Wednesday, April 25, 2012

Olivia's Birth Story

Editor's note: this is long.  And probably just a first draft.  Having just finished writing it, I already am not happy with it.  It tells the order of events, but not much about the emotions or thoughts involved.  Expect edits.  

On Monday night, I was 40 weeks and 3 days pregnant.  And FRUSTRATED.  I'd had no less than 8 people at work say some version of "You're still here!" (Mental note: this is not what a pregnant woman wants to hear any time after 38 weeks.)  Super frustrating.  But my husband was amazing and we spent the evening together, just having some quality time, watching TV, hanging out.  But after the lights went out, I didn't sleep well.  I feel like I was up every 30 minutes or so (but refused to look at a clock).  My stomach hurt.  I tried to remember if I'd eaten anything that would give me intestinal trouble.  Ben snored.

By 4:30 am, I was awake enough that I decided I should look at a clock.  That would at least tell me whether or not I had enough time left to get any decent sleep before work.  And by 5:00am, I figured out that it wasn't just a stomach ache, these were contractions.  Was it the Evening Primerose I'd been taking? Or the red raspberry leaf tea kicking in?  They weren't very strong, but I figured I'd time them anyway.  Some women have light contractions for days, so I didn't really want to get my hopes up.  Ben snored.

At 5:30am, I got out of bed to go to the bathroom.  Standing made the contractions a little stronger.  I realized, while in the bathroom that our hospital bag wasn't completely packed... I'd gotten *most* of the stuff in days/weeks earlier, but had been lazy about finishing it up.  And I recalled our friends' recent story about her water breaking without a bag packed.  So I wondered if I could sneak around the bedroom and nursery quietly enough to not wake Ben but still finish packing the bag.  He'd been working hard recently, and if this really was labor, he'd need all the sleep he could get before things got serious.  Unfortunately, when I got back to the bedroom, I had a contraction and had to lean over on the bed... which woke my snoring husband.  He looked up (out of just one eye) and said, "did your water break?"

As soon as I told him what was going on, he snapped into action-- his first 2 actions included downloading a contraction timer app and feeding the fish a weekend feeder.  Completely hilarious in my opinion.  Those would have been the last two things on my mind.  We rushed around for a few minutes, tidying the house (only a little) and putting things in a bag.  My contractions still weren't very strong or long, but they came much more closely together when I was standing/walking than when lying down.  By 6:00am, Ben decided to call the midwife on call... which brought on the next funny story.  The answering service asks for information to page the midwife with -- name, date of birth, and what the problem is... Ben got so confused about "date of birth."  He thought they wanted Olivia's date of birth.  I had to help. :-)  Once we were talking to her, my contractions were anywhere from 2-6 minutes apart, only 20-30 seconds long, and I definitely could talk and breathe through them.  The midwife told us to hydrate, rest, and call back as things got moving along more strongly.  It also was convenient that I had a scheduled appt at 5:30pm that evening-- completely random chance.

After getting off the phone, we finished packing the bag up, showered, but eventually decided to lay down and rest.  I slept on and off for 2-3 hours-- probably got 1.5-2 hours of actual sleep during that time.  When we woke, Ben (my awesome labor partner) decided we should take a walk, so we went to JP licks for a muffin (for me) and a coffee (for him).  He was wonderful on the walk-- we went slow, he let me stop for contractions... he kept me entertained so I didn't think about them.

After eating a light lunch back at home, the contractions felt stronger... I convinced Ben to go to work for a couple hours-- if he didn't go soon, he wouldn't be able to make it back before the 5:30 appointment.  And if he went after the appointment, he might be too late to be helpful to the guys.  So he scurried off to the Museum of Science and I laid down to watch a little TV.  Once laying down, I could get the contractions slowed down significantly-- up to 11-15 minutes between them.  Occasionally they lasted 30-40 seconds, but typically only 20-30.  And still not so strong that I'd call anything painful.  Definitely uncomfortable and irritating.

When Ben got home from work, we packed up to go to the hospital appointment.  We decided to take our bag and the car seat with us "just in case," but both figured that my contractions were light enough that Jen would check me and send me back home to try to get some sleep for the night.  We got to the hospital early and I had a few contractions in the waiting room.  I paced a little and tried to breathe evenly so I didn't draw too much attention to myself.

At 5:30pm, they brought me in and the nursing assistant was stunned to hear I was in labor!  She took my vitals and went to get Jen.  When Jen came in, she said "You're famous!  I heard you called this morning 'cause you might be in labor!"  We chatted for a few minutes about whether or not I wanted her to sweep my membranes when she did my internal exam.  I'd declined a membrane sweep the Friday before (when I was exactly 40 weeks), 'cause Ben really encouraged me that my body would go into labor at the right time for us.  But on Tuesday evening, having had contractions for 12 hours, I thought a membrane sweep would be just fine to help progress things along.

Well, I'll be honest, I don't really know if she swept my membranes or not... I laid back on the table and she began to take a look.  The look on her face was the next funny moment.  She looked stunned.  I asked what was wrong and she told me that I was 5-6 cm dilated and 50% effaced.  I can't remember her exact words, but it was along the lines of "I don't know how you did that!"  I asked if it was good that I'd brought the bag and car seat with us and she said yes.  She told us we could go home if we wanted to, but she encouraged us to stay in the area instead... recommended we go to Harvard Square for some dinner and then come back to get admitted around 7:30pm.  On our way out, she asked if I'd done a lot of walking that day, 'cause if I hadn't she was worried that the walk to Harvard would get my labor progressing a lot faster.  Her two pieces of advice were "You don't have to go all the way, you can turn around any time and come back and they'll admit you.  And Amanda?  Don't worry, your baby won't fall out."  HA!  I guess she thought this thing was happening!  Jen happened to be scheduled for L&D on Weds from 8am to 8pm.  We'd joked for weeks about convincing Olivia to be born during one of her shifts.  On our way out the door she said, "Don't wait for me.  I'll come meet your baby when I get back in the morning."

On our walk to Harvard, we called all our families and told them the scoop.  I was walking a lot slower, but still walking through most of the contractions.  We went to Chipotle for dinner-- Ben got a burrito bowl and I munched off the edge of it while we sat outside (it was too warm inside, loud, and I was nervous to have contractions in front of so many people).  Before going back to the hospital, we also walked over to Peet's Coffee so that Ben could get an iced coffee for the evening.  A "celebration coffee" as he put it.

On our walk back, contractions were stronger.  I had to stop or slow down when they happened, I couldn't really talk, and you could tell from my face and body posture I was uncomfortable.  One occurred in the middle of a crosswalk, of course.  While stopping in the cross walk, a 60ish year old woman wheeled up on her bike, waiting for us to cross.  I looked up and apologized for being in her way.  She laughed and said "Wow.  You guys are in for some fun, aren't you?"

We made it back to Mt Auburn and to the L&D floor around 7:15pm-- Shift change for the RN staff.  When we walked in the door, about a million nurses looked up... "Um... I'm Amanda?  I'm in labor?"  One of them took us to our room.  At 7:30ish, the midwife (who was leaving at 8pm) came in and said hello, explained that Arianne was coming on duty after she left.  Between 7:15 and about 10pm, my contractions stayed pretty level.  Especially when someone else walked into the room (a nurse or midwife), I could almost ignore the contraction-- or at least outwardly didn't look too bad when it was happening.  But by 10pm, they must have been increasing in strength, I couldn't 'fake' comfort any more, and we decided to check to see how far along I was... only 7.5-8cm dilated.  It felt so disheartening to be 4-5 hours farther through this and only gain a few cms.  But there was nothing to do but wait.

By midnight (which brings us to Wednesday), contractions were definitely uncomfortable.  I needed encouragement to breathe through them.  I didn't like them.  And I didn't like the lack of rest I felt I got between them.  Getting in the bath tub made things a little more comfortable, but not a lot.  And at midnight, the nurse and midwife started saying things like, "you'd have your baby in your arms if you could just get your water to break."

I guess it was around midnight that I threw up for the first time.  (Don't read this paragraph if you're squeamish about vomit.)  I was in the tub and I kept saying I felt nauseous, but I don't think they believed me.  Finally I grabbed the pitcher that Ben had been using to poor water on my belly and just chucked right into it-- when I gathered my wits, I could tell that the full contents of my stomach including completely undigested burrito bowl was there.  As I passed it back to Ben and Arianne for dumping out, she gave him the thumbs up... this was a good sign that I was in transition.  I, being the annoying medical person that I am, mentioned that if I weren't in labor and had that much undigested food in my stomach 6 hours later, it would suggest a GI motility issue.  Just one little moment of clarity in my craziness that night. :-)

I guess it was around 1:00am that they wanted me on my hands and knees for a while, trying to open my pelvis and get my water to break.  I didn't want to do it because it was making my reflux bad to be leaning over like that... but they offered me an antacid, which helped some.

I spent quite a while at 9+ cms dilated.  But the positions that Arianne thought would help progress things were so painful during the contractions, that I was avoiding them.  At 2am, I really thought that Arianne was going to offer to break my water, but instead, she asked me to go sit on the toilet (my least favorite position) one more time.  It was in this position, squatting in the bathroom with Ben standing just in front of me for support, that my water finally broke.  I have to say, I cannot understand how this part of labor occurs for anyone while at work, in a mall, or while at a friend's house.  It felt like so much pressure and so much fluid (mind you, all over Ben's pants)... what the heck do you do if it happens while you're not naked in a bathroom at the hospital???

Unfortunately, after my water broke, I had some how regressed back to 8 cms.  :-(  Arianne suggested it was due to the pressure release from the water breaking.  Ben, on the other hand, thinks that the sphincter law and my dislike for the RN had something to do with it.  Regardless, after telling everyone for hours that I didn't want to do this any more (a classic sign of "transition"), Arianne asked me if I wanted to know what my options were for intervention.  I said yes, if only to decline them.  She said I was too far along for narcotics, but I could get an epidural.  "Okay then," I said, "we're not going to do that, so what's next?"  Back in the tub, Arianne suggested-- so back we went.

Arianne was, by the way, amazing.  She, of course, had to leave every once in a while to check on her other patients.  But she always seemed to be around at the right times.  And when there, she was such a wonderful help to me and to Ben.  She knew all the right things to say at the right times.  She took turns with Ben just holding my hand and rubbing my back.  She encouraged him to help me, she showed him good techniques.  And when he was feeling hopeless, she gave him energy to keep going with just an eye gaze and a few encouraging words.

I guess it was around 3am that I heard a couple nurses in the corner of the room talking about needing to get an IV into someone else down the hall.  Again, in a moment of clarity, I reminded Ben that the only real problem I'd had in my pregnancy was getting light headed/passing out when I wasn't hydrated.  And for hours, I'd been barely drinking anything, despite the RN telling Ben over and over that I needed to hydrate.  So I asked, "Do I need an IV?"  The RNs were like, "oh no, no, honey, we're not talking about you."  But Arianne said, "Did she just ask for IV fluids?  'Cause that's a good idea."

After they got the IV in (which ever RN did that while I was fussing and moaning through contractions, btw, gets a medal in my Amazing RN Book), I really felt like I couldn't help but start pushing.  But Arianne had told me not to push because I wasn't at 10 cms yet.  Ben thinks that this time, too, was confusing and frustrating for me (the rule follower), as I was sorta pushing but knew it was "bad" to push.  But finally at 4am, I was given permission to push!

Pushing.  Pushing means that you stop trying to breathe through your contractions and you start trying to use them to get the baby out.  Pushing means you hold your breath rather than encouraging yourself to breathe and stay open.  I had not practiced pushing.  I couldn't hold my breath long enough.  I couldn't get in the right position.  My body naturally wanted to arch away from my cervix and vagina rather than curling up toward it.  My pushing for the first hour was essentially completely ineffective.  But as we rounded into hour 2 of pushing (5am), the RN reminded me that the average first natural pregnancy pushes for 1-3 hours, so I was right on course.  We changed positions frequently, used the fetal monitor more than I wanted to, and the encouragement kept coming.

I guess it was around 6am that they brought the mirror in for me to watch what was happening.  Arianne said that seeing Olivia crowning would encourage me... let me tell you... seeing about 2 cm diameter of your baby's head when you know how big it actually is was not encouraging to me.  I turned away, closed my eyes, but I didn't refuse the mirror.  I thought that it would at least help Ben see what was happening while he stayed at the head of the bed with me.  By this point, I actually was really only comfortable on my back (as comfortable as you can be at this point) and got angry when I had to change positions.  So, we went with it-- and it was probably better for Arianne and the RN anyway.  The one problem, however, was that the RN and Ben were holding my feet differently and I spent a lot of time worried about pain in my right knee (the side that the RN was on) related to my knee surgery last year.  I recall being frustrated once I got my pushing technique improved... if this push didn't get her head farther out, what would really be different about the next push that would make it any better or more effective?  Arianne reminded me that Olivia had to move slowly down the birth canal, slowly stretch me open, and slowly prepare me for handling the entire width that she'd require to get out.

After her head came out far enough that it didn't keep slipping back in, I could watch in the mirror.  At that point, it was finally motivating to watch.  Unfortunately, at that point, it was also excruciatingly painful!  I shrieked like a child when the widest part of her head came through.  Ben cried.  The RN yelled at me, "Amanda!  You have to listen to Arianne now!!!"  But soon enough, the head was out.  This was one of the biggest moments for me-- put it in the category of seeing the little plus sign on the pregnancy test, hearing the heart beat for the first time, seeing the ultra sound, and feeling her kick -- there was a head between my legs.  It belonged to a human I'd never seen before.  In Ben's words, this shit just got real.

I don't really recall much of the next few minutes.  Ben says Arianne spun Olivia's head "like a top" and I remember her asking me to push again.  The next thing I knew, the head I'd seen between my legs along with a purple squid of a body was flopping against my chest.  6:55am, my daughter was born.

I don't know how long we hung in that moment... crying, saying "oh my goodness, oh my goodness."  It certainly didn't seem real.  The RN wiped her down... I remember asking "Does anyone have an apgar score?"  She had a 9, she was fine.

Another moment of clarity-- I asked Arianne what I should predict for the placenta.  And as if my body had known the perfect timing, it was then that I need to push just a little and it came out.  After the cord stopped pulsing, Arianne showed us the cord, how it wasn't needed any more, and helped Ben to cut it.  We got our "tour of the placenta," Arianne showing us the different parts, how miraculous it was... and we loved our baby.

In the next 15 or so minutes, Ben and I hugged and kissed little Olivia while Arianne took care of me with a few stitches.  And just as fast as this whole process started, poof- it was finished.  It was shift change time for the RN staff and Arianne had just an hour before the end of her shift to wrap things up.

And just like that, we were officially in the post-partum phase of life.

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