Birth Story of My Second Child: An Induced Delivery

Baby RIt is funny how maternity leave with child #2 makes the element of sleep all the more important. These days I feel like I am juggling between children’s rooms at night, comforting one, then the next, and spending the days in a bit of a haze, trying to catch up on lost sleep. Despite this, the time brings me even more happiness as a parent. Close cuddling with my son in the early hours of the mornng means pure joy. And after breakfast, once the tyke is at school and busy with his day, I get cuddles and nuzzles with my little one-month-old R.

Yes, it has now been a month since my first meeting with my new daughter.  I’ve been working on her post here and there and just hadn’t completed it yet.  T and L and I feel incredibly fortunate to have her in our lives.  It was a little rockier than birth story #1, let me tell you.  Given that I’d been having Braxton-Hicks contractions since Christmas and had several instances where I thought I was going into labor – subsequently fizzling out, I really thought I’d be delivering before my due date.  But suddenly the due date came and went and still no baby.  That due date was Friday January 17th.  My next midwifery appointment was scheduled that Monday when I was 40 weeks and 3 days along.

My Birth Plan (and how it changed)

For my second baby, I expected a quick and slippery delivery along the lines of my first – go into labor, get to birth center a few hours later, deliver in 1 hour and be home by midnight.  Sounds crazily simple enough, but that’s pretty much how I remember my first birth experience.

Unfortunately, luck was not on my side on the Monday morning of my 40-week-visit with the midwives.  For starters I wasn’t feeling quite right. My little one did not seem to be moving as much as she should have been over the past 1-2 days.  But whenever I lay down on the couch and counted movements, they seemed to add up to 10 or so within an hour. So I was trying not to worry too much.  Otherwise things seemed to be normal. I was eeking along, just extremely tired and sleepless during my last days of pregnancy and very impatient for my butterfly to emerge from her cocoon.

T set out to drive me to the Birth Center for my checkup.  We were fortunately between winter storms and the sun was shining brightly–giving me more optimism. I asked T to load the hospital bags into the car ‘just in case’ and we set on down to Delaware. When I arrived the midwife reassured me that everything seemed to be all right. To try to push me along, the midwife stripped my membranes (do not be fooled, this is an excruciating but brief experience and makes you very crampy) and also noted that I was 1 centimeter dilated. She said that pregnancy was progressing as per usual but just to make sure that the baby was well, we would do a fetal nonstress test (NST) in the office.

So they strapped monitors to me – a contraction monitor and a heart rate monitor, to check the baby’s activity level as well as my body’s movements and the baby’s response to them.  In order to pass the NST, during a 1 hour period the baby needs to show two sustained episodes of ‘reactive’ heart rate during awake periods.  There are numbers that tell you how “reactive” a reactive heartbeat is. While my baby’s heart rate was increasing by about 10 beats per minute above baseline, this was below the required difference of 15 beats per minute.  Furthermore, the heart rate showed this inadequate level of reactivity fleetingly and for short periods of time. The usual tricks of the trade–drinking two big glasses of ice water and eating a popsicle–did little to improve her activity.

My heart sank when my midwife instructed me to go across the street to St. Francis to get a Biophysical Profile (BPP). A BPP is an ultrasound which detects five major areas of fetal wellness. In preparation, T and I grabbed a [delicious] lunch at a local pizza shop and then headed to the appointment. I felt like the baby was moving well at the ultrasound, but sadly, the activity level was still not up to par.  And more concerning with this picture, my amniotic fluid index (AFI) was found to be low. They were detecting a fluid level of 3.5 which is below the normal range of 5 to 25.  We returned to the birth center for a repeat NST but unfortunately the results were the same. Individually neither the low AFI nor the decreased reactivity may have been overtly concerning, but together they were worrisome. With low AFI (also known as oligohydramnios, or low amniotic fluid) and the nonreactive stress test, one could infer that my baby was having some difficulty and possibly outgrowing what my body could provide for her.

Bottom line: she needed to come out.

So that same afternoon I found out that I would not have the natural birth that I desired. I’d be going the route of Pitocin and all that follows. It helped that they planted the seed early in the day. I had about six hours to process the idea of being induced before the decision was made for me to be admitted. Bracing ourselves for a tough few days we headed to the mall. there we picked up some entertainment and a big chicken sandwich for me to eat before going to the hospital, where I knew that they’d make me either liquids only or the dreaded “NPO” – nothing by mouth. This unexpected mall detour brought us a little happiness, however.  As we mentioned our predicament to salespeople at the mall (“We have to go to the hospital to get induced because our baby needs to come out.”) it felt heartening to hear their reactions: “Wow!” they would say, “Your baby is coming! That is so exciting!”

Yes, it was, rather. Within the past day we had faced uncertainties, but at least we knew that we’d soon be meeting our daughter!

As we arrived to register at the hospital I wolfed down my sandwich (to the horror of our registering nurse who turned the other cheek). We headed to a waiting room and were quickly shuttled to labor and delivery room where a kind nurse took some blood, hooked me up to an IV and started to tank me up with fluids and put me on the monitor. The plan put forward by my obstetrician was simple enough. Rather than starting with a chemical induction (Pitocin), I would be induced manually using a foley bulb – a process which is possible as long as you are at least 1 cm dilated. I had never heard of it but it makes perfect sense. They insert a foley catheter into the cervix and inflate it with water to about 30mL (imagine 6 teaspoons of water) – This creates a diameter of about 3 centimeters. They then tape the foley end to my leg and allow it to come out on its own. When it does, you are thought to be 3 centimeters dilated.

What I learned from a foley induction.

a) It is painful to have the foley put in but once it is in there are no issues
b) labor isn’t so bad and is pretty tolerable IF you can move around and get in comfortable positions, BUT when you have a heart rate monitor and contraction monitor strapped to your belly and one arm is attached to an IV pole, activity is pretty difficult. The only thing I did willingly was go to the bathroom to void every half hour. So labor is much more painful.
c) I am glad that I had to get up to void every half hour because at least it helped me get a little comfortable during labor.
d) Night nurses who want to sit at their station and don’t want to spend time with the patient don’t believe you when you tell them you are having a contraction. They only believe the monitor.
e) The monitors just don’t work that well – they displace, they don’t pick up. And for me I think they only picked up 2 out of every 3 contractions I was having.

So after learning items “a” through “e,” I realized the inevitable: my nurse began the dreaded Pitocin that night. Basically she was following the order set that she had been given, but rather than admit that, she told me that I wasn’t contracting adequately, that I wasn’t dilating, that the doctor wanted me to have this medication before the other doctor came in during the morning. Nothing seemed to add up because among other things, as it turned out, I learned the same doctor would be covering me for the duration of my admission. Furthermore, by my own experience I knew I was contracting every 5 minutes or so.  Thus, based on her inadequate explanations I was quite ready to turn down the Pitocin.

But . . . .rather than go that route we elected to call the midwives and discuss what was going on. It was enough for me to be able to talk it over with Sarah Grace in detail and hear from her that Pitocin sounded like the right course. The baby’s health was a concern and she needed to be delivered. I also learned that to start at a level of 1 mL/hour and to increase very slowly was a conservative approach (compared to physicians who normally started at 2ml/hour and increased by 2 ml/hour each hour). Personally, the concept of “pitocin contractions” induced me with a sense of fear from the words of other mothers.  Sarah Grace provided me with some relief here, saying that because I was already in labor for several hours it wouldn’t be too much of a transition in terms of pain – the contractions are basically emulative of active labor right away. And, as it seemed to me, the doctor was going as kindy and gently as possible and if the baby truly was in mild distress – which looked like it was the case, if I wasn’t able to get labor to progress more I might be on the road to cesarean anyway.  So on went the pitocin and I decided to brave it without anesthesia. Initially.

The Labor Song, or How I managed through Pitocin for a night

It certainly helped that I was able to embark on a fairly normal unmedicated labor to begin with. When they started the pitocin I was that much closer to active labor and was already used to breathing carefully through contractions.  I had developed a “labor song” early on – basically a low pitched melody which I repeated during each contraction. I based it on Tzchaikovsky’s Sleeping Beauty.  Coming from a singing background I found the strategy helpful ; the melody had given great focus to my first labor and suddenly came back to me during this one.  It did help me in a similar way to both relax and to keep focus. Of course, singing seemed strange to my night nurse.

The night nurse – the same one who wanted to turn on the Pitocin without really explaining the “why” of it – took it upon herself to coach me through one of my contractions when she was helping me to the rest room. Considering that I had been dealing with painful contractions for the previous 6 hours I found it unnecessary for her to tell me not to sing through my contractions – which was helping me a LOT this time.  She thought it would be better if I breathed in through my nose and out through my mouth like a straw.  Pish tosh, I thought to myself. Forget trying to breathe in through my nose – it was already thoroughy clogged from the hospital air and a very cold winter. Plus, I can sing a heck of a lot longer than I can blow my mouth out through a straw, and singing makes me forget I’m having a contraction.  You get zero points on that one, nurse.

The Next Morning

By the morning the Pitocin had inched up to 4 ml/hour. The contractions began to get longer and more painful. The day nurse who came on offered to reposition me into a seated position. She placed pillows around me to make me comfortable, but once the Pitocin was up to 5ml/hour I was undergoing each contraction and hoping it was the last of my labor. It hurt a lot and the nurse and T could see it.  The nurse was highly recommending the epidural. In the event that I couldn’t relax and could not dilate, she said, I may have to go to cesarean and at that point they said it would be too late to use epidural anesthesia and that I would have to go under general – which I was clearly not a fan of doing.

Also, while I consider myself very suggestible to recommendations like this nurse’s, I also felt that I was tiring out. My concern was that if I couldn’t stay relaxed during contractions, I wouldn’t have the strength during the pushing stage. And relaxing my body was getting harder and harder. So again we spoke with the midwives over the phone and got some reassurance that we had labored a good portion unmedicated, and that hopefully the epidural would not cause labor to arrest at this point – if I was already significantly dilated.

Within about half an hour of my agreeing to the epidural the anesthesiologists came and inserted it in a matter of minutes. – at about 10:00 a.m. The feeling of the needle insertion will be hard to forget. It was a nerve wracking and mildly painful procedure to be sure, but once you’ve gone through a night of labor pains the needle isn’t such a big deal. And it goes quickly. The strangest feeling was the mild euphoria of being suddenly pain free and the importance of changing the dependent leg when starting the epidural. As I changed position I felt myself getting numb in the right side, the the left side, then again on the right side. It was interesting to suddenly feel like I could go through several hours ore of labor and not care at all.

Shortly thereafter, my OB came in and checked my amount of dilatation (which was much easier once I had the epidural. 4 cm, good effacement, and +1 station). So all in all, baby was descending). He broke my water bag and my dilatation increased immediately to 6 centimeters. He estimated that my baby would be born in a few hours and headed back to his clinic (which was a drive a way).

During the next few hours my nurse came in and was extremely attentive. I believe she spent more time with me than with any of her other patients because she was so busy checking my monitor and holding it to my body. It didn’t have to be held so closely once I had the epidural because I had stopped changing positions to relieve pain. But the baby’s heart rate continued to be nonreactive. But the contractions became just barely sensible to me and suddenly got very close together.

I started to feel the need to push around 12:15 p.m. or so. I had no desire to request any more epidural anesthesia. In fact, I wanted the epidural to wear off so that I’d have the right bodily cues to push. The nurse called the OB who started his drive over in about a foot of snow and zero degree temperatures outside. Not the ideal situation, and I held onto the side of the bed and breathed out as long and deeply as I could so as not to push the baby out on my own. This feat, which felt like it lasted forever, was in my estimation my biggest accomplishment of my delivery. It was SO HARD not to deliver before the obstetrician came. Just as I felt desperate to push and nearly asked for the residents to come in and deliver my baby, my OB arrived, up went the bed and they asked me to start pushing. AT this point my sensation had pretty much returned and I was certainly experiencing regular labor pain. It took a few minutes of pushing and the baby was out. I could describe it in more detail because the memory is still there, but I’d prefer to leave it at that.

However, I will mention that natural labor is far superior to medicated labor in the respect of positioning. It was a far better thing to be able to get into a position that was comfortable for me as a patient to deliver a baby. When you are on Pit with an Epidural you are basically in a labor position that is convenient for the doctor. And it feels so counterintuitive. Rather than push down and have gravity assist you, I felt like I was pushing my baby up and out against gravity. With that very odd position, it was all the more difficult to keep the same intensity of push that I was able to during my first labor.

But my daughter was born and all was well. Apgars of 8 and 9, which is to say that at 1 and 5 minutes of life she had healthy color, pulse, cry, breathing rate, and tone. Immediately she was on my chest, nursing, and looking great. Although I was very sure that starting to nurse her would be tough since I had an epidural, she seemed well enough awake and nursed immediately.  I think my milk came in a bit sooner than with my first simply by virtue that I hadn’t stopped nursing since my last delivery.

The rest I am afraid is a blur. If you haven’t already guessed, I wrote a lot of this blog post weeks ago and now it is all a distant memory. I remember having to get a rhogam shot, remember having to get stitches, remember having difficulty with normal bodily functions after the delivery – but not so much compared to my first delivery.  I remember getting the epidural out and finally the IV out and being able to walk again, phew. I remember our hospital room. While I wasn’t particularly surprised by the hospital room we ended up in, I think it was a slightly rude awakening for my husband, who remembered the cozy, softly colored and comfy room of my first delivery at the birth center.  The towels here were tiny, the meals were not our home-cooked ones, but jello and all that a hospital can provide. The nice thing was that because of the snowstorm they were generous with the meals they provided my husband at the cafeteria downstairs, and we were all cozy and didn’t have to brave the snow.  We elected not to have my son visit initially when I was on the floor because of the cold weather, but by the time I had spent about 20 hours in the postpartum room I was itching to go home.  So rather than let them keep me another night we clamored for the nurse to get our discharge done and we were out on hospital day 2.  It’s a good thing to be lying down in bed and resting – which they make you do while you are in the hospital. But I missed my home and was incredibly bored.  So my son did end up coming late in the afternoon to meet his sister.  That day happened to be his own birthday so we celebrated with a chocolate birthday cake and then slowly made the drive home in frigid weather.

Ok, I’m going to give up on this post since it just took me waaayy too long and so much more interesting things are happening in life now that labor is over. Yes, it was tough to have an induction and I would not choose to do it, but it helped put in perspective that labor is a millisecond in the grand scheme of parenthood and there is so much more to it all. If things don’t seem to work out – which at the time it didn’t seem to be – I still had a healthy baby in the end, and that meant the world to me.