Wednesday, January 31, 2007

Adriana's birth story, part 3: Transfer for maternal exhaustion

Marsha said that they could hook me up to IV fluids to see if that would help with my energy level, since food and drink weren't staying down. I pushed the thought of the hospital to the back of my mind and agreed, all the while knowing that Brian was getting more and more worried. I don't know who went to set up the IV, but then Marsha was calling me over to the side of the tub, and I saw Pam with an IV pole in the doorway. As I moved toward Marsha, another contraction hit. I tried to stay calm, but throughout it all I could think was that I couldn't handle any more. I didn't have the strength. As it ended, I told her that I needed to go to the hospital for some pain relief.

I don't remember what Marsha said at the point, but whatever it was and whatever tone she took, she didn't make me feel guilty for my decision. In fact, once I made the decision, I felt relieved. I was finally going to be able to get some rest. I would go to the hospital, get the epidural, sleep for a while, and then have them turn off the epidural so I could get the baby out. It seemed simple and clear (although clearly naive), and I was more emotionally prepared to handle contractions while Brian loaded our things back into the car, and Marsha called the physician to let him know we would be going to the hospital.

Pam stayed behind to clean up the birth center, and we followed Marsha to the hospital. I concentrated on her taillights as we drove, because otherwise I concentrated on the clock and how long it seemed to be taking to get there (it was only about 20 minutes).

At the hospital they got us quickly into a room, and I was hooked up to IV fluids. I remember telling the nurse that I didn't like needles in the back of my hand, and asking several times how long it would take for the bag of fluids to be emptied so that I could receive the epidural, and then how long it would take for the anesthesiologist to get there. At that point I no longer cared about giving up a natural birth; I only wanted to rest and escape from the pain. A resident checked my cervix and said I was between six and seven centimeters.

The anesthesiologist arrived. He asked Brian and Marsha to sit down while he put in the epidural. Both protested, and while he still made Brian sit, he allowed me to lean forward into Marsha's arms as he put it in. I complained of pain in my neck just after it went in. Puzzled, he removed the epidural and was surprised that that seemed to help relieve the pain. He replaced it and the pain came back. It wasn't a severe pain, just a sort of sore, stiff feeling on the left side of my neck, and it eventually eased on its own.

I don't remember lying down in the bed or trying to sleep. It simply happened. The cramping pains that I had been feeling in my low back for more that 24 hours were gone and I could finally relax. Brian settled down in a fold out bed beside me, and Marsha dozed in a chair.

Sleep was easy, but it was easy to wake up, too, and I did wake up on and off as people came and went from the room. Various things happened throughout the night. I was given some Pitocin. I was alarmed when I realized that was happening, but Brian and Marsha reassured me, saying that they had explained it and it was necessary. Later we woke when the resident was explaining to us that they wanted to use an internal fetal monitor. I protested this, saying it wasn't something we had wanted. But the baby's heart rate had dropped significantly for four minutes, and they wanted to monitor her more closely. Feeling tired and stupid, and beginning to regret the decision to come to the hospital, I consented. It was for the baby. Anything for the baby.

At some point during the night, I asked Brian if he was okay. He had to remind me of this, but I do vaguely remember it. I remember chuckles from other people in the room, who were apparently amused by my concern for him. But I knew that it was probably distressing for him that we were so far from our planned birth, and it had to be hard for him to see me in the bed, hooked up to monitors and IVs and oxygen.

I woke up around six in the morning when the attending physician who backed up the midwives came in. I'd met him at some point during the night. He checked my cervix, and told me that I was at only an eight or a nine, after several hours of Pitocin, and encouraged me to consider a c-section. I looked to Brian and Marsha, but couldn't read their faces. I realized that a c-section might be necessary, but I wasn't ready to accept that yet. I told him so and asked to keep on trying. Maybe if I got back up on my hands and knees I could get the baby to turn. I don't think I really believed there was any chance of that. The baby was already at +1 station, I knew. It was probably too late. But I felt that I needed to try a little longer. The doctor agreed to let me, and said he would be back in an hour. Brian helped me get up onto my hands and knees.

Brian had helped me push the button to increase my epidural once around five that morning, but I was beginning to feel contractions again. They were long and hard, but with the epidural the pain wasn't severe and I could manage them. In fact, I found the sensation somewhat reassuring. Although it hadn't occurred to me at the time--probably because I was so relieved for the rest the epidural provided--it was rather eerie to know I was in labor but be completely unable to feel it. Feeling determined, I labored on my hands and knees for what seemed like a very short time, sometimes letting my head fall to the bed to help support my weight. Finally I couldn't hold myself up any longer, and I was so discouraged, thinking I'd only stayed up for five or ten minutes, but as I laid back down, Marsha told me I'd been that way for half an hour.

I knew nothing had happened. I knew that the doctor was going to come back and tell me I needed a c-section. I began to come to terms with the idea, and tried not to wonder what would have happened if I hadn't had the S&S, had gone to the birth center earlier in the day for some Ambien, hadn't decided to come to the hospital for an epidural, had fought against the Pitocin. I listened to the sound of my baby's heartbeat on the monitor, and told myself that all that mattered was a healthy baby. I thought about telling Brian that the doctor was going to tell me I needed a c-section, and that I understood and was okay with that, but when I looked at his exhausted face I couldn't do it. I lay there on the bed, feeling the contractions in my back in spite of the epidural, touching my belly with my hand in order to feel them there, and breathing slowly through each one.

A new nurse, Barbara, came on at seven, and I liked her immediately. A new anesthesiologist also came in briefly to introduce himself. The sky was beginning to get light as we waited for the doctor to return. Marsha sat beside me, with a hand on my belly and we agreed at one point that I was back to the run-on contractions--my belly never seemed to relax. I wondered what was going through Brian's mind. I knew he was scared and worried, but he wasn't showing it very much. I wished I could tell him something to make him feel better. I pressed the button to increase the epidural one more time as we waited for the doctor.

Just before eight, the resident came in. Although we knew the doctor would be there soon and would want to check me himself, the resident checked me. I was down to eight centimeters, she said, and the front of my cervix was swollen. A few minutes later, the attending physician entered the room, checked me, and repeated the resident's news.

"You need c-section," he said.

Whenever he spoke to me that night, and throughout my hospital stay, I had to concentrate hard to understand what he was saying through his heavy African accent, but those three words were very clear.

I looked at him, as he stood to my right, down near my knees. I glanced back up at Brian who was at my shoulder. Marsha was to my left, across from the doctor. I glanced at the clock and did the math: I had been laboring for 33 hours, if I included all those hours I didn't actually believe I was in labor. I turned back to the doctor, and told him that since the baby's heart rate was fine, I would rather just keep laboring.

Either the doctor or Marsha explained to me that I shouldn't keep going until the baby became distressed and the c-section became an emergency. It was Marsha who convinced me. When a midwife tells you it's time for a c-section, you know that you've gone as far as you can. I struggled not to cry (and completely failed at that) as I nodded my consent.

The doctor left the room, and preparations got underway. Barbara sat beside me on the bed and explained how the c-section would go, things I basically knew. I don't remember looking at Brian during this time, or anything he said to me, although I know we were both concerned about when he would be able to join me in the operating room. Barbara said that he could come along and wait just outside the room, and as soon as the doctors said it was all right, he could come in. Soon we headed off down the hall. Near the OR, Barbara handed Brian some scrubs. I was concerned about whether they would have booties that would fit over his shoes--that had been an issue when his mom had taken us to see an operation at her hospital, but here they fit with no problem. Barbara fitted a cap over my hair, and realized I was still wearing earrings. It hadn't occurred to me to take them off. Brian gave them to me for our first anniversary, and unless I want to wear something dangly for dress-up, I keep them in all the time. Barbara covered my ears with the net, but checked me for other jewelry and had me give my wedding rings to Brian to put in his pocket. I was touching my bare ring fingers with my thumbs as I was wheeled into the OR at 8:34.

Barbara introduced various people to me as they came in. The anesthesiologist was checking my IV, attaching those round EKG things to me, putting the oxygen meter back on my finger. I had a different kind of oxygen mask on now, one with tubes into my nose instead of something that fit over my mouth and nose. I kept talking to the anesthesiologist, because he was the only person in the room that had to stay right by me. I asked him about everything he was doing, and what other people in the room were doing. He patiently answered my questions, although I mostly tuned out his answers. I just had to keep talking to keep myself calm. I know that at one point I told him I was nervous about surgery. He assured me that it was a routine procedure and very safe. "Some women even choose to have c-sections," he told me. "Those women are crazy," I said to him, and went back to asking him questions about what was going on in the room, having realized that he and I had different perspectives on medicine and childbirth.

Brian was finally let into the room and came over to my side. I relaxed a bit with him there. I remember him commenting that he couldn't believe I was making jokes on the operating table, but neither of us remember what I was joking about. The last people to arrive were the pediatricians who would be taking care of the baby when she was born. I reminded Brian that he needed to go with the baby wherever she went, as it occurred to me that with a cesarean birth we wouldn't be allowed to wait until the cord stopped pulsing before we cut it, and Brian wouldn't be the one to cut it.

As the operation began, Brian began speaking to me in a soothing voice. I shushed him and closed my eyes, no longer joking around to help myself relax. I felt pressure moving slowly across my abdomen, and then a few minutes later there was more pressure further up, almost to my ribs. For a moment it felt as though someone was sitting on my chest. I didn't realize it at the time, but in addition to being posterior, the baby had also decided not to tuck her chin to send a more manageable part of her head through the birth canal, but instead had stretched out her neck, putting her in a bad position for a normal birth.

I counted through my breaths to keep myself calm. Finally the anesthesiologist told Brian he could stand up and look over the drape, which he did. Someone announced that it was 9:10. As we I listened to the baby being suctioned, I asked Brian if the baby was really a girl. He said he couldn't see, but someone said yes, it was a baby girl. Finally there were cries from the baby, and I began to cry too. The baby was taken over to where the pediatricians were waiting, and Brian followed. I listened to her cry as I sobbed myself, so glad to have my baby born at last. I heard Brian asking about her size, and someone said she was probably about nine pounds. It took a few moments for me to realize that I could glance back over my right shoulder and see the baby. They were holding her up at the moment that I looked, and I was amazed. She was screaming and had a head of dark hair. "She has hair," I told the anesthesiologist, who was still seated at my left shoulder.

Soon I felt a horrible pain in my right shoulder, and told the anesthesiologist about it. I heard some comment about "referred pain," which I didn't quite understand, and then I told them that the pain was also in my left shoulder. The anesthesiologist quickly gave me something to stop the pain, but I remained tense as I waited for it to return. Someone announced that the baby weighed nine pounds and eleven ounces. "I knew I was going to have a big baby," I said to no one in particular.

The doctor continued to work on me, stitching me up, I assumed. Marsha told me later that after the long labor, my uterus had trouble clamping down after the baby was out. I apparently was losing more blood that I expected. It wasn't an emergency, but I was given a transfusion that night.

Brian was finally given the baby to bring over to me. Someone helped him bring her down so I could look into her eyes, and I reached out to touch her hair. Someone took the camera from Brian and photographed the three of us together like that. I don't remember the photo being taken, or Brian and the baby leaving to go to the nursery.

1 comment:

janet said...

Just wanted to leave a comment that I've been reading your whole story. I'm amazed at your dedication to have the birth you want and it sure seems like you did everything you could. I'm eager to hear more :)