Tuesday, January 10, 2012

An Induction Birth WARRIOR!

I just love this birth story because it shows that you can have a great induction!  I am not encouraging induction by any means, but this mom felt and was told she needed one because of a health condition.  That didn't make her give up on her desire for a natural birth.  No, she got a doula, she worked hard, she asked nicely for the things that would make her labor better and more mobile and SHE DID IT.

Love it! Enjoy!

My almost natural birth story - becoming an induction birth warrior

A year after my baby girl joined us earthside, I am finally ready to put her birth story into words.  Her original guess date was 12/29/2010, then they (the OBs) changed it to 12/25/2010 but, I think the dating was off and that a week into January may have been a little more accurate....

12/12/2010 - The day before my induction

The local streams were flooding. I tried to take some inspirational notes from nature to draw on during labor.






We headed to the hospital at 5:30 a.m. on Monday, December 13, 2010.  My husband and I loaded up our car with my birth ball, birth supply bag (okay, it was BAGS of stuff, most of which I didn't need), out little sprout's first clothes -- SO CUTE!, and a new infant car seat for the baby girl we were anxiously waiting to meet. 

I had intrahepatic cholestasis of pregnancy and was being induced early at "38 weeks" for the safety of my baby (see previous blog post for details on my ICP experience).  I was originally scheduled for induction the week before, but I just couldn't bring myself to do it (and I wasn't confident that my guess date was accurate -- I had major worries about inducing a baby who might not be ready).  Instead, I started my leave from work and attempted to stay some sort of sane while buying baby some precious baking time all the while hoping that my attempts to get labor started naturally might take hold.

I took LONG walks in the woods and around our hilly neighborhood, I used evening primrose oil, hubbie and I worked at some natural prostaglandin creation, I had my membranes swept, I did Reiki, I tried acupressure point treatments, I drank TONS of raspberry leaf tea... all of this and I really thought baby was going to come along early on her own accord.  I had been walking around at over 3cm dialed and 75% effaced for weeks -- it was only a matter of time!

Well, when baby didn't come along early by herself and I was at 38 weeks 2 days (according to the OBs who "dated" my pregnancy) it was time.  I couldn't justify waiting any longer and it was getting riskier each day that she was in utero with ICP.  I wouldn't have been able to forgive myself had anything happened due to waiting for labor to begin naturally so we headed to the hospital for me to be induced.

I have to pause here to share a quick side story before we move on...


At a company holiday gathering the week prior I was lamenting over my likely induction with the wife of one of my coworkers.  We talked most of the evening about birth and she shared her two birth experiences with me. 

In speaking with this incredible woman, she told me about what had worked for her to have two mostly drug free births despite being induced with Pitocin.  I had never heard such brilliant and hopeful words.  The idea that a woman could labor through Pitocin without an epidural or massive amounts of pain drugs was just not something I had heard of.  Well, she had not only done it, she had done it TWICE! 

I was impressed to say the least and I took some serious mental notes.  I called on her story and the strength that I could just feel radiating from her when she recounted her birth stories to me and I was so thankful to have such hope.  Listen to empowering, strong, positive birth stories all you mamas-to-be out there!!! Drawing on the oral history this amazing mother shared with me was instrumental in shaping my own birth experience.
So, back to the hospital...

We got to the hospital and I was admitted.  The process and the legal paperwork and such are such an impersonal bother and I could sense myself getting more and more uncomfortable and anxious as we were tagged and directed into the secure layers of labor and delivery.  Although I could leave the place of my own free will whenever I wanted to, I couldn't shake the feeling that I was entering a lockup of some sort and surrendering the rights to my own body. 

This is where having a doula came in big time!  Something about institutional processes and procedures makes you feel like a pawn or a lab monkey at a hospital -- at least it did for me.  My doula, Doula J, was so great at reminding me that I have rights as a patient and can advocate for myself and barring anything actually life threatening, I get to call the shots. 

The problem was, my doula wasn't there yet.  It can take a long time for an induction to get rolling and so I didn't think it made any sense for her to be there until we had decisions to make and labor really got going.  In retrospect, I wish she had been there.  Her calming presence would have been the most natural thing in that hospital and would have been most reassuring for me.  Hindsight huh?

Anyhow, I'm a really tough cookie but I somehow just knew that the worst part would be getting the IV.  I have a major problem mentally with IVs and my induction experience did nothing to lessen those issues.  The nurse who started my IV was awful.  Not only was it the most painful IV catheter insertion I have ever experienced (and I've had my fair share of them), her lack of bedside manner made me feel like I wasn't there as I tried to express my needs. 

After it was finally in place I wanted to cry (I did, actually), crawl under a rock, and disappear forever.  It was so disheartening -- especially knowing that getting the IV should be the easy part before INDUCED LABOR.  I asked for a new nurse (or rather, my husband did).  Thank goodness we asked!  The new nurse's energy was totally different.  I felt like she actually saw me -- the scared little animal that I felt like at that point, and she did what she could to reassure me.  I should have let her give me a new IV in a different spot when she offered but I was terrified of repeating the awful catheter insertion so I declined.  Bad call.  I had pain and bruises at the site for almost a month afterward!!!

Once they got me "settled in" they checked my cervix to see where we were starting from.  I can't say I was very surprised when they told me I was only dilated just over 2 cm after three weeks of running around at over 3 cm -- I was terrified and my body was responding accordingly!  I was over 80% effaced though so they started administering Pitocin and we waited.    

In my birth preferences I outlined the importance of mobility and my desire for intermittent or telemetry monitors [*note* I call them "birth preferences" because plans notoriously go awry for me and most of the other people I know so using the word preferences made a world of difference to me and I actually felt like a couple of my care providers took them a little more seriously because I wasn't providing them with a rigid plan.  The connotative power of words is pretty incredible].  They require that you have constant monitoring while Pitocin is administered and all of the telemetry monitors were in use at the time things got started so I was stuck in the hospital bed hooked to cords and tubes galore.  I knew that this isn't what I wanted before we even started the process, I didn't realize just how much it got me down until I was stuck on that bed.

Words that I associate with a hospital bed:  infirm, weak, sick, ill, ailing, faint, feeble, fragile, frail, failing, recovering, convalescing, etc...  The hospital bed is so not where I wanted to be.  I was not there to be any of these things... I was welcoming my sweet baby girl into the world!

I continued to request intermittent monitoring so I could move around and they continued to tell me (in an almost threatening way) that they would stop the Pitocin if I wasn't being monitored.  Gosh did that mess with my head each time.  Of course I didn't want the Pitocin (uh, who goes into a hospital and starts begging for Pitocin?!?) but it was a pretty logical means to an end and so I had to keep reminding myself that the Pitocin and bringing baby into the world while she was strong and healthy was the entire reason I was there in the first place.

Over and over I asked if a telemetry monitor had become available.  This is when I learned that there were only THREE mobile monitors.  Are you !?%$#@$ kidding me?!? There are often a heck of a lot more than three woman laboring at a time.  I'm pretty sure St. Joe's could afford more of them and it struck me how often woman must be made to labor in their hospital bed due to a simple lack of proper monitoring equipment.  I also found out that birth balls were often hard to find in the labor ward and that if you did get your hands on one finding a pump to inflate it could be even harder.  Thank goodness I brought my own along.

They asked a number of times to break my bag of waters.  We declined each time and when I asked for some actual fact based data that suggested that ARM (artificial rupture of membranes) would help start active labor in a first time mother and only then did they admit that there isn't any evidence to support the intervention and that it is simply standard procedure for an induction. 

Well goodness am I ever glad that I declined ARM over and over.  Hospital procedure only allows for 24 hours after your bag of waters is broken before they worry about infection and push you into a Cesarean.  They also will not allow you into the tub if your water has broken so why on earth would I agree to an unnecessary intervention that would only up my chances for a surgical birth and take away a major natural coping measure that would also help protect my baby through unnaturally strong Pitocin contractions?!?

At the end of day one, after 16 stressful and emotionally exhausting hours, they had increased my Pitocin up to the highest dosage possible and while I was contracting every three minutes, they weren't progressing into active labor.  I was disheartened and completely exhausted.  They told me a Cesarean section was an option then an there.  I discussed my options with my husband and Doula J.  I could agree to a surgical birth.  I could go home and come back to try another day.  After all of the pressure to agree to induction over a week before for the safety of my baby (the chances of unpredictable and unavoidable stillbirth go up drastically each day over 38 weeks gestation with ICP, according to research), I could not bring myself to go home and risk my daughter's life.  I asked for another option.  There had to be a better option.

We chose to have me taken off the IV fluids and Pitocin and monitors for the rest of the night.  The nurses talked me into taking an Ambien and I slept on the hospital guest bed (way more comfy than the awful hospital delivery bed) to rest up for day two of Pitocin -- scheduled for 6 hours later.  I still don't know why they had to wake me up so early at 5 a.m. to start things up again.  It sure would have been nice to get a few more hours sleep but I didn't get to call all of the shots.

Pit day #2.  Regular contractions but still not progressing.  I gently demanded the telemetry monitor over and over (one of those ladies using the three in the building just had to be finished with it by now) and sure enough, I finally got one!  My elation was short lived though and I was so bummed when IT DID NOT WORK!!!!!  I made my opinions on the monitor situation well known and finally had my OB lobby to have the nurses do whatever it took to get me a functioning telemetry monitor (or I was quite possibly never going to shut up). 

By late morning I was back up to the max dose of Pit and they finally managed to get me a working monitor.  I started doing hot laps walking the hospital hallways with what I had already begun to call the "evil tower of fluids."  I rocked and moved and walked some more and guess what?  My contractions started to get stronger with all the movement.  They got closer together.  Eek!  I was actually going into labor!!! 

I stared playing Scrabble with my mum at 1:30 p.m. (I heart Scrabble) until the contractions began requiring my full attention to get through them (hello active labor).  This is when I had my doula clear out everyone but her and my husband from the room (per my birth preferences) and we created a little birthing cave to welcome our baby.

I started out moving and focusing on my breath in the rocking chair and was indulged in aromatherapy and some awesome doula massage.  Doula J had dimmed the lights very low.  We turned on my favorite relaxation music and listened to Dean Evenson's Forest Rain album.  I had been eating yogurt, fruit, nuts, chocolate, and indulged in tons of my favorite Revive Vitamin Water throughout the morning and early afternoon.  My birth preferences made it clear that I desired access to food and drink whenever I wanted it during labor and they kept the hospital meals a-coming but they were way too gross to consider eating.  I drank the juice and fed the food to my husband (men will eat almost anything).

Doula J ran me a bath around 4 p.m. and suggested I try nipple stimulation in the darkness of the bath to try and prompt the release of natural oxytocin for pain relief (the dimmed lights also help with natural oxytocin production to help with the intensity of the contractions since your brain doesn't produce it the same as with Pitocin/synthetic oxytocin). I was already 5+ cm and progressing quickly by then and I labored in the tub for a good long while.  The woman in the room next door was screaming bloody murder and I could see from the look on Doula J's face that she didn't want me to focus on the terrifying sounds. 

Instead, up went the music that I asked at that point to have looped over and over until baby arrived -- regardless of how sick of it anyone else got.  Speaking of sick, an indescribably awful smell started wafting into the bathroom and I couldn't focus.  I asked Doula J to figure out what it was and to PLEASE GET RID OF IT.  They had brought another hospital meal into my room and whatever it was the smell of it made me crazy with disgust.  Doula J had the food removed from the room and some aromatherapy essential oils I brought helped restore me to my happy place.  T

he noises from the next room continued and the intensity of my contractions continued to increase.  Doula J suggested I try toning along with my deep breathing and visualizations and she toned along with me until I was comfortable making the long and low sounds on my own without feeling self conscious.  I am still amazed at how much toning helped keep me grounded while in labor land.

Next, I moved to sitting on a backward hospital shower chair while my husband and Doula J traded off with me -- spraying my back and belly with the shower wand while I focused on low tones and visualized ocean waves in a dark cave coming in strong like the high tide and then receding to give me a break to regroup before the next wave came (note to mothers birthing at St. Joe's: they don't have shower chairs in the rooms already -- you have to ask for one and if you shower after baby is born you will be so pleased to be able to sit down). 

After awhile that position was no longer comfortable and I began to get cold.  We moved to standing with my birth ball on the bed and I rocked with my husband while I loaded up on hot blankets (I was FREEZING!!!). Here my toning picked up even more and I tried moving to hands and knees on the bed.  This position was a no go.  Did I mention how much I dislike hospital beds and the evil tower of fluids yet?  The bed was impossible and the IV seemed to be in my way no matter what I did.

It was now about 6 p.m. and with the bed a total fail I moved to the floor, using the guest bed/couch cushions to make me a mattress on the floor.  My cervix was checked and I was 7-8 c.m.  I was REALLY hoping at that point that I would be close to complete.  I began having a crisis of confidence as I was side lying on the floor mattress.  Lying down during labor is pure hell.  I was at a point where I felt too exhausted to stand any longer and that coupled with the additional pain of the horizontal position made me question my ability to continue that way indefinitely (well, it sure felt indefinite at the time). My hubbie provided me with amazing encouragement in the progress I was making and Doula J also kept encouraging me along with just the right words.

At this point I needed a distraction.  Although I had vehemently refused to let them break my bag of waters during early induction (and had I chosen otherwise I would have had a guaranteed Cesarean, in hindsight), I wanted it done now.  I was SO tired and I wanted to move things along NOW.  The nurses called my OB to tell him I wanted an ARM (OB #2 at this point as OB#1 who began my induction had gone off rotation early that morning). We had to wait for him to finish dinner (or something like that) and drive his butt over to the hospital. 

It felt like an ETERNITY.  This is where my inner comedian visited and I'm told I got pretty funny and sarcastic.  I was apparently cracking up the nurses.  What I remember most about this part was that I was swearing and cursing at the evil tower of fluids and I was seriously contemplating pulling out the darn IV.  The ONLY thing that stopped me from doing so was the fear that I might have to have another catheter inserted while contracting if anything surgical became necessary.

At 7:35 Dr. OB finally arrived and broke my bag of waters.  This is where things got really interesting for me.  My sweet baby girl flipped OP (sunny side up) during the rupture of membranes.  Now I got to experience back labor on top of the EXTREMELY INTENSE Pitocin contractions.  I didn't want an epidural (I was terrified at the thought of one) but I began to worry that I wouldn't be able to deliver an OP baby (an irrational fear... she would have eventually joined us, OP or not). 

My fear stemmed from my mother's birth experience with me.  She had a 36+ hour drug free labor that ended in a terrifying Cesarean after she tried pushing my OP head out for hours and hours only to end up with an epidural that only partially worked during surgery.  I was so scared that my birth would end up like my mother's and that all of my hard work up to that point would be in vain.  This is when I opted for a half dose of fentanyl.  I actually don't think it did much at all for me other than serve as a distraction, but a distraction was exactly what I needed.

Doula J and my hubbie then teamed up to strategically help me get the baby turned back into a favorable position with belly lifting for 5-6 contractions.  I visualized my baby spiraling down the birth canal and reminded myself that she was also working hard along with me to get into a favorable position.  The lifting made the contractions a lot more intense.  After belly lifting, Doula J and the most incredible nurse ever (who we had asked to please come back on her next shift after being so impressed with her during induction day #1) "tortured me" some more (yes, I remember transition as being rather tortuous, but heck, at least it was way short), using the roll over method with me lying on my side on the bed to try and get baby turned some more. 

I had a lot of trouble with this position as I didn't want to straighten my leg as the maneuver called for.  I was trying to self protect but, eventually I surrendered to the movement and my efforts with Doula J, my hubbie, and Nurse Awesome had managed to get baby turned more than half way around.  Then my OB was able to manually turn her the rest of the way.  That. really. hurt. A lot.  But I was so happy to remove the fear of an OP baby getting stuck from my mind and surrender again to the contractions and the baby's progress.  I got nauseous and told Doula J that I felt like I needed to vomit and she reminded me that it was normal and good and meant baby was almost here!  I remember feeling oddly excited to be so nauseous... baby, baby, baby!!!  

I had been repeating various mantras to myself the entire time but eventually my mantra became, "I can do this!" and it helped to have people continue to tell me that I was doing great and that I could keep on going and that the intensity of the contractions was normal (yes, it helped to hear this despite the Pitocin) and good and bringing me closer to my baby.  

When things got really intense I just took things one contraction at a time.  I have a distinct memory of Matt needing a quick break from me literally hanging from his neck as he danced rocking side-to-side with me and I instantly grabbed onto Doula J to take his place and the feeling of gratitude I had for such giving support was overwhelming!

At 8:15 p.m. I was 100% effaced, 10 cm dilated, and baby was +1 station.  I had asked over and over for the amount of Pitocin being administered to be turned down and at this point they finally turned it down to 12 (half of the dose I had been pumped full of the majority of my labor).  Meanwhile Nurse Awesome maneuvered around me with a flashlight to be able to see what she was doing... not once did anyone turn up the dimmed lights in our room which was so wonderful! I didn't have the urge to push quite yet but I knew it was coming and I was so excited get rid of the darn IV and evil tower of fluids AND TO MEET MY BABY GIRL whose life I had been so terribly worried about due to the ICP.

Once I got the urge to push I got into the bed side lying and just went with it.  I had requested NO DIRECTED PURPLE PUSHING in my birth preferences and Doula J tactfully reminded the additional nurses who had appeared in the room (and I was oblivious to) of my wishes.  I wouldn't say that pushing was easy, but it was by far the most satisfying part of labor and delivery for me.  I will never forget when baby's head began to crown and I reached down to touch her head... I totally didn't believe that her head could feel so squishy.  In less than 30 minutes after the urge to push began my baby girl came earthside and immediately up into my arms.  I have never known such joy.  Such relief.  Such love.

   

Estella Lynn was born at 8:54 p.m. on Tuesday, December 14th, 2010.  She was pink, and vocal, and healthy, and BEAUTIFUL!  She also was so very tiny and absolutely perfect. I was instantly mesmerized by my new baby girl but slapped quickly back into reality by the OB when he declared that he wanted to give me a fat dose of misoprostol [Also known as Cytotec]  rectally to stop bleeding and prevent hemorrhaging. 

Typically Pitocin is administered if needed to stimulate contraction of the uterus and slow bleeding when necessary but after two days of being on the max dose it is no longer an effective option.  I had a moment of fear before I agreed and it worked just great and I was back to being being in a world that only included Estella and my husband. 

Her cord was cut after it quit pulsing and baby had all of her vitals checked while in my arms as I had some tears stitched.  Estella's Apgars were 9 and 9 and she was latched on and nursing within minutes.  Pretty awesome for going through two days of Pit contractions while inside my uterus!  Our little sprout was born weighing 6 lbs, 5 oz and 19 inches long when we finally let them take her to be weighed and measured.


Being fully present and experiencing my daughter's birth has been the single most incredible and empowering event of my life so far.  My husband was the most incredible support during the induction process and having an amazing doula was absolutely key for both of us.  I simply cannot imagine giving birth without a doula! ICP and the induction process were no cake walk but, I wouldn't give up the experience of my almost natural birth or what I learned about myself and my inner strength for anything.










8 comments:

Hannah said...

Wow, she is amazing!
Yay for a supportive team too!

Claudia said...

wow. What a rock star.

The Phillips Trio said...

AWESOME! I love reading about successful "almost" natural labor & birth!
I also had an induction "almost" natural birth. At 36 weeks 0 days my water naturally broke. After 12 hours of no interventions & no progression my military hospital midwife recommended Cytotec. After 2 doses "real" labor started & I labored in the shower & I reached down to deliver my baby girl. I was able to pull her directly to me & keep her with me. After nursing her & bonding for about 2 hours I allowed the nurse to weigh & measure her. My beautiful little girl weighed 6 pounds 1 ounces & 17 & 3/4 inches. She was born 21 hours after my water broke with no pain meds or additional interventions!
Baby #2 was born natural at 38 weeks.I had back labor due to her OP position. The only intervention was the turning of my baby... TORTURE! Baby girl #2 was born 19 hours after my water broke. She weighed 6 pounds 12 ounces & 19 inches long. <3

Maria said...

Awesome! I know exactly how she feels. I too gave birth in Dec 2010 after an induction because of ICP complications. I was 37 weeks. It was my second birth and after a straightforward natural birth the first time around, I was blown away to find out about ICP. I took a Lamaze CBE workshop just two weeks before my induction (at that point I had no idea I had ICP) and remember being horrified at the thought of having to make the choice of how to induce if it ever became necessary (never dreaming it would). I was terrified of Pitocin. After having given birth twice with no pain meds, I can attest to the intensity of labor with pitocin! It was also a reminder for me that although it is rare, induction is sometimes necessary. It gave me chills seeing the similarities between our stories. Way to go!

Carolyn said...

Wow, Maria! After seeing your comment I found your blog and birth story, and yes... major chills reading your story and its similarity to mine (even the timing!)!!! ICP is AWFUL. What a great birth story despite the induction. We are so blessed to have our healthy baby girls here today!

Petra said...

I am a midwife at hospital but I also assist with planned homebirths.
I wish we had more of your type at hospital - more warriors are needed for having OB´s and midwifes reminded about that IT IS possible with natural biths even in hospital and even when an induction is needed. Than you for telling me and others about it.

Mommy Baby Spot said...

Beautiful, thank you for sharing. It's good to read a birth story that combines some of the goodness of the medical world (because intervention is necessary sometimes) with the beauty of a woman's ability to birth. And yay for Nurse Awesome...I had an awful pushy nurse during my last birth and she cause me a lot of grief...I never thought to request someone else.
I am going to start using "birth preferences" instead of "birth plan" in my childbirth classes...it just makes so much sense.

Renate said...

Congratualtions! I went through something similar with my first daughter. I took the Bradley Method of childbirth because I believe it's a natural process & one should work with her body. But I'm also an RN and know very well how sideways things can go. At 37weeks, my water broke just enough to be a trickle when I laid down; not realizing what it was at first, I didn't call the OB until the next morning. She had me come in, not convinced herself until she did the testing. Not knowing when the water actually broke, I needed to deliver. At the hospital, my water was fully ruptured & we waited, hoping that natural labor would start. A few hours of mild contractions but no further dilation/effacing, pitocin was started. Yes, I was on monitors, too, but I was unhooked every hour so I could walk to the bathroom (leaned over the table, too while I was at it). I spent some time in the rocking chair and even fell asleep; my husband will never believe that labor is painful because of that. (Sorry?) My husband was a trooper; he rubbed my belly through all of the contractions; that & calm breathing was all I needed. I also got nauseous when it got closer to pushing but didn't need anything. I laid on my side from time to time & that helped get the baby moved down. She was born right before 7pm that same day. I tore a little & needed a couple of stitches (no episiotomy). My mom & husband were a tremendous help; although I'll be honest & admit that when my husband left to get lunch earlier in the day, it just wasn't the same.
The baby was 7lbs 5oz. She had a bit of trouble right after, however. There was a tear in the cord & it had looped around her neck once. My OB was very calm about it & I didn't even know about it until afterwards. My mom (also an RN) tells me that she & the OB could tell instantly that the baby wasn't breathing right; she had developed a pneumothorax so her lungs weren't expanding as they should have. I didn't hear any of this during, however, which was probably a good thing, since I was delivering the placenta & getting stitched. I did get to hold her for a little bit then was told that she needed to be examined by the pediatrician. She stayed under an oxygen hood for three days; I couldn't do more than pat her back. It was such a joy to finally be able to hold her!
My mom teased me about yelping when my blood pressure was taken & when the nurse washed me off before the baby was born. I had had some blood drawn on the same arm as the cuff; I had a HUGE bruise there for a couple of weeks. And that water was HOT. I mean, come on; it's already a sensitive area, why HOT water?!
Epilogue: Though she has asthma, like me, she is otherwise strong & healthy & is graduating high school today. I've had three girls since then, all c-sections because the 2nd was a transverse breech. After the first c/s with pre-eclampsia, the other two were nothing. I do wish I had waited a bit to try & get #2 to turn around on her own but she was just past 34 weeks & I was a little more frightened (that child never stopped moving during labor). She was small for a few years, also has asthma, but is just fine now.

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