Wednesday, May 15, 2019

Baby Story - Induced Labor

Warning! This blog post is very text-ey without a lot of pictures.  It’s also more a record of what happened for my benefit and for Baby #2, so if you’re more interested in baby pictures than in a gory labor and delivery story, wait for the next blog post. :-)

My most amazing midwife, Gabriela!
After the False Alarm one week before Baby #2 (aka Baby H)’s due date, I was ready and anxious to have the baby!  Literally every night, I would think that contractions were starting again, only to discover they were Braxton Hicks “practice contractions”.  I would go to bed hoping to go into labor naturally and wake up in the morning super grumpy that I was still pregnant.

My doctor (Dr. Shikha, who is fabulous!!!)  offered to perform membrane stripping a few days after the false alarm, but I held out for a few more days, and finally, we scheduled a membrane sweep for 09-May.  This was my due date based on my 12-week ultrasound, and slightly later than the due date calculated by my last period.  By the time we got to the day of the membrane sweep, I was so uncomfortable that I scheduled labor induction for 48 hours later — CTG Machine be damned.

The membrane stripping didn’t really do anything to progress labor - other than give me cramps and make me nauseous from the hormone release.  So after a day, we started to prepare for an induced labor.  Our instructions were to check into the hospital Labor and Delivery Ward (L&D) a little after midnight on the day of of induction. The midwife and nurses on duty took a few blood samples, hooked me up to the CTG for a few minutes to get a baseline for the baby, and then told me to get a few hours of sleep - we would start the procedure at 6am.

G - getting some zzz's before the excitement begins

At 5:30 am, a light breakfast was delivered to me, the midwife did a little more monitoring, and then she went ahead and ruptured the membrane - i.e. manually broke my water in hopes to kickstart labor. My belly was so big and stretched that the release of fluid was actually a huge relief, I felt so much lighter! I was instructed to walk around for a few hours, and see if things progressed.  So G patiently walked with me around and around the labor and delivery ward until finally I asked for an exercise ball to sit on because my back hurt from walking with my big belly.  
Waiting for something to happen...and yet...nothing

Around 8am, I’d had a few contractions, but still nothing regular, so the nurses and midwives began to set me up for medical induction.  I was given the option now for an epidural in advance of induction because it would be easier now than in between contractions. I originally was not going to use an epidural, but I also was originally not going to be induced - I figured if I was going to be strapped to the chair, I might as well have pain relief, so I agreed.  By 9am, drugs were flowing, and I was being induced!
My midwife, Gabriela, prepping me for my epidural
I tried to watch a movie but there were constantly people coming in and out to check this or that so eventually I gave up and tried to doze for a little bit.  According to G and the CTG machine, I was having contractions about 2-3 minutes apart, so I took that as a good sign - until I started to feel some of the contractions, like monthly period cramps. The midwife looked concerned and with the anesthesiologist permission, increased my epidural and checked my dilation - it was maybe 11am? And I was dilated to 4 cm.  I had started at around 2 or 3, so not much progress.

It was a busy day at L&D with 1 woman having already given birth before I started my induction, 2 more laboring at the same time as me.  At this point, there was an emergency C-Section thrown into the mix, and G and I could hear mad chaos in the hallways of people running around to tend to the patients - I think this was the busiest the labor and delivery ward had been since opening 9 months ago! I give this context because it sort of sets the tone for the rest of MY delivery.

The epidural seemed not to really be working - it was taking the edge off the pain, but I started feeling contractions very, very strongly. The midwives were not happy about it, and they tried to call the anesthesiologist, who was with Dr Shikha tending to the emergency C-Section.  The unit manager came in with one of the midwives because they didn’t like how the baby’s heartbeat looked, so they helped me roll onto my left side - which was horrendously painful for me at that time.  I don’t think the unit manager is normally on the floor, but it was all hands on deck in L&D!

My original midwife - an angel named Gabriela from the Czech Republic - came in boosted my epidural further. It seemed to help very, very briefly, but in the short period between with Gabriela left me to check on her other patient and come back, I was in pain again. G suggested maybe I’d made some progress, but I didn’t think I’d go from 4cm to ready to delivery in less than an hour.

When Gabriela came back she checked the insertion point of the catheter, and found part of it had slipped out. “Do you want to have it replaced? I’d like to increase your induction meds to help lengthen your contractions, but I know you’re in a lot of pain”.  I told her I was concerned that my contractions were too close together to re-do the epidural, and she offered to check my progress. Sure enough, I was at 8cm. Gabriela advised again, we could either re-do the epidural or try to deliver the baby, and I said let’s have this baby! And can we take the epidural out if it’s not going to help me?

Well, I had to wait for Dr. Shikha and the anesthesiologist to come out of that emergency C-Section.  In the meantime, Gabriela offered me nitrous oxide, which didn’t do much for the pain but definitely helped me relax in between contractions.  When the doctors came, I tried to negotiate removal of the epidural and she offered to give me a booster dose to help take the edge off while she fixed the catheter - again, it worked for a few minutes, but then wore off shortly after she left. Dr. Shikha advised me to rest as much as possible in between contractions, and let them know when I start to feel pressure to push.

Shortly after Dr. Shikha left for her afternoon appointments, I told Gabriela that I was starting to feel pressure, sort of like constipation.  She checked my cervix, and told me it was open enough, but the baby’s head position wasn’t quite where it needed to be - so she then started coaching me on starting to push the baby downward during my contractions. She helped me figure out where I was wasting energy by tensing up, and she helped me focus my efforts into the right muscle groups. She was hoping that by pushing the baby downward, the baby would naturally rotate into the correct position for delivery.  We did this for maybe an hour, and G was standing right next to me holding the laughing gas mask for me to take a few breaths to relax in between - I have a tendency to continue clenching my muscles even after the pain has subsided, and I really needed to conserve some energy. I couldn’t breathe the N2O continuously though, because it made me really dizzy, so G would count 3-4 for breaths for me and then take it away.

After about an hour of this, I needed a break, so Gabriela and G helped me roll to my side to just rest and breath without pushing.  I could feel the baby’s head moving downwards, and I think while I was on my side, she rotated to where she needed to be on her own.  I was so tired, I felt in that moment “This is how women end up in emergency c-sections - they just can’t push any longer!”, and after all the pain and struggle, I really didn’t want that to be me.  I quietly started squeezing my abdominals during the contractions while on my side to see if it helped move the baby, and when I felt I had energy to push the way Gabriela wanted me to, I told her I was ready to move back to sitting.

At this point Dr. Shikha happens to walk in - apparently Gabriela called her while I was resting on my side to tell her I was very exhausted.  Doc took a quick check of my cervix and announced that I was ready - we’d have a baby in 10 minutes, so the nurses needed to help her scrub in!  After that, there was an insane flurry of activity, and then Dr. Shikha started talking me through it.  “Ok, Kim - chin to your chest, deep breath in, and hold your breath for a long push.  When you can’t push anymore, quick breath, then push again.  Goal is to do three pushes per contraction”.
G and the nurses getting ready for Baby H!
I don’t think I ever got to 3 per contraction, but I did push that baby out at 3:27pm.  At the very end, I was pushing even without contractions because the baby’s head crowning was so uncomfortable, I couldn’t wait the extra 2-3 minutes for my body to help me. I’m not sure where the extra energy came from, but I imagine most mom’s who delivery naturally go through something similar - you just do what you have to do.  And then I found out why this baby - Baby H - took so freaking long to come out - she was 4.4kg, or 9.8 lbs - 2 1/2 lbs heavier than her sister!  And she wasn’t really any taller, Baby L was 51 cm vs Baby H’s 52 cm - so this little baby was all chunk! G even joked that her umbilical cord was twice as large around as Baby L’s, so she had access to a lot more food.


My gorgeous newborn! So chubby!
I was able to hold the baby for a few minutes, then after her cord was cut, the nurses and midwives took her for cleaning and checkup.  Similar to with Baby L, I started bleeding, but Dr. Shikha was already ready for it - and so I was given meds to help my uterus contract and my doctor called for help from another one of the L&D Ward doctors to control the bleeding while I tried to push the placenta out.  This actually took awhile because I was just so tired from pushing the baby - I felt like I had no abdominal strength left.  I think they tried to see if they could remove the placenta without me, but they were concerned with tearing, so eventually I was able to find some strength and push it out as well.  Gabriela told me later that it was huge 1.5kg, so no wonder I had a hard time! The doctors stitched me up, and kept massaging my abdomen (both of which were painful since the epidural had completely worn off by now) to stop the bleeding. I told G to take some photos of the baby, and he did, but then he came back to help hold my N2O to get me through this last part.  

Our gorgeous Baby H!  H for HEAVY at 4.4kg, or 9.8 lbs!!
When the docs finally finished, I still lost about a liter of blood - twice what I should have lost for a normal delivery.  The L&D Ward doc who was helping Dr. Shikha had to rush off to another delivery, along with some of the nurses and the other midwife. Apparently, with 5 deliveries in one day, L&D had also started running low on supplies, so Angie, the unit manager, was also running back and forth from the post-natal maternity ward with extra dressings and gloves, supplies to clean me up and a fresh hospital gown for me to wear that was specially designed for nursing moms.  Dr. Shikha wanted me to stay in L&D for a few hours to ensure I didn’t have anymore blood loss, and so they cleaned up my baby, put her in a crib next to me, and while she slept, G and I ate some food for the first time in hours. Gabriela also had another delivery to run off to, but told us she would be back because she still needed to do a lot of clean up and documentation for her report of our delivery.

After her other patient delivered, Gabriela came back to remove my epidural catheter and transfer me to the maternity ward.  I decided early on that if the baby wasn’t born before 2pm, we would not bring Baby L to the hospital, and it was a good decision - we didn’t get to our maternity room until 7pm.

I have to give a shout out to my amazing and wonderful husband throughout this whole ordeal. He was involved every step of the way, from walking with me in the hallways, to holding my laughing gas mask, to massaging the tight spots on my back when I was sore.  He held my hand when I cried, stroked my hair through the worst of the labor pains, and helped the midwives move me every time I wanted or needed to change positions.  Even Gabriela commented on how helpful he was in the delivery room, and I couldn’t be more blessed to have him as my husband and father of my children.  Even after delivery, when Baby H and I were in the hospital, he made it a point to spend extra time with Baby L every day to make sure that she still felt that she was special and loved.  

My amazing husband with our new baby girl
Compared to Baby L’s birth story - I would say I definitely felt more “beat up” and sore everywhere, but that is probably a combination of the epidural being less effective and Baby H being 30% larger.  On the other hand, I didn’t feel as physically drained / fatigued, despite losing the same amount of blood, most likely because (1) labor was only 8-9 hours instead of 17 hours and (2) I’ve been able to eat red meat during Baby H’s pregnancy and my iron levels were much higher.  I’m glad we induced when we did, if Baby H were any bigger, I think I would have likely ended up doing an emergency C-Section at the end of my labor .  Fortunately, now that we have 2 beautiful baby girls, G and I have decided the baby making factory is officially closed. ☺
Dr. Shikha with Baby H

No comments:

Post a Comment