Thursday, February 5, 2009

Annalise's Birth Story

This gets REALLY long, so be warned!

It was Sunday, January 25th, and we were scheduled for induction at 9 PM. However, we were instructed to call in at 7 PM to make sure that there was enough space for me. Apparently it would be a rare occurrence, but if for some reason Labor & Delivery (L&D) was flooded with emergencies, my induction could be postponed. At about 5:30, S & I took a nap for an hour or so, anticipating a busy night ahead. I actually did fall asleep, but S said that he just rested. I don't think that I was having any significant BH contractions, as far as I could tell.

Halfway expecting to be delayed, I called L&D at 7 PM and was told that yes, they were expecting me at 9. The next 2 hours were a flurry of activity as I rushed to finish packing my toiletries, do two loads of laundry (why? I don't know... I guess I do laundry when I'm nervous!), and eat a few bites (S ran up to El Portal for a chicken fajita platter, which we split). We didn't actually leave until sometime around 8:50 PM, but I assured S that 9 was an estimate, not an exact appointment time.

Our trip to the hospital had that same air of anticipation that I always thought would accompany a trip to L&D, minus any pain, discomfort, or sitting-in-a-puddle sensation on my end. S dropped me off at a circular driveway in front of the hospital, and then went to park the car in the lot across the street. I stood there impatiently with our bags, pillows, etc as I watched him move the car at least 3 times to different spaces within the lot. S later explained that some spaces were designated "reserved," and others didn't have a number required to feed the payment machine. While I was waiting, a Bronx Pizza delivery car drove up within the driveway and the driver attempted to enter the hospital. The front door, however, was locked! I suddenly remember that on our hospital tour, we had been instructed to use the side entrance, near the ER, during evening/night hours. The pizza guy immediately got on his cell phone to try to figure out an alternate plan, and meanwhile another person walked up confidently to the locked sliding glass doors and literally pried them open with his hands and walked on in. Pizza delivery guy followed. S soon joined me, and I tried to pry open the doors myself. It turns out that it was easy! Later, I found out that the pizzas were actually for the residents working on L&D, so it was all around kinda funny.

It was about 9:15 by the time that S and I entered the L&D area and checked in at the window. It was really quiet, and I definitely had the impression that they had been waiting for me. I could see a whiteboard in the nurses area with "B____ [our last name], 40w5d, induction" written there. The triage nurse came out and escorted us to our room. There were actually a few staff members in there watching the TV, but they scattered quickly when they saw us coming. I was told to undress and put on a hospital gown, which I did awkwardly. Since I wasn't 100% certain that I was going to stay, I kept saying things like, "Are you sure that you want me to sit in this bed?" Yes. And when a woman from admissions came in to have me sign some papers, I sent her away as I wanted to talk to the doctor first before committing to the induction. Our triage nurse was friendly; she didn't have kids yet, but she was 14 weeks pregnant with her first child.

On the monitor, I was surprised to see that I was in fact having some contractions about every 7 minutes. I guess they were B-H contractions, but I couldn't feel them at all. Soon a resident named Dr. E came in and introduced himself. It was sort of awkward because he made a sort of big deal about saying, "OH, I know you from somewhere. We've worked together before, I'm sure of it!" I told him that he has probably seen me in clinic at the cancer center, as I work right next to the Gyn/Onc attendings, and they usually have a parade of residents accompanying them (and I usually have to kick them off of my computer). He agreed that I must be right. So a bit awkward, but whatever... He examined me and declared that I was still about 1-2 cm, now 70% effaced, and still -3 station. He reiterated Dr. K's plan to start with a Foley catheter bulb to dilate my cervix, then to give Pitocin and/or break my bag of waters (amniotomy) to induce contractions. We talked again about the risks/benefits, etc. He agreed that the rate of C-section would be higher than waiting for natural labor, but he also alluded to the small risk of Bad Fetal Outcomes. Thinking about our friends who had a stillborn daughter (one of twins), S & I decided to proceed. Yes, C-section was an outcome that I wanted to avoid, but obviously, our baby's health was paramount. Besides, I definitely was not going to be comfortable going beyond Wednesday (41w1d), and I wasn't convinced that I would be going into labor by then, in which case, I would be in the same situation, only three days later.

After we committed to staying, the triage nurse drew labs and tried to insert an IV into my left arm. Even though she went for the "intern's vein" (plump vein on the forearm, near the base of the thumb), and even though needles do not usually bother me, it really hurt and I glanced over to see a big hematoma forming around the needle. It took over a minute to stop the bleeding. Luckily, she was able to get the IV in on a second attempt. I was glad that she wouldn't be drawing any more blood from me, though. Soon, I met my "real" nurse for the evening, Katie, who was from Maryland and had a 3 year old child. Katie had been "on-call", and had been called in from home to be my nurse for the evening. She told us that I was actually the only patient in labor on this particular evening. There were other patients on the floor, but they were women with PPROM and other conditions.

The insertion of the Foley catheter was not as bad as I had feared, but immediately thereafter the contractions became closer together -- and suddenly very painful. As I had discovered by reading, the balloon part of the catheter was actually above the cervical os, simulating the pressure that a baby's head would put on the cervix. Katie could see that I was in pretty severe pain already, and encouraged me to take some morphine for some relief, and to hopefully get some rest. I resisted for a bit, but it didn't take long for me to change my mind. She told me that the usual dose was 5 mg IV and 5 mg SQ. I opted for the IV dose only, reasoning that I could take the SQ dose as well if needed. She was right; soon after getting it the pain improved to the point where I could make it through the contractions on my own, without S's attention. He dozed a bit. I tried, but there were weird tapping noises in the ventilation system, a car alarm, and the contractions that were still grabbing me every 4 minutes or so. Meanwhile, I was started on penicillin for the Group B Strep, and got this every 4 hours up until the time that I delivered Annalise.

Every hour, Katie was supposed to come into the room and tug on the catheter a couple of times. By the 3rd or 4th time, the Foley balloon suddenly popped out! Katie told me that this generally implied dilation to 4 cm, as this was the diameter of the balloon. Dr. E checked and confirmed this. I can't remember the effacement and station at this point, but there was not a major change. I asked to labor on my own for a while, as I was having regular contractions and hoped to avoid Pitocin. He agreed to let me go for an hour, and during that time, S got up with me and I sat on the birthing ball and we sort of watched some TV and chatted. It felt wonderful not to have a catheter taped to my leg, and to be unhooked from my IV. After an hour, Katie returned and said that Dr. E had decided to let me go another hour based on my still-regular contractions on the monitor. However, I did notice that since the Foley was out, the contractions were no longer painful again. When I was checked again, it was probably about 5 or 6 AM, and there had basically been no progress over the two hours. It was time to start Pitocin.

I can't recall the exact details, but basically they start a certain dose of Pitocin and then escalate it every 15 minutes or so as long as you are tolerating it. I think I did OK at the initial dose, but by dose 2 or 3, the contractions became extremely painful. I was told that I could have the epidural "at any time." I tried to wait for a bit, but after 10-15 minutes of ever-worsening pains, I pushed my call bell and asked for the anesthesiologist. Suddenly, my body became wracked by uncontrollable shaking. I remember going to the restroom and grabbing the bar next to the toilet during one such contraction, and getting hit by another one between the bathroom and my bed. By the time the anesthesiologist came, I was afraid that I wouldn't be able to be still enough for the epidural. Meanwhile, I was begging the nurse to turn down the Pitocin, or stop it altogether, but she resisted, saying that she would have to start from zero if it was turned off. I eventually reasoned that I didn't care; it would only delay things by one hour if we had to start from zero.
The anesthesia resident who did the epidural was calm and efficient. By the time his attending arrived to supervise, I wasn't able to talk much at all due to severe pain and shaking. I do remember that they mentioned something about puncturing the dura (intentionally, I think), but I think that they never actually gave me any medication via this route (spinal). Instead, they administered standard bupivicaine and fentanyl by epidural. The pain relief was almost immediate, perhaps helped by the fact that my nurse finally relented and turned down the Pitocin. Around this time (just before 7AM), S had to go and move his car to avoid a ticket.

Sometime around this time I managed to call my mom, who was planning to come over as soon as she dropped my sister off at school. I was soon visited by a flurry of new faces as most of the teams seemed to turn over at 7AM. Two new anesthesiologists came in, I met my new nurse, Veronica, and Dr. E was replaced by Dr. V (attending) and Dr. W (resident). Dr. V told me that it was her first day back from maternity leave. Dr. V was actually the OB/GYN who I saw for an annual exam when I first suspected that S and I were having fertility problems. I was not impressed with her back then, but today I found her to be reassuring and straightforward, so I was happy about that. The resident, Dr. W, was sort of distant, and I didn't feel much of a connection with her. They told me that I would labor another hour or two, and that they would then plan to break the bag of waters.

My mom arrived around 8:45 or so, and had brought a half-dozen bagels and strawberry cream cheese. I was hungry, but was told not to eat. It's kind of sad, but a lot of the rest of the day was sort of a blur to me. At first, I thought that I was merely tired from being awake all night. I remember watching part of "A Baby Story," and that Dr. W came in a few times to check my progress, which was slow but seemed steady to me. The contractions were regular and didn't hurt much. They broke my waters some time in the mid-morning, but strangely, no amniotic fluid ever came out until I was at the pushing stage (many hours later). Some time in the early afternoon they didn't think I was progressing fast enough and they decided to put in an intrauterine pressure catheter to directly measure the strength of the contractions. They said this would be more accurate that the external device. They said that if my contractions were strong but ineffective over the next two hours, they might need to talk to me about C-section.
Sometime in the following hour, there were some fetal decelarations (I believe they were the relatively less-concerning type), and so I was checked earlier than originally planned. At this point, Dr. W was replaced by another resident (or maybe an intern) named Dr. B. I really liked Dr. B's bedside manner and trusted her immediately. She found that I had actually progressed, so the C-section was looking less likely at that point. For the fetal decelerations, she and the nurse found that my baby preferred for me to be on my right side, which is a bit unusual (most prefer the left side). At times I had to wear an oxygen mask, but no one ever seemed alarmed by the situation.

At some point I did have increasing pain and I was instructed to push the PCA button (PCA stands for "patient controlled anelgesia"; basically, I was giving myself an extra dose of the epidural medication by pushing the button. I could push the button as often as I wanted, but it would only deliver extra medication every 15 minutes.) Well, I needed to push the button several times over the next hour or so, but unfortunately, this made me increasingly groggy to the point where I could barely stay awake. Even more disturbing was the fact that I lost most of my ability to move my lower extremities. I could wiggle my toes and feet, but I completely lost the ability to life my legs off the bed, or even to turn from side to side. It was not a good feeling. I kept asking the nurse and the anesthesiologist whether it was normal for me to feel so groggy from the epidural medications (fentanyl and bupivicaine). They said that most people do not feel groggy from the epidural, but that it was possible that the narcotic component (the fentanyl) was giving me systemic side effects. I did ask about whether I could get a different combination of medications through the epidural, but I never got a clear answer about that. I think I actually had them turn it off for a while, which allowed me to wake up but also led to increasing pain.

At around 4:45 PM, I was told that I was around 9 cm , and that I had more cervix remaining on one side. Ideally, I should have been lying on my left side to help this, but again, the baby's heart rate tended to drop when I was on that side, so I had to stay on my right side. Now, up until this point, someone had been coming into the room every 15-20 minutes all day long. Suddenly, there was this 1+ hour period during which no one came to check on me. My contractions were very painful, and I needed lower back counterpressure from S and my mom's hands to squeeze to make it through them. I was able to feel the contractions very easily. I remember crying out, "Oh comes another one!", and I could feel it starting several seconds before it showed up on the monitor. My mom and S help me by telling me when it had peaked, and it felt good to know that an end was in sight. During this time, I wasn't feeling an urge to push or anything like that. We thought it was really strange that no one was coming to check on me, and we finally called for the nurse around 5:45. However, she was apparently busy, so I kept suffering through these contractions for a while longer. I think that my nurse finally came in around 6 PM. She explained that they had suddenly had a string of something like 4 deliveries and one other emergency situation come up in the past hour, and that is why no one had come in to check on me during that time.

I don't remember which doctor checked me, but it turns out that I was fully dilated at this point. It also turned out that Dr. K (the OB/GYN who had been taking care of me for my entire pregnancy) had come onto her shift at 5 PM, so she was going to be helping me deliver. Before I knew it, Dr. V was replaced by Dr. K and I was being told to push! They had me push to a count of 10, three times during each contraction. Now, prior to pushing I had felt every painful contraction, but for some reason during the pushing stage, I wasn't able to feel the contractions again. Thus, the nurse had to tell me when to push. For the pushing, I was lying down with me head tilted up. My mom lifted up my left leg and Veronica held up my right leg. S was on my left side, holding my hand, I think. Dr. K was at the end of the bed, and she placed her fingers in my perineal area to give me a target to push towards.

Dr. K was really encouraging with each push and kept saying how great I was doing. I didn't really believe her, but within what seemed like only minutes, she was saying that she could see the baby's head! They got a mirror and I was able to see it, too, a little bit; we were all surprised to see that she appeared to have a fair amount of dark hair! (S and I always assumed that we would have a bald or possibly a wispy blonde-haired child as we both had blonde hair as children and since we both still have baby-fine hair.)

After really only a few more pushes, Dr. K announced that the baby was about to crown! She told me to stop pushing as they still needed to remove the bottom section of the bed. Using the mirror, I could see that my perineum was bulging. Also, there was some blood coming out, and Dr. K said that I had torn a bit already. By the next contraction, I gave a push and Annalise's head and body came out without much difficulty! (I believe they came out in the same push.) I heard my Mom and S saying something like, "Oh my God! Here she is!" Dr K put Annalise directly onto my belly and then S cut the umbilical cord and she was moved up to my chest. I cried tears of joy and held her tight. I felt like I didn't really know how to even hold her. I can't even remember hearing her cry, but I remember that she initially looked a bit bluish but quickly turned to a rosy pink color in her face and trunk. Her hands/fingernails remained a bit bluish for several hours. She had some blood in her hair, and only a small amount of vernix on her skin. She was beautiful...perfectly beautiful! I held her for a long time (probably almost an hour) before she got measured, weighed, and diapered.

Meanwhile, at the other end of the table, Dr. K delivered the placenta. I honestly did not even notice this part. After that, she sewed up my tear, which I was told was a second-degree tear. She later mentioned that my placenta was unusual in that the cord was inserted onto the membranous portion of the placenta. I don't think I quite understand the implications of this even now, but I believe that it could have caused Scary Things to happen to the baby, and I also later found out that because of this, she had to "reach into my uterus" to get the placenta out. (If I understood correctly, she was afraid that if she would have tugged on the cord, it might have detached from the placenta entirely). Anyway, because of this, I took IV antibiotics (Ancef) for an additional 24 hours starting the next morning.

My dad and sister (age 10) arrived pretty soon after the delivery and it was a nice family bonding time. I was still doing a lot of skin-to-skin contact with Annalise and somehow it didn't even bother me that my breasts were pretty much on display. My sister was a little surprised by my half-nudity at first, but quickly got used to it. My mom and S made a few phone calls to other family members, but I just laid there staring -- no, marveling, really -- at the new baby.

I feel SO lucky that we have her.


ashley said...

Oh my. It was nice to hear a real first time experience of labor and delivery. You sounded like you made it through it with flying colors. Thank you for sharing your story.

Soapchick said...

You'll be proud that I read the entire thing! It was a beautiful birth story and honestly I don't know how you stayed awake to push after so little sleep. Annalise is absolutely beautiful and I'm so glad your mom got to be in the room too. I was in the room when 2 of my sister's kids were born and it's amazing! Enjoy motherhood with your precious darling!

alison said...

She's so fantastic!! Congrats again!

Jen said...

What a cutie! It sounds like a very long night and day. I'm so excited to hear more about how she's doing and how motherhood is treating you so far. Congrats!

Lorrie said...

Thanks for posting this, Sarah! Again, your daughter is beautiful!

Jill said...

Thanks for sharing your birth story! I'm so glad that everything went so well. Your daughter is just beautiful!!