Shortly after the recent birth of my first child, a dear friend asked on Facebook whether I had gone for the epidural. Oh, how to respond to this unintentionally insensitive question?! To ask this question is to completely ignore the unique complications of my labor. The complications began with the fact that I was GBS (Group B Strep) positive. Oy! This subject could take a post all its own because of it’s controversial implications to the natural birth mom, but suffice it to say that it requires antibiotics to be given during labor (though you can refuse this) to ensure that your baby does not become fatally ill at birth.
After research and discussion, my husband and I agreed to have the antibiotics, though we knew this could complicate my natural birth – and complicate it, it did.
The first day:
On January 10, one of my “due” dates, in the evening, I felt a trickle when I sat down on the couch next to my husband after using the restroom. (TMI portion – While I was in there, I had been rocking back and forth on the toilet as I always did, to “get it all out.” You pregnant mamas know how it is, not much comes out at a time unless you shift your body! Anyway, I felt a teeny tiny “something” low in my side when I was rocking but forgot about it till I felt the trickle.)
I told my husband about it and we looked at each other in surprise. This could be “it!” (We had honestly thought it would be another week.) I kept telling myself not to get excited. I wasn’t having contractions yet and should try to get a good night’s sleep before I started laboring for real. The problem was, once you rupture your membrane, you are supposed to start the antibiotics, but what if my contractions weren’t supposed to start for another day or two? We were adamantly against induction, but if this was a true rupture and I didn’t start contracting, we would eventually be pressured to do exactly that.
I talked to my older sister on the phone about the situation and basically decided to go to bed and tell my midwife that trickle had started the next morning. Meanwhile, my husband was reading an article about GBS and ruptures, and thought that we should call my midwife just to “touch base.” I was concerned that they would make me come in to begin antibiotics, but he didn’t think so. Alas, he was wrong! They wanted us to come in right away to test the fluid to see if it was a rupture. (TMI portion – I had already changed my underwear twice and then went through two pads, so I was sure it was a leak.) I started crying because I knew they would not let me come back home. This was “it.” I was going into the hospital and coming back with a baby, and I hadn’t even started contractions yet! So much for my dream of laboring as long as possible at home – which everyone knows is the best way to avoid interventions in a hospital birth.
It took us a couple of hours to finish packing everything because I now had no idea how many days I’d end up being in the hospital. I think it was around 1:30 AM by the time we were driving to the hospital (and 4 degrees out). Luckily we had pre-registered that very day, but it still took time to get checked in and changed into a gown. I was in a very glum mood, but the nurse gave us some unbelievable news! The amniotic fluid tested negative and we could go home! (She said I had probably just been peeing myself as the baby was dropping and putting pressure on my bladder.) We had it double checked and then went home and climbed into bed around 4 AM. I was unable to sleep and took a long shower before getting to sleep myself.
I woke up to another small gush of fluid at 7:30 am.
The second day:
After the gush at 7:30, I tried to sleep for at least another hour before waking my husband. We had a leisurely morning in which he made coffee and cooked me breakfast before we called the midwife. They said to come on in to the office to check the fluid again. Meanwhile, by 10:00 AM I was definitely feeling my first possible contractions. They were a little bit like menstrual cramps, and a lot like I was about to have diarrhea. We didn’t get to the hospital till just before 4 PM. I had my first really strong contraction that brought tears to my eyes as we were checking in.
We got to our room and they started hooking up my IV and the monitor and I was beginning to need to concentrate during the contractions. We noticed on the monitor that they were very close together, like a minute apart. My midwife came in and asked if I would like to have her check my cervix for the first time. (We didn’t do any checks at any of my office visits so here I was 40 weeks, in early labor and having my first check.) I decided I might as well find out where I was at since I was stuck there at this point. I was a bit disappointed to find out that I was only at 2 cm.
From this point on, everything is a blur, both for me and my husband. You won’t hear me saying anything like, then at 5pm I got on the birthing ball, then at 6pm I got in the shower. My contractions began to get very strong and very quickly I was moaning and vocalizing through them in order to cope. At some point, my arm began to hurt intensely where the antibiotics were coming in through the IV and I began to cry for the first time because it had already been all I could do to manage the contractions, the pain of the arm on top of them just threw me off and was more than I could bear. We called in the nurse and something was done to relieve the pain. I let them add Lidocaine, and/or they moved the IV to the other arm instead of my hand. Or maybe they moved the IV at the next dose of antibiotics. (I ended up needing several doses because we were there for so long.)
At some point, I began to have horrible, burning back labor, that lasted for the rest of the night, no matter what position I tried, I couldn’t get the baby to reposition himself in a way that would stop the back labor. So for the next 13 hours, I was in agonizing, screaming, moaning misery. I tried the birth ball. I tried standing and leaning over the bed. I managed to get in the shower twice, for an hour each time. The shower-head was broken and my husband had to hold it to direct the spray where I wanted it and each time we finally came out of the shower he was drenched from the steam and water spraying him. In the shower I would sit on the bench seat and lean into the wall in front of me with my head on my arms on the safety rail. When I was about ready to get out, I would say, “I’m getting ready to get out, maybe 3 more contractions and I’ll try to get out.” I’d wait through about 3 contractions and then he’d help me stand up and dry off – during which I’d get one or two more contractions. Then he’d stand outside while I screamed on the toilet (TMI portion- I kept trying to poop, had been trying since that morning, but it wasn’t happening) and I’d inevitably have a contraction while on the toilet. Then I’d call him in to help me out and I’d stop and lean against the sink for another contraction. I couldn’t do anything without having one or two contractions in between.
Then it would be time to have the fetal monitor on for a bit. Anytime they asked me to move anywhere I’d say, “Okay…..Okay…..I’m coming….I. Just. Think. I’m. Having. Another. Contraction. First. Oooooohhhhhhhhhh, Ooooohhhhhhhh, Ooooohhhhhh…..Okay, okay. I’m coming. Where do you want me. Oh, I think I’m gonna have another one….Oooohhhh.”
This went on for hours. I was having this extremely intense, long labor, and not progressing. My back was on fire with every contraction. My husband had to learn from the excellent nurse how to push his fist into my back during contractions. Sometimes the nurse would give counter pressure while I buried my face in his chest, sometimes he would give counter pressure and I’d bury my face into the nurse’s chest. A couple of times when we were re-situating me for the monitor or just to change positions, he’d try to move to my other side right when a contraction hit and I’d begin to cry and say, “Don’t leave me in the middle of a contraction!!!!!!”
Eventually, the midwife came in and suggested breaking my water. Looking back, we think this may have been after 8 hours or so. And I don’t remember, but she may have checked my cervix and it was still only at 4 cm or something. I didn’t want to, but I honestly didn’t know if it was better to keep it in tact and continue like this for possibly another 8 hours, so I said okay, though I kept saying I was scared to do so. I think right after she broke my waters was when I threw up, a lot. I had been scared to have her break the sac because my contractions were already so intense and I knew that doing so could make them even worse. I’ll never know, because I was in such excruciating pain the entire time, I didn’t really notice them worsening. Except for the fact that I started getting contractions that were double or triple peaks. Many, many times, I had three contractions in a row with no break in between. Then several more every minute. Then another triple peak.
Time kept passing. My husband was exhausted. He says it was more intense than any call night he has ever been on (he’s a doctor). We kept having me try every position we could think of – none of which did anything to alter my pain or help me along, though I kept stubbornly trying and trying – and all I really wanted to do was rest sitting up, leaning against pillows. We checked my cervix a couple of times and I had stalled for several hours at 8 cm, though 100% effaced. At some point I could tell something was happening, like my body was pushing involuntarily. Sometimes this sensation was accompanied by sudden pain that would cause me to literally scream out, while tensing up my whole body into a plank (think about those pictures of people dying of tetanus in history books) while trying to relax my midsection, to try to keep my body from pushing before I was fully dilated. This involuntary pushing feeling was in the center of my body, something like when you sneeze, or throw up, but forceful and though different from the actual pushing feeling, I was afraid I shouldn’t be doing it. The midwife would sometimes pop in to see how I was doing while I was screaming and trying not to push and tell me to moan lower – as in pitch, not volume. She said it was better for the baby to hear than screaming. I did my best to comply.
This went on into the night. I ended up in a sort of sitting position with the bed turned into a huge throne. Miraculously I fell asleep between a couple of contractions. I dreamt during one spell, something about a hole in a piece of fabric. As my next contraction was starting, I started to tell my husband, “We’re lucky, that was just a small hole,” when I stopped myself, realizing I had been dreaming. I was out of my mind, in my own world for a while.
Eventually the midwife came in to check my cervix and said exactly what I thought she would – my cervix was not only stalled at 8 cm, it was now swollen.
At 5 AM, with my swollen cervix, my midwife began to discuss my options with me. She began to suggest getting an epidural to help manage my pain and slow my labor so that the swelling could go down. I asked her many questions and if there were alternatives, and finally consented to letting them put Fentanyl in my IV, because they said it would give me a break and would wear off within 45 minutes.
My husband took a nap and they dimmed the lights so I could rest. I still had contractions, but fewer and slower for awhile and easier to manage. I kept thinking, “Open. Open. Open.” Eventually, it began to wear off and she checked me again. Not swollen anymore but still only at 8 cm. And the contractions were coming back in full force again. Sometime only a minute apart, sometimes, more than one peak. As strong as ever. And I was getting tired. I was having trouble coping. And I knew I still had up to 2-3 hours of pushing ahead of me. The midwife suggested an epidural again.
Oddly, my doctor husband never said a word or asked any questions of his own during these exchanges. And oddly, though I was in excruciating pain, I was still very sharp mentally and able to advocate for myself. I discussed with my midwife that the some of the risks that made me so anti-epidural in the first place (such as that it can slow down and stall labor) were pretty moot at this point because I was almost fully dilated and the baby’s head was so low (don’t remember what station, but very low). We knew this baby was coming out but that I needed to regain my strength if I was going to be able to push it out on my own. I was concerned that I wouldn’t be able to change positions anymore with an epidural but they assured me they’d keep it weak enough so that I could.
So I consented to an epidural. I was very scared and didn’t think I could possibly stay still for it. It seems many people were in the room. At least the anesthesiologist, my nurse, the midwife, and my husband. The anesthesiologist was awesome. He placed it very quickly and it was the perfect strength.
My husband went back to sleep, I tried to rest, and soon the shift-change occurred and the other midwife came in. She marveled at the fact that I had decided on an epidural. I told her I didn’t feel like a failure. I insisted that I wanted to try squatting for a bit even though they didn’t want me to use that position for actual pushing. They brought in the squatting bar and I did some modified squatting at the edge of the bed. I was determined to squat to demonstrate to myself that I was doing everything I could to keep progressing and that I wasn’t stuck strapped to the bed. Somehow I got to 10 cm and the midwife suggested that I keep resting and let the baby come as far down on his own as possible before I used my energy pushing.
Eventually, I couldn’t stand waiting anymore. I wanted to try a couple of “practice” pushes and then wake up my husband and get the show on the road. I didn’t really have an “urge” to push, but the pressure I was feeling in my bottom was getting much stronger. I suppose I started to push around 9 AM. I tried pushing on each side, because they suggested it, and eventually settled in the middle, resting with my feet up against the squatting bar, pulling my legs in for each push. My contractions were very very far apart now. I kept trying on my own and then after quite a while consented to a very small amount of Pitocin to get them coming faster again.
(TMI alert! – that poop I had been feeling all day finally started to come out during the long, slow pushing stage, and it took its sweet time about it. The nurses kept wiping it off for me after each push, and I kept thanking them profusely.)
At some point they asked if I wanted the mirror and I said yes. For a very, very long time I watched a bit of his head peek out and then slide back in with each push. I didn’t feel the ring of fire when he crowned but it really hurt. I had to moan and concentrate in between contractions. I put absolutely ounce of energy I had in to pushing, letting go of any fear that I might tear or give myself hemorrhoids. My husband was dressed in scrubs ready to catch the baby and putting pressure above and below the head when I pushed as instructed.
I gave one last long, strong push and the head popped out. I expected to wait until the next contraction to push his body out, but the next thing I knew he was being pulled out and placed on my chest. Somewhere in there, unbeknownst to me the baby had shown decelerations and Peds were brought in. The midwife also stepped in to catch the baby at the last second because it turned out Sebastian had his arm wrapped around his neck.
Suddenly, at 12:05 PM, January 12, 2011, my very, very, blue baby was out of my body and on my chest. There was a very scary minute of me staring at him and saying, “Hi, baby. Hi, baby. Are you okay? Is he okay? Is he okay?” As we stroked his back. His eyes were open but he wasn’t breathing or crying. The next thing I knew the cord was being cut and he was being swooped across the room for Peds to step in. Meanwhile the midwife was tugging on my cord trying to get the placenta out. I delivered it quickly while keeping an eye on my baby across the room. I was comforted that my husband was over there. My midwife told me she wanted to turn on the Pitocin again to help my uterus contract. I asked her if that was protocol. She said no, it wasn’t protocol, she was just worried that I had lost a lot of blood. I said okay.
Next she put her hand on my leg and said she didn’t want to alarm me but I had a very bad tear and they were calling in the OB doc to sew me up. Meanwhile Sebastian’s APGARs were 4 and he wouldn’t cry but he began to recover quickly. They wanted to turn my epidural back on since my tear was so bad, but I said couldn’t they just give me localized shots – even though the baby was out I didn’t want anymore drugs in my system – what if it somehow affected my nursing? They were skeptical that shots would be enough, but agreed to try. While the doctor was assessing how bad the tears were he said hang in there this might hurt quite a bit. I said it just tickled and he looked at me like I was crazy. He announced that it was a third degree tear(s) and started giving me shots. He said they would hurt a bit. I said oh, this isn’t bad at all, I’ve been through much worse!
Eventually, I was all sewn up and my baby was in my arms. I un-swaddled him and held him to my breast. And that is how my son was born after 20 hours of laboring in the hospital and only 3 hours of sleep in the past 50 hours.
