Monday, December 9, 2013

The First Birth- "All Beginnings Are Hard"

Honestly, I think every first time mom should read this birth story.  Beautifully written, and while a great birth story, it also has many lessons it for those preparing for their first birth.  
No, you simply can't learn everything there is to know about birth from books!

For my daughter, in honour of her fifth birthday

Throughout his novel "In the Beginning", Chaim Potok circled around the following theme: "all beginnings are hard." Giving birth to my first child certainly fit into that mold, and, strangely enough, so has attempting to write about it. It wasn't that her birth itself was traumatic or even disappointing, but I usually frame it as the birth that first led me to question the medical establishment, as compared to my son's birth, which made me want to be a midwife - hardly fair treatment for my beloved first born.  Though I don't want to forget the lessons that I learned from my first birth experience, I don't want to leave my child thinking she came into this world as a cautionary tale.

What's more, that child is a daughter, and, therefore (hopefully!) may one day be a mother, and that too pushes me to show a more balanced picture: birth can be hard, it can be a marathon, it can take you on turns you never expected, but, as a woman, you are so much stronger than that. Yes, it can stretch you, but you handle it. As much as hindsight shows the points where I should have said no, or at least have asked why, I do not ultimately feel that this birth was something that was done to me. It's still something that I did; in fact, it was one of the greatest somethings I did. And my daughter deserves to know that. So, without further ado, here is the story of my daughter's birth:

My first baby's due date was April 6th, 2007, which fell on Great and Holy Friday. Being practicing Orthodox Christians blessed with a parish that holds at least one service a day in the week leading up to Pascha (Easter), my husband and I had pretty much assumed that I would go into labour at church. My carefully packed labour bag spent the week in our trunk, in case we needed to leave straight from church to our chosen hospital. Given that said hospital was actually closer to church than to our home, it seemed like a sound plan. My daughter, however, is a girl who's slow to change, and she wasn't about to be rushed into the world for something as arbitrary as a due date. So I spent an uncomfortable and tiring Holy Week, sitting next to open windows, smiling thinly at yet another observation of "no baby?", but thankful to have somewhere to go and something to do other than sit at home obviously not contracting. Pascha came and went, and then I was back to sitting at home, without an agenda other than munching Easter goodies, still very much pregnant.

At my 41 week appointment, my doctor was pleased to announce I was 3 cm dilated. I now know that means diddly, but at the time it was pretty exciting - something was happening after all! Since I was on the table anyways, my doctor suggested we stretch my cervix to move things along. I wasn't exactly sure what she meant, but said okay anyways. It was probably the most uncomfortable and invasive procedure I've ever experienced, but I figured since a baby's head was going to be far larger than my doctor's finger I was best to get used to that feeling. Fortunately, I was wrong on that point. Unfortunately, my doctor's optimistic assumption that she'd be seeing me at the hospital over the weekend turned out to be less than accurate as well. With the ten-day mark coming on Monday, however, an induction was scheduled for 6am, so if there was no weekend baby after all, there would be one right after.

After my brief visit was over, I waddled across the parking lot, to a McDonalds, conveniently placed between my doctor's office and the bus stop. I'm afraid I'd become a regular customer over the last few months; the long bus ride home seemed somewhat more palatable with a drink and a little something greasy to keep me company. I had discovered that fatty foods did wonders for quelling the queasies back in my first trimester, and had never quit regular indulgence afterwards. Given that I was anticipating a baby in the next couple days, I figured a full meal was in order - even in was only four in the afternoon - so instead of grabbing something to go, I found myself a booth and settled into a burger and fries.

As I was munching away, I noticed a mild cramp in my lower back. In pre-pregnancy days, it would have been a sign of imminent menstruation, but those pains were usually constant - this one rose in a wave and faded off. Huh. About ten minutes later, it happened again. Was I in labour? Much as the weakness of said cramps would have implied to the contrary, after zero uterine activity for nine long months, I didn't see what else it could possibly be. Lumbar muscles tightening and relaxing of their own accord means back labour right? There it goes again. We have a pattern. Wahoo! It looked like that cervix-stretching ordeal had been worth it after all.  I called my husband at work to tell him the good news, and asked him to come pick me up when it was convenient. Mild discomfort was hardly worth rushing just yet, but the idea of labouring through public transit didn't sound like my idea of good time. I dawdled through the rest of my meal, waiting for my ride, and watching all the people who didn't know they were in the presence of a labouring woman.

My husband came soon enough and we headed back home. Not much had changed in the cramp/contraction area, so I suggested we make good on my mom's pre-baby advice of making some meals for the freezer. I'm pretty sure she'd meant that recommendation for considerably earlier in the pregnancy, but making a big pot of chili seemed like a good way to pass the time until we could go to the hospital. I hung out with my husband in the kitchen, pausing between sous-chef duties to lean on the counter and breathe through contractions. This coping method wasn't strictly necessary, but I'd read enough prenatal material to think that it was what I was supposed to do, and it made sure I could focus on what was happening to my body. The contractions had slowed down in frequency but picked up slightly in intensity; still, I found myself wondering what the big deal was about coping with labour. I'd had period cramps way worse than this. Eventually I managed to have two "contractions" only five minutes apart - that magic number that meant hospital time, right? Without waiting to see if the pattern repeated itself, or any thought to contraction duration, we dumped the labour bag back in the trunk and headed for the hospital.

By the time I'd gowned up in the antepartum unit, my little contractions had all but petered out. I lay on a ward bed, hooked up to the fetal and contraction monitors, under the gaze of a busy nurse, waiting impatiently for something to happen. After what felt like an embarrassing eternity, another contraction finally started. "Oh, here's one! See? Ow, ow, ow..." Now, I don't know anything about reading contraction monitors, but judging from the nurse's face, I'm guessing my performance measured in around "why is this woman wasting my time". I was curtly informed to head back home and not come back until the contractions were much stronger and consistently five minutes apart. So much for a Friday-night baby. We drove over to my in-laws, which was much closer to the hospital that our own place, to hang out for a while in case things picked up again, but eventually ended up going back home to rest up before what looked like a Saturday baby.

At some point during the night, the contractions moved away from being simply "there" to something that actually required some of those coping mechanisms I'd been practicing. The back tightness was joined by a clenching of my lower abdomen just above my pelvis - it felt like everything around my panty-line was pulling my thighs toward my belly. I climbed up onto my hands and knees - which helped immensely - and breathed until the clenching abated. Afterwards, I rolled over onto my side to see if it happened again. It did, but not for another twenty minutes. The next clench was similar, but came no sooner than the last. And so we passed the night - me rolling onto all fours every ten to thirty minutes, my husband staying by for support, and both of us trying to sleep in between contractions. Not much happened on the sleep front, and while the contractions didn't let up, they never fell into a consistent pattern either.

Eventually morning came, and we gave up trying to sleep and headed upstairs. The fourplex we were living at the time had an odd mix of a few small rooms along with a very long one on each level, so we'd made a living room/dining room split by using our couch as a divider. I discovered that morning that the couch was the perfect height for me to lean over if I stood behind it during a contraction. This gave my knees a break and also made it easier for my six-foot husband to apply pressure on my sacroiliac joints (i.e. the disc-shaped ones on either side of the lower spine) which really helped with the continuing back labour. And so we passed the day - me curled up on the couch reading until a contraction hit, at which point I rolled off the couch, hollered for my husband who met me at the back of the couch to help me deal. The contraction "pattern" from last night continued all day, never further apart than thirty minutes, never closer than ten. We tried a walk, but my chosen contraction coping mechanism didn't work nearly so well out in the open, and the trek only proved to tire us out all the more. No change, so no hospital, but no real break either.

Some good friends gave us a call to see how things were going - my mother-in-law had given the heads up the night before - and offered to help. My faithful husband came back with "can you bring over some food?" Being on call for contractions every ten to thirty minutes meant that making a meal was pretty much beyond him. We'd raided my carefully-packed labour bag, but there was only so many granola bars a sleep-deprived dude-la (i.e. male doula) can eat. Friends came, rotisserie chicken and salad kit in hand, and stayed to help put it all together. My friend, who's a maternity nurse, helped me through a few contractions while her husband took mine out for a walk. She cheerfully encouraged us to keep doing what we were doing and not to feel self conscious - if I wanted to moan, go ahead and moan! I remember thinking, "why would I be moaning? Are labouring women supposed to?" Clearly, there's some things you just can't get from reading a book. Our friends didn't stay too long, and soon we were back to business as usual, refreshed by the change of company and with food in our stomachs. Well, my husband's stomach at any rate - my tentative nibbles came back up again within a couple hours, so I stuck with juice boxes after that.

Night came again and still no change, so we went downstairs to try that sleep thing again. We met with little success; Saturday night was a repeat of Friday, except this time I needed my husband for more than just moral support to cope with the continuing back labour. Sunday passed much the same as Saturday had, and when evening came we called the hospital. The closest clocked contractions were still seven minutes apart, but we couldn't imagine passing another night like the last two. After that many hours of practically no sleep or food, how was I going to have energy left for the actual birth? We explained our situation over the phone and the nurse who answered recommended we come in to antepartum again to see how things were going. We repacked the labour bag and drove back to the hospital - a far more uncomfortable trip than last time - with no notion of whether they'd let us stay.

This time my body provided plenty of fodder for the antepartum contraction monitor. There was no suspicion of "cry-wolf" wimpism this time around. The internal exam, however, was far less encouraging. It turned out my two-day stint of hard but inconsistent labour had yielded only half a centimeter of extra dilation. I was afraid they were going to send me home again. I'm not the biggest fan of hospitals, but the hospital = baby equation was so firmly planted in my head that I felt like staying was the only confirmation that this baby was truly on her way. All the prenatal material I'd read had focused on the hospital part of the labour process. The idea that the majority of labour could happen at home was fairly foreign to me.

Then it happened. The fetal monitor went crazy. My baby's heart rate experienced a momentary partial deceleration. Just once and then back to normal. It could have been a hiccup. It could have been a sign that this long and latent labour was as hard on her as it was on me. But, as we were in a hospital with staff trained to prepare for the worst, that little blip that triggered an alarm was enough to convince the antepartum nurses that they should keep me overnight for monitoring, lest that partial decel be a sign of true distress to come. Given that the induction was planned for 6 am the next morning, it didn't really make sense to leave at this hour of the evening anyways, so I finally got what I'd wanted: hospital admission. I was given a bracelet and escorted to the labour and delivery unit and into a private birth suite - a spacious room with lots of windows, its own bathroom, and all the delivery equipment tucked discretely behind a curtained closet by the door.

My husband brought in my labour bag and stuck around while they hooked me up to the fetal and contraction monitor and set up my I.V. The nurses offered a shot of Demerol to take the edge off the contractions to help me get some sleep. I accepted, despite my original drug-free birth plan - well, maybe "plan" was too strong a word; it was more a set of vague notions that I hadn't managed to tell anyone about, not even my husband. It probably would have helped if I'd written them down. At any rate, I had no reason to believe we were anything but hours away from the birth, so I figured the drugs would have cleared my system by then. Plus I really, really wanted some sleep.

At some point during this process, my nurse pulled my husband aside and advised him to go home and get some sleep himself. While there was plenty of space to move around, there wasn't room to wheel in a cot, and my nurse assured him that with the Pitocin not starting 'til 6 am, it would probably be 7:30 before it really started to kick in. Much as it pained us to leave each other - having our first night apart since our marriage be the night before the birth of our first child didn't sit right - it was sound advice. He was just as beat as I was, and I'd need him again tomorrow. So I traded my dude-la for Demerol, kissed him goodnight, and settled in for what I hoped would be a restful night before the big day.

Unfortunately, my situation was not well suited to sleep. My IV was all prepped for a controlled-drip induction, meaning that the pole didn't just have a bag of fluid hanging from it, but an electrical contraption wired to the contraction monitor to ensure that the amount of Pitocin I'd be receiving would wax and wane with the strength of my contractions. Very smart. What wasn't smart was its bafflingly short electrical cord, nor the fact that said IV pole was on the opposite side of the bed from the contraction/fetal monitor. So, for all intents and purposes, I was chained to the bed; paddles on my belly attached to the monitor on one side, and the IV coming out of my arm on the other. This scenario was precisely why I hadn't wanted an epidural - well, that and the freak out factor of a sharp metal object being that close to my spinal cord. I couldn't get to the bathroom without calling a nurse. There was a sink just a few feet over from my bed but I couldn't get to it to refill my water glass without removing the monitor paddles. This was the first time I'd been hospitalized since I was born myself, so I unsure of what the appropriate etiquette was for a healthy "patient" in a maternity unit in relation to the staff. I felt silly calling my nurse to help me with something I should really be able to do for myself, but I was cowed enough by the medical equipment that I didn't want to risk breaking something just to make it to the bathroom my own.

My nurse's lack of bedside manner didn't help to put me at ease, or even feel comfortable with asking her to show me how to put the paddles back by myself. I could tell she was put out about having to do such simple things for me, but I couldn't think of another way around it. When I asked for water, she got me ice chips, and eventually cut me off of those too, assuring me that I was getting adequate fluids via the IV and that my stomach needed to be empty in case of a cesarean (who said I was having a cesarean?). I asked if she could get me my labour bag so I could grab some gum - I wasn't really all that thirsty, but all that breathing through contraction had left my mouth paper-dry. That was also refused, as it would cue the secretion of gastric juices, which again, would be bad news for that cesarean I wasn't having.

On top of these requests, I was also calling her in every ten to thirty minutes because the fetal monitor alarm was going off again. After a couple of such occasions I figured out that the fetal paddle was falling off my belly every time I got on my hands and knees to deal with a contraction - like I'd been doing at home for the two nights prior - and told her so the next time she came in to turn the alarm off. She looked at me incredulously and asked why I couldn't just lie on my back and take it. I had no idea what to say to that, but, as she quickly stormed off, I didn't have to think of anything. I had, however, noted which button she'd pushed to cancel the alarm, so when the next contraction came, I assumed my usual coping position and turned the silly thing off myself, listening to make sure the heart beat was indeed continuing as normal. It was, and it did - all night long - so I never had to call Nurse Battle-axe again. I even took the paddles off to get some more water and felt like a real rebel.

And so I passed the rest of the night in solitude - climbing onto my hands and knees to breathe through contractions, and trying to rest in between. I had pretty much decided the Demerol wasn't working, but, given that I wasn't missing the sacroiliac pressure that my husband had been providing for the last two days, it must have been numbing my back a little. I didn't notice at the time. Sleep continued to elude me - between the IV and the paddles that I wasn't quite brave enough to ditch completely, it was hard to get comfortable - so I took to praying instead. Nothing complicated, just simple calls for mercy and protection through the intercession of the Mother of God. She gave me something to focus on other than my fatigue, and, despite all the uncertainty, pain, and discomfort of this seemingly never-ending labour, kept me from despair.

I've heard many times since that day that all mothers reach a point in their labour where they feel like they simply cannot do it, just cannot go on. I must have come close, but I never quite reached that point - with either of my labours, actually. With cesareans dismissed out of hand (a side benefit of my spotty pre-baby research), I was left with the conviction that no one could birth this baby but me. This was my baby coming out of my body - a body that was made to do precisely what it was doing right now.  No one could step in and give birth for me. I had to do this myself, therefore I could. Failure was not an option. Along with this notion was an ever-growing awareness of being upheld in prayer - that of my own, supported by the intercession of the saints, and by the prayers of my friends, family, and church community in the weeks before I reached this point and even throughout my long vigil. So even though I had to do this myself, I certainly wasn't doing it alone - if that makes any sense. It sure did to me.

Eventually morning came, bringing sunshine streaming through a wall of windows, Pitocin dripping into my veins, and a new nurse on shift. If my night shift was Nurse Battle-axe, then this was Nurse Awesome. For the first time since entering the hospital, I encountered a staff member that didn't intimidate me. Nurse Awesome was cheerful, patient, informative, and flexible. I was so thankful to have her around for the actual birth. My well-rested husband soon arrived as well (kudos to Battle-axe for that one), alert and supportive. And good thing too - the Demerol had definitely worn off and the Pitocin was already kicking in. My labour induction had turned into a labour augmentation, and, after over sixty hours of flexing its muscles, all my uterus needed to kick into action was a faux-hormone nudge. I was too tired to get up on my hands and knees anymore for my lengthening and strengthening contractions, so I settled for lying on my side, speaking in short hand for when I needed back pressure. My contractions were finally getting consistently closer together - according to protocol, I was officially allowed to be taking up that bed I'd been occupying all night (the one side benefit of that lone partial decel).  Now I was ready for some moaning, and a little writhing, and toe clenching, oddly enough. My husband had to keep reminding me to relax my feet.

I don't remember getting checked, but there must have been a cervix measurement in there because all the sudden there was a couple extra nurses around and several attempts to get a hold of my doctor. I found out later she'd gone out for a run and forgotten her beeper. I was ticked at the time, but now that I know how long induced labours usually take I guess I can't blame her for thinking she had some time to kill. It was about 8:30 in the morning.

Active labour continued on like this for half an hour or so. At some point my husband realized he'd forgotten our music bag (I couldn't decide what I'd feel like listening to ahead of time, so I'd packed maybe 30 CDs or so and left them with the rest of our collection in case we wanted them at home before the birth), and called his dad to bring it over. My father-in-law popped in with it eventually and left right away - either he figured we'd want some privacy at that point or he'd read my mind about the "no males other than my husband" clause in my unwritten birth "plan". The bag lay forgotten at any rate; my contractions were close enough together that there wasn't much time for thinking much beyond another prayer.

The next thing I remember (my husband tells me it was about 9:15 am) was my nurse presenting me with pain relief options and then leaving the room to let us think about it. Once again, awesome. I don't think I could have collected myself enough to say no while she was standing right there waiting for an answer. As it was, I did consider pain relief for a couple minutes. I was pretty well convinced that the Demerol didn't work for me, so I didn't see the point in trying that again, and while I wasn't lucid enough to recall all the potentially permanent side effects of the dreaded needle-in-the-spine that I made up earlier on, the idea of staying perfectly still long enough for them to insert it seemed downright laughable. My contractions were coming every two to three minutes by that point and, though I wasn't moving much, I wasn't about to commit myself to motionlessness either.

At any rate, by the time my husband asked, "so what do you think?" I answered "I think I want to push." When Nurse Awesome returned, I asked if I could start pushing, and she said "let's check and see." The internal check revealed a mostly dilated cervix with a little lip left at the top, but my baby's head was right there. She suggested I try pushing with my next contraction and she'd try easing it out of the way. The back of the bed was raised a bit, and she had me hold on to my thighs as I gave that first push. I had wondered how I would know how to go about pushing, or be able to tell if I was doing it effectively, but it turned out my body had that one down pat. My uterus just started doing its thing and I added upper abdominal effort and joined in for the ride. A couple pushes was all my nurse needed to get that cervical lip out of my baby's way, and for the next push after that she had my husband help her create human leg-braces for me to provide better counter-pressure than I could to for myself in that position - kind of like a squat without worrying about balance (or the help of gravity, but I didn't know about that at the time). My husband appreciated getting to be this involved - there would be no shooing him out of the room.

My nurse must have called for back-up, because a couple pushes later my room was swarming with people. The bottom half of the bed disappeared, and someone set up the actual leg-braces. I had been envisioning stirrups, so these sturdy and padded appendages were a welcome support. My husband went back to holding my hand and whispering encouragements. It felt good to know that the end of the marathon was in sight. Time to sprint to the finish! After a few more pushes, my doctor arrived, seated herself between my legs and added her own encouragement - cheerleader style. I'd been familiar enough with her bouncy enthusiasm throughout my prenatal care, and it was fun to see it kicking into high gear. Its speed, however, didn't lend itself well to communicating what exactly she was about to do over on that end of the bed before she was actually doing it. My water was broken (a mere trickle, my husband observed), an internal fetal monitor was attached to my baby's head, an episiotomy was performed, and a vacuum extractor was engaged. All with me saying, "um, okay?" as the previously unwanted or unconsidered intervention was being performed. I was about to say no to the episiotomy, but I was so relieved to see scissors (I had pictured a scalpel knifing millimeters from my baby's crowing head) that I didn't object. After so many hours of labour, I just wanted that baby out already. Nurse Awesome leaned over to inform me that a neonatal specialist had been required due to that partial decel, and apologized that the only one available was a man. Given the number of people that had already milling around my exposed nether regions, I didn't really care about their genders anymore. Besides, anyone in his field of work would have seen it all before. The doctor in question stayed discreetly in the side-lines until after the birth, so it was hard to find his presence objectionable.

In the midst of all this bustle, I was still pushing, and pushing with all my might. My poor feet still clenched with every contraction, my husband and Nurse Awesome got furious hand-squeeze after hand-squeeze. Every muscle in my core dove for my pelvis, and my lips buzzed from the effort. I vaguely remember noting that I didn't want to scream (who had the energy?), but I did need to be reminded not to hold my breath. All that effort paid off quickly; a mere half hour from that first push, my doctor announced she could see the head. I must have been given some local anesthetic for the episiotomy, for I did not feel her crown. My husband ducked down for a look, and in another push, my baby was born. Another flurry of activity ensued, and my husband came back to whisper, "it's a girl!" My husband got to cut the cord, and then she was whisked away to a warming table to be checked by the aforementioned specialist. It was 10:27 on Monday, April 16th, ten days past my due date, and three days since that first hint of labour.

I have no memory of birthing the placenta, or getting stitched up post-episiotomy (no tears, though). All I could focus on was the distinct lack of baby in my arms. I don't remember being told the results of that neonatal examination, but she must have passed in flying colours, for after a few impossibly long minutes, the specialist left and she was finally in my arms. She was beautiful. Still is, in fact. She calmed down quickly and took to studying me as we cuddled, blinking ointment away from her big blue eyes. My husband took advantage of our room's courtesy phone and gave our parents and a few friends the good news, while my daughter and I gave breast-feeding a try. After all that hard work, she was hungry and took to it right away, eyes open all the time. I called my best friend to let her know about her new god-daughter, but otherwise stayed quiet, drinking in the perfection of ten tiny fingers and ten tiny toes. The room cleared out, the bed was reassembled, and the three of us were left to our devices for a while. My husband and I remembered our abandoned music bag and finally made use of the provided CD player. Nick Drake's "Five Leaves Left" proved the perfect fit in the aftermath of that marathon of a birth; a soothing calm after the storm. Lunch time must have rolled around, because someone wheeled in the most amazing burger. Rabid hunger can bring out flavour even in hospital food. Looking back, it amuses me to think that my labour was bracketed by burgers, but at the time all I could think of was how wonderful it was to be eating - and soon digesting! - my first real meal since Friday. Sweet, sweet calories.

I didn't quite clue into how exhausted I was until I got the shakes in the shower, nor how sore I was until we drove our girlie home in our sports sedan. It took two more sleepless nights before my daughter's first chiropractic visit relieved the pressure the vacuum extractor had placed on her poor little head. And it was nearly a week before the enormity of what we'd accomplished really sunk in. We had taken our newly-minted Sarah Brianna to Vespers on her first Saturday - absurdly soon, in retrospect, but my husband just wanted to do something normal, and I kind of wanted to show her off. I was sitting along the side of the sanctuary - my over-taxed muscles could handle singing or standing, but not both - with my little babe still asleep in her car seat beside me, perhaps soothed by the return of the sounds she'd heard daily not so long ago. I, too, was soothed by those sounds, those songs, those prayers, and I remembered how they'd sustained me in those long nights of labour such a short time past, yet on the other side of a great divide - that life before giving birth. It was as if returning here confirmed that it had all really happened to me, that I'd really done it. And thankfulness washed over me, for the strength given that was so greatly needed, for the trust that this body could what it was made to do, and the knowledge that it did indeed do just that, and brought us both safely through. It had been the hardest weekend of my life - I've never been so tired, never worked so hard, never been so elated to succeed. I'm tempted to divulge in more sports metaphors (extreme ones), which is odd for someone so nonathletic, but all fell short - just as much then as now. For no trophy can compare to receiving your first child.

Happy birthday, sweetheart.

1 comment:

Katie Whitehouse said...

Lovely and positive birth story. My little beauty is now 7 weeks so its all fresh in my mind still, and I found it a positive experience as well. Yes it hurts and yes it is uncomfortable but I look forward to my next pregnancy and birth x

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