Saturday, November 24, 2018

The Birth of Good News

Our first little girl was born to us at 2:30 in the afternoon. She was 7 pounds, 10 ounces, 21 inches, 40w4d, and “born in the normal way.”

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I know I’ve talked a big game about induction in the past, reiterating some of the things I don't like about how it's used by contemporary OBs. I’ve mentioned that it can sometimes lead doctors and patients to a false sense of control about the whole process. I've talked about the fact that induction is, at times, used unnecessarily as a preventive measure, when in fact there was (or is) nothing wrong with the mother and baby. I’ve talked about how pitocin contractions, caused by a synthetic mimic of oxytocin, hurts a bit more than natural contractions, which is caused by oxytocin

Well, as much as I think that spontaneous labor is generally best for mom and best for baby, because I do believe both are more likely to be ready for the taxing event of childbirth when labor begins spontaneously, I was ready to eat ALL MY WORDS and do an induction this week anyway. I knew that it was a great compliment to my body that baby was still in there, but I was really tired of on again, off again labor. I was tired of extreme pain in my pubic bone every time I laughed, coughed, sneezed, got out of bed, or walked up stairs. And most of all, unreasonable as it is, I was afraid the baby would get too big. Medical professionals caring for diabetics during pregnancy, take note: we hear you loud and clear about our risk factors!

Besides the physical pains and anxieties of pregnancy, there were social complications associated with baby’s delayed arrival. My mother in law had arrived from the west coast, and I did not want her to have to go home without meeting her first granddaughter. My husband had decided to take these two weeks off work, and while I welcomed his help for pregnancy, of course I wanted his help for at least one week after birth, too. And I had scheduled a court date in the expectation that baby would already be here for at least a week by that time. 

On Monday afternoon, three days after my official due date and one day after the very latest due date I could have possible given myself, I was still as pregnant as ever, having contractions all afternoon and most of the evening every day, occasionally waking up with a painful one at night, too. But this night, the contractions were maybe a little longer, stronger, and more frequent than in days past. We decided to go to the hospital. Part of me knew that if labor stalled tonight, this would simply bump my scheduled induction date up by a few days.

Contractions slowed a bit because I got cold and nervous during the car ride, and the nerves had not worn off by the time we arrived. In fact, the nerves intensified, because I could tell the contractions were weakening. I didn't want to wait too long to "pull the trigger," so to speak, on going to the hospital, because I didn't want to deliver a baby into the passenger seat of our car on a cold November night with cars whizzing by us on the highway. I didn’t want to be sent home.  I didn’t want to not have a baby tonight. I didn’t want to be pregnant for any more nights, or days, or even hours.

We came up to triage and were found to be at 4.5 centimeters with a posterior cervix. (Translation: cervical checks hurt more.) We were given orders to walk around the halls for a couple hours. By now, tired, sad, and with contractions slowing all the time, we were admitted, but at a rather weak 5.5 centimeters with contractions about 10 minutes apart. When the doctor checked cervical dilation again following admission, we had reached 8 centimeters, but the contractions had slowed to a complete standstill. 

This was, at one and the same time, thrilling and unnerving. I was at 8 centimeters with almost no pain! Hooray! But the last two times I had been told I was at 8 centimeters dilation, I was mere minutes away from pushing a small human being out of my body. Now, I was painlessly walking and talking and wishing I could lie down for a nap. Was something wrong? Was the baby malpositioned for labor? She seemed like she had been head down, LOA, for months. Was my uterus just too tired to give birth? Well, that didn't seem likely to change much between now and when I was hoping to give birth, so how on earth was I supposed to get the pregnancy over with?

They asked if I'd like them to break my water. Usually this causes the baby's head to descend a bit, apply pressure to the cervix, and the descent + pressure combination has, in the past, gotten things going right quick. But that also meant I had to will myself through intense pain after being awake all night and exhausted. Is there a painless way to get through this part? No. No, there is not. I started crying. I told the nurse and my husband that I was not in any pain at all, but I was merely afraid of  the pain I knew was coming. No one ever talked about an epidural, and I'm sort of glad I didn't have to deal with the question. The epidural is its own sort of scary anyway, they don't always work, and once I'm actually in pain, we're only looking at an hour, tops. So I asked for a little while to think about it. I sent a text message to some good friends, asking them to pray for us, and lamented my sudden cowardice. I laid down to try to rest.

But you know what happens when you're staring down the chute at the most intense pain of your life? You're just not in the mood to take a nap. Every time I felt anything at all in my womb, whether part of a contraction or baby's reassuring kick that she was still alive and happy, I experienced a jolt of adrenaline that kept me wide awake. I thought about whether the contractions would start up again, how fast and how strong, how soon I would get to meet her, what would happen if they didn't? I thought about whether there was any hope that the delivery might be one of those painless ones I'd heard of and dreamed about. I thought about how this was the most natural thing in the world, and yet still so terrifying. I was afraid that if I went to use the bathroom, I might accidentally push the baby out into the toilet. I thought about how complicated the recovery would be if I had a c-section.

After a couple hours, I agreed to have my water broken, but contractions still did not begin as I expected them to. I knew the only option left was pitocin. It was like being at the top of the chute, but the slide is made for children not heavy pregnant women, and you can't gain enough momentum to actually get going down the slide. And you're just terrified to push yourself forward anymore, because you know there's pain down there at the bottom. I was getting hungrier all the time, feeling weaker, still exhausted, and still afraid. "This is not going well," my left brain thought. "I wish they could just put me to sleep like they used to and I'd wake up and have a baby," my right brain thought. After a while, the nurse asked about pitocin. I asked for a little while to think about it, laid down to try to rest, and found, again, that the same interior turmoil of before would not allow it.

Around noon, I agreed to start the pitocin. Contractions picked up almost immediately, but they weren't the kind of contractions that push a baby out. That was reassuring, because it meant that the baby would not be born without warning. At this point, labor felt utterly normal. The doctor had mercifully ordered only the very lowest dose, and it was enough. After a while, however, the contractions were so strong that I had to stop moving and couldn't talk when they came on. Between contractions, I was an emotional mess again. It hurts too much. I can't do this. The baby is going to get stuck. I'm too tired. ISN'T THERE ANOTHER WAY?!?

My husband reminded me that I couldn't get unpregnant if I didn't go through with it. "Good point," the left brain part of me mused. "What kind of lazy race of people are we that we haven't figured out a way to make this hurt less yet?!" the right brain part of my shouted. When I confided my fear of a too-big baby to the nurse, she looked at me as though dumbfounded, and tried very hard to be patient as she rattled off all the reasons that was unlikely. "You're right," said my left brain. "But what if it's not enough?" worried my right brain. I did a few squats, hoping to help the baby's head descend, because I knew that would speed things up. It quickly became too much effort to assume this position, however, and I climbed into the bed. I cried a little bit. I gave a few small boluses, but basically didn't worry too much about 130 mg/dL. I was alternately hot and cold. I was shivering. I was still scared.

After a little while, I told the nurse that I felt like pushing. She checked the dilation and said that the cervix was not fully dilated yet, but that it would be OK to push a little bit, just to relieve some pressure. They kept asking about whether I felt like I needed to push, and I kept saying 'yes.' My husband kept telling them it was close, and asking if the doctor would come in soon? Every time they left the room, I was gripped with anxiety and asked my husband if he was ready to catch the baby. He didn't answer. The nurse reassured us that the doctor was right outside and would be ready when the time came.

Suddenly, I experienced one big contraction in which the left brain part of me thought, "My cervix is posterior, therefore I need to lift up off the bed a tiny bit, so that I'm not pushing her out into the mattress," and the right brain part of me thought, "GET HER OUT! NOW! NO TIME LIKE THE PRESENT!" During this contraction, the following also happened: a) I could feel the cervix pull back around the baby's head, b) a pocket of amniotic fluid sprayed out and drenched the nurse, and c) an infant came out of my body.

Yep, that's right. All it took was one contraction, one push. The nurse was planning to help me push slowly to avoid tearing, but all she had time to do was tell me to put my butt back down on the bed while I was pushing so that the baby would have a big enough opening to come out. My left brain was mistaken about the posterior cervix, because it straightened itself out just fine! The nurse thought my hip-raising was a right brain response to the pain, but I tell you, it was utter determination to get the baby out before anyone had time to even think about shoulder dystocia. In any case, I still didn't tear, which really makes recovery a lot easier!

The doctor mentioned that the umbilical cord was short. This might explain why our little girl hadn't descended and applied pressure to the cervix, which probably would have sped things up some. This site says that prolonged labor (along with a bunch of other scary things) is a complication of a baby with a short umbilical cord. It probably also explains why the doctor swiftly put her hand up inside my uterus to be sure there was no part of the placenta retained. Everything stung or ached for about the next 30 minutes, I was trying to catch my breath for the better part of an hour, and one of the baby's nurses brought me yogurt parfait, a turkey sandwich, and something else which I devoured as soon as I was in my postpartum recovery room. I let my blood sugar rise to 270 mg/dL without an ounce of regret or anxiety for the first time in nine months.

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Our daughter is amazing. I know your baby is too, but I'm especially fond of mine. Even the two year old is in love, in spite of the jealousy that many parents fear and some kiddos experience. I cannot believe how small she is! I've always said that it doesn't matter how big the baby is, labor is going to hurt, but I do sort of wonder if the pushing was just really fast because of her (relatively) small size. And seven pounds, ten ounces, is not even all that small! The nurse seemed genuinely impressed with my "performance," but labor is almost as much something that happens to you as something that you do, so I don't think there's really much to be impressed by.

They gave me the dextrose drip by IV during labor, which I have never had before. My blood sugar was higher than during other labors, but hers fortunately never dipped too low. This makes me think that the theory about a diabetic mother's blood sugar being high during labor leading to an insulin response in the baby, which ultimately causes the baby's blood sugar to drop after she is separated from the mother's blood supply, needs some perfecting. At the very least, our definition of "high blood sugar during labor" should perhaps be relaxed from 70-100 mg/dL, which is where my blood sugar has often been during labor, up to 110-140 mg/dL, which is where it was this time. In any case, I was grateful that she nursed eagerly and frequently, and never got too sleepy, too cold, or too jittery. 

I think I basically ended up with an induction this time around, with labor stalling in the wee hours of the morning and requiring membrane rupture and pitocin to get going again. My fourth labor was a little bit like that. I wonder, if I had just taken another Epsom salt bath and laid down to rest like last time, would labor have started up hard and fast and left us catching our breath as we went from living room to car to triage to hospital room to baby is born? Perhaps. Maybe I could have avoided the emotional drama that sapped me of so much energy between 3:00 am and 12:00 pm. Either way, even a small amount of pitocin this time was more effective than spicy food, less violent than castor oil, and less exhausting than walking for miles and miles, so I'm OK with the way it all turned out.

We are poorer than we ever have been, and yes, I know this all just means one more mouth to feed. But we are so happy to have another baby, a daughter, and so ready to take on the difficulties we know will come, for the sake of our family. There are things we could wish for, things we could complain about, and things we regret, but the fundamental fact is that we somehow have hope that things will work out for the best, a chance to wake up tomorrow and discover something new together, and six loving, mostly healthy, innocent children with whom we can learn how to love God. We have discovered the Truth of Christ's teaching about welcoming the little children in His name, and we are still searching hard for the Way to follow Jesus through the wild thicket of their many childhoods. But we can finally say that Life itself has graciously entered our home, time and time again, in the form of an infant, a humble state which Our Lord embraced in both the pure womb of the Blessed Virgin Mary and a dirty stable two thousand years ago. May my body, our hearts, and this home be always ready to receive Him!

1 comment:

  1. This is life giving on many levels! Our prayers are with your family! Thanks for sharing all of the details.

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