only thing that matters is that your little one end up in your arms and you know you made all the right decisions to put him there safely.  Labor can be hard, but it is nothing to fear.

Before I begin, I must tell you my Birth Plan.  I went in visualizing what I wanted and hoping I would get it.  I wanted a completely natural birth; I didn't even want drugs mentioned.  I was going to use hypnobirthing and find a state of ultimate relaxation to work through the labor and "breathe down" my baby.  I wanted the lights dim and the environment quiet when my baby came into the world.  I wanted my baby placed on my chest immediately afterwards with a delayed cord clamping and delayed medical attention until we had bonded.  I wanted to breastfeed immediately.  I wanted the least amount of intervention possible despite being in a hospital.  I was very clear in my mind exactly what I wanted and certain I would get it.  The best laid plans, right?

My birth story begins around 10:00 a.m. on a Sunday morning.  I began to feel "pressure" in my uterine area, very much what it feels like when you begin menstruating.  At this point, never having been through this before, I really had no idea what to expect and it was difficult to tell if I was having the same gastrointestinal distress I had been having for the last month of my pregnancy.  But then it went away and came back, went away and came back, and soon, I was wondering if I might be experiencing the uterine surges we all know as contractions.  After a couple hours I was sure they were contractions, but I wasn't sure if it was practice labor or the real thing.  The only thing I knew was to wait to call my midwife until they were five minutes apart and one minute long for an hour.  So we waited.  We went for a walk.  We got excited but then tried not to get too excited.  By late afternoon, they were predominantly five minutes apart so we called the midwife.

Per usual with a first labor, things progress slowly and my midwife didn't feel like anything I was saying was kicking me into active labor.  She told me to stop walking and go relax; see if they go away.  She told me that I should call her again if they got to two or three minutes apart.  I got into the bath, had my first real glass of wine in nine months, and tried to relax.  Things subsided a bit and moved to seven or eight minutes apart.  I figured this wasn't it and crawled into bed trying to get some sleep.  I fell asleep maybe three times for 20 minutes each.  By 3 am, the contractions were two to four minutes apart.  We called my midwife.  The thing about labor, however, is that it should be more patterned.  I should be going from four minutes down to three, then down to two, and so forth.  The fluctuation between two and four did not indicate active labor.  My midwife felt that this pattern meant we were still in a pre-labor phase and she knew I wanted to labor at home.  She suggested we could go to the hospital and get checked, but that she didn't think I was there yet.  So we waited another five hours.  Still having contractions so close together, we decided to go get checked.  The car ride intensified the contractions and my hypnobirthing came in handy at these moments as my husband reminded me to relax and breathe.  At the hospital, we got our answer...2 centimeters dilated and 60% effaced.  Back home we went.

Before arriving home, we decided to stop by my chiropractor who I had called that morning.  We went straight from the hospital and she gave me and adjustment.  I was hoping that this would speed things up or slow them down.  After checking me she thought my son was in a great position and that we'd probably see a baby by the end of the day!  Excited, we headed home.  My sister arrived to give me amazing massages and take care of me for a while and we settled in.  I went to the bathroom an hour later and my mucous plug had dropped...my first sign of fluid change meant things were moving along!  We called the midwife again midday, but the time intervals between contractions were still fluctuating.  My midwife prescribed me an Ambien.  She felt some sleep would either get things moving or stop them, and at this point, these contractions needed to put up or shut up.  With my sister rubbing my head, I fell asleep.  An hour later, I was up again.  No change.

In and out of the bathtub I went, trying to relax, trying to make it through.  It was 4 am when we returned to the hospital.  I was now 2 centimeters dilated and 80% effaced.  I felt like I was going nowhere and I was exhausted.  But I still wanted to labor at home and avoid the "clock" of the hospital.  Back home we went, and I was beginning to feel defeated.  Not afraid, but exhausted.  Things didn't slow down or speed up.  By 9 am (and nearly 48 hours in), I looked at my husband and told him we had to go to the hospital for good this time.  I now needed a clock.  I didn't think I even had another 24 hours in me.

At the hospital, I was 5 centimeters dilated.  Progress!  Things were looking up and they put monitors on me (not something I had wanted for more than 20 minutes, but we were over 48 hours in and both my son and I needed continuous monitoring).  Into the laboring tub I went.  I was trying to hold my hypnobirthing state of relaxation and began riding the contractions.  I was doing well and things felt great in the water.  Two hours later, my midwife checked me again.  6 centimeters.

Now, at this point in active labor, you should be progressing a centimeter an hour.  Normally, a centimeter in two hours isn't bad and would probably indicate a long active labor.  However, I was now over fifty hours in and exhausting fast and my water still hadn't "broken."  My midwife felt that an even longer active labor would mean I'd have no ability to make the final push.  She asked to rupture my membranes ("break my water") to move things along.  This was the first intervention I succumbed to.  I knew she was right.  My body didn't have the energy to make it much longer.  She ruptured my membranes.

When I saw the explosion of brown and the disgust on my midwife's face (meconium tainted membranes are vile), I knew I was in trouble again.  My little guy had defecated in his amniotic fluid, meaning he had experienced some form of stress.  It also meant that he had to go straight to the nurse's station in the corner of the room to be checked immediately.  If he aspirated meconium, he'd be in trouble.  No straight to breast, no delayed cord clamping.  I succumbed to another necessary medical intervention in the best interests of my son.  Back into the tub I went.

Contractions began to rock my body.  Hypnobirthing became impossible for me at this point.  To properly hypnobirth you need to enter into a state of mental relaxation.  In this state, it really is easier to let your body do what it needs to do and breathe through the experience, minimizing any discomfort.  However, when you are exhausted, it's almost impossible to achieve any mental state.  I was at the mercy of my exhaustion.  It took my husband, my sister, my mother, and my stepmother to all help me breathe through it by allowing me to concentrate on their eyes and follow their example breaths.  I wouldn't have made it without them.

I think it would be valuable to try and explain what a contraction feels like to those of you who may not know.  A lot of people will tell you it's pain, but I disagree.  Pain is a feeling your body gives you when there is something wrong.  Giving birth to a baby is not an unnatural thing.  Your body is working, but most of the time, there is nothing wrong.  The best way I could explain a contraction would be like explaining the experience of vomiting.  It's something you can do and it's something that is not necessarily painful.  It is just very uncomfortable.  Most of the time if you just make it through the vomiting, you reach the end result of feeling better and all is well.  Essentially, that's all a contraction is.  Let your body do what it needs, relax, and let it achieve its necessary outcome.   I, personally, can vomit like a champ.

Now...that's a normal contraction.  I, on the other hand, was full on into back labor.  Back labor is when the contractions are felt stronger in your back than your uterus, and this is accompanied by pain (sort of -- consider it violent vomiting)...because something IS wrong.  It means the baby is not getting into the right position.  The only thing that helped was my sister's exceptional lower back massaging through the contractions.  For the past 5 months, I had been doing Optimal Fetal Positioning and had kept my baby in the perfect position the past three months, and now, he was posterior (his back was towards my insides not my outsides).  The nurse and my midwife got me out of the tub and checked me gain.  Two hours and I was now 7 centimeters.  Progress again.  They laid me over the back of the back of the bed with hopes of helping move the baby in the right position and, again, my family helped me breathe through it.

An hour later they checked me.  I was still 7 centimeters.  I had gone nowhere and contractions were rocking my body so hard that I can only explain the experience as the emotional and physical equivalent of dry-heaving continuously.  A whole lot of physical output only to go nowhere.  At this point, I'll be honest.  For the past two hours I had been thinking "this is why women have epidurals."  However, I kept going; I could do this, I could endure this for the right outcome.  When I saw that all this work I was doing was getting us nowhere I began to feel a little helpless.  I could do this if it was getting us somewhere, but I was exhausted and the idea of no end in sight was starting to wear on me.

When my midwife said "Pitocin" and "epidural," I experienced a feeling of relief.  My amazing husband, who (it would later turn out) was pro-drug the whole time but wanted to be fully supportive of whatever I wanted, tried to support my original plan.  "Are there any other options?" he asked half-heartedly.  "No, hon," I said. "There aren't."  I was done.  And the moment I decided I was done, I just wanted it all to stop.  This is the moment, my friends, where women who have no medical intervention give up and eventually die.  However, none of us ever have to worry about that.

They told me the epidural would take 15-20 minutes to kick in, and I remember thinking I just couldn't do anymore.  Not only that, but I had to sit perfectly still while they put it in and I was still having contractions rock my body.  Then all the scare stories of pain from putting in the epidural ran through my head.  But I just wanted to the contractions to end; I just wanted to rest for a minute.  So they placed my husband in front of me and had him hold my hands.  I stared into his eyes and he breathed me through two contractions.  By that time, the epidural was over and I hadn't moved a muscle.  I can tell you now, an epidural does not hurt.  It is not much different than getting an heparin lock placed in your hand for an IV.  Actually, I think that hurts more because the tubing is larger.

My midwife reminded me that it would take 15 minutes and I looked pleadingly at her.  I told her that I didn't know if I could do it.  She asked me if I felt that last contraction.  I didn't.  She asked me if I felt the next one.  I didn't.  She smiled and I felt relief carry over my entire body.  I am not a religious person, but this moment felt like a gift from God.  I am not a fan of unnecessary medical intervention, but in this moment, when I knew I was one of those statistics for whom it was completely necessary, I was grateful for western medicine.

The next two hours went fast.  I rested trying to get my strength up for the birth.  They turned me on my side to get the baby to rotate and get into the right position to move down the birth canal.  Two hours later they checked and I was 100% effaced and 9.5 cm dilated.  An hour after that, I was 9.5 cm dilated.  My midwife looked stressed.  She knew where things were headed and she didn't want it any more than I did.  She looked at me and said we needed to start talking caesarian.  I pleaded for her to give me another hour...it was half a centimeter!  She gave me her honest opinion.  Another hour was not going to get us closer, my uterus (which had been working for over 55 hours, regardless of whether I could feel it now) did not have the strength to push as was evidenced by its inability to fully open even with Pitocin.  I asked her again for one more hour and she said she would put a device in my uterus to measure whether or not the contractions were even strong enough and we'd see.  In the end though, she couldn't get it in.  My son was in the wrong position and wedging up against my pelvic bone.  My midwife knew that if we tried to do this vaginally, either he or I, or both, would have to be rescued.  In the end, it was the only choice we had.  Left alone while they got everything together to wheel us into surgery, my husband and I cried.  But now, all that mattered was my son, and it was all we could do for him.  I was officially a "failure to progress."

Surgery was easy.  It was fast, beautifully handled, and neither my son and I were in trouble during the procedure.  As they wheeled me into surgery and got prepped, I had worried so much that maybe something was wrong with him and that's how we got here.  My husband squeezed my hand as the surgery progressed.  And then, he was out, and he was screaming.  Fifty-nine hours of labor and I had a son.  They took him over to the nurse's station and my husband ran over.  I couldn't see him past a pole in my way and I remember feeling frustrated and sad.  But he was fine; ten fingers, ten toes, screaming lungs.  His APGAR ended up being an 8/9.  He was near perfect.  They brought him close so I could see him and he was so beautiful.  They wheeled him out of the room and my husband followed, grinning like a new father should.  He looked back at me and promised "I won't leave his side."  I was crying then...because I was a mother, and because I couldn't touch my son.

I laid in recovery and all I wanted was my son.  It was not long after that he was brought to me.  While babies are not often brought back to recovery, my midwife knew that I needed this.  Within an hour, he was placed in my arms and we were breastfeeding.  He latched perfectly and fed for a half hour.  The nurse was amazed.

My birth plan had fallen apart.  Everything had gone wrong in my mind.  There was nothing wrong with him, but with me, as I endured the diagnosis of two small a pelvis.  My poor son just couldn't figure out how to exit the womb.  But at the end of it all, it was that first moment we had together that mattered.  And it was all the moments that came before my labor, and all the moments that would come after.  That's the silver lining.  It's not just that you have an amazing child, which you do and that is a miracle in itself; it's that you still did everything you could to do the best for him.  At first, before I processed what I had been through, I was afraid that this birth had undone all that I had worked for to bring my son into the world in the best way I thought possible.  But nothing can undo any amount of love you give your child.  All that preparation for the perfect birth plan left me calm and fearless as I went into labor, and it kept me calm and fearless throughout all I endured.  Hypnobirthing gave me confidence, eating well and staying healthy kept my body and his strong, and focusing on any kind of plan made me bond with him and prepare for the experience.  He felt all of that.  And from the moment he was on my chest, the world was right again.  He felt all the love that I put into my pregnancy and, despite those brief moments of stress trying to get out, he would feel nothing but that love from that point forward.  And now I know one thing, I can and will be the greatest pillar of strength to give him whatever he needs.

I also learned a lesson.  The first lesson of my parenting experience.  A lesson I knew intellectually, didn't truly comprehend the magnitude of.  Children create themselves from the very beginning.  You have to be ready to adapt and change with them, and plans can only go so far.  Our birth experience was essentially that; I had to adapt to his needs, no matter what.  In the end, it's always about what's best for him, and only he can tell me what that is.





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