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Tuesday, February 02, 2010

The Best-Laid Plans – Labor & Delivery


By my 40th week, stubbornness was no longer an option. My blood pressure, which had averaged 116/64 during my pregnancy, had begun to climb. It was 134/84 at 38 weeks and 140/90 at 39 weeks. Showing no signs of protein in my urine or blood, I didn’t have pre-eclampsia but it seemed like that was the next logical step. The day before I was admitted to the hospital, my blood pressure was 150/94 and I was showing trace amounts of protein in my urine. Official diagnosis: Pregnancy-induced hypertension, referred to by some doctors as “pre-pre-eclampsia.” I wonder if those doctors also work for the Department of Redundancy Department.

Humor aside, my need to compromise wasn’t over. My doctor explained that being induced while still relatively healthy increased my chances of a somewhat natural delivery and reduced my chances of requiring a Caesarean section. Though I come from the school of thought where “natural childbirth” is defined as allowing your body to naturally do its own thing (no induction, no painkillers, no medical intervention, etc.), I found myself compromising yet again.

Hurry up and Wait
I admitted myself into the hospital at 8 a.m. Jan. 21. Since my body was showing all the signs of being ready to deliver on its own, the doctor agreed to be less aggressive and start with prostaglandin gel. The baby’s head was right on the cervix so there was no need for pitocin-induced contractions to bring the baby lower into the pelvic outlet. We just needed to get the cervix opened up so the baby could come out.

The gel did its work on my cervix, and regular contractions began shortly thereafter. The doctor visited me around dinnertime and said that we’d most likely have a baby Friday afternoon. My night-shift nurse decided to administer another dose of gel around 8 p.m., figuring it would cause my cervix to soften overnight while I slept. We called the doula and told her that we wouldn’t need her services until the next day. None of us knew at the time what lie ahead of us.

They Don’t Call it ‘Labor’ for Nothin’
The second dose of gel threw labor into overdrive for me with intense contractions starting at 11 p.m. The most intense contractions alternated between belly and back, indicating the baby was most likely sideways with its shoulder and elbow digging into my spine.

This is when I should have called the doula, but I still believed “hard labor” wouldn’t begin until the following morning and didn’t want to disturb her. Only now do I realize that was the wrong move.

Thinking I should conserve my energy for the hard work ahead the next day, I agreed to the nurse’s offer of a small dose of Stadol to help me sleep. Bad idea. The drug hit me hard and fast, making me just this side of crazy. I swear, I haven’t felt that intoxicated since taking up the challenge of drinking 21 shots on my 21st birthday. I was out of my mind but aware enough to realize I couldn’t articulate a complete sentence and should just stay quiet.

Fear Sets In
Here is where things got a bit hairy. Brian, the doula and I were all prepared for the signs of transition, which has symptoms that mirror severe hypoglycemia. We were also prepared for the possibility that I might have a hypoglycemic episode (blood sugar dipping below 50) during labor. What we didn’t prepare for is that both could occur at the same time, and that none of us would figure it out.

Between the hypoglycemia and the Stadol, I was incoherent. I couldn’t follow simple instructions and kept having flashbacks to my bowel obstruction three years ago. I had a hard time differentiating between past and present. I was terrified and couldn’t effectively communicate.

My blood pressure was escalating, giving readings of 150/99 up to 165/ 104. The nurse suggested an epidural. I fought the idea. I had already compromised my ideal natural birth experience; I didn’t want to compromise further. Yet I couldn’t figure out how I would deliver my baby when I couldn’t even figure out where I was or speak a complete sentence to anyone around me.

Seeking a way to clear my head, I agreed to the epidural. The anesthesiologist arrived at the same time as our doula. But by that point, there was little she could do for me. Instead of giving me a full epidural, the doctor administered a bolus – a temporary dose of medication – with the intention of returning to give me more later. Once the epidural kicked in and the doula began feeding me diluted juice, the fog in my head began to clear. I wasn’t numb from the epidural – just a little tingly. I could feel my contractions but I was no longer in fear. I knew where I was and what I was doing. I was able to put the terror of the bowel obstruction behind me and focus on the task at hand. Once I had enough juice in me, I realized the uncontrollable jitters, nausea and mental fog were due to low blood sugar.

I had a moment of feeling like an epic failure at the birth process since I caved to offers of drugs, but that gave way to excited anticipation that I would soon hold my baby in my arms. The bolus began wearing off after a couple of hours and my contractions got more intense. I felt the full force of each, most concentrated in my back, and my doula and Brian coached me through relaxing as each one came and went.

Getting Down to Business
It soon became apparent that the baby would arrive quickly. The nurse called our doctor and said she was on her way, but the baby had no intention of waiting. The urge to push was overwhelming, and the nurse led me through a practice push to see how effective I would be at it. Apparently, I did a great job because her next instructions were to avoid pushing and to breathe through the contractions. Fat chance, I told her. Her response: “Tonya, I cannot deliver your baby. We have to wait for a doctor.” Then she started paging residents.

I don’t know if I said it out loud, but I didn’t care if she wanted to deliver the baby or not. As far as I was concerned, she could step aside and let Brian and the doula take over. One thing was certain, the baby was coming, and I wasn’t holding back. My doula whispered to me that I could push if I wanted. So I did.

Lily Ann was born in the next push. Her cord was around her neck but the nurse calmly took care of that without much distress. She was in my arms as the OB residents entered the room in time to clamp the cord for Brian to cut. My doctor arrived just in time to handle the cleanup, which was pretty extensive given the speed at which Lily was born. But by that point, I had Lily on my chest and I didn’t care. Brian and I were in awe of her. Such a perfect little being that we created, and I birthed into the world. The achievement -- even though it required compromises on my part -- still boggles my mind.

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