Thursday, June 30, 2011

Maia's birth story

Maia's birth was much faster and less annoying than Chloë's. As the attending midwife said, "First babies don't just fall out." It had a bit of a run-up in medical advice and family politics, but otherwise was nice and uneventful.

At my 39-week appointment, the midwife, Amy, who had delivered Chloë, talked to me about being GPS positive, which you'll remember from last time meant I would need antibiotics during delivery to prevent possible serious infection in the baby. She checked me and found that I was 3 cm dilated, 80% effaced. "Your body's ready to have this baby," she said. She went on to say that since I was clearly on the cusp of active labor, it might start at any time and things were likely to happen very fast, and in that case the baby was at more risk of infection if I didn't get at least four hours' worth of antibiotics before she was born, and controlling the start of labor might be the best thing. She concluded, "So, should we strip your membranes?"

I was nonplussed, and wasn't excited about being induced before my due date. (I looked up stripping membranes later and it's not exactly induction, more encouragement, but I didn't know that at the time and she didn't explain.) Amy said that my next appointment should be scheduled for my due date and we'd talk more about induction then, if I actually made it to the appointment. It was clear she didn't think I would.

But I did; five days later, on April 26, I went in and talked to a different midwife, Heather. She, too, was concerned about GBS, though she wasn't as strongly in favor of induction as Amy had been. She said, "At this point I could go either way. In a week, we'll draw the line and say 'You have to have this baby now,' because outcomes get worse after 41 weeks. Right now, it's your decision." Eric and I discussed it and decided to schedule an induction for the next day.

I was ambivalent about this decision, since I've been inculcated in the natural-childbirth school of thought and also wasn't sure whether insurance would cover the induction itself (they did). Also nearly changed my mind when told we should be at the hospital at 6 AM. But we showed up almost on time, after having sent Chloë to spend the night with the mothers, and got checked in.

Getting registered and set up and settled in took some time (especially since the first nurse couldn't get an IV in me, instead "blowing up" my vein which gave me a horrible bruise for three weeks afterward) and I didn't see the midwife on duty, Sue, for an hour or more. She told my nurse, Midge, to get me started on antibiotics and then an hour after that I'd get Pitocin. "We'll increase it a little bit every half-hour until you're at about two to three minutes between contractions," she told me. "And in a while we'll break your water, and that should help get things going too."

So they started the IV at around 8, added the antibiotics at 9, and started Pitocin at 10. "How long was your first delivery?" Sue asked. I told her 20.5 hours. "Oh," she said. "Well, this will be much faster. We're aiming for before 6."

After that, there wasn't much to do for a while. We looked at the readout of my contractions, which were unnoticeable. Upon first getting hooked up, it turned out I was in fact having contractions at ten or twelve minutes apart already, but I wasn't feeling them, and didn't for a few hours. I shifted positions every so often and read or knitted. Eric played on his phone. We talked. We got me to the bathroom regularly, which was an ordeal since I had to bring the monitors and the IV stand with me. Midge came in to check on us a few times. "Is there anything I can get you?" she said. "Most of my patients are more needy than this; I feel like I'm neglecting you." I asked for some juice to make her feel useful.

Somewhere around 11, Sue came in to break my water. "I thought we wanted to avoid that because of GBS," I objected. I was also kind of creeped out by the whole idea, though I didn't say that part.

"You need at least four hours of antibiotics, and you've had two," she said. "I'm watching your progress, and I don't see you having this baby before one." She got out the water-breaking tool, saying ,"Some women don't like this because it makes the contractions come. But they have to come."

*WARNING: GRAPHIC GIRL CONTENT* The water-breaking tool was basically a long crochet hook, and she inserted it into me and started sawing back and forth, which really creeped me out. After what I thought must be longer than necessary, there was a little trickle between my legs, and she removed it, saying, "Fluid nice and clear. Good. It's just trickling now, but in a while you'll get up and there will be a gush," she told me. *END WARNING*

She left, and I started crying a bit because the procedure had made me feel awfully vulnerable and I was still ambivalent about all this intervention. On the other hand, delivery before dinnertime was a happy thought, and I recovered quickly and had lunch, such as it was. Since I had said I might think about an epidural, Sue had put me on a clear-liquids diet plan, so I had some juice and some sorbet and nothing else. (They provided broth and gelatin as well, but the broth was chicken and the gelatin was "varied flavors" flavored, so I passed on both.)

I started noticing the contractions, first more as involuntary motion in my muscles than anything else. Midge felt at the top of my bump and explained that she was feeling for the strength of the contraction. "Press your nose," she said. "That's a soft contraction. Your chin is a medium, and your forehead is a strong one." Then I started feeling a bit of pain. Then I started staring at the clock during them--ostensibly to time them, but really because the staring helped steady me. Midge asked how my pain level was. We'd discussed this at length when she first came in, and she made it clear that she was in favor of drugs but could happily help me do natural techniques if I wanted. We'd also discussed her pain scale, in the first actually helpful description of the 0-10 scale I've heard. "0 means no pain," she told me. "1 means it's there, but it's no big deal. 5 means you're antsy in your seat, starting to think you can't tolerate it. 10 is your arm being torn off. 5 is when we'll start talking about pain meds. But we can get something for you anytime you want it. Just tell me."

As I got up the scale from 0 to 3 and 4, I started, as I told Eric, thinking about the breathing techniques we'd learned in our birth education class last time--not necessarily relying on them, but thinking about them to distract myself. Then I started actually using them. Midge watched me through one and counseled me for the next-- "Slow, deep breath in for the count of five," she said, and counted for me. "Then slow breath out."

I was still going back and forth on the pain meds issue, but I was also starting to have trouble keeping control during contractions and wanting to vocalize--which is not the same thing as needing to scream, but is the step before it, and I remembered how awful it was with Chloë. So at this point, around 2:15, we asked Midge to call Sue to check my progress and help advise me. Sue came in and checked. "You're at about six centimeters, and your cervix is tissue-thin," she said. "I'm actually not going to leave the floor until your baby is born, just in case. But this is the perfect time for some medication if you want it." When I still couldn't decide, she suggested that I try some Nubain, "To get you through the worst of it," since I was coming up on transition (seven to ten centimeters), and I finally said yes.

Midge left with the order to get the Nubain, and so did Sue, after telling another nurse or technician (I don't remember) to get the delivery cart into the room, just in case. I lay in the bed, on my side, through another contraction or two, squeezing Eric's hand, and started vocalizing--an "Aaaaaaaah" sort of sound, fairly controlled, though it was getting more difficult. Now that I'd made the decision to get some pain relief, I was happy I'd done it, and complained about why Midge was taking so long.

Then, in the middle of another contraction, the pain turned into a sudden stuttering urgent need to push, and my focused vocalization turned into a wild uncontrollable wail that I probably couldn't reproduce now if I tried. Eric says when he heard it, he thought, "Okay: now an hour of the hard stuff." I was pushing, though I knew I probably shouldn't since no one else was in the room, and just as the contraction ended Sue and Midge and a couple of other people burst in.

"What changed?" Sue demanded.

"I'm actually feeling the need to push," I said, apologetically, because I knew I was supposed to have gone through transition first and what had happened to it?

"That’s what I thought," she said in satisfaction, as people started scurrying around. "We were at the end of the corridor, and I heard you and said, 'That's a baby coming.' Nothing else sounds like that. Let's get you on your back and into the stirrups."

"Nooooo," I said, because another contraction was starting and the idea of rolling over and putting my legs up was totally ridiculous. But Midge and whoever else was in the room--I totally don't remember--started moving me, getting me and the bed set up quickly and smoothly, and I cooperated because I knew dimly that they were right and I couldn't possibly deliver a baby with my legs shut tight like they were. *WARNING: GRAPHIC GIRL CONTENT* Also, I had had the classic I-need-to-poop feeling during the previous contraction and wasn't convinced I hadn't, and figured that if I had and I moved they could remove the pad from under me and clean it up. (They didn't.) *END WARNING*

"Remember, use the cries for efficient pushing," Eric said, remembering last time when I'd been told I was spending too much energy screaming and not enough pushing. I did my best, though it felt like everything was so urgent and happening so fast that I wasn't able to focus and figure out how.

That contraction ended and another started. "This is it!" Sue said encouragingly. "This is your baby coming!" I was panting and feeling a wild need to push with all my might. "Here it is!" Sue said. "Push!" I pushed, a long, long push, and felt a sort of weird scrambled feeling down there, and wasn't totally sure whether I had just delivered a baby or not, but was still feeling an adrenaline-fueled need to do something, sort of a panic but without the actual panic--"Keep pushing!" she said again, and I pushed, and felt the "ring of fire" start and expand, and then, all at once, Maia was born.

Sue held her up, limbs sprawling, weakly mewling. "Do you want her?" Midge said. I was still panting, my heart racing, feeling like I couldn't get a grasp on what had just happened to my body, and didn't answer right away, so she said again, "Do you want her?" I gasped, "Give me a minute." So Eric got to hold her first. In a bit, when I was enough calmer that I thought I could hold her without dropping her, she came to me, the umbilical cord slapping cold against my lower belly. She had a funny ridge on her head, sort of Klingon-like, and a burst blood vessel in her left eye. Sue said the ridge was normal, from pressures in the birth canal, and the blood vessel wasn't surprising. "She'll probably have a bruise later on because she went through so fast," she said. "It's a good thing I ordered the delivery cart just in case."

Maia was pretty alert, so we tried nursing right away. When she was done, the nurses/technicians took her and started doing the usual procedures--cleaning, weighing, administering medicines, and so on. Sue pulled on the cord, cut now, to get the placenta out. I could feel it and pushed to help get it out, though she hadn't asked me to. In the meantime, Midge was throwing away the Nubain, which she'd had in her hand when she ran in. "That was what we call a slam-dunk baby," Sue said, partly to us and partly to the nurses, as she was sewing me up (I got a second-degree tear, same as last time). "I've got two more births today and they're both going to be just like that!" It was less than half an hour after she'd pronounced me six centimeters.

One of the technicians helping take care of Maia turned out to be the same one who'd wanted to watch while I had Chloë. Her name is Monica, not Martha. Eric mentioned it, and she remembered us, and was pleased he remembered her. She and Midge went to help me out of the stirrups and sit up. "Chin to your chest," Monica instructed me. I obeyed, though I thought that was kind of odd, and Midge said, "No, no--no epidural. She can move."

"Oh, that's right!" Monica said, as they helped me up. "I always forget that about natural births."

Before long, Maia was measured and cleaned and wrapped up, and I begged for food (should I have another baby, I must remember to pack some snacks), and we all started feeling life slow down a little, though we weren't over the speed of the birth. Or at least Eric and I weren't. Maia was pretty nonchalant about the whole thing. "Here I am," she seemed to be saying. "You'll have to deal with me on my terms." She's still saying it, and we still are.

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