Before the birth...

When I first found out I was pregnant I was terrified of lthe pain of labor. I was very happy with the idea of epidural anesthesia. My biggest fear was having an episiotomy. I didn't fear c-section, because somehow I had a confidence that my body was built for the task, and I would birth vaginally. I approached pregnancy/labor as I did most challenges I had met in life thus far-by reading. I read everything I could get my hands on about pregnancy and labor.
When I was about 5 months pregnant I started talking to a friend I had lost touch with from college. It turned out that she was also pregnant with her first child, due 2 months before me. She was taking Bradley Method childbirth classes, and thought I might be interested too. On her advice I looked into it. I was not totally convinced to pursue un-medicated childbirth at that point, but the level of education offered by Bradley Method classes as opposed to the standard hospital childbirth classes appealed to me. By the end of the class series I was convinced that I had the tools and ability to handle labor without pain medications.

I think I might be in labor...
(I wrote this portion of my birth story just before midnight on Wednesday, October 28, 1998.)
...but Steve is more certain of it than I am. Around 7 this evening I started noticing that I was having what I have been labeling Braxton Hicks contractions, so I started trying to time them. (I am calling them B-H since they are just low in the front, nothing from the back like I keep hearing that "real" contractions are). I wasn't really getting a regular pattern--I think partially because some of them are so mild that I don't feel them--unless I put my hands on my belly when I am "expecting" a contraction, then my belly is usually really hard. But anyway, from 7-8 the "contractions" were anywhere from 6 to 15 minutes apart, usually no longer than 30 seconds.

Steve and I went to see a movie at 8:40, and the theater was pretty empty--including us there were 5 people. At 9:08 I told Steve about a contraction, and he started timing them. Pretty much throughout the rest of the movie (until about 10:30) contractions were coming 3-5 minutes apart, but again, they are really mild, so I don't really feel them all, and they are entirely in front. Since there were so few people at the theater, and since we sat the furthest back, I had a lot of freedom to get up and walk around.

We came home, and took a walk from 11-11:30. Didn't time contractions through that, and haven't really since either, but they've been coming. I'm just not sure they are "real," or even "regular" since they are so mild. I did have some bloody discharge show up once, but that may be from when my Dr. started to strip my membranes earlier today (which I am still kind of torked about. I realize he can't keep each patient's preferences memorized, but I don't think he should tell me he is going to just check to see if I am making any progress, then tell me he is starting to strip my membranes only when I complain that whatever he is doing really hurts! It hurt more than any of these contractions I have had so far! He should have told me he was going to strip my membranes before he started so I could remind him then that I didn't want it done! All he said was "okay, you are going to feel me pushing a lot, and you may feel some cramping" -- I thought he was going to check to see how far the baby has dropped.)
So anyway, I've finished getting snacks together for Steve & Dotty in case this really is labor, now I'm going to try to get some sleep...I'll keep you posted!

Yes, I'm in labor...but its going to be a long haul! (more)
(I wrote this portion of my birth story at about 11 am on Thursday, October 29, 1998)
I woke up shortly before 5:30 this morning with a contraction--I looked at the clock and must have just rounded the time to 5:30 thinking that they would be pretty far apart, and I just wanted a general idea. The next contraction came at 5:30, then at 5:38. I got up that time to use the bathroom and had a "bloody show." Woke up Steve, and we called Dotty to see if she thought we should call the Dr. We weren't really timing through this, but they were about 2 minutes apart, 30 seconds. Hurt a little bit, still all in front.
Dotty said to call the Dr, who told us to come into the hospital to get checked. After last minute packing, we left the house around 6:30, got to hospital at 6:45. I was still 2-3cm dilated, 50% effaced (same as yesterday). My contractions slowed to every 5-6 minutes when they hooked me to the fetal monitor, and I also noted that laying down (even with the head of the bed elevated) made the contractions hurt more. My blood pressure was slightly elevated (I think just from all the running around to get to the hospital), so they wanted to run blood work, which all came back fine. While they were waiting for the lab results on my blood work, they let me walk around the halls, which brought my contractions back to about 3 minutes apart, 40-55 sec long, but MUCH easier to handle.

Since it seems I am going to take a while, they told me I could go home. Somewhat funny thing...while we were there I was getting hungry, and it didn't help when I walked past the nurses' station and they were all discussing what they were going to get from the cafeteria for breakfast. The hospital I am at only has 6 LDR rooms (+2 rooms for women who need to be admitted early for complications), and I was the only patient there. All the nurses went to the break room together, so I got to smell their food when ever I walked past. Steve was getting hungry too...well on one of the rounds past the area where they have a small fridge & microwave for patients to use (but of course we are not "supposed" to eat during labor...) we noticed one of the drawers was a little open and it was filled with plastic utensils and little packages of graham crackers. So now we are guilty of petty larceny...LOL. We snatched some crackers real quick and high tailed it to my room and hid in the bathroom to eat them. Boy did that hit the spot!

But anyway, I'm home now. The contractions hurt quite a bit, and did start hurting in the back while I was at the hospital. We went out to Friendly's for breakfast, and got quite a few shocked looks from people when we kept standing up every 3 minutes for a contraction (me because it was more comfy, DH because he was rubbing my back). We did ask for a table in a back corner so we were somewhat less on display. The waitress stopped by while DH was in the bathroom though to comment that she thought it was great that he was rubbing my back and all because when she was having kids "husbands just dropped their wives off at the hospital to have the kid, and showed up after the baby was born."

{Note: When I arrived at the hospital my OB was there, we'll call him "Dr. M." Dr. M. had been my GYN for 4 years prior to my pregnancy. He practiced with 3 other OB/GYN's, so during my pregnancy I had appointments with the others to meet them. At about 5 months I started trying to get scheduled with Dr. M., but there was always some reason why he was not available. I did not see him until I was 39 weeks pregnant. I discovered in the hospital that not only had he not read my birth plan that I submitted at 32 weeks-explaining why he stripped my membranes without my consent-but he would not be on duty for my labor. Not only would he not be on duty, but none of the other OB's from the practice would either! A Dr. who I had never met before, Dr. Rittenhouse, would be caring for me while I was in labor. This scared me very much, but turned out to be a very good thing in the end.}

(the remainder of my birth story I wrote on Sunday, November 1, 1998)

Time to go to the Hospital!

...when I finished the last section of my birth story on Thursday I was going to go take a nap with Steve to rest up for the "hard stuff." Also, Steve was really tired because he hadn't followed my advice the night before. He works second shift and usually goes to bed around 3am, well I had finally conceded that I *might* be in labor by midnight Wednesday night, so I urged him to get to bed early. He "just wanted to get a few things done," and didn't go to bed until 3, and like I already said, I pulled him out at 5:30...

Well the nap didn't work. Laying down made contractions much worse, and they were only about 3 minutes apart, 1 minute long, so we kept jumping up and down out of bed. After about about 20 minutes, we gave up. We decided to go for a walk. So we walked around the neighborhood for about an hour, stopping for each contraction for DH to hold me up. Got some strange looks from passing motorists...LOL!

When we got back to the house I was contemplating taking a warm bath, thinking that would be helpful, but all of a sudden my contractions started coming about 2 minutes apart. So we decided to go back to the hospital (with visions of the Jacuzzi dancing in our heads...). We called Dotty, who was going to come assist us at the hospital. The hospital is only a 10 minute drive from our house, but we had to stop about 5-6 times for me to have contractions. We would jump out, I would lean against the car and Steve would run around to my side and massage my back. We decided to call this routine a "Bradley firedrill"--not meaning to offend anyone of Chinese decent out there.
We got to the hospital around 3:45, Dotty arrived slightly after 4. We were only patients there (and would be until Friday evening). The nurse we got we had met that morning-Jan, and she was great! I heard her tell another nurse in the morning that I looked like "a good candidate for the Jacuzzi," and I was definitely all for that! We found out later she is studying to be a mid-wife. After being hooked up to the fetal monitor for 20 minutes (nurse let me sit in a rocking chair so I could stand up for contractions) then getting examined by a resident--Dr. Eckert (5 cm dilated, 75% effaced), we were allowed to do what we wanted. We decided to walk the halls while the Jacuzzi was being filled. The standard hospital policy is 20 minutes in the Jacuzzi, then you have to get out for fetal monitoring. Well Jan talked to Dr. Rittenhouse, and got him to have an order put in my charts to allow me to stay in as long as I wanted, with Doppler monitoring every 15 minutes! We stayed in the Jacuzzi for an hour, then got out because we were turning into prunes.

Slow Progress, But Still Doing Fine...
I went on the monitor, then was checked again by Dr. Eckert--6 cm dilated, 90% effaced. The progress was a bit slower than "textbook," but we were happy with it, and set off walking the halls. During this time, Dr. Rittenhouse was hanging out at the nurses' station and observing Steve and I as we would walk past every 5 minutes or so. He was apparently really impressed with how we were handling labor, and went to talk to Dotty to learn more about what preparation we had for labor (the Bradley Method classes). Dotty was hanging out in our room at that point because as a doula she tries to allow husbands & wives as much time alone together as they want for bonding; and also she needed rest because she had been at a birth the previous day for someone else in our class, and she does have a regular job.

Sometime around 7pm there was a shift change, and the new nurse I got, Judy, was really nice. She had only been in Labor & Delivery since June or July, she had been in Pediatrics before that, and this was her first experience with a "natural" childbirth. She has kids of her own, and she couldn't believe how relaxed and cheerful I was with obviously intense back labor, and that I wasn't yelling, moaning, swearing...she willing continued the same kind of care Jan had provided--fetal monitoring in a chair, offered me some Hi-C, allowed us to go into the Jacuzzi. Again we stayed in the Jacuzzi for an hour, then got out. I threw up a little while in the Jacuzzi (I felt it coming one contraction in advance, so I had Steve bring the waste can close to the Jacuzzi). The throwing up encouraged me that I was reaching late first stage. I was kind of disappointed that at 9pm I was only 8-9cm dilated with a lip, but I figured I would be pushing by 11 at the latest...

28 Hours of Labor Can Tire You Out!
Well I wasn't pushing at 11 pm yet, I was stalled at 8-9cm with a lip. There was a shift change at 11 and we got a bad nurse--a real stickler for rules. The first thing she wanted was to put me on the monitor, so she directed me to the bed, and I politely told her that being in the bed made my contractions too intense for me to handle, that I had been sitting in the rocking chair for contractions prior to that. She argued a bit, so I didn't bother to tell her that in addition to not being in bed for monitoring (God forbid!) I was also allowed to stand up for each contraction. I assured her that the monitors would stay in place under the belly band. I don't think she was as skilled as the other nurses because the heartrate monitor fell out right away when I stood up, and it keep loosing the baby's heartrate--which I had not had problems with at all before. Also, the contraction intensity numbers didn't seem at all like the numbers we had seen before--my contractions felt more intense to me, but were measuring less intense. While being monitored I started to leak fluid, so we requested a check to see if my water had broken.

After the monitoring session the nurse came in and took the monitor off and again directed me to the bed because Dr. Eckert would be coming to check my bag of waters. I again told her that being on the bed was too painful, and that I would get on the bed when the Dr. was in my room. You should have seen the look on her face! I was going to make GOD (oops, I mean the Dr.) wait for *the patient*!!! She just spun around and walked out because I'm sure by now she knew she wouldn't be able to budge me, and that Dotty and Steve (who had been pulling me out of the rocking chair for contractions because I was too tired to do it myself) would back me. Dr. Eckert came in, and as usual, was just fine with waiting for me. She was even okay with waiting if I started to get into bed and had to get out because a contraction started. She started checking me, and determined I had a small break in my waters, but had not completely broken. As she was saying that, I felt a POP!, and my water completely broke.

I thought the contractions had hurt a lot before that, well they REALLY started to hurt after my water broke. Steve, Dotty, and I began to walk the halls...we walked for about 20 minutes then I needed to use the bathroom. While I was in the bathroom the nurse came in and wanted me to get monitored again, even though it had only been 30 minutes since I got off! I hid in the bathroom for a bit, but eventually came out and got hooked up. While on the monitor, we asked her to get the Jacuzzi ready, I wanted to go back in (lucky thing that I was the only patient on the floor, they didn't have to keep draining and refilling the tub, just adding warm water).

We went to the Jacuzzi and I trustingly stepped in, expecting the relief I had felt the previous two times. What a shock when I discovered that the temp was 94F (LOWER than body temp) rather than the 102 I needed to have any "theraputic effect!" It sent me into a contraction, and I could not get out! All I could do was try to get as much of my belly submerged as possible to "float" it off my back while we desperately drained & refilled to get the temperature up. I had the contraction for 5 minutes straight, until the temp got up. Poor Steve was scrunched in an awkward position to keep the water level up--that was the only time in labor I raised my voice to him. He kept trying to get up because it was cold and his position was awkward, but when he did, the water level dropped around me, and the pain was terrible!

Barely 10 minutes after we had gotten the temp correct, the nurse came to get us out. We told her of the Dr. order on my chart, and she left in a huff. She returned in a few minutes with the Doppler though. After 45 minutes in the Jacuzzi, I was feeling I needed to push, so we got out.

It's Time to Push! ...or is it?
We went back to the room, and requested a check. I was still 9 cm with a lip, it was around 1:30 then. We were all getting exhausted, I was no longer cheerful. I just sat in the rocking chair, and would drift off between contractions. Steve & Dotty would pull me up, I would lean on Steve & Dotty would massage my back. My contractions were coming in pairs--1.5 min apart then 6 min apart. We all "zoned out" for a while.

By 3:30 Dotty was wondering why I had stalled, and she was praying. She clearly felt that the chair was the problem, I needed to get on the bed and get on all 4's for contractions. I argued--the bed was too painful, I had tried all 4's earlier and it hurt...but Dotty persisted so I got in bed. It took until nearly 4 to get me on the bed, but after just a few contractions I was definitely feeling the urge to push! We got Dr. Eckert to come check me, which she agreed to do with me on all 4's. I was ready! The room sprang to life, and I began pushing right there. After a few contractions Dotty said I should try squatting, but I didn't want to--my legs were so tired! (I was so tired, that for the last hour I had actually been trying to ignore contractions, hoping they would just disappear if I did! I tried this during pushing too--"maybe if I just relax I can let this contraction pass without pushing"--that didn't work! I couldn't help but push once I started!) Dotty insisted, and had the nurses get the squatting bar set up. Then we got me turned around, and after 3 contractions Jessica Ann was born at 4:41 am! Dr. Eckert actually caught Jessica, while Dr. Rittenhouse looked on.

There had been some meconium staining (Dotty later told me that Jessica's head was fairly covered with meconium-enough to concern her. At the birth though she just tried to calm Steve down as he saw Jessica's green head crow ing), so Jessica was taken to the corner of the room to be suctioned--did she ever scream! Her Apgars were 8 & 9, she was 7lb 1oz, 21in long. I had no episiotomy, but did have some internal tearing.

We came home Sat. afternoon and she is such a doll! Nursing just fine (was nursing while I typed some of this). I'm so happy I did Bradley and was able to go natural. It was tough, but having a VERY supportive husband, concentrating just on one contraction at a time, and being educated made it doable.

Thoughts after the birth-
Jessica was very clearly in a posterior position for the majority of my labor-as evidenced by my experience of "back labor," and intense contractions that did not produce quick progress. 25% of all babies are in a posterior position, yet they account for 50% of all "failure to progress" (dilation too slow) and "CPD" (Dr. determines during pushing stage that baby will not fit out vaginally) c-sections. C-sections for "failure to progress" and "CPD" are the leading cause of primary c-sections, accounting for 33% of all c-sections performed in America. 33% of c-sections are planned repeat c-sections, and the remaining 33% of c-sections are for other causes. Posterior positioning is very effectively corrected by having the mom assume a hands & knees position for 20 minutes or more at a stretch-this is what worked for me. But it is very rarely suggested to moms who are having a non-progressive labor. Instead these women are augmented with Pitocin to strengthen contractions. But the strength of the contractions is not the problem, so the "solution" does not work, and the mom is taken to have a c-section.

At many points in my labor an OB who had less faith in the natural progress than Dr. Rittenhouse might have suggested augmentation of the labor with Pitocin or even moving to c-section-when I didn't dilate the "textbook" 1 cm per hour after 5 cms, when I stalled for seven hours at 9 cms... (As a doula I was once told as my client was taken in to have a c-section that the hospital staff had been "generous" to allow to her remain at 9 cms for more than 2 hours.) But in the end I had a vaginal birth with an excellent recovery-I was out shopping 2 days after getting out of the hospital.

In all fairness to other OB's out there, many use Pitocin when they don't really think it is needed because they know that their clients, who lack the education about the normal birth process that I had, will be upset about having as long of a labor as I had, and hold their OB's to blame since they heard that their friend got a "magical drug that made her labor speed up."

 

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