Birth story pt 4

First, a note. I recognize that this birth story is incredibly detailed. Part of the reason for that is that, in general, I like to record this kind of detail for really important events anyway – it helps me have clearer recollections when the memories start to fade. Additionally, of course every birth is different, but there were some things that I only knew to be aware of because I read others’ very detailed birth stories. Some of that new awareness turned out to be factors in my own birthing experience, some didn't, but it was nice to be aware. For people who haven’t done this before but plan to, I hope that these posts will give a little bit of a heads' up on some things to consider or ask about, or even give ideas on which things to develop an opinion about vs. decide you don’t care about.

Also, birth stories are fun.

Part 1, Part 2, Part 3

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The window between 6:45-9pm was pretty much ‘hang out in bed’ time. We made a few family phone calls, and I began my audio journal of the labor experience so far. My audio journal started like this:

“So, here we are in the hospital. Jonny’s sneezing! Bless you. Mom is rubbing my neck right now, and Jon and Mom are taking turns. I have the epidural in me, which … I don’t know if it’s my hormones or the epidural that’s making me shake, but it happened after the epidural but they said it was the hormones, so, whatever. But, I’m kind of shaky which I much prefer to contractions, so. Ha.”

I thought I was totally normal, but I sound a little woozy on the recording. It’s pretty awesome, I totally recommend recording yourself on an epidural (and the residual narcotics) if you ever get a chance.

Anyway, they mostly let us be during this window. We had the lights off for a lot of it, which oddly I don’t really remember (Mom and Jon assure me that we did.) They offered me some Jell-O and then there was a disagreement about how much/what food/liquids I could have (one nurse thought one thing, another nurse thought something else, and we had been taught a third thing in the birth class … more on this later.) So, I had some Jell-O and popsicles.

Also, Pitocin storytime! No actual Pitocin featured in this segment. We got a lot more of those Pitocin comments during this window. Nurses and doctors alike came in periodically, checked my NST readouts (or whatever they call it when it’s continuous and not just for 20 minutes), and said, “Oh, let’s turn down your Pitocin.” Or I would overhear them discussing my Pitocin levels between each other, so I would have to interject something about how “I’m not on that.” Always followed by surprise and a double-checking of my chart. I’m told it’s because the contractions were very strong and very regular, which is apparently something you see with Pitocin and not so much when there’s an epidural and no Pitocin. (Since epidurals typically slow things down.) This made me feel good that apparently I was progressing? But it made me feel less good because that was one of my top Things to Avoid During Labor, mainly because I have heard that Pitocin can hurt and it sounded terrifying. It kind of irritated me that possibly I got to enjoy that feeling anyway, but I guess that’s life.

Near the end of this window, I was getting pretty bored, so I decided to watch “Leverage” on the tablet, but I only made it a few minutes in when the pain started to intensify. They checked me at 9pm, and I was dilated to an 8. They wanted to break my water, so I asked them to give me the *pros and cons of doing it at that time. They talked it out a little bit and then decided that they wouldn’t even let me do it if I had wanted to, because they said the baby was still too high (+2) and the umbilical cord could slide down to the wrong place or something. I’m sure they would have figured this out before actually performing the procedure, but we felt like it was good that our questions made sure that everything got thought through thoroughly. It’s the middle of the night, everybody’s tired, so anything you can do to help take care of yourself is good. Plus, having the extra knowledge as they took the time to explain things (because, I was surprised to find out, there is a lot more in birth that is not immediately urgent than that is) helped me feel empowered during each step to really be on board with what was happening.

*The birth class, which was very focused on taking charge of your own birth experience, actually taught us two good techniques for this. They said, if the doctors or nurses suggest a procedure or technique that you’re either unsure of or just want more information on before it’s performed, ask: “Can you ask me again in an hour?” Their answer to that will give you an idea of how urgent the procedure is. I guess the ‘pros and cons’ question was more our own – we didn’t see a big reason to try to delay things without first trying to understand why the procedure was being suggested at that time. This ended up being pretty helpful for our own ability to understand what was going on around us.

At this point, my back was really starting to hurt, and nobody could tell why. My mom thought it was back labor, but no medical professional ever suggested that possibility, so we’re not really sure what it was. It was like a charlie horse in one place on my back, at the low left. It corresponded directly with the spot on my lower left front that kept cramping up. Later on, from what I could tell by reading online, the epidural is supposed to help back labor the same as any other labor pains, but no matter how many times I turned to allow gravity to slide some meds into place, the pain in that ping pong ball-sized spot never subsided one bit. I was also starting to feel my other contractions more and more, and needing to click the epidural clicker every chance I could (it only works every fifteen minutes or so, and made an annoying ‘ping’ noise if you clicked too early.) Sometimes I wasn’t sure the clicker was even working – I wondered if the little clicker was just there for the placebo effect, because if it was, I wasn’t getting it. Later, I decided that the issue might have been that my back hurt so badly that it overwhelmed any good the epidural was doing in the places where it was actually effective.

By 10pm, I was definitely in transition. The main thing I remember about this part was that there was more pain.

I shifted positions several times, to make sure the epidural medicine was staying evenly distributed. This was kind of a catch-22, because my back pain was worse in certain positions, but overall the shifting was probably helpful (even though it didn’t make the medicine work any better on my back.) The shifting itself, though, was a production… Jon or my mom would take one leg, a nurse would take the other leg, and then they would ask me to scoot my rear. I was like, you know I have zero leg muscles, right? The nurse would say, “Just put all your weight into your heels,” and I would say, “I can’t even FEEL my … from what muscles do I even do that?!” It was only possible if I gathered up every ounce of strength I could find, and even then it didn’t always work. It was also difficult because I had the IV pump in one hand (the machine started beeping weird if I tried to push off with that hand, because it messed with the IV) and the blood pressure cuff on the other arm, and man, alive, I’ve never had that much trouble just adjusting positions.

Speaking of the blood pressure cuff, that was one of the worst things of the whole experience. They monitored my blood pressure off and on through the whole thing, but one of the cords to the cuff was broken and kept falling off, so they would have to redo it all the time. Sometimes they said they needed my blood pressure every five minutes, sometimes every fifteen minutes, 30 min, etc. It’s boring to read about and, frankly, boring to write about, but I really cannot stress enough the irritation of getting my blood pressure taken over and over and over for hours on end. I ESPECIALLY wanted to tear it off during transition. Ugh.

Speaking of transition, I didn’t really think I was going to feel it because the epidural had worked so well to this point, but I sure did! I’m sure it would have been much more painful without the epidural, but I didn’t get to skip it, anyway. Also, somewhere in there, probably during transition but before the shift change around 11pm, I threw up. More about that later, that’s a whole thing.

Anyway. Music! My music was on by this point. I tried to make a labor playlist in the days before Alex came, but I kind of struggled because I am pretty mood-specific about my music. Sometimes I make playlists, but more often, I listen to one artist at a time, whoever I’m in the mood for. The idea of labor was still pretty nebulous, so I wasn’t sure whether I would want music to pump me up, or something soothing, or what. In the end, I didn’t really end up making much of a playlist, which worked out fine. Right around transition, when I was dilated to an 8 or a 9 and things were starting to get worse, we turned on the music so I could have a distraction. I just decided in the moment that I wanted to listen to Andrew Bird, so I just had Jon pull up all my Andrew Bird and push play. After a few songs, I asked him to mix some Joanna Newsom in there, too, and that was that. It was perfect, especially the Andrew Bird — it was familiar and relaxing, but there’s a lot going on in both the music and the lyrics, so those nuances were interesting and distracting to be able to focus in on. One issue to think about for next time … not everyone is a fan of the music I like, so something like earbuds might have been a better choice, EXCEPT that earbuds also block out all other sound. People were talking to me and giving me instructions a lot, which I wouldn’t have been able to hear if I had been wearing earbuds. (Plus, extra cords.) I also wonder if it would have taken away from the bonding experience of being able to hear encouragement from Jon, my mom, and the nurses and doctors. (Also, someone turned the music off at one point - having it the whole time probably would have helped me, but it also wasn't my goal to stress everyone else out because I listen to things they don't like.) Any ideas about how to handle this next time would be great.

11:15-11:30pm – They came back to check on my dilation, and I was a 10. My water broke during this check. That was rather anticlimactic. My doctor and midwife talked a lot about how much amniotic fluid I had all throughout my pregnancy, and in the end, when my water actually broke, it was maybe a cup of liquid. I didn’t feel anything (probably mostly because of the epidural), and I actually didn’t really experience any sense of waters breaking other than that they told me it had happened. There was also a shift change at this point, so my nurse went home and we got a new nurse. It was still at least an hour before I started pushing. I always kinda thought, “oh, once you’re dilated to a 10, it’s time to start pushing.” I guess that’s not necessarily true. I remember that once my water broke and they told me I was a 10, I thought maybe Alex would be born on August 4, before midnight. They were like, um, probably not, and sure enough, I still had a few hours to go.

Food in Labor

I had heard that a lot of people throw up during transition, and I did, too. Backing up a bit, there was this whole thing about food. I am a person who doesn’t do well on an empty stomach, so I really, REALLY wanted to be able to eat in the hospital. I was relieved to find out (in the birthing class that the hospital puts on) that ‘clear liquids’ didn’t mean ‘water and Sprite and that is all,’ it meant liquids without things floating in it – so, broth is OK, broth with noodles is not. Orange juice is OK, but not if it has pulp. That kind of thing. I also did a TON of research and found some recent studies published in reputable journals that said that eating during labor, epidural or not, shouldn’t really cause any problems and could even be helpful. I printed them out to take with me. (Since then, the American Society of Anesthesiologists has even published this, though they haven't changed their policy on it. By the way, at the time I didn't know it was a codified policy.)

Anyway, I wasn’t trying for a cheeseburger or anything, but I wanted to have my options as open as possible. (From what I can see, the biggest reason cited for not eating in the hospital is that, if you end up having to have a c-section and go under general anesthesia, they want to reduce the risk of you aspirating, aka throwing up and choking on it. C-sections aren’t really done with general anesthesia that much anymore, but maybe that is in an extreme emergency? We assume they want to be prepared for the worst case scenario, which I can appreciate.)

Right after I got settled in bed with my epidural, I started to get pretty hungry and feel pretty weak because of it, even though most food still wasn’t sounding that great. I hadn’t really eaten much before heading to the hospital because labor caught me off guard and then I didn’t feel well enough to eat much once I was in full active labor. I asked the nurse what was available to me, and she said she could give me ice chips, jello, or popsicles. I think. That actually sounded pretty good, so I got a little red Jello, and immediately felt better.

A couple hours later, I got hungry again, when my nurse was on a break and there was a ‘break nurse’ there instead. I requested a couple more jellos and a popsicle this time, but this nurse said no, and that I could only have ice chips. What?? Not only had I just been given non-ice chips sustenance, but the HOSPITAL’S OWN CLASS told me their ‘clear liquids’ policy … you know, the one that allows for a lot more than ice chips. I told her all of that and just kept getting “I’m sorry, it’s policy,” and it was maddening. (Probably more maddening because I was so hungry…) I reminded her that I had been given food earlier, I showed her my study, etc., but nothing. I started to feel bad and backed off, because she seemed like she was really worried that she would get in trouble for giving me anything else, and I didn’t want to make her do something she was obviously so uncomfortable doing. (There was some of that “it only takes one time for a policy to be created” and “yeah, I’m sure there’s liability going on here,” etc.) She told me she would go check with her supervisor or someone, but by then, my nurse was back and told me it was up to me. She said that I wasn’t on Pitocin, I hadn’t had any complications, I was progressing, and she didn’t see any reason why she would even consider that I would end up having a c-section – I was low-risk, basically – and that as long as I wasn’t feeling nauseated and if I felt comfortable with it and thought it would make me feel better, I could have it. I explained that before, I was feeling shaky and a little bit sick UNTIL I got that first jello, which calmed my stomach because I usually feel sick if I get too hungry. So she brought me the jello and popsicles, and I felt better. (She also requested a copy of the study I brought, because she thought it was really interesting.) I really liked this nurse, she may have been my favorite of the whole time I was in the hospital.

Fast-forwarding to now, during transition, I felt very vaguely sick for maybe five minutes, and then for about 20 seconds I felt really sick while everyone scrambled to get something for me to throw up in. Jon was the fastest and grabbed my ice pitcher, which I used while Mom got an actual expandable vomit bag from the nurse. I only threw up 3-4 times, totally emptying my stomach (and almost making Jon sick in the process … sorry about that!)

Later, Mom asked me if I would go through the whole food debacle again, knowing that I would throw up. My answer is yes, without hesitation, because having some food made everything much easier when I needed it to be easier, and then the coming-back-up process only lasted a few minutes and was over. (Although, my prideful self did NOT want the break nurse to know that I had thrown up, haha.) And, as weird as it sounds, throwing up was almost a welcome distraction from the difficulty of transition – it was the one time I could actually feel better from something post-epidural, where everything else got harder the whole time. Jon actually mentioned that he thought I probably would have thrown up whether I had eaten anything or not.