Tuesday, January 3, 2012

Monkey's Birth: The Beginning of My Crunchy Journey

My Monkey's actual birthday is tomorrow, but my labor actually started on January 3, 2011. So here is my birth story, explaining what I went through last year on this date and the journey that got me there, culminating with Monkey's birth. Prepare yourself. It is LONG.

My pregnancy with Monkey was quite a surprise, as was my journey onto this pseudo-crunchy path. When I had Sassy and Diva, the "normal" thing to do was see an OB for prenatal care, give birth in a hospital, and have an epidural, or c-section if needed. I had what I considered "typical" experiences, the type that I could sit in a circle of women and share all the horror and pain I went through to bring my children into this world, much like people try to "one-up" one another with their experiences.

My journey for a Natural Unmedicated Childbirth (NUCB) began when I went to a monthly meeting held by Esali Birth, Breastfeeding Cafe. My goal was to find some education and support for breastfeeding. As I've said before, I breastfed Sassy for 3 months and Diva for 4 months, both while supplementing with formula. I wanted to educate myself so that I could do better when Monkey was born. Little did I know that I would walk out of that first meeting with my eyes wide open to an entirely different world of childbirth.

I started picking up books and doing online reading. I continued to go to the monthly Breastfeeding Cafe, but also went to several other events hosted by a local group, Mamaology. In this time, I learned that some women in my area DO choose something other than the standard "OB-hospital-epidural" birth. I learned about the midwives in my area and homebirths. I read about the actual risks of standard medications and interventions, plus the history of why they are used and why some of them are very outdated. I learned more in this research on my own than I ever did in my hospital-sponsored childbirth class that I had while preparing for Sassy.

I cannot say that my births with Sassy and Diva were "bad." What I can say is that my research led me to realize there might be a better way. My birth with Sassy at 41 weeks included shoulder dystocia, which in turn caused my OB to schedule an induction 2 weeks early with Diva.

My experience with Sassy started with contractions every 2-3 minutes apart that did not cause dilation for 6hrs, so I was then put on pitocin, which cranked the contractions up enough that I was dying to get the epidural when I finally reached 5cm. But the epidural pump malfunctioned all day, leading to the nurses turning it off roughly 90 minutes before birth. I was told that I had enough medication in my system to last through delivery. THEY LIED! It turns out that the malfunctioning epidural was only partially effective on one side. So I felt a good part of that delivery, including all the loveliness that was shoulder dystocia.

Diva's birth was induced to avoid shoulder dystocia. I was actually induced at 37 weeks 6 days. I went to the hospital for Cervadil overnight, then started on a pitocin drip at 6am. Because I has a successful prior delivery, I was allowed to get an epidural at 3cm, which is before labor really kicked up. I progressed slowly until I hit 5cm. Then my body hit transition and I felt like I was feeling everything. My body went from 5cm to baby being delivered in 40 minutes. I went from feeling nothing because of the epidural to feeling like I was experiencing birth without an epidural, it was THAT intense. I was later told by the anesthesiologist, who didn't make it to my room to top off my epidural before delivery, that when your body transitions so fast the medication in the epidural does not keep up with your nerves, making it less effective. I would like to add that it was MUCH less effective.

So, after learning so much about birth halfway through my pregnancy with Monkey, I decided to go for a NUCB. I figured I had went from 0-5cm with Sassy, plus felt a good chunk of the delivery thanks to a malfunctioning epidural, and went from 5cm-delivery with Diva, feeling "just the edge taken off" per the anesthesiologist. So I decided to educate myself and go for it. I would prepare for a NUCB, but I would also actually educate myself on the options for pain relief and all their risks, something I never bothered to do with the girls. After all, if everyone delivering in my hospital received an epidural, it couldn't be bad, right?!

My OB is not overly NUCB-friendly. The hospital is also a very intervention-happy hospital. All L&D patients have standing orders for IVs, pitocin, epidural, etc. The epidural rate is about 90% for vaginal deliveries. I researched my other options (other hospitals, home birth, etc), but I knew that I was most comfortable with my OB, who had been there for my prior deliveries and knew my history of dystocia. I was already halfway through my pregnancy. And poor Hubby was concerned about a repeat of shoulder dystocia, so he insisted a hospital birth. I decided to just educate myself and prepare.

I had a lot of "pre-labor" the week after Christmas. My appts are always on Mondays. I knew that my OB would want to induce at 39 wks due to my history. However, I really did not want an induction unless it was medically necessary. With my recent crash course in NUCB, I knew that "big baby" and my history of dystocia was not a valid medical reason, so I was prepared to stand my ground.

My OB stripped my membranes at my request at 38 wks because I wanted to do what I could to get my body optimal for when Monkey decided to start labor so I could avoid an induction. I had a mix of real contractions (cxs) & Braxton Hicks that were 10-15 mins apart straight for Tues & Wed. Thurs morning I lost my mucus plug and everything stalled. Saturday I had bloody show and more real cxs, but never anything regular. I chalked it up to "false" labor.

On Monday, January 3rd, I went to the OB again. I was 39wks and 3cm at this point. I told him about all the signs I'd shown in the previous week and he said that he figured I'd go in the next few days. I'd actually started having cxs again that morning 10-15 mins apart, but they stopped before my appt. The doc went ahead and did another membrane sweep at my request. He told me that he was perfectly content letting me go to my due date and that we would discuss induction after that point (YES---small victory!!), but that he sincerely believed I would not make it to my next appt.

Throughout the day I continued to have cxs 10-15 mins apart. By 3pm, I picked up my girls at school. I realized that the cxs were getting closer together and slightly stronger, so I decided to head home and prepare. I called my Mom to let her know that things seemed to be gearing up and to go ahead and get the girls for the night. She came over around 4pm and picked up Sassy and Diva. The cxs were still getting stronger and closer together, but not painful. I did some housework to keep me busy.

I finally started timing the cxs at 5:30pm. They were about 7 mins apart and lasting 30-45 sec, so I knew I had a way to go. I waited on Hubby to get home from work (10 mins away, so I told him to stay there until the end of the day). In the meantime, I ate dinner: soup, yogurt, toast, and almonds. I sat on my birthing ball and played on the computer while watching TV to pass the time (multi-tasking!). Hubby got home around 6pm and ate dinner while I sat on my birthing ball and bounced/rocked through the cxs that still were not painful. The cxs continued to get closer and made it to 3-5 mins apart by 8pm.

I decided to take a shower to see if it would get the cxs to pick up. They continued to stay in a pattern of between 2-4 mins apart and lasting around 45 sec. They really were not painful enough to make me think it was really time to go to the hospital, but I was getting worried that I might be further along than I thought, especially given my fast transition and delivery with Diva. Even though my cxs were not painful, I was starting to second guess myself and decided it couldn’t hurt to get checked out.

We left my house at 9:30pm and went to Mom's to get her digital camera (couldn't find mine, lol). My girls were already in bed at this point. I raided the kitchen for leftover Christmas fudge (YUM!!). I was sitting in the living room with my phone timing cxs. They had gotten to the point that I had to sway through them, but they still were not painful. Honestly, I just had to be still during them, almost like when you do a crunch and have to hold it---you keep your body still until you can release. Mom was really freaked out that my cxs were 2-3 mins apart at this point. She rushed us out the door and we headed to the hospital with a bag of fudge in my pocket.

We arrived at the hospital and got checked into L&D triage at 10:15pm. I was only 4cm, so I was pretty disappointed. I felt like after being in early labor all day, I would have progressed more than just one measly cm. But I reminded myself that this was the same reason that so many women refuse vaginal exams and tried not to let it get to me. The nurse said they would monitor me for an hour to see if I would make progress because they cannot admit you unless you are having cxs in a pattern AND making cervical change. They also wanted to get the preliminary readings on the monitor, so I laid back in the bed to rest while being monitored. Because I was laying in the bed hooked up to the monitor, my cxs slowed down to 5-7mins apart.

I was checked at 11:15pm and still only 4cm. I was starting to get a really disappointed at this point. I had figured that I would be in for a fast and furious delivery like I had with Diva, not slow progress like Sassy’s birth. The nurse said that she wanted me to drink a lot of water to confirm that my cxs were real labor and not just from dehydration. I figured that the more water I drank now meant that I would be less likely to have them suggesting an IV later, so I think I drank 24oz in the next hour.

I decided that I would start sitting up on the bed almost indian-style and rock through cxs, knowing that the change in position and gravity would help me progress. This made the monitor lose Monkey's heart rate during each cxs, which caused the nurse to come in eventually. She started in, saying I needed to lie still for the monitor to pick up the baby, but I cut her off and told her that I was going to move through cxs, but would make sure that I moved the monitor and got his heart rate back at the end of each cxs. She seemed ok with this, although I could tell she thought it was weird and maybe was a little annoyed. I figured, "Oh well! My labor, my body!"

At 12:15am, I was still only 4cm. Since I’d spent more time sitting up in the last hour letting gravity help, the cxs did get more intense and started getting closer together. I remember the first cxs that was strong enough for me to need to moan through it. I closed me eyes and let out a low moan. Halfway through, I opened my eyes just enough to see the sign on the wall in front of me. It had the word “STOP” in big letters in a stop sign, which said “Call your nurse before you fall” under it.

How ironic. Here I sit in triage trying to coax my body into progressing and each time I open my eyes I see the word “STOP.” Are you freaking kidding me?! I decided to spend my time during cxs to focus all my attention on the “O” on “STOP.” My goal was to focus on this “O” and keep telling myself that my cervix needed to expand like an “O.”

The hour between 12:15am and 1:15am was the toughest of the entire labor. I got the shakes pretty bad in my legs and in my jaw, like I was cold. I was still in triage, so no IV or medications. The only “intervention” I had so far was just the fetal monitor that I largely ignored. The cxs got stronger after I got the shakes and I started moaning through each cxs. I got up to use the bathroom at 1pm (I really had to pee from all the water I’d drank in the last few hrs to prove I wasn’t in false labor). I went to the bathroom and tried, but couldn't pee. I sat there for a minute and then the next cxs came. I felt lots of pressure and tightened my body up in response to the cxs, then felt myself pee (not my water breaking) in the middle of that cxs. This was the first cxs that was really painful.

I didn't realize it until later, but I had beared down during that cxs. The pressure caused me to tighten my body up and bear down, which caused me to be able to pee. The cxs got even stronger as I walked back to the triage bed. I think that the triage bathroom and my bed was maybe 25 ft apart. I had THREE cxs while walking 25 ft. The nurse saw that I was off the monitor, so she came to check me again at 1:15am. I was finally at 5cm and she said that she would admit me & move me up to L&D. She also called my OB, but told him that he didn't need to come in yet because it would be several hours before I was complete and ready to deliver. Boy, was she WRONG.

As we were getting ready to leave the triage room, I told the nurse that I thought I might want an epidural if I was in for a long labor with slow progression all night. I had been at the hospital for 3 hrs and only progressed 1 cm. This last hour had made me doubt that I’d be able to go through without meds. I was freezing and shaking, the cxs were right on top of each other, etc. Little did I know that I was in transition. She said that she would call up anesthesia and get things rolling for an epidural. The thought entered my mind as I was walking to the L&D room that I was such a failure for giving up on my NUCB.

It only took 10 minutes in between the nurse checking me at 5cm and walking in the L&D room, mostly because it took them time to prep the room and I walked really slowly up the hallway, having cxs the entire way. I had a really big cxs as I walked up to the bed. My nurse hooked up the monitors while I was leaning on the bed through the cxs. Something on the monitor let her know that I was fighting the urge to bear down...something I didn't even realize because I had always had epidurals before and never felt the "pushing" urge. Her voice had a tinge of urgency as she said, "Get in the bed, get in the bed, stop pushing, get in the bed!"

She checked me as soon as I laid down and I was at 7cm at 1:25am. The nurses started hurrying to get an IV to prep me for an epidural, even though I had only told the nurse that I thought that I might get one. I remember that a nurse was putting the IV in and I was thinking in my mind, “I’m not getting an epidural, I'm progressing too fast, why am I getting an IV, I don't need an IV, I'm not going to be able to get an epidural.” One of the nurses replied that I would be able to get one as long as I was not fully dilated, which is when I realized I'd said all of that OUTLOUD. Funny how labor messes with your stream of consciousness.

At this point, tons of nurses popped out of the woodwork. My OB had written in the chart to call him for the delivery and not the on-call OB, so no other OB was there for the delivery. They called my OB back and told him to hurry and get there. Thankfully he only lives 15 mins away from the hospital, but they still were not sure that he would make it in time.
This was the point in my labor that I got my second wind. I also got my brain back. I realized that I’d been in transition the last hour, which completely explained the shakes and sudden intensity of the cxs. I also knew that I would not have time for an epidural, which made me happy. My whole mood changed in between cxs. Even though I was reclined with a cold washcloth over my eyes and moaning loudly through cxs, I was still talking and making small jokes in between cxs. I never turned mean or said nasty things to Hubby or the nurses. I just focused on moaning through each cxs, trying to not push since I was not complete, and listened to the nurses talk in between cxs.

They checked me at 1:45am and I was at 8cm. I'd been trying really hard to not push during cxs since I was not fully dilated, but it was getting harder. They quickly broke down the bed and my main nurse asked if I minded if any student nurses came in so they could see a natural delivery. I jokingly told her that was fine because we needed all the nurses we could get since my OB might not get there. I still had the washcloth over my eyes and was focused on breathing through cxs instead of pushing. I could hear the nurses and knew there was at least 5 in the room and nearly double that many standing outside the door, watching and waiting.

At 1:50am I was trying to breathe through a cxs and could no longer fight the urge to bear down. The nurse suggested I push gently to relieve pressure and do my best to not push hard. I beared down and felt a pop and immediately felt a big decrease in pressure. My gentle push at broken my water and immediately stopped the cxs dead in its tracks. I sighed really loud and said, "Ahhhh! Now THAT feels better," causing the nurses to laugh. The nurse checked again and I was 9cm. That relief in pressure also gave me more than 5 mins until the next cxs, which was a good thing. I needed the break so that my OB could get there.

My OB walked in the room at 1:55am and said, "Nicole, I'm going to do a quick internal check to see where we are and then I'll get dressed and we'll have this baby." I laughed and replied with, "I REALLY don't think you've got that kinda time." He must have heard the urgency in my voice because he said, "Ok, let me get dressed and I'll be right there."

He came over just as the next cxs started at 2:00am. The nurses were trying to get my legs raised up into the leg braces, but my body was fighting them with a mind of its own. I honestly was not aware that I was moving my legs, but was aware of how funny it was that they were trying to move my legs and my legs were moving in the opposite direction.

At the end of that cxs, I leaned back and took a deep breath. My OB told me to take a quick break and then it would be time for the shoulders. I ripped the washcloth of my eyes and said, "WHAT?! His head's already OUT?!" I had no idea since I'd been expecting to feel the ring of fire that so many people talk about!! I was so shocked that it allowed the nurses to slip my legs completely in the braces. The next cxs came and I pushed easily through it. My son came out entirely in that one long push (no shoulder dystocia--YAY!!).

Monkey was born at 2:02am at 7lbs15oz and 21.5inches. So I went from 5cm at 1:15am to delivered at 2:02am.

I'd always been skeptical about women that say that you get instant pain relief after the baby comes out, but it is totally true. The doc put my son on my chest while he checked me out. I didn't even tear! I was in a little bit of shock because things went so fast, so I completely forgot to tell my doc to not clamp the cord until it stopped pulsating. Hubby cut the cord and I tried to nurse Monkey, but he was largely uninterested. While I delivered the placenta, I let the nurses take Monkey to be checked for his weight, height, etc. in the room. After they brought him back he was calm and ready to nurse.

People look at me like I have 4 heads when I say that my NUCB with Monkey was less painful than my pitocin/epidural births with Sassy and Diva, but it is true. I won’t lie. It was painful, but manageable. It was exactly how many friends described their NUCB to me: like running a marathon. You will feel some muscle pain, you will get tired, and you will grunt and vocalize your way through it. But, at the end, you will feel EMPOWERED that you made it through it. The recovery was fantastic, too.

So that is the story of my little Monkey, the journey of my NUCB, and the beginning of my new-found crunch. I've told Hubby that he is lucky that our family is complete because I would be adamant about having a homebirth from here on out. Now I am a total birth junkie, even thinking about taking a perinatal class or educational purposes only. And now you see one of the main reasons I am blogging: To share my experience and help others that might be headed down the same path. And hopefully they will share their stories with me. Because I NEED to hear birth stories. It calms my soul.

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