Monday, March 3, 2008
Asher Dean: A Doula's Beautiful Cesarean Birth
On Wednesday the 27th, I went and saw my midwife for my weekly appointment. I was 7 days past due and thought I would have gone into labor at that point. I still felt pretty good though, and knew it was getting closer. When I got to the office, I saw my secondary midwife, and one of the students. They wanted to check my cervix to see if I had made progress from the previous week where I had been 2 cm dilated, 50% effaced, and Asher was at -1 station. When she checked me, she informed me there had been no progress from that point. I was ok with that, although a bit surprised. I had been losing bloody show for about a week (I'd never heard of anyone losing show for more than a few days) and I had been having pretty decent crampy contractions. She told me that my primary midwife wanted to do a Foley Catheter induction if I hadn't made any progress. I had never actually heard of a Foley Catheter induction (to my surprise, being that I am a doula myself). I talked it over with her. She was aware that I wanted to be as non invasive with this labor as possible, and I wanted to know the details. With a Foley Catheter, they insert a balloon into your cervix and inflate it to about 4 cm. You walk around and the pressure of the catheter causes you to begin dilating until you're a four, at which point the balloon will fall out. If it didn't work, there were no negative implications so I agreed to it. My primary midwife had to be called into the office to do the procedure. It was actually not nearly as uncomfortable as I imagined it would be. She told me that she actually hadn't had a ton of success kick starting labor with the Foley, but had heard other midwives that swear by it. I started getting crampy immediately. I had left the office with the orders to walk as much as I could so that the pressure would cause dilation. I was also told that it shouldn't be in more than six hours, and if I hadn't dilated to four after six hours to remove it. I called my partner Jake to let him know what was happening (he had stayed home with Eli- our first son- during my appointment). I drove to Home Depot to walk around and pick up a few things. I had burnt the vacuum filter earlier that day and knew if I wasn't able to finish vacuuming I'd probably be horribly embarrassed when everyone got to my house for the birth. I was having regular contractions while walking around. When I got home, I tried to wander around the house and stay upright. I watched American Idol and tried not to pay attention to my contractions. After a few hours, I was getting upset the balloon hadn't come out yet, so I went on a walk to the Red Apple about half a mile from our house and back. My contractions were getting much crampier and I was pleased. Still the balloon hadn't come out, so I took a shower and decided I would have a quick nap. Jake told me he'd wake me up at midnight and we'd see what was going on. I was supposed to take the catheter out at 11:30. At midnight I woke up and it came right out!!! My contractions weren't as regular though, and I didn't want labor to go away. Jake's best friend Tommy was sleeping in one of the rooms to keep an eye on Eli (I wasn't ready to send him away yet), so Jake and I took a walk to the river. There was a nice cool breeze and we had a really good time walking together. Contractions were crampy while we walked, but once we were back and I was sitting or lying down, they weren't as intense. I was very surprised at how easily I made it to four cm this time around, because with Eli I had horrible back labor and it took a long time and a lot of very hard contractions to get to a four. I decided then (probably 1:30 am or so?) that regardless of whether or not the contractions peter out, I needed to try and sleep because I was sure to have a full day ahead of me. I fell asleep immediately. I remember waking up to a couple contractions, and Jake swears I moaned a couple of times in the night. I slept all night though. Woke up at around 7 am the next day, Feb 28th. I wasn't feeling regular contractions and I was slightly irritated. I called my midwife and left her a message saying that the balloon came out, I was having contractions, but they weren't regular and so I wasn't getting too excited about it. I wanted Jake and Eli to sleep, so once again, I got up and walked to Red Apple to get myself a coffee and back. As soon as I started walking, my contractions got regular again. Jake and Eli were up once I got back (which was surprising to me! Jake will normally sleep as late as possible. I knew he was very excited and antsy about our new son making his arrival soon though!). Eli played around the house, Jake cleaned, and I tried to busy myself with this and that. I didn't want to sit too much because I didn't want contractions to space out. I let my doula (Megan- also my business partner) know what was happening. It was a bit funny and ironic, because she had told me the week prior that Thursday was the only day I wasn't allowed to go into labor since she wouldn't have a sitter that day! I received a call back from my midwife in the late morning/early afternoon. I told her my contractions were coming back, but they weren't horribly strong yet. She told me she wanted me to call her at 2pm regardless of what was happening, to update her. She also highly suggested I have someone come get Eli at that time. One of my best girlfriends, Xamara, came and picked him up (she got pulled over on the way to our house!) I talked to my doula at 12:30 or so in the afternoon- right after Eli was picked up. I told her we were still doing well on our own. She listened to me moan through a couple contractions. She thought that she ought to head over at that point since it's a little bit of a drive. She arrived right before 2 pm. When she got to our house, I was having a contraction in the kitchen and smelling lemon dishwasher soap (I've been in love with the smell of lemon dishwasher soap this entire pregnancy)!! We chatted between contractions and tried to keep the vibe light hearted. The sun was shining through my windows and I was in a fabulous head space to be in labor. I called my midwife back at 2, as promised. I had told her the contractions were more intense, but I felt I was really dealing with them well. She listened to me vocalize through a pretty powerful contraction and told me that she and the students would be over at 3:30. I told her I still felt I was doing well if they wanted to wait longer. She had a chat with my doula, and they thought I was making good progress and that we should get the team together. Megan and I spent time together during contractions talking and just all around trying not to focus fully on the sensations. When the team arrived, I was checked. I was 5 cm dilated and 100% effaced. She continued checking me through another contraction, and I went from a 5 to a 6. I was very enthused to hear this! I knew I was doing hard work, but it felt completely doable! My midwife suggested that Jake, Megan, and I take a walk. I was ok taking the walk, but knew it would be a bit interesting. We live in a business district, and it was a sunny afternoon- and here I am moaning through contractions! We walked about forty five minutes or so. I tried to walk through contractions, but it didn't work for long. Megan was very amused at all of the cars that leered while I was contracting in the middle of everything! Once we got back to the house, I decided I wanted to take a shower and just have Jake in the room. I think this was probably my favorite part of the labor. I stood in the warm shower, and I had Jake bring his guitar in. He played guitar and I sang while the sun was shining through the bathroom window. It was very beautiful. We sang Elderly Woman Behind a Counter in a Small Town, Mr. Jones, and Lola. The water then started getting cold and I had to get out. I was bummed the water was giving up because I was really enjoying that time with Jake and it made my contractions seem like they weren't even happening. She checked me again soon after that and said I was more than a 7, but not quite an 8 (this was around 5 pm or so). I felt like this was going so easily! The only issue we were having was that my cervix was still posterior. I labored in the living room with the midwives, Jake, and Megan. I still tried to keep the mood light and joke in between contractions. It was around 8pm now. The contractions began getting more and more difficult to cope through. I was really getting to a point where I wanted things to speed up. When I was checked again (time is now foggy), I was still about a 7. Because my cervix wasn't coming forward, Asher's head wasn't putting even pressure on it causing it to dilate further. My midwife held my cervix forward during a few contractions (Yowza!), but it wouldn't stay put. My water still hadn't broken, and I was thinking that it would be a good idea to help it along. I had been a 7-8 for a couple hours by then, and transition contractions were kicking my butt. When she broke my water, it absolutely gushed out. It was clear, no meconium staining. Contractions were the most intense I had ever felt. I wanted to go upstairs and labor with just Jake. We went up and turned on the labor music I had downloaded to our computer. I labored on my left side for quite some time. It made the contractions space out a bit, but they were even stronger. I was becoming very tired, and I fell asleep between a few contractions. It was hard, because once the contraction hit, it would wake me up and I didn't have enough time to get on top of it. I was alternating the ways I tried to cope to see what worked. I banged on the bed frame with my hand while I counted, I tried thinking of Eli and the cute things he says, nothing was working just right. I then realized that if I pushed *just a little bit* during my contractions, that it eased the pain slightly. Everyone had made it upstairs by then. I asked if it was ok to push just a little bit. I was told to go ahead, but don't push much if it's not time- and that I'd know when it was time. After a bit, I was checked again and I was still a 7. I was very irritated and disappointed. I had worked through these extreme contractions for hours, and nothing was happening. I remember thinking that transition was supposed to be the shortest part, and I was angry. I needed to get off of my left side. I went downstairs and got into the shower. I was hitting the shower wall rhythmically during contractions. Jake was in the shower with me. I kept telling Jake I couldn't do it and I didn't want to do it any longer. Jake was very strong for me, because I know it was hard for him to watch me while I was in pain like that. He told me I wasn't giving up and I had to keep going. He knew that I would be angry with him if I felt he let me give up to easily. It took me a little bit to get into the right head space and stop disagreeing with him, but I reached deep down and found every last piece of energy I had inside of me. I began to fill the bath tub with water. I thought this would be my secret weapon and allow me to get in some good contractions but still be able to relax slightly between them. There was not a ton of hot water left, so Jake began boiling pots and pots of hot water. He kept the water pretty warm for me and I am very grateful. I needed it.. I lowered my noises which had gotten very loud and screamy. They weren't helping me cope and I knew I needed to change that. I oohed and rolled my head from left to right, right to left, during contractions. I know it probably looked like they weren't too intense from the outside, but I have honestly never felt anything so all consuming before in my life. I did this for some time, but I'm not certain how long. When I was checked again, I was STILL a 7. This was around 11:30. I had been at a seven and having transition contractions for about 6 1/2 hours. My midwife said that although I could feel my contractions, they weren't affecting my cervix while I was contracting (based on what she felt during a check). She said that she felt we should transfer to the hospital for Pitocin. I was disappointed, but agreeable. I couldn't handle transition contractions unmedicated any longer, not to mention they weren't doing much of anything to my cervix. We grabbed everything and quickly left. The hospital was very close to our house, so we were there within a few minutes. We had called to tell them we were coming. They were very friendly to us when we got there. We were expecting a battle since I am a home birth vbac transfer. I told them to please have the anesthesiologist come to the room asap. I had to sign consent forms and give insurance information when we first got there. The nurses were working quickly to get a heploc inserted into my hand. Dr. Paul came in after we had been there maybe ten minutes or so (he was German? maybe and his last name was hard to pronounce, so everyone called him Dr. Paul). I asked him to give me an epidural quickly. He said something along the lines of wanting to give me a full spinal block for cesarean. I told him I was planning a vbac and wasn't needing a spinal block at this time, just an epidural. He sort of mentioned that since this is the second time I've stalled out in labor that I'd probably end up with a c- section anyway. It was a bit insensitive of him, although I understand where he was coming from. I explained to him the importance of my trying for a vbac, and we would decide at a later time if a c-section was necessary. He complied and gave me my epidural. When the OB Dr. Tan arrived, he had come on the assumption that we were here for surgery. I told him that I needed pitocin and I wanted to labor longer. He tried to talk me into a c-section, at which point I began my spiel again about the importance of a vaginal birth to me. He didn't seem very interested at first, and began to explain the reasons I ought to have a c-section right away. I finally talked him into letting me labor. I asked everyone to leave the room so Jake and I could talk. He had had a very hard time accepting the hospital transfer and then c-section with Eli, and I wanted to make sure he was holding up well. During that time, Dr. Tan came back and spoke with us. He said that he only wanted to let us labor for a couple of hours, and then if there was no cervical change, do a cesarean. I did not consent to that, but sort of told him to check back in a couple hours and we'd talk. I told him I felt I needed pitocin. He said that my contractions were two minutes apart and pitocin wouldn't be necessary. I told him they were two minutes apart, but they weren't strong enough and I did indeed need pitcon (I later joked with Megan that I never thought I'd be begging an OB for pitocin!) He said he'd like to check my cervix. His "check" took about half a second and he told me I was only a 6. I know for a fact that he didn't actually check my cervix. I have a posterior cervix and he had small hands. He didn't have to reach to grab it or anything, and even if it wasn't posterior, he couldn't have possibly measured it in the time he gave himself. He left the room. About fifteen minutes later, he returned. It was weird, it's like he thought about the things I had said to him and changed his mind or something. He said to me that he'd like to let me labor without pit for a couple of hours and measure the intensity of my contractions (thank you! That's what I was asking all along!) He said if they did not seem intense enough, that he would give me pitocin around 4 am. Sounded very fair. I fell asleep (sort of) in the next couple of hours. I don't know if it was the nerves or being in transition, but I was shaking like a leaf since before we had even gotten to the hospital. I prayed and I changed positions as best I could with an epidural. I chatted with Megan in between cat naps. Jake went home to get some things and to blow out candles (we had run out in a hurry!). He got back during my nap. I was woken up at 4 am by our new nurse who was fabulous- I believe her name was Lori. She was up to date from Dr. Tan and wanted to check me. She said I was a 6-7 and that we'd start pit. I was only allowed to have 8 somethings of pitocin ( I don't recall the measurement), but that normally they can do up to 30 on people that aren't vbacs. I tried to nap more and keep changing positions after they gave me the pit. The contractions were very hard and pushed on my ribs which made them quite sore. The Dr. came back in at 6 am to check me. He truly checked me this time because he had to reach a bit for my cervix and it took longer than a millisecond. He said I was still a 6-7 and he felt it was time for a cesarean. I sobbed and sobbed. Dr. Tan became very genuine then. He looked truly upset that I was so distressed over this. He told me he doesn't like to see his patients cry, and that he's sorry that this is happening. I think we really connected at that point, and I was glad that if I needed a c-section, that he would be doing it. Not only that, but I'm hoping that our experience together will help him understand his patients that desire vaginal births a little better. I think most patients are probably not as outspoken as me about my wants. There are so many people that don't even realize that they have a say. Then I spoke with the nurses who knew how badly I wanted a vaginal birth. Through sobs I told them about my fears from my previous cesarean. I told them about how the curtain had been up against my face and I have some claustrophobia and it frightened me. I told them about how, also because of claustrophobia, that the thought of having my arms strapped down scared me. I told them about how I can't do oxygen masks for the same reason and to use tubes instead if that was ok. I remembered how my mouth went dry immediately when I got into the OR and I wasn't allowed to have anything to drink...and I told them how a nurse that time snuck me a wet washcloth to suck on and could someone please do that for me? I also told them about how my anesthesia didn't take with my first cesarean and I could feel them cutting into me. Not only that, but everyone in the room was chatting amongst themselves and not talking to me to keep me calm and as happy as someone could be in that situation. The nurses all listened and really cared and absorbed what I said. So did the Dr. So did the Anesthesiologist. I told them about how I'd like to play music in the OR and how I'd really like for my doula, as well as Jake to come in. Their protocol is to only allow one person in the room, but they made an exception for me and allowed Megan as well. They prepped me and we went to surgery around 7:45. They knew how frightened I was, and they didn't make Jake and Megan sit outside while they got me anesthesia situated like they generally do. Dr. Paul (the Anesthesiologist) was very warm and caring and talked to me while he gave me more meds. He also mentioned that he could get in trouble for allowing them in the room while he was doing this, but it was ok because he wanted me to be comfortable. I was shaking very hard but trying to keep my head clear and allow it to be a beautiful birth anyway. I could feel the cold run down my spine every time he gave me another shot of something. He kept pinching my stomach. I went from completely feeling it, to feeling absolutely nothing. I got very anxious after each shot because of the feeling I got in my feet and legs. I didn't mind being numb that much, but there is a strange warm feeling with each injection that's a bit unsettling. Megan and Jake sat on either side of me and Megan set my birth necklace on my chest and I said a blessing. The Doctors put in my Janis Joplin cd and turned it up when I asked them to. When they cut into me, I was crying and telling Megan I couldn't feel it! I had felt everything with Eli's cesarean. When I was having a hard time concentrating and not getting anxious, I began singing to Janis. Megan sang with me. Jake looked into my eyes and held my hand. The Dr's explained what was happening and were talking with us, rather than amongst themselves. They told me we were almost there and that he was a big one! They told me how handsome he looked before he was out enough for me to see. I had to breathe through the tugging when they pulled him out. I told Jake and Megan that I was focusing on how interesting the sensations are and thinking about them as just interesting sensations that most people wont get to experience in their lives. When he was out, they let Jake cut the umbilical cord. They showed him to me over the curtain and Megan took a picture. Jake was able to sit behind me and hold him briefly, before he and Asher had to leave to recovery. I gave him kisses and told him I loved him and how beautiful he was. Jake had to leave with him while they sewed me up. I cried and told Megan how happy I was that she was there to experience that with me. She cried too. I kept asking if I was ok because I had a feeling something was a bit wrong. Everyone kept telling me I was doing fine. I did find out later that I had lost quite a bit of blood. They had to give me medication to keep me from bleeding further. They took a good long time sewing me up and did a fabulous job. I would say just about everyone in the room when we were finished came and either gave me a hug, or held my hand and told me what a great job I did and how beautiful Asher is. It was a very healing experience from my first cesarean birth. It's not exactly the birth I was dreaming of, but given the circumstances, I don't think it could have gone any better. Asher immediately knew how to nurse, and is an extremely content and handsome little boy. I now know that it's not the way you give birth that really matters, it's the way you feel about your birth that matters in the long run. It's a very humbling and eye opening lesson learned by this doula.