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Friday, August 24, 2012

Part Two: Labor and Delivery

As a reminder, I'm sharing all the ooey gooey details. I figure if it's worth being embarrassed about, it's probably worth remembering and talking about. Anyway.

If you don't think you can handle all the blood and guts, here's a summary: We went to the hospital to be induced because my water had broken. They started me on Pitocin and I started having contractions. Turns out Pterodactyl was facing the wrong way, so I was in back labor. The back pain eventually got so bad that it hurt almost as much in between the contractions as it did during a contraction... so constant extreme pain. So I got an epidural. After the epidural, I finished dilating pretty quickly, pushed for a while, and out came Amelia. Tada! I think I was in labor for a total of seven hours.

Now for the ooey gooey details. Those with weak stomachs may now leave the blog.

Labor

Once in the delivery room, they hooked me up to an IV system and a continuous fetal monitor. There was also a contraction-o-meter sort of thing. Cervical check was 3-4 cm and mostly effaced. Woo! I was disappointed when I threw up everything I had eaten that morning just after the IV was placed. Surely I needed the energy contained in what was coming back up. Surely.

It took a while before I actually got any Pitocin, though, because they had to have two people verify that I really was supposed to be getting some. Gugh. They also told me that, unfortunately, the contractions you get with Pitocin are harder and much more painful than natural ones... but with only the same efficacy in dilating the cervix as natural ones. So basically normal contractions with bonus pain! (Yay?)

This was a discouraging fact which I tried to ignore. I did not get any pain medication; my options were pretty limited given the Harrington rods I have installed on my spine. I had already consulted with an anesthesiologist, who told me that an epidural had only a 10% chance of working.

They started me out with just a little, and pretty soon I was having some real contractions, though they were certainly manageable. They hurt mostly in my lower back, like menstrual cramps. Really devilish menstrual cramps. I explored different positions that might be helpful... standing, sitting, hands and knees, side-lying, rocking back and forth on the ball...

They kept slowly increasing the dose. My contractions started coming more frequently. They were pretty long, lasting on average about 90 seconds, and always feeling murderous in the lower back. My main coping thought: So what if this hurts. I can do anything for a freaking ninety seconds. I also found eventually that rocking back and forth in the jacuzzi tub with warm water was helpful, but that ended up making me way too flushed and hot and otherwise uncomfortable. And I threw up again. I got out and spent more time rocking back and forth on my hands and knees and such.

Up through about this point, I mostly found James to be annoying. Far too many wise cracks and he was way too results-oriented for me. And really, the most annoying part was that he seemed happier every time I had a contraction. He's just too results-oriented for me, I suppose.

I found it far preferable for him to occupy himself by posting live updates on Facebook and playing video games. It was also okay for him to sit and watch the printout from the contraction-o-meter... But it wasn't all that helpful when he came over and tried to give me encouraging comments. I think my response to these was mostly "shut up, go away", but I'm not confident he heard me because I was concentrating more on the contractions than enunciation. It may have just sounded like "shup gaway". (James: Hmm... She might have said that... but I ignored it so thoroughly that I don't even remember it.)

Of course, things started escalating in intensity. Remember that the main thought I kept telling myself during the contractions was: So what if this hurts. I can do anything for a freaking ninety seconds. To my horror, I felt the pain in between the contractions start to approach the pain level of the actual contractions, which of course, were also increasing in intensity. So the next time the thought I can do anything for ninety seconds popped into my head, I thought, Yes, but this definitely isn't just ninety seconds any more. This is painful ALL the time.

At this point I started liking James a lot more, because the midwife showed him how pressing my hips up and out of the way helped relieve a little of the back labor pain. So I was able to keep going some, but it was getting harder and harder to relax in between contractions. It was also getting harder to maintain movement during the worst of it. I was getting extraordinarily fatigued.

I requested some sort of pain medication. They gave me some IV Fentanyl. It was helpful... but it seemed like it only numbed the pain a little, and hardly lasted all that long. (Ah. I checked on the Interwebs. IV Fentanyl has a halflife of 2.5 minutes... That explains why I thought the effect had worn off completely 15 minutes later.)

At the midwife's urging, I tried a new pain management tactic... vocalization... also known as primal scream therapy. (This is the part that traumatized my little sister, who spent the entire labor observing from the back corner.) Man, I screamed and cried as loudly and as pathetically as I could. It was at this point I realized that although my contraction back pain was now an 8.5/10 on the pain scale (10 is reserved for more unimaginable pain), my non-contraction back pain was a formidable 7/10. And screaming was only doing so much for me.

I think my energy disappeared in an instant. It seemed like one minute I was capable of rocking back and forth during the contractions, and another I wasn't. I stopped moving so much and just moaned. It hurts, it hurts, it hurts. It hurts all the time. Too exhausted. Not enough energy to stay on hands and knees.

They had me try the jacuzzi tub again, but I got out almost as soon as I got in. No. Birth ball? Oh no. I'll just lay here nearly immobile and moaning for a while.

I requested an epidural. If I'm too tired to move, I am definitely too tired to keep this up without more pain management. I chose to pretend I hadn't heard about the whole 90% chance an epidural wouldn't work. They checked my cervix. 8 cm.

The anesthesiologist showed up within five minutes. To our surprise, he looked at my back and said, "Oh yeah, I can definitely do this." Dude, where were you when that other anesthesiologist guy was examining my spine?

They had me keep completely still for three minutes while he put it in. I had two contractions at this point, both 9/10 on the pain scale, but I was now at a constant 8.5 anyway. Keeping still pretty much just involved letting the pain wash over me. Apparently this was pretty impressive. I don't think the midwife or the nurses had ever thought me a wimp, but in any case, this pretty much sealed the impression that I was a non-wimp.

The epidural, thankfully, did work. My legs started to go numb. Of course, the epidural did not take away all the pain. It felt much better, though, and the only real struggle was the super uncomfortable (almost painful) intense pressure from baby moving further down the pelvis and... butting her head against my tailbone, which, unlike many of my bones, is immobile after having been tethered in place by a couple titanium rods. BUT. The contractions were all of a sudden quite discernible in magnitude from the background pain and pressure.

Ah. I can do anything for ninety seconds. I can also definitely "relax" now. And guess what relaxing did?

They put in a urethral catheter (standard procedure with epidurals, apparently). But when they checked to see if it was in place correctly, they discovered that despite being at 8 cm only minutes before, I was now completely dilated. Also, I felt like pushing. So, they took out the catheter, and the pushing phase began.

I think I pushed for about half an hour. I started out on my side, but the midwife commented that she knew of a position that is often more helpful for pushing out occiput posterior babies. We switched to that one, and then she really started moving down the birth canal. Woot! They offered me a mirror to watch, but... I didn't think seeing my "progress" would be helpful for me. Soon I could touch her head.

Push! James was right there watching in fascination. I suppose I might as well have had a mirror, because I could definitely tell how close I was by how excited his face and "Oh! Oh! OH!"s got. Happier and more high-pitched James exclamations equals more and more of baby's head visible. Gotcha.

And then, during the last push, James' "oh" got really long, really loud, and really excited... "Ohhhh! OHHHHHH! OHHHHHHHHHHHHHHHHHHHHHHH!" And then her head was out. One more push and the rest of her followed. Let me tell you, that is a VERY strange sensation. Baby bodies are kind of irregular in shape. And I could definitely feel all those little bumps and limbs as she slithered out. (I think at the last minute she flipped her face the right way, so she came out with her face down. Gee, I wish that had happened much earlier in labor.)

And then there was a flailing, vernixy, purpleish conehead plopped on my chest. My first words to her were something like, "Hello, my little conehead!" Poor kid was so bruised all over her head. She totally was trying to scream, but at first it was just lots of angry, angry air forcefully expunged from her lungs. Eventually, though, her vocal cords kicked in and she made lots of noise.

With the baby on my chest, I pushed out the placenta. Apparently it was ginormicous. It was as big as the baby. They asked me if I wanted to take it home. No, thanks. They also asked me if I wanted to eat it or something. (Some people do that, I'm told.)

I shook my head. "I'd only eat that thing in revenge." That evil thing made me sick the whole time. True, it kept the baby alive for a while, but it also made my pregnancy nasty. Take it away! Don't touch it! It's evil! Okay, okay. I do owe it some gratitude. It definitely did a good job keeping Amelia healthy.

Well, since labor was over, the midwife started to sew up the perineal tearing. I had hoped to avoid that, but being sewn up wasn't too bad. After the labor pain, this sharp needley and pulling pain was nothing. (Although, it was more pokey and pulley...)

Anyway, I guess I can describe the rest of the hospital stay in a separate post. You may anticipate an epic part three, but it won't be as exciting or as dramatic as this one. That's okay. The next one will have more baby details.

Labor definitely did not go at all as I had imagined it would. And I seriously had thought my expectations were pretty wide. I felt like, eh, all these things could happen. And all of those things are okay.

I expected to give birth in the birth center, or at the very least start laboring there and then move over to the hospital if needed, but never did I imagine that I would have to be induced and start out in the hospital... at least not until 41 weeks or so. I also didn't expect back labor. Heck, I didn't expect my water to break first, nor did I expect to this to occur precisely on the day I told Amelia to get out. I didn't expect I would get an epidural, but then I expected a break in between contractions. I also didn't expect that an epidural would work if I did get one.

So I guess what I should have expected was... the unexpected! 

Stay tuned for part three!

Jenna and Amelia

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