As my regular readers (or those following my pregnancy posts) know, I was planning on an intervention-free birth, if possible, in part for the aesthetic/philosophical reason of wanting to experience all of childbirth, and in part because I believe the safest birth and the one least likely to end in a c-section is the one with the fewest interventions. That is not to say I disregard actual medical need/emergency situations; interventions certainly have their place in some labors and deliveries as necessity, and some women may balance the risks of interventions against the discomfort of childbirth and come to a different conclusion than I did. I simply wanted to avoid the intervention super-highway and take a scenic byway instead. I chose an OB and a hospital who understand that point of view and are accommodating to it whenever possible.
This is the story of my son’s birth (in full and rambling details so I can preserve them for myself): what happens when labor stops being polite and starts getting real.
I want to start with a reminder that I was diagnosed at about 32 weeks with gestational diabetes. Most OB’s like to induce GD patients on or before their 40-week due date because GD mothers are a “high risk” category. First, there is a link between GD and oversized babies (specifically macrosomic babies, that is, babies that are big from excess body fat), which is “risky” because a very large baby can have trouble being born vaginally (at least, on the timetable demanded by most hospitals and OB’s). Second, there is a heightened risk of placental degradation before labor begins. My GD was controlled via diet, which made me feel like I didn’t have much of risk for a fat baby (how could I, if my blood sugars were like a normal mom’s?) nor a failing placenta (the cases of early degradation, from my research, were linked to women who had to take insulin). So I was very resistant to the idea of inducing labor rather than going into labor spontaneously, and I had let my OB know that I wasn’t comfortable with induction, period, and certainly not before I hit the 41 week mark. We had an uneasy truce on that, where she would remind me at appointments that she didn’t want me going over but would never actually schedule an induction date because she knew I was unlikely to agree to it.
On Sunday night a week ago, sometime between 11 and midnight, I got up to pee and had a gush of amniotic fluid while I was on the toilet. Not enough to be a complete emptying of my water bag, just enough to make me certain of what it was. I nearly cried with relief that I would not have to fight my OB about inducing. I was 40 weeks and 3 days, and spontaneous labor had started.
I contacted my friend who is a midwife, and she suggested that unless I was feeling strong labor pains in the regular pattern of 5 minutes apart for 1 minute each for 1 hour, to just stay at home and rest. My OB had given me a 6-hour time frame to go to the hospital if my water broke and I hadn’t started labor, but the midwife, my husband, and I all agreed that was pretty arbitrary and short a time, and that I’d be more comfortable staying at home longer. Maybe 20 minutes after that initial rupture, I had my first labor contraction. It was not really any stronger than the Braxton Hicks/prodromal labor cramps I’d been having for weeks, but it was a clearly defined contraction rather than being an amorphous period cramp type of feeling. When the next didn’t come for 15 minutes, I went back to bed. (My poor husband was too nervous to sleep, so he stayed up.)
Throughout the night I continued having small gushes of fluid and the same type of labor pain. They weren’t really establishing a strong pattern; the closest I got was about an hour where they were 7-8 minutes apart. I got up around dawn and found my husband still wide awake and nervous about my safety and the baby’s; I reassured him there was nothing wrong, that early labor can go on for a while. We made breakfast. We watched a movie on the couch. We took the dog on a walk. I did crabsteps on the curb. We waited as long as my husband could stand it, which was about noon, and then slowly got everything together to go to the hospital. We arrived around 1:30, lying about when my water had ruptured so as to not seem totally irresponsible to the staff at the hospital (we said 4:30 that morning not pre-midnight).
They took me back to evaluation and tested that I was, in fact, leaking amniotic fluid (which was still slowly leaking and definitely not completely gone), strapped me to a fetal monitor for a non-stress test to make sure baby was handling labor well, and did a cervix check: about 1 cm and 60% effaced, or barely more than I had been on my last OB appointment (1 cm and 50%). This was disappointing to hear but not really surprising, as I was still in very early labor. Baby’s heart rate and movement were fine; my blood pressure was fine; everything was fine.
I was moved to a labor and delivery room at around 3:30, and my husband left to go pick up the friend who was going to be my birth partner. While they were gone the nurse told me I was not allowed to eat anything but clear liquids (despite my birth plan stating that I was to be allowed to eat as I liked) and that my doctor wanted to start me on Pitocin to try and get my labor kicked into gear. This was very upsetting to me, because the doctor was just making this arbitrary medicalized choice without really talking to me about it or explaining why it was necessary. Basically, the nurse said, doctors don’t like to have babies undelivered more than 24 hours after the water breaks. Thank God, I thought, that I had been smart enough to lie about when I started leaking! And to stay home longer than the 6 hours. Otherwise I’d have been on Pitocin since 6 a.m.
I asked that my husband and birth partner be back in the room before they started the Pitocin drip, and the nurse agreed to that compromise. I texted my husband to dawdle on the way back and tried to avoid an emotional breakdown. The nurse saw my tears and asked what was wrong; it was impossible for me to articulate to her that I felt abandoned by my doctor and tricked into a medical path that terrified me (a friend reacted badly to Pitocin, and by badly I mean not at all to two entire bags of it, and ended up in a section cum hysterectomy to avoid hemorrhaging to death; plus everything I had read about augmented labor said it’s much more intense and hard to deal with sans pain medication). Not to mention how annoying I found the nurse’s attitude of nonchalance about what was happening. So she sees 10 births a day, 9 of them involving Pitocin; so what? This was my first and potentially only pregnancy, and it was already going a way I did not intend! But she was clearly of the “I see nothing wrong in interventions” school of L&D thought, so, again, I could not explain my upset to her, nor did I feel like I needed to.
My husband and friend (let’s call her Robin, for narrative ease) came back around 5:00. They hadn’t been in the room more than two minutes before the nurse was back in and hitting go on the Pitocin drip. My husband, bless him, did offer to raise hell and physically prevent anyone from touching me; to remove my IV lock and “break me out,” not to return until I was in full labor naturally even if that meant going to the ER and delivering with whoever was on call because my OB had washed her hands of me. By this point I had resigned myself to at least partial concession to the system. Perhaps my body would, as the nurse suggested, pick up a good labor pattern with just a little push and take over very quickly. And I had anecdotal stories of women going through a Pitocin-started labor without further interventions. I could do it, I was sure.
I did start to get stronger contractions within a few minutes on the Pitocin. That was a positive. There were more negatives than that one positive, however. First, I was told that I had to be on constant fetal monitoring (rather than intermittent, which is normal for women planning to forego an epidural) because of the Pitocin. They had to be certain baby was able to tolerate an accelerated labor – so I had to stay on the bed for now, until they could get the portable hooked up. Second, the nurse casually said they wanted to see contractions 2-3 minutes apart.
Whoa, whoa, whoa, I thought. Back the FUCK up.
Early labor is basically until contractions are 5 minutes apart. Active labor is 5 minutes apart until you hit about 2 minutes apart. Late active labor/transition is where you get contractions coming about 2 minutes apart. They wanted me to go from not even a regular pattern to a late stage active labor contraction pattern? What the fucking fuck. I honestly don’t know if that is the standard goal for any augmented labor, or if my doctor wanted me to labor quickly because of that 24-hour time clock ticking away due to amniotic rupture; if the latter, perhaps in retrospect not going in sooner (even with my adjusted timeline) had been a mistake…perhaps I would have been left on the low-dose of Pitocin longer, and would have been given the chance to move from early labor into active labor more slowly. Or perhaps not. Perhaps Pitocin is merely a blunt instrument used to jackhammer a baby out of one’s body, and the only speed it knows is late-stage active.
Either way, after about an hour the nurse came back in and adjusted the drip up. My contractions started to show up, according to Robin, about every 3-4 minutes at this point. I was getting a lot of pain in between them, fairly low-level but enough that it was hard for me to tell when a contraction was really coming on and when I was “resting.”
Robin and I were having a decent time (my husband left fairly soon after the Pitocin was started). The Pitocin had made me loopy; I felt like I was tweaking, and my ADD went out of control. During this time we decorated my room with my motivational posters (“Fire cannot kill a dragon”; “Life IS pain”; “So it’s to be torture, then? I can cope with torture”; etc.), I put a sheet on like a cape on over my hospital gown because it wouldn’t stay up and then swooped about Snape-like, we joked about Robin running home for some of my cosplay (particularly my death mask) to see what reaction the nurse would have, etc. I was in some pain but not more than I could handle, even knowing it would get worse from there, and the main annoyance was that I couldn’t move about a whole lot because they wanted that constant fetal monitoring. But if I had to pee we’d disconnect me and then I’d move around till the nurse came back in to reconnect. So that part was actually kind of fun.
My OB stopped in around 6:30 for a cervical check. 3 centimeters now, and 80 or 90% effaced. Yay! It was working. Then she did some math and said that she wanted the baby out by 10:30 or they’d have to put me on antibiotics to be proactive in preventing sepsis, due to time lapse since (alleged) amniotic rupture. Robin was not impressed with her bedside manner, which was very much making rounds, we’re on a timeline, make that happen OR ELSE, pregger. No personal touch, no asking me how I was beyond the clinical status, and she didn’t really explore my comment that my pain was constant rather than restricted to my contractions (which is the main thing I am annoyed by, looking back, because if she had looked into it more it would, I think, have saved me a lot of pain later).
Anyway, the OB left after like 2 minutes, and, according to Robin, at this point my contractions just stopped. Between the pain of the cervical check (the doctor was not gentle in her checks: they always hurt enough to make me bite my lip near to bleeding – and the one I’d been assessed with coming in hadn’t hurt at all, if that gives you a comparison), my doctor’s attitude, and knowing I was being pushed to speed things up when I had thought things were moving adequately, I got hit with one of those anxiety-induced stalls in labor. It’s where fight or flight instincts work against a woman giving birth in a hospital setting; my anxiety told me I was not “safe,” so labor stopped until I could get safe again. In nature that’s a good instinct. In a hospital it’s a disaster.
The nurse came back in within a couple minutes of my OB’s departure and hit up again on the Pitocin. I remember asking her with a sort of horror, “More?” because, again, I had thought at this point things were moving along well. She reminded me that their goal was 2-3 minutes-apart contractions.
And so on we went for another few hours. At the 7 o’clock shift change we got a new nurse who had a much better sense of humor and a bit more sympathy, so that was a positive. The contractions started up again shortly after that third increase and got steadily worse. They got the portable fetal monitors working, but every time I actually moved, be it to stand up or even shift position on the bed, the baby would slip off the monitor, so they wanted me as still as possible.
This took away almost every comfort measure I had counted on being able to use to endure the pain of labor, ESPECIALLY a Pitocin-driven labor. I could not move around to “walk through” a contraction. I couldn’t do stair-steps to try and help the baby’s head descend. I couldn’t get in the shower or the tub to use hot water therapy. I couldn’t get into a position where Robin could offer me useful counter-pressure on my back, much less any of the other moves our birth class instructor had gone over. Literally all that I had were breathing/focusing through a contraction and causing myself physical pain from a different source to distract me. I did both but it was mostly the latter that worked, digging my nails into my thighs as hard as I could…hard enough to leave claw marks, not quite hard enough to draw blood. Barely, I’m sure. There was a point where I was tearing up through every contraction. The pain and pressure were constant, just intensifying with the contractions. It felt horribly unnatural, and I don’t mean in a psychological sense. In a literal physical sense it felt unnatural to be in constant pain, to be given no break from it, and to have my contractions coming as close together as they were with such a minuscule ramping up to that frequency.
During this time it got harder and harder for me to pee. There was a point when I couldn’t pee at all, even though I felt like I needed to. I tried to tell this to the nurse; either she didn’t hear me or she didn’t think it was anything abnormal, because she didn’t say anything about it and certainly didn’t do anything about it. In retrospect, I should have been pushier about saying, “This is wrong.” But for all I knew it was just part of how labor feels, and I didn’t actually have to go. I thought my not having anything to pee was quite possible, as the nurses seemed to glare at me every time I drank on my coconut water because “women often throw up in labor.” Well, excuse me for preferring not to dehydrate and to have something to throw up in that event rather than just dry-heaving. So when the nurse didn’t think it was weird or wrong that I couldn’t urinate, I dismissed my instinct.
That was the second worst mistake of the night.
The worst came when my OB stopped in around 10 and did another cervical check – I had not progressed at all. I had an emotional collapse at that point. Here I had been in constant pain, some of it tear-raising, for the last 4 hours, and NOTHING had moved? I realized there was simply no way I could physically endure the rest of labor without help, when all I could do was sit or lie on the bed and, essentially, cut myself to get through the contractions already happening…that were bound to get worse because they hit up again on the Pitocin. They asked if I wanted something for the pain, and I asked what my options were. An epidural (which I was resistant to because of wanting to be able to birth in a non-prone position) or “something to take the edge off.” The way it was described, the way it sounded to both Robin and myself, was that the latter would essentially do what aspirin does for a migraine: take the pain to a dull roar. You know, take the edge off. The epidural would still be there if it didn’t work. I made what, given that information, was a logical choice and said “let’s take the edge off.”
Worst. Choice. Ever. The second that shit hit me, I knew it was the wrong decision. “I don’t want this,” I said. “Turn it off.” Unfortunately for me, it wasn’t like an IV drip they could just unplug from me but a one-time, all at once shot of a dirty downer drug. I don’t know what it was, probably morphine, or if not morphine something similar. I have never been a fan of the opiate-based painkillers (one addiction I never have to worry about is that type of pill-popping!). I HATE the loss of control (which should be no surprise given my greatest fear). I can’t stand not to be able to command my mind and my body, and I fight very, very hard against that type of narcotic. “Just relax and go with it,” the nurse told me. I couldn’t. I can’t.
I told Robin to get my husband. In that moment I just knew I needed him. In retrospect, I can pinpoint exactly why I needed him: in order to feel safe. I do not feel safe when I am not in command of my faculties, and I know that no one will watch over me like he does. When I knew I would be slipping into a place where I was out of control, I needed his presence beside me in order to not fear what would happen to me during my mental leave of absence.
That was the first moment of fear that I felt throughout the labor process to that point. The idea of labor, of physical pain, of what my body was attempting to do, didn’t frighten me in the least. But not being able to keep a clear head and be cognizant of what was happening? THAT terrified me.
Things get a little blurry here. Robin stayed with me holding my hand or back or something so I knew I wasn’t alone until my husband got there. The fuzzy-head shit did nothing to dull the pain. All it did was leave me unable to do anything except lie in the bed, dizzy and hardly able to speak because I was slurring my words so badly, and suffer through it. Robin stepped out for a little break when my husband came in. I wanted him to hold me on the bed but all he could really do was sit next to me and put his hands where I told him to. On my back. No, lower…yes, there. More pressure. No, less pressure. Perfect.
The contractions grew excruciating shortly after my husband arrived. The best I can describe them is a soldering iron being shoved through the front of my abdomen all the way to my back. I wanted my husband’s hands at the exit point for that imaginary burning impalement. I was crying through contractions, moaning and sometimes screaming like a dying animal without any control of my breathing or my focus. At points the nurse, Robin, husband, the OB…someone….would try and breath me through a contraction. The best I could do was a shift in vocalization to the “sex moan” but it wasn’t much help to me to do that. It felt better to simply scream. The OB apparently heard me and came in to see what the problem was; my husband said I wanted an epidural, and by that point I knew I needed it. The other stuff hadn’t helped my pain at all; I was at a point mentally where I just wanted the pain to stop, even if it meant a section.
Before an epidural can be placed you have to take I think 2 bags of saline fluid, to be sure you are properly hydrated. That usually takes 20 minutes. The epi team was placing one next door, so it would be more like 30-40 before they could get to me. I think that was probably the worst half hour of my husband’s life. I barely remember it, except that I pretty much spent it screaming and having full-body spasms with each contraction. Finally someone asked me where it was hurting and when I said it was all front and center thought to check if my bladder was swollen. Very. Apparently that was the source of all the in-between contractions pain and possibly some of the contraction pain, as well. I begged to have the catheter placed as soon as possible, even if it was before the normal timeline on placing an epidural, and that gave me some relief. Enough that I could moan through contractions rather than scream.
The OB checked me around the time she placed it; I had gone from 3 centimeters to 8 in the space of an hour and a half. Small wonder the discomfort was so acute. She asked me if I really wanted the epi, since by the time it was placed I would probably be fully dilated. My husband said yes, she does, and I let him speak for me.
The catheter had finally done its job, and either the relief from that pain helped put me back in control or by then (2 hours after it hit me) the nasty drug was wearing off. Whatever the cause, I was mostly clear-headed again by the time the epi team came in. My husband tried to tell me afterward, when we talked about what had happened while he was there, that my clear head came after the epi was placed, that it was a “candy-flipping” effect of using an upper to counteract a downer, but I specifically remember very lucid and rational thoughts from the point when the anesthesiologist came in. Medical protocol is that no one but staff are in the room while an epi is placed, so Robin and my husband had to leave. I asked the OB to give me one more check before they placed it, because if I was fully dilated then I thought I would be able to get through delivery without it, now that my head was my own again. I was still only 8 or 9 centimeters – almost there, but not quite. I weighed my choices. I could suffer through another who-knew how many contractions, exhausting my body and my mind that much more before the hard part came, potentially with the result of not having the reserves I would need to deliver my baby vaginally, or I could get relief from the pain and rest until it was time to push. I made a very clear and conscious choice to take the relief. I felt like it was the only way to be sure I had enough left to push. Had I been 10 centimeters and ready to go, I could have soldiered into it. I couldn’t lay there in pain for another 5 or 10 or 30 minutes waiting and still be certain I’d be able to do anything when my body was finally ready to deliver.
So they placed the epidural. The relief was almost instantaneous. By the time my husband and Robin were allowed back into the room (pretty much as soon as they laid me back down) I was calm, clear-headed, and relaxed. I could tell when I was having a contraction because my inner thighs, where the leg connects to the pelvis, would grow tense and then shake, quivering my thigh fat like I had epilepsy in only my upper legs.
The staff began prepping the room for delivery, as we all knew there wouldn’t be much time before I was ready to push. I dozed for most of it, I think, because it feels like it was only about 5 minutes before the doctor was moving the bed configuration to get me into delivery position. Maybe it was only 5 minutes; maybe that’s how close I had been when they placed the epi. My husband, who had thought he might stay through delivery, decided to go back outside, after first making sure that I was fine with just Robin beside me. (According to Robin he asked me if he could go right after the first drop of blood hit the floor….)
The bed was laid flat, and my feet were hoisted into stirrups. The OB told the nurses that with every push they were to pull my legs back toward my chest and told me to curl up my shoulders. We were basically going to have me do a mild McRoberts Maneuver every contraction, which made sense to me since the OB had concerns about baby’s size (and possibly my stamina).
And so we pushed. And pushed. And pushed.
Almost right away came the comment that the baby had a full head of long hair. They asked if I wanted a mirror. “No!” I was quite happy feeling the baby low in my pelvis; I didn’t need to see anything and didn’t really want to. I was fading in and out of consciousness between bouts of pushing, and when I was pushing I was pretty far in my own head. I didn’t need the distraction of a visual.
I had half-expected not to really feel anything, despite the anesthesiologist’s claim that I would be able to feel the pressure of contractions, just not the pain, but I definitely felt the pushing urge. It would start for me about 2 1/2 breaths before the OB, who was watching my contraction monitor, would say “Push, push, push,” but after I figured that out I had time to get a couple deep breaths in advance.
Coordinating my body to pushing was surprisingly hard. I was pulling my upper body up with hands either behind my legs or on the handle-holds on the bed, trying not to release my breath until the end of the push, trying not to put pressure in my face and abs but rather in my sphinctal muscles…all while half-asleep and exhausted. It took a while for me to get any kind of physical handle on what I needed to do. It actually got easier the more tired I got; once I gave up on pulling myself up into the curl I pushed more effectively. That was like…2 hours into the process. Apparently no one realized how long we’d been at it at first, and then someone looked up at the clock. We’d started just after midnight, and now 2 a.m. had come and gone. All the while the OB had apparently been lubing me up and stretching things as much as possible to help. I could feel what she was doing as a pressure that slowly built until it was pushing time. I could feel the baby squeezing me from the inside.
Robin said it was at the point when the OB seemed like she was starting to worry that I seemed to finally have figured out how best to push. The baby was stuck just behind my vaginal opening for several good pushing sessions, and the OB said she wanted to try an episiotomy. I said “Okay,” and then I could hear the snips of scissors (or whatever the instrument was) and hear/feel the rasp of tension being cut through. It was my body’s muscle fibers, being cut like a rope. Bizarre.
The OB made a good call on the episiotomy. On the next set of pushes I could feel his head emerging, and instead of doing 3 or 4 pushes we did six, and he was delivered. Three for the head, one for the face, one for the shoulders, and one for the rest of him.
This kicking, squalling, mucous-covered little thing was lifted away from the area between my feet. It was the most surreal moment of my life, to see this amorphous abstraction in my belly suddenly actualize into a unique being, separate from me and undeniably real. And alive. And tangible, when he was laid on my chest a few seconds later.
My reaction surprised me, to be honest. I had expected that, despite my clinical INTJ detachment from things, that I would feel the overwhelming burst of love and wonder and it’s a fucking miracle, etc., that every new parent I’ve ever heard from harps on. I didn’t. It was this insane dreamlike sequence where I was witnessing something that I couldn’t really believe but yet I was there, I was seeing it, so it must be true. That is not to say that I didn’t feel an immediate love for my son; I did. But the primary reaction was…I don’t even know how to say it. Existential crisis as something impossible happened in front of me, so that I could not deny it even though I simultaneously could not believe it?
Everything was smooth from there. Baby was healthy and fit (Robin called to me from the observation station things like “10 fingers, 10 toes!”). The doctor carefully sewed me up (Robin assures me it was all very straight!). I did not tear beyond the episiotomy, not that I gave a shit at that point, but it does prove that the doctor knew what I needed and chose her placement well. I thanked her for coaching me through what I knew then had been a long and more-difficult-than-anticipated delivery; she might have upset me and pissed me off a lot of times along the course of my pregnancy and that labor, but in the end, at the delivery, she showed me why she is so highly regarded amongst the local natural birth community. She was patient and calm throughout delivery, and never once caused me any anxiety about whether she would whisk me off into a section or use forceps or a suction cup to move things along: she let labor happen.
In the end, labor did not go as I had wanted it to but it went a way that I can look back on without upset or regret. The two main things I wanted to avoid were an induced labor and a c-section, and neither of those happened. I came out healthy with a healthy little boy, and in the end the interventions that happened did not interfere with that outcome. I am sad I was unable to experience a natural labor, but that was always a secondary consideration to the desired outcome.
***
Addendum
Oh, and as a postscript on the whole GD front…my son WAS over 9 pounds, but he was not at all fat. He just came out a big, strong baby, the way both my family and my husband’s family grow ’em. So, in conclusion, I am glad that I didn’t spend too much time fretting over the GD even if the 36-week ultrasound that put him in the 80th percentile was right. Yes…but not because of any condition besides his genetics!
Lily White LeFevre 