Wednesday, January 9, 2013

A Hospital Induction Without Pitocin or Pain Medication

There is something wonderful about reading someone's progression from a high intervention birth to more natural birth.  I am always interested to hear from women about their OWN personal journey to getting the birth that they wanted and that they felt wonderful about.  
 
This is a beautiful story about how this mom was able to have a hospital induction, avoid the pitocin, avoid pain medications, and end with a triumphant birth.
 
Enjoy!
 
Charlotte's Birth Story
 
Charlotte is my third daughter. Her birth story starts long before her birth, actually at the birth of my first daughter.
 
I was 21 years old when my first daughter was born. I'd been married for a year and had no idea what to expect from birth. My mom had mostly inductions and with all of us, received epidurals. She never talked to me about birth. At 39 1/2 weeks I was 3 cm dilated. My OB stripped my membranes without asking (if only I had known...) and that night my husband and I walked for 5 miles. My water broke in the wee hours of the morning and I went to the hospital when contractions were 5 minutes apart. Then the interventions started. I ended up losing a lot of water when my water broke and at the hospital, they put an internal fetal monitor on me. I couldn't move with the monitor and after a few hours my contractions slowed, so they started me on Pitocin. I had reached 7cm but couldn't handle the Pit contractions anymore. I asked for an epidural, got one, then the baby's heart rate started dropping. I was given oxygen. Unable to move anywhere, labor lasted for 4-5 more hours. Finally she was crowning and her heart rate dropped to 60 bpm and didn't come up for three contractions. My OB acted quickly, gave me a huge episiotomy and out she came, after 12 hours of labor. Whether it was because she was born partly posterior (her body was posterior, her head turned to the side) or because of the episiotomy, I had a third degree tear through the muscle layers to the layers of the rectum. Breastfeeding was difficult and I stopped producing enough milk at 6 weeks postpartum. Recovery was even more difficult and it was many months before I could do much without pain.
 
During my second daughter's pregnancy, I knew I wanted a different birth. We had moved and I had a much different OB-- one who was willing to talk to me. But at 38 weeks he told me he was going out of town for conferences right when I would hit my due date. My husband was also going to be in state testing where he couldn't leave (even if I was in labor! He asked!!) the for the 3 days before and after my due date. Since I'd been 3cm and 75% for 2 weeks already, I opted to be induced at 39 weeks so that I wouldn't be completely alone. My OB did not pressure me into this and double checked several times to make sure I really wanted this. I had a typical induction-- Pitocin, AROM. I wasn't free to walk around because of the Pit and external fetal monitor, but the hospital encouraged me to stand and sit as much as possible. When I hit 6 cm I asked for 1/2 of the smallest dose of Nubain (the lightest narcotic). They gave me 2.5ml of Nubain and I was able to sleep a little on my way to 9 cm while still being aware. I asked for the second half dose at 9cm and got it and relaxed my way to full dilation. Before I knew I was fully dilated I asked for an epidural shot and got that, but when I sat up for it to be administered I felt the pressure of the baby dropping. It was too late because I'd already received the shot, but I immediately lay down and a few pushes later (just as the epidural shot was taking effect) my 2nd daughter was born, also posterior. 7 hours of labor and 2 stitches.
 
Before I was even pregnant with my third daughter I started researching birth. My library is small and I only read "The Thinking Woman's Guide" by Henci Goer, but I decided that a completely natural birth was the only way I would birth. I had a very peaceful third pregnancy and very easy-- none of the usual hip and back pain. At 36 weeks, my OB (same one as my second birth) checked my cervix-- 3 cm and 75% effaced! I was so excited. He didn't check me again until I got to the hospital.
 
At 41 weeks my OB and my husband were pressuring me to get induced. I should mention here that my husband is an ER nurse and because of his medical training, often is more supportive of my OB than he is of my ideas. (I'm much more forceful this time around and I share everything I learn with him. He is now much more supportive) I told my OB that I would get induced and, even though it wasn't what I wanted, I felt very peaceful about this. I showed up at the hospital when I was 41 weeks.
 
I got to the hospital at 5am and I was alone. My husband had gotten off work at 3:30am and I let him sleep at home, knowing that it would be awhile until I needed him and I like to labor alone. They checked me in, did nurse stuff and at 6:15am started Pitocin and put on the external fetal monitor. I felt blessed to have the same nurse I did with Nathalie because I was feeling a little alone (maybe a dumb idea to be alone).

Between 6:15 and 7am I wallowed in my negative feelings about induction and had no noticeable contractions. At 7am my OB came in to break my water. I had devised a plan to avoid Pitocin. I asked him to turn off the Pitocin after he broke my water, hoping that breaking my water would be enough to send my body into labor. He agreed to that and turned off the Pitocin.

Before he broke my water, he checked my cervix again. It had been 5 weeks since my last cervical check. I was STILL at 3cm (5 weeks!!!) He broke my water at 7am and the fluid was stained green.  Without Pitocin I was only hooked up to an IV of fluid. My nurse was totally supportive of me trying to labor on my own. She told me to be back in my room every hour so she could check the baby's heartbeat and to keep track of my contractions, but I was free to walk around L&D. An OB resident came in and told me some tips to keep contractions going. I'd done my research too and knew some things that would help.

So started my labor. That first hour I walked and stood a lot. Contractions were coming, but they were very irregular, depending on whether I was moving, sitting, on the toilet. I wanted to keep moving, knowing that if my contractions slowed I'd be put on Pitocin and have very restricted movement.

Between 7am and 9am my contractions slowly built in intensity and regularity. Around 7:45 I did some nipple stim. I knew nipple stimulation would help and I went for it-- I stood and stimulated both my nipples continuously for 45 minutes. (I was determined not to get Pitocin!) After that I would do it 15 minutes on, 15 minutes off until 9 am.

At 9am I called Matt. I could still easily talk through contractions, coming every 5 minutes. I didn't even need to stop and breathe through them. I was bored and lonely. Between 9am and 10 I started feeling tired. Contractions were getting stronger but not faster, unless I sat on the toilet. I'd been walking for 2 hours and didn't feel like sitting on the toilet (which sped up contractions) until I delivered. I asked a nurse for a birthing ball and she brought one that was shaped like a peanut. Not only did the ball give me a chance to sit down for a bit, it also put me in a position like the toilet and so my contractions didn't slow. I was even able to doze off a bit by leaning against the bed.

My husband arrived at 10 and we started walking again. Contractions were getting stronger but still 4-5 minutes apart. Between 10 and 11, my husband and I walked a lot and I sat on the ball. By 11am contractions were strong enough that I had to stop walking during one. I started breathing and relaxing during the contractions. I stopped wanting to go out of my room and got really quiet. I was able to doze on the ball a little bit and the two hours passed quickly.

By noon I was leaning over the birthing ball. When I contraction came I closed my eyes, rolled back and forth on the ball and put my head on Matt's knee. The contractions were 3 minutes apart and strong. Nothing I couldn't handle though.

Around 12:15 my nurse and a resident came in to check me (this was the first time she had checked me except before the AROM). I was only 5 cm! I felt a little discouraged because it'd been 5 hours, but because I was progressing enough for them, no Pitocin was mentioned. I could no longer talk, move or open my eyes at all during a contraction. Since about 11am I had completely retreated into myself. With the exceptions of the hourly monitoring, my room was completely silent. (My husband has a very specific job during active labor-- don't talk to me, look at me or touch me. But don't leave.)  At 12:30 or so my OB came in to look at me. He'd just finished a C-section and could tell that we wouldn't need any Pitocin at that point. He left, but stayed in the hospital.

Around 12:45 I suggested my husband to go get lunch. I was going to get in the shower. My wonderful nurse was unsure, but the resident was totally supportive again, unhooked my IV and taped a glove over the IV. The contractions were really getting intense. I climbed in the shower and things changed. All of a sudden I couldn't labor silently anymore. The contractions moved to my whole abdomen instead of just the front. They were still 2-3 minutes apart, but I started whimpering through the contractions. Some people moan, I whimpered and moved my stomach from side to side, rubbing my stomach. (Now I realize this was transition, but I didn't know it.)

After 10 minutes I got out. My husband walked back in the room at that point and I was whimpering in the bathroom doorway, dripping wet naked. I'm sure that was a sight!!! He helped dry me off. I told him to go get the nurse and ask for Nubain and I moved toward the bed.

I thought I was still only at 5 or 6cm and knew if it was this intense, I wouldn't be able to finish without some pain medication. It had been about 40 minutes since I had been checked at 5cm.  My nurse walked into the room as I lay down on my left side on the bed. As she typed on the computer for a minute with a shot of Nubain in her hand, another contraction hit.

Pressure. Intense pressure. SO MUCH PRESSURE. I said, "J, pressure! Pressure!!!!" She checked me, told me I was completely dilated and it was time to go, and asked if I wanted the Nubain. I had gone from 5cm to 10 cm in 40 minutes. I shook my head "no" because I knew that I had made it to the end and gripped the side of the bed with all my strength as the next contraction hit. My whimpering turned into a moan which turned into screams.

It all becomes hazy here. I was so focused on the contractions I don't know what was happening around me. As each contraction hit I clung to the bed and screamed. When the baby descended I started pushing on my own. There was definitely the ring of fire as she crowned. Matt tried to hold my hand and I yelled, "NO TOUCHING!" Then I asked him to rub my back with a cold towel (what I didn't realize then is that my nurse was prepping things and needed my IV hooked back up. But the baby was crowning so she needed to be doing other things too. My husband was actually hooking the IV back up because she was doing the other things). He asked me if I could lie on my back to deliver and I yelled, "NO!" because it was ALL back labor at that point, so I delivered on my side.

I had 5 or so contractions. I pushed and screamed "OW!" every time. Somewhere in there my OB arrived. Charlotte crowned and I pushed as hard as I could. Her head was born and my OB told me to push gently (yeah right!). Her shoulders were born and she slipped out. She was born posterior, just like my other two.

I had an abrasion on the top of the birth canal and 1 stitch needed on the bottom. She was 8 lbs 2 oz. I had done it and in only 6 hours!!! I had her completely naturally and recovery has been SO EASY. There are definitely endorphins that come after a natural birth.

After it was all done, my OB came over and said, "Congratulations Michelle, you did it!" I looked at him and, triumphantly, said, "I did it, I did it!" I still feel triumphant.
 

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