Sunday, November 11, 2012

She could have died: a birth story

So I've been reading birth stories and I realized I haven't contributed mine to the chorus.  Here's the story of how we got the kid.

At 37 weeks gestation I was diagnosed with hypertension and was on high preeclampsia watch as a result.  For some silly reason we weren't on high alert for imminent kid arrival yet and I was lucky they didn't have me admitted and induced right away.  My doc (a family practice doc, not an OB) put me on modified bed rest with me allowed out of the house only to go to class and absolutely no standing for very long (since it made me dizzy).  This went fairly well although sometimes I'd get downstairs and my blood pressure would be so high I'd just stagger back up (very slowly) and skip class.

And then we got to 40 weeks according to all the ultrasounds' dating (10 days before my due date based on LMP but with all those ultrasounds dating her 10 days ahead, they moved my due date up).  Nothing happened.  I was maybe a cm dilated and still hypertensive right at the line between "panic! Deliver now!" and "well, it's not a big deal."  We had a NST about 4 days after my due date on a Friday and the kid was downright feisty and the tech doing the test was just shocked at how active she was.  My area had a lot of high risk pregnancies because of limited prenatal care, lots of drug/alcohol abuse, and environmental pollution that causes all kinds of nasty birth defects, so I'd bet the tech had seen lots of sad things too.

My doctor decided to let me go to 41 weeks and then schedule an induction for about 42 weeks if I was still doing all right.  I had to come in for a mid-week appointment and she'd do another NST in a week.

Sunday I started having contractions in a pattern.  This was maybe the 4th time I'd had contractions for a few hours, so at first it wasn't so exciting.  In about 8 hours things progressed to where I was having contractions every 5-7 minutes that lasted about a minute each, so we called our doula and she turned up about an hour later (she lived a distance away).

Brief interlude: I have attended hundreds or even thousands of births as a farm kid, so I knew that when things go south, it's fast and you need to be right there ready to intervene but I also knew that I wanted to stay at home as long as possible because my mom had a really long labor her first time and my grandma had as well.  I also figured that since we'd never been to a hospital for a birth, having a doula who knew what to expect and how things usually went would be helpful.

We all chatted, the three of us, for quite a long time.  We wandered around, did some massage because my back and hips hurt like mad, usual stuff.  We griped about our 3 TV stations and that two were the same network.  At about 2am my contractions got to be 3-5 minutes apart and were hard to talk through, and by 3am I couldn't talk through them, so we decided to adjourn to the hospital so there would be plenty of time to get settled.

At about 7am my water broke and I started throwing up with every contraction.  It was no fun and such a relief to have two people to alternate holding the puke bucket and washing it out.  By 10:00 I hit transition and was in a very different place (with less vomiting).  I'd done a modified hypnobirthing meditation thing to help with pain and it was working pretty well.  I opted for no epidural mostly because I have a lot of very surprising reactions to medications and I figured that while in labor wasn't the time to test out what happens if I got an epidural.  During this phase of birth I got super quiet and was very internally focused all of the time.  Everyone was shocked (the lady in the room next door was howling, and her baby was over 10 lbs, so that's totally fair) and I don't think the nurses quite understood what to do with me being so quiet so having a doula along with the spouse was invaluable.

Shortly after 10, the fetal heart rate monitor dipped way down.  It was great there to have a doula, because she caught this first and wiggled the thing around trying to find a better heartbeat, figuring that the kid had just shifted.  In a few minutes the nurse turned up and they found a heartbeat again (phew) but it didn't last very long and we had to go to internal monitoring which meant staying in bed (which I'd mostly been doing anyway!).  My doctor showed up (yay for delivering during the day, in this practice it meant I got my doctor if she was in the office) about 11 and it was time to push.  After about a half hour the kid's heart rate quit rebounding as much after a contraction and then it dipped really low during contractions.  I wasn't making much progress pushing (she was just short of crowning through a lot of contractions).  Very quickly a whole lot of things happened, maybe three more people showed up, and my doctor decided it was time for a vacuum extraction.  We were given the options of continuing to push or go with the extraction, but knowing that for three contractions things had looked worse each time, it was clearly time to intervene.

The vacuum extraction meant an episiotomy (boo), one last push, and some yanking and then we had a baby, a few minutes shy of 24 hours from that first contraction.  She was quite purple (almost blue) because she'd had her cord around her neck quite tightly.  She wasn't breathing on her own but within a few seconds she took her first breath and then wailed. Once.  She got whisked off to the nursery (no NICU at this hospital, just a few beds for babies who needed some care short-term) after I saw her for just a moment.  The spouse went with the kid and my doula stayed with me.  The placenta turned up intact and I quit bleeding fairly quickly so I never had to have an IV or any pitocin.  In about an hour, I'd had several drinks and was permitted to go visit the kid in the nursery by my nurse and my doula headed home to crash.  The kid was just starting to get some good color to her after being under an oxygen hood the entire time (almost).  She'd had to have a chest x-ray because she stayed purple too long and they were worried she had a heart defect and would need to be flown to the hospital with neonatologists and a NICU for surgery (an hour flight).  It came back fine so we got to stay put.

If we hadn't been in the hospital being monitored, the kid could easily have died during birth.  Her cord was short and around her neck, maybe more than once.  At the least, without that intervention she could have been oxygen deprived enough to have some serious complications like cerebral palsy.  That's why nobody will ever convince me that a home birth is a good idea.  The kid's birth was going great until within 5-6 minutes it went downhill, and we only knew that because she was being monitored constantly.  Just because you are considered "low risk" during pregnancy doesn't mean the birth will go smoothly.  Being right there in a hospital means the intervention you need is right there, easily reachable really fast.  Don't be afraid you'll miss out on some magical experience because you deliver in a hospital.  Remember that you're ensuring that if things go wrong, you have help right there.

I will say that the hospital experience was so much easier having a doula.  If we'd had someone who was less trained but had been through a hospital birth before like a sister or friend, that extra support person probably would have been enough for us, although the help in labor positioning was really great.

After 2 days we got to go home and adapt to life with the kid, and it's been exciting ever since.

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