Wednesday, June 26, 2013

My Weird, Natural, Prodromal, 'Induced,' Pitocin, Drug-Free, Long, Beautiful Birth Story | Part 1

THE BIRTH STORY | PART ONE
the most dedicated, difficult, wonderful, supported experience i've ever lived through and accomplished
Preparation + Expectations 
Both Caleb and I come from families who really support and affirm natural childbirth.  His mom had many homebirths (including a set of twins! and carried another set of twins 42 weeks without induction!) and my mom took Bradley classes, labored mostly at home and then delivered at a now-closed area birth center.  The dads were always very and eagerly involved in the entire process.  Because this happened to be "normal" and "what we were used to" growing up, it just seemed natural (ha.) to investigate this option first, and was also what we both automatically desired - more out of familiarity than anything else.

Movies like "The Business of Being Born," friends who delivered naturally, our moms, Bradley classes and the book "Husband-Coached Childbirth" were all brilliantly helpful in educating us and helping us talk through what we hoped, wanted and expected out of "the birthing process."  


We learned more about the "domino effect" of medical intervention in healthy women and babies, the approach most hospitals take, what birthing has been like in history and in most places around the world, what l&d medicine has been in America the past 100 years (actually quite scary... chloroform and twilight sleep?!), the biology of the body, the details of natural and synthetic hormones used in labor, animal/mammal instinct in labor, benefits of laboring in a "home/home-like" environment, definitions of all things "birthing," etc.

"Comparing birthing to swimming, the doctor is the lifeguard.  Both swimming and birthing carry irreducible and minimal risk, and doctors and lifeguards are necessary, but only for complications.  Good swimmers and good birthers need them to be present, but just in case problems arise." 
"Their happy chatter as they strolled together in the early stages of labor would be rhythmically interrupted by contractions... Whenever a contraction occurred, the same calm pattern of relaxation, abdominal breathing and affirming talk would be automatically repeated.  The couple performed their respective tasks calmly - observers were impressed by the obvious fact that here were two people, who knew each other well, happily working together.  The close relationship between husband and wife, the total trust and dependence on each other, was heartwarming to see... even seemingly trivial acts reduce the tasks of nurses, and instead direct the gratitude of a mother to the one she loves: her husband."
We really think mamas and couples need to make decisions for themselves, and we think being educated is the best way to make decisions.  The goal is healthy mama, healthy baby.  It really is.   And there are lots of ways to get there, and no matter what you "want" life seems to throw change-ups like a Hall of Famer.  There is no "right" or "wrong" and there is mostly no judgement.  Every story and birth and mama is so different.  As it should be.

We spent time figuring out what was best for us - and we really enjoyed the process!  I, personally, wanted not just Caleb's help, but for him to not be helpless.  I hated the idea of him standing there, watching me suffer, with no idea what to do and no idea what was going on or with nearly noway to practically help.   I would struggle being tossed into a traumatic situation I knew nothing about!  I didn't want him to feel like a bystander or observer.  I wanted to have our baby together.  We both also wanted to do everything we could to let my body do what God made it able to do by itself.  We both WHOLEHEARTEDLY wanted medical help and intervention if my body wasn't able to do it on it's own.  We are so grateful for drugs, hormones, needles, surgeries and procedures that can protect, keep and save life.  But unless those were necessary we didn't want to take 'advantage' of them.  We felt like this was the healthiest and best 'plan' for me as a woman, and also for our little BorisMorrisBoy.


We learned in our Bradley Class about the reasons medical intervention should be used.  We talked about - to the best of our ability - "what if ______ happens?"  We knew it might not be possible for us to have a totally natural birth - heck, Dr. Bradley's own daughter had an emergency (life-saving!) c-section!  These things are not evil or something we were trying to avoid.  It was more of a mindset: we want to pursue these other things first, and go to those grace-of-God medical interventions if we needed to. 


I've heard/read/seen women say something along the lines of "I'm too wimpy for a natural birth/I have a low pain tolerance/I don't need to be the hero!/We have the drugs for a reason!" and truly: I'm too wimpy too not try a natural birth ;)  I'm a tough woman, I really am.  But I'm terrified of needles and drugs and "the works" (really, I get cavities drilled without novacaine... Because I'm more afraid of the shot than the drilling.  I'm weird.)   I'm more scared of epidurals and c-sections (and the recoveries after them) than I am of the pain of natural birth.  Again, proof that eeeevery mama is different! Haha! So as natural as possible was the plan :) The Back Story

Most of the 20 Morris and Snyder children were late.  Caleb, a twin, was 14 days late and I was 11 days late.  My mom's last baby was 14 days late.  Basically, I was expecting to pass my due date with a baby inside me ;)

I shot a wedding on June 1, and made it to due date - June 6 - with very, very nothing exciting to report.  The "craziest" thing to happen was just so.much.mucus. Like. SO. much.  Enough that I was almost daily wondering if my water broke, but instead of the liquid being clear, unscented, and watery it was always slippery, yellow and smelly.  I called the office two different times to ask "Should I come in? Not sure what's going on..." but from my descriptions I was reassured: nope, just sounds like your body is getting ready - when your water breaks, you will know!  At my midwife appointment on June 6 I found out I was 3cm dilated and about 70% effaced.  Encouraging news - yes!  But not all that exciting - I know women can be 3-4 cm dilated for weeks before going into labor.  I carried on with my week, waiting for something to happen.  On June 10 I discovered two different super-leaks in bed.  But it was all slippery mucus, as usual, and not watery.  I felt no burst or pop, and it didn't keep "leaking" throughout the following hours or day.  My body is just getting ready, I told myself.


On June 12, around 1:00 pm I started having consistent, trackable, painful contractions.  They were about 8-10 minutes apart, with varying degrees of pain.  It felt like everyone said: bad menstrual cramps.  I went out with my mom to run some errands.  Maybe once an hour I had a "strong" contraction (had to stop and focus and breath through it).  Caleb started timing them around 4:30 pm and they were happening about every 2-3 minutes, lasting a minute each.  It was confusing because I couldn't usually tell when one contraction would start and another would end.  It kind of always felt tight and crampy and then it would just "peak" and I could say "Oh! Okay! Yeah, something just happened!" but I couldn't predict when it would happen.  The hard, churning was just sort of "there."  I texted a few friends to give them a heads-up.  Did some laundry.  Went to the grocery store with C to walk and get a few last minute hospital items.  After 7:00 pm things were still moving and grooving.  The painful peaks hurt more and more.  This seemed very likely to be "it."  And then all of a sudden, right after 8:00 pm, everything stopped.  EVERYTHING.  No more tightness.  No crampy-ness.  No peaks.  Nothing.  One good hard painful peak, and in a *snap* it was all gone.


I was confused and a little discouraged going to bed that night.  What the frick was that?  That was not a few Braxton Hicks.  No way.  I did some googling and came across the term "prodromal labor."  Not false labor, not pre-labor - no, no, prodromal labor is it's own animal.  REAL labor that takes place over days or weeks, not hours.  The analogy used was one of running a race.  Many labors have a distinct (ish) start.  Looking back a woman could say "I started active labor contractions here, and ____ hours later the baby was born."  Start, run, finish. 30 minutes. 8 hours. 36 hours.  Whatever the length of time, it is definitive "active" labor.


But prodromal labor is apparently more like a race that begins, and you have no idea how long the race is, mile-markers are prohibited, and you are forced by a race official to sprint for as long as he says so, and then forced to stop racing and sit and wait until he says so, and then to walk when he says so.  You're really "in the race" and can have genuine, intense, even transition-esque contractions for a full day, only to be told "Okay, sit down and stop now." and be left sitting on the side of the track for two full days, waiting all over again.


It's quite mentally, emotionally and physically grueling.


And I read all kinds of blog posts and testimonies of mom's who experienced this kind of labor, getting my mind around the idea that this was probably going to be me as well.  I was relieved to know I wasn't a dramatic or stupid first time mom: I was feeling something more than "false labor."  I fell asleep assuming I had a solid few days ahead of me before I'd be checking into the hospital to deliver.


The Curve Ball - Hospital Day 1
I had a pre-scheduled appointment with my midwife for June 13 - one week past my due date "just in case" I was late.  Caleb and I left for our 10:00 am appointment and on the ride over discussed where we wanted to stop for lunch on the way home.  Long story short, while I was there I told the midwife about the night before and I repeated the "SO MUCH MUCUS" story I always tell them when I'm there ;)  She seemed somewhat head-pat-y and polite, and not even slightly rushed or curious or "intrigued."  After chatting I laid down to hear baby's heart, be measured and see what dilation was looking like.  As soon as she "took a look" the midwife said, I quoth, "Oh wow, there IS a lot of mucus down here."  I trriiiied to tell you!  She ran over and grabbed one of those paper-strips to see if this was amniotic fluid (from a broken water bag) or just above-average-lady-part-scuzz.  "If it turns blue, it's amniotic fluid," she said as the strip turned a brilliant shade of deep royal cobalt.  "Hmmm. We're going to need to send you to the hospital to do another test.  I'll let the midwife on call there know you're coming.  And I can't check your dilation here because if this really *is* amniotic fluid, then we don't want to risk infection."

And with that, we were off to the hospital.  A few things were going through my head, but mostly that "24-hour-rule."  I knew that aside from the odd-case, most hospitals wanted babies out no later than 24 hours after broken water (because of, yes, infection and the chance of risking the baby's health.)  But if this was amniotic fluid, I was fairly sure it had started coming out three days ago... at least!  Maybe longer!  I was just praying that I wouldn't be rushed into an emergency c-section.  Interestingly enough, as we walked back to the car, contractions started up again.  They'd been ALL TOTALLY NOTHING since 8:00 pm the night before, but now they were rearing up, roaring in my nice-sized middle.  I breathed and counted and instructed Caleb to "drive gently!"  


We checked into the hospital a little before noon, scooted over to triage, had a more "official" test done and it was confirmed: this was amniotic fluid.  My water bag had broken or ripped enough to leak and I wasn't leaving without a baby.  It was weird laying there in my gold hoop earrings and cotton wrap dress trying to understand what was happening as they started strapping arm bands and stickers on us.


(one very excited daddy... precious thing.)



By the time we were in our room, the contractions had totally stopped again.  We sat there and kind of laughed - it felt like we were checking into a Holiday Inn Express or something.  It didn't feel like... well... what I was expecting to feel at this point: nearing transition, after laboring most of the time at home!  My mom and sisters met us and helped bring our bags (which have been in the car for weeks) into the room.  Katie braided my hair, the little girls took our order for Chipotle, oh... and a tornado hit.  In very movie-esque evening-medical-drama form, a blue summer day turned green and quiet in hot stillness.  And then *blam* a storm moved in.  Nurses were RUNNING up and down the halls, with beds of women moving them from "window rooms" to "middle rooms."  Lights flickered.  Computer systems shut down. "Code White, I repeat, Code White" was being monotonously spoken over the speakers.  And we just kept walking the halls... excited when contractions picked up, and then always bummed when they stopped for five... ten... fifteen... shoot... twenty...twenty-five... DARN... minutes.  At this point it was 4:00 pm and I had gotten an IV in which fed me a stinging, cold dose of antibiotics, to help protect BabyBorisMorris from infection.  My midwives had no problem with me laboring naturally - even though it appeared that the water had been broken for days - as long as my heart, his heart and my temperature remained healthy.  I even asked "So, if I'm still here in 24 hours...would you feel like 'Okay, times up! We're getting the baby out!'?"  The midwife - very helpfully - promised that there was no timeline.  As long as all my information and baby's information came back "healthy," they'd let me labor as long as I needed.  Loooooad of concern off my back with that answer!

(smiling is not a 'good sign' in natural labors ;) a clue that... i wasn't even *close* to the intense stuff yet. haha! it felt hard, but little did i know...)
So Caleb and I walked.  And walked.  And walked.  And squatted.  And walked.  And contracted sometimes.  And then stopped.  And then contracted! Yay!  This must stick around this time! Walk! Walk! Walk! DOH. WHY DID IT ALL STOP AGAIN? (Reminder: I'm not talking spaced out contractions, I'm talking contractions on a 7-9 on the pain scale, every 2-4 minutes, lasting a minute each, for 45 minutes... then nothing.  Not so much as a twingy cramp.)





At 9:00 pm I had "witnessed" quite a few mamas arrive, and deliver their young.  We heard the grunts and pushes and first yelps over and over.  I wanted to know how far along we were.  I had been 3cm for over a week,  and these contractions must be doing SOMETHING.  My midwife checked and said hesitantly "Mmmm, thr... eh, maybe, yeah, I'd say four." Four?  Double-You-Tee-Ateshe, body!  We kept walking and visiting the friends who had come to cheer me on in the waiting room (the were like a spring in the desert lands.  SO hopeful and motivating and happy to see them all.  Shared joy is addicting.) and snacking and eating ice and feeling slightly more confident because the contractions seemed to be getting harder and sticking around.

(Becca was SO happy to see me in labor.  It was adorable. "KRISTEN.  You're having a BABY.  You're SWAYING!")
(remember? smiling = bad. waaaay too happy-go-lucky during my contraction breaks ;) but, hey, i'm glad i wasn't a total crab for my family and friends?)
At 10:00 pm I fell asleep briefly and the monitors showed that I was still contracting, but they weren't intensifying during my snooze.  I, I'm told, appeared much more tired and far less social at this point.  For the next few hours Caleb and I worked on the birth ball, walked SOME MORE, and the peaks in the contractions started becoming 10 on the 1-10 scale... every time. Intensity was actually building and lasting.  So we WORKED. HARD.  We buckled down, focused f'real and concentrated every part of ourselves on helping this baby work his way out.

 

(mama bear took over for a bit so daddy angel could re-group and refresh.  i needed him to have plenty of energy to last the long haul with me, and i needed mom to help me while he rested. i could not have done it without her. she's the best.)


(the time stamps on these photos are painful.  i scroll through and watch 10:00 go by... 10:30 go by... 11:00 go by... 11:30... midnight... 12:30... 1:00 in the morning... 1:30 in the morning... TWO O'CLOCK... TWO THIRTY...! Makes me tired just thinking about it!)
But when 2:30 am arrived and, once again, all signs of labor seemed to stop, we decided to take a break.  The friends had left to go home, mom and my sisters (who were still there, waiting and helping away!) were so sleepy.  Caleb was worn out.  I was frustrated. So we went to bed with a plan.  My midwife said we could either try castor oil or breast-pumping to get contractions staying and really going.  We decided on pumping.  


 The Next Day - Hospital Day 2

After sleeping on and off until 6:30 am, Caleb and I embarked on the Great Pumping Adventure.  15 minutes on the machine, 15 minutes of walking, repeated four times.  This two-hour process finally wrapped up around 9:00 am.  I knew things weren't happening the way they should be.  I was also emotional because every four hours I had to get the antibiotic through the IV and I hated the way it felt.  So burn-y and uncomfortable.  I HATE needles.  And I hated being "hooked up" or having something stuck in me.  I couldn't grab or hold or move freely with an IV port in my hand.  And it hurt.  And I just didn't like it one bit.  I would always get a bit teary when that four-hour mark came again.  Every time I'd hope I'd be close to pushing - or maybe even with the baby! - by the time the next antibiotic shoot-up was scheduled.  But over and over I had to get it, sometimes right in the middle of a bratty contraction.

At 9:45 am, after all that pumping!, my midwife checked me: 5cm.  Almost 13 hours had gone by, and I had progressed one.tiny.centimeter.  And! To top it off, the midwife said "I feel a bulging bag of forewaters."  The nurse quickly asked "Wait, I thought this was the patient who has had a broken water for three days?  That's why she's on the antibiotic...?" That's why I am HERE, I thought ;)  The midwife talked about how a water can break, but then the baby's head can plug it up like a cork so it's "there" but open.  My mom and I were confused by that, but believed them.  Just.  Didn't quite know what to think.  5cm.  My water still needs to break (or needs to break again).  Okaaaay? 


In the meantime, the hospital was still going bonkers.  Babies babies babies.  The tornado babies.  The heavy, barometric pressure babies.  Firing off like a shooting squad.  The nurses and midwives were very, very busy.  And I was now on my third or fourth shift with a new midwife.  I rarely saw them because they had SO much going on (surprise twins! mother almost dying! baby getting stuck! crazy and scary.)  Meanwhile, I was the slow one over in Room 3, with an involved husband and doula-mama.


It wasn't until 11:00 am that my midwife kind of laid down the law for me, in a gracious, smart way.  She, for the first time in 24 hours, said the dreaded 'P' word: Pitocin.  I didn't want pitocin for a number of reasons.  If you don't particularly care why I didn't want pitocin, skip these bullet points and continue on with the story ;)  The best is yet to come.  But, if you are curious about what my train of thought was, have at it: 


1) I hate IV's and needles.  So enough said. 

2) Being on IV that drips would mean I couldn't be as mobile and free to do anything I wanted (like walk the halls, take a shower, etc).  I'd also have to be strapped into the continuous fetal monitors - another limiter for my positions and ability to move about.  My midwife did assure me I could move around the bed and my room as much as I was able and wanted.  But still.  I didn't like being limited in options ;)

3) I know that most women who use pitocin end up getting an epidural.  The pit contractions are a force working "outside" your body, as opposed to the "natural" oxytocin contractions that are triggered by baby's brain and mama's brain and working "with and within" your body.  I had been taught that pit contractions are harder, faster and more intense, with longer "peaks" and shorter breaks.  Overall it seemed to be a much more painful experience than natural labor, which seemed painful enough to me!  And I didn't know if I'd be able to do it without an epidural. (

4) The side effects of pitocin on mama was exactly what I was hoping to avoid (and why I did not plan on being induced to begin with).  Anything from mild to severe allergic reaction, nausea + vomiting (I was working hard to keep my body fueled and hydrated... I did not want to start losing my 'energy source'!), rupture of the uterus, premature separation of the placenta, dropped blood pressure and slow/fast/uneven heart beat, headaches, seizures, pelvic hematoma, increased swelling and engorgement (pitocin is an anti-diuretic so the body retains more fluids), etc.  Of course I could experience none of these side effects.  And, of course, these things could happen 'on their own' without pitocin!  But, like I had said before, I wanted to avoid adding risk and medical involvement unless necessary.  

5) Worse than potential effects of pitocin on me were the potential effects on my little boy.  Just a month before my due date, on May 7 2013, The American Congress of Obstetricians and Gynecologists released the findings of a study specifically directed at pitocin and the baby.  "Induction and augmentation of labor with the hormone oxytocin may not be as safe for full-term newborns as previously believed. 'As a community of practitioners, we know the adverse effects of Pitocin from the maternal side,' Dr. Tsimis said, 'but much less so from the neonatal side.'"  In keeping with many past techniques used in hospitals for labor&delivery, the research showing harm to mother/baby doesn't come along until after they have been using said technique for years or even decades.  Slow/fast/un-even (dangerous) heart-rates, limp and poor muscle tone, low APGAR scores, increased likelihood of jaundice, bleeding in the eyes and/or brain, poor reflexes (including sucking), etc are the known potential side effects.  As a mom I did instantly become protective and careful/aware of my baby's well-being and safety when I found out I was pregnant.  No alcohol, or tuna, or processed deli meat, or soft cheese!  Take the prenatal vitamins!  Have prenatal care!  Hydrate hydrate hydrate!  No contact sports (aka: no scrimmaging with my basketball team)!  No sleeping flat on your back! No roller-coasters! All for the safety of the baby! That same protective mama-bear came out when "pitocin" was said.  I wanted to be so careful what I was exposing my little guy to.

6) I didn't want the pitocin to cause an 'emergency c-section' scenario because the BorisMorris' heart rate was dropping.  He had been remarkably stable and healthy, with a strong, dependable heartbeat, the entire labor.  And I was willing to work through labor longer if it kept him in a safer situation.  It was 'okay' with me if he and my body needed more time.  And if he simply wasn't ready, I didn't want to 'force' him out and exasperate his sweet little heart.

That being said, Caleb and I talked and we had a couple other choices: castor oil and breaking my water (again? or whatever.)  Our midwife affirmed and supported those other two options, but we ultimately decided based on our midwife saying: "Castor oil could help contractions get consistent, breaking your water could help get things moving, but pitocin will make this happen.  Pitocin is really a great tool when used right, and we are not using it to try to start your labor.  You are in labor.  You are having active labor contractions.  Your body might just need an extra little nudge to fall of the edge, so to speak.  You've been in real labor for over 24 hours, and I want you to see the light at the end of the tunnel, and have enough energy to do this.  We would start you on the smallest does possible, and only increase it if we needed.  We're not about to pump you with pit."  My midwife knew what we wanted for our birth, we had talked many times, and I trusted her.  She said she believed this would be best, and she was confident it would help, not hinder, us in having the birth we wanted.  So.  We went for it.

Interestingly enough, I had written on my birth plan that I didn't want any students present at the birth, but a nurse asked me while I was there if I would allow the student following her to come in and observe.  For some reason I said "Sure! No problem!"  God knew.  The student came in as they were hooking me up to those two bags full of clear fluid.  I was a bit teary.  She came right over, looked me in the eyes, and said "You are so strong.  What you've done so far is incredible.  I know you can do this."  I pathetically muttered "I really don't want an epidural or a c-section."  She got very serious and told me that she had two vaginal deliveries with pitocin and without an epidural.  "You'll be just fine.  Really.  You've got this.  I know you can do it."  During contractions she would encourage me ("GOOD Kristen! GOOD.  You are so relaxed.  GOODJOB.  Gooooood.")  I didn't know this woman from Adam, and after this conversation I don't remember seeing her again, but wow: she was an angel from God sent into Room 3.
Around noon I was all hooked up, with the Powerful Synthetic Oxytocin dripping into me.  I tried to gear up mentally for what was impending.  Hopefully harder, faster, stronger, BETTER.  Hopefully closer to the end than the beginning.  Hopefully ready for... whatever it was that was about to happen.  Some "labor verses" came to mind - ones I'd written down, prayed through, and enjoyed before labor started, hoping they would help in my sure-to-come-time-of-need:


"Run with endurance the race set before you."
hebrews 12:1

"You will not labor in vain... How joyful we are! We will enjoy the fruit of our labor!"
psalm 128:1


"He increases the power of the weak!"
isaiah 40:29

"He enables me to negotiate the rugged terrain."
isaiah 59:1


"The Lord is in the midst of her, she shall not be moved."
psalm 45:6

Funny story: on the playlist we had in iTunes there was a Johnny Cash rendition of "I Shall Not Be Moved."  We laughed that this was BorisMorris' anthem ;)  "I shall, I shall, I shall NOT be moved!"

But when I think of the labor, almost immediately those lyrics come to mind.  From here on out this song will take me back to that dimly lit, beige, clean hospital room.


"Though all hell assail me, I shall not be moved
Jesus will not fail me, I shall not be moved.
Just like the tree that's planted by the water
I shall not be moved.

Though the tempest [or uterus ;)] rages, I shall not be moved
On the Rock of Ages, I shall not be moved.
Just like the tree that's planted by the water, 
I shall not be moved."

{Part Two to follow...}