Wednesday, May 21, 2014

3rd Unplanned Cesarean: The Best One.

I must admit I still had some preconceived notions of what a 'good birth' is this third time around. We all know the end result that is desired is a healthy baby and mom. But what is a 'good birth'? I did not get my VBA2C. This birthing experience ended in another unplanned cesarean. However I would still deem it a 'good birth'. I will always grieve the fact that I never got to experience a vaginal birth but I feel that this experience was healing for me. As my doula points out this was likely the result of all the emotional work that I put into healing from my previous 2 cesareans. I now know in my heart and in my mind that all 3 of my surgical births were medically necessary. I do not feel like my body failed me. I feel grateful that modern medicine was able to safely get my darling babies outside. Each had their own valid reason for needing to come into the world this way.

J’s Birth Story:

I woke up bright and early on Good Friday morning at 515am with contractions that were painful and about 15-30min apart. I was staring at Chris’s face when he woke up. He got a little freaked but I was excited. I had actually gone into labour or at least it felt like it was going to be. I went about getting ready for the day and was getting my makeup on when I felt something gooey slide out. I quickly wiped and saw that it was my mucous plug. I texted my mw to let her know and she said to just keep ignoring it until I couldn’t anymore. We got everything left ready to go to the hospital just in case things went fast. I texted Jen to say I might need her for the kids that day. I went to the grocery store to get some last minute supplies and stuff for Emmett’s party the next day because this might peter out. I got together the kids Easter stuff into a garbage bag and we packed overnight bags for the kids. I attempted to eat all day since I knew I was going to need the energy. By the evening I was having to breathe through contractions I texted the doula to let her know where things were at. She was encouraging. I called Jen and she said she would come and get the kids. I had to tell Emmett at some point during the day that his party might not happen if the baby was coming. He kept saying what if she doesn’t?  This was hard I didn’t want him to resent his sister for arriving on this day. I told him she was in the heat of a contraction. The kids kept staring at me when I was breathing through the contractions. I tried to reassure them but they still looked so scared. They cried and cried when Jen came to get them. I felt terrible like I hadn’t prepared them for this. My heart broke sending them away but it felt like I needed all of Chris’s attention, which couldn’t happen with the kids there.
We went for a walk after they left and the contractions sped up to 3-4min apart. I decided to have a bath and try to sleep a little. The bath felt good but hard to move with the contractions. The contractions seemed to be coming in a pattern of one long one and then some smaller ones. I rested on and off get up to the bathroom several times and after pee or bowel movement I had a contraction on the toilet with so much pressure on my tailbone. The contractions never stopped but they spaced out a bit by morning. I called the mw to come and check she wanted me to go to the hospital in case I needed pain medication or gravol. I had already taken Gravol and didn’t want anything for pain. She came and checked me. I was effaced but not dilated yet. This was disappointing because the contractions felt real but didn’t seem like they were doing real work. I also had ketones in my urine and needed to eat and drink more. She asked about the pattern and I told her. She said it was likely the baby’s position and suggested doing the miles circuit. I called the doula after this and cried about the disappointment she helped me to breathe through some contractions and relax in the bath. I tried to drink a smoothie and juice and some emergen C packets in juice and water. At some point I vomited up the smoothie. I think it was after the first round of the miles circuit. That was hard. The contractions while in the inversion position were excruciating shakey contractions. I rested for a while and then when the contraction pattern didn’t change I did another round of the miles circuit. By evening I was feeling like I wanted to see the mw again. The contractions were very painful in my back and hips. It felt like they were simultaneously being burned and ripped apart. I ate a couple bites of soup but that was all I could stomach. Tried to distract with tv but it didn’t really work. We met at the hospital that night and she monitored the baby and checked my urine, which was full of ketones still. I got a couple bags of fluid. Baby wasn’t totally happy at first until I got the fluid. We were there for quite a while until the monitoring looked better. Then we headed home again about 9pm to try and sleep again. The contractions picked up when we got home. I had another bath but couldn’t stay in. I tried to sleep but the contractions were 4-6min apart and they got harder I was having to vocalize through them and waking Chris up. Needless to say I got no sleep that night. I had the heating pad on my hips and was buried under the warm blanket but had to throw everything off during a contraction. Still some were worse than others some I felt like I couldn’t get to the peak. Chris was a trooper pushing on my back and hips to counter the pressure. I think he only slept through one or two. I could tell he felt helpless but was doing what he could.
I got up around 6 and called the doula to talk through it with her. I felt like I couldn’t do it anymore like I just needed a rest and maybe if I got some meds I could do that. She agreed and I called the mw not thinking it was Easter morning and she likely had plans with her family. She met us at the hospital at 730. She put me on the monitor and checked my urine, which was not too bad. The monitoring was still showing a not very happy baby, no variability. I drank some juice to try and pick it up. I tried lying down, nope that was way to painful I was writhing on the bed. I told the mw I was probably getting dehydrated again so she gave me some more fluid and went to get herself food and call the ob to find out what I could take for pain since I am allergic to morphine. We still hadn’t gotten a good monitoring strip on the baby by the time the fluid was in and the mw was back. She checked me and I was 1 cm dilated and station was still very high. She went to show the ob the strip and consult. The ob came in to talk to us. She said at this point they could not send me home with pain meds because that would depress the baby’s responses even more. She gave me the option of breaking my water and starting Pitocin and an epidural. She said she the chance of it working was small and that it was a stress test for the baby. She said the other option was to go for the c-section sometime that day. She gave Chris and I time to talk about it. She was the NICEST OB I have ever met. She sat on my bed and talked to me like a person. I immediately trusted her. I asked about delayed cord clamping and she agreed. I decided I couldn’t go through with the induction. I knew in my heart it wouldn’t lead to a vaginal birth it would only be so I could say I tried everything. I knew that I was at the end of my rope. I decided I couldn’t take the chance of the baby ending up in distress and going through all of those interventions just to end in another c-section and then to possibly have the baby go to the NICU or for me to have complications with the epidural. We told the mw and she told the ob who said 1-2hrs. I called the doula to come. I felt like a failure but knew I was making the right choice.
The mw got me prepped for the surgery, the ob came in and got my consent, bloodwork was taken, all the while between fast and furious contractions. Chris ran home to get the bags although he was afraid to leave. Every time he has left I have had to be whisked to the OR with a baby in extreme distress. The monitor kept falling off. I wanted to ditch it but the mw said no since the baby is not happy we can’t. At this point things got fuzzy. I remember Chris and the doula arriving and having to stand between contractions and then excruciating agony of the catheter that took 2 attempts. Then it was in and during a contraction I was peeing down my legs. I’m a nurse. I know that the pee is not supposed to go past the catheter. So back on the bed for more agony, lying down during a contraction was so intense. The mw got it fixed and although I felt the awful burning sensation no urine was running down my legs. A nurse came to get me with the OB for the OR. I remember the doula not getting dressed for the OR and wondering why but not asking. I found out later the nurse didn’t believe in doula’s in the OR and had made a fuss before. The mw and the doula decided I needed a calm, drama free birth so she didn’t come in. The mw stayed with me in the OR while I was getting the spinal. She held my hands while I held the table. I had about 4 contractions in the 15 minutes it took to get that spinal in and I had to hold still for all of them. I remember the anesthetist land marking with my hips and just about jumping out of my skin because they were so sore from the contractions. The relief after the spinal took effect made me feel euphoric. It was bliss. I made a conscious decision to feel happiness in these next moments and not disappointed. It was my last baby’s birthday and I was going to celebrate. The stars had lined up with the OB being great, the paediatrician on call was fabulous, the OR was available right away, and the other nurses in the room were jovial and joked with me. No talking over top of me, no time alone in the OR, my wishes were being heard and respected. I made the decision to be present and to not let anxiety, fear or disappointment cloud this moment. I could only do this because I had mentally prepared for this possibility and I had been through this twice before. The mw lined up the baby warmer with my head so I could see everything. They brought the camera in the OR. This was huge I have no photos of either of my older children’s birth. My husband took a photo of her coming out. The OB exclaimed"Oh there's her face" she told us she was face up with her forehead pressed to the front of my pelvis. This presentation was why she wasn't descending and I wasn't dilating. t didn’t get skin to skin or nursing in the OR but Chris did skin to skin as soon as they got back to the room. I had to stay in the OR for a bit after they closed me to get a special anesthetic block of my abdomen because of my allergy. That was fabulous. I didn’t feel a thing. I had such poor pain control last time it really traumatized me so I was very grateful for this.
              My mw recovered me because the L&D department was short nurses. I knew from previous conversations that she didn’t do this I was supposed to go off to the surgical recovery ward where I couldn’t have my baby or nurse. I was incredibly grateful to her for this. It made a world of difference in my experience. The doula snapped pictures, we called the kids and I blubbered on the phone scaring my 8 year old. They arrived an hour later and I blubbered all over again pulling them into bed with me. That was the hardest part being separated from them, sending them off again afterwards, my son’s cancelled party, their tears and sadness. At this point I had been up over 58hrs and I didn’t sleep until that night. I was woken every 3hrs by the nurse to make sure I wasn’t bleeding out or suffering a post op complication. I was a bit cranky with her and she was old school but in hindsight she was great because she brought me my meds and made me take them on time and had everything prepped in the bathroom for me to get up to. The OB let me out a day early because of the construction outside my room starting up. The staff knew I was eager to leave and got all the paperwork done. My mw told me that the cord blood gases were pretty bad and that J would not have tolerated the induction at all. This and the OB's statement of the presentation helped me to make sense of my body's response and validated my choice. All in all I felt supported which made this my best birth experience and very healing. I will always mourn the fact that I will never experience a vaginal birth but I don’t feel broken or that my birth’s weren’t the ‘right kind’ anymore.