Wednesday, 17 August 2011

The birth story

Email me at doctordandle at gmail dot com for photos.

We visited my gynaecologist a day after my due date. She asked how I was, and I replied “still pregnant”. She decided to schedule us for an induction two days later, which was fine with us. She wrote out a prescription which looked a lot like “1 baby, 8h30, 29 July 2010”.

On Friday morning, we got everything ready. It was weird knowing that (hopefully) next time I returned to our home, it would be with a baby. It was a beautiful summer day as we took the ten minute walk through the park to the hospital. My husband tried to meander, but I was feeling very mission oriented.

Once we got there, we were asked to wait on the chairs by the entrance until a room became available. I was seated next to a young girl, her boyfriend, and her mother. Her mother couldn’t stop crying and said that her 22 year old daughter was too young to have a baby. I didn’t see them again - I hope everything is going well with them.

The midwife called me in and gave me an internal exam. I asked if I was going to be induced with oxytocin, and she said that she had to calculate a score first. I asked her if she was talking about the Bishop score, and she asked me if I worked in the field or just read a lot. I told her that I just read a lot.

It turns out I had a bad Bishop score, so they were going to induce me with oral Prostaglandin 1 tablets instead of a drip. They would monitor me for an hour, give me some tablets, monitor me for another two hours, another tablets, etc, until something happened.

They set me up in the delivery room around 10am, where we were to spend the next day and a half. There was an uncomfortable padded shelf for my husband and a bed for me. I got changed into my “I dream of sushi” delivery outfit, complete with belly hole for monitoring. The midwife said that in all her 11 years of work, she had never seen anything like it. I showed her the low back for the epidural, and she said that she hoped I got an epidural so we could make use of her. I assured her that I would certainly be getting an epidural.

For the next ten hours, it was a little like we were on a long haul flight. I couldn’t feel anything, but we could watch the irregular and small contractions on the monitor, and listen to the baby’s heartbeat. We could see the baby’s transition from wake to sleep every hour or so.

They served me meals but didn’t have anything for my husband, so he popped out for ten minutes to grab a quick dinner. While my husband was out, at 8:02pm, I felt this little pop and then this extreme gushing. It took a few moments for me to realise that my water has just broken. I send my husband a text message saying “Water just broke.” My husband rushes back and is there almost before the nurse.

The nurse comes in and I tell her the news, feeling somewhat alarmed. There is now a huge quantity of liquid gushing out of me and I’m starting to panic. I am astonished by her response - perfect, fantastic! She tells me that she was worried that she would have to send me home. Now she can finish her shift happy, knowing I will have this baby tomorrow. I ask her about the colour of the fluid, and she tells me that it is clear, that everything looks good. She is sad that I have gotten my dress dirty, but I tell her that it was sort of a single-use outfit, and I change into my spare one.

The midwife asks us for our baby clothes, and it starts to hit me that they are actually expecting a baby to arrive. We give her the outfit, and she asks us "is this all you brought?". Apparently over here, babies don't just wear a nappy and a onesie, they also wear baby underwear, which is weird. Throughout our stay all the healthcare professionals are puzzled by the lack of underwear we dress our baby in, even though it is summer and the hospital does not have air conditioning.

At around 10pm, the contractions become painful, and I ask for an epidural 10pm. The next midwife seems rushed, sad, and distracted. We sense that it has been a difficult night on the ward, with perhaps an unhappy story. She says that I am only 2cm dilated, and the minimum was 3cm. She gave me some more oral prostaglandin 1 to help with the contractions. At 11pm, I ask again, but my contractions are not regular enough.

The contractions are getting more and more painful. I remember reading that one should visualise the baby through each contraction, but for me this isn’t very useful, as I realise that I am terrified of being responsible for a baby, and thinking about this just sends me into a panic. The common mantra “labour pain is good pain” is also not very helpful. I end up sitting on a Swiss ball, and having my husband massage my back. I repeatedly tell him that I really like the bits in between contractions. As I feel each contraction begin, I feel ambivalent. As they get stronger and closer together, I become a better epidural candidate, but they still hurt a lot.

At midnight, I ask for an epidural again, and she checked me, and very kindly announced I was “3 very small centimetres”, and confirmed I wanted an epidural. “Yes”, I answered immediately, without pause or hesitation. She called the anaesthetist, who explained the procedure.

I start shaking from fear, as I sat on the edge of the bed with my back curled over. I tell myself that the pain of the procedure will be less than the contractions, but I am still really scared. They ask me to tell them when I was having contractions and they would stop their work, and luckily they weren’t so close together yet so they only had to stop a couple of times. The doctor explained what she was doing each step of the process, and my husband and then the midwife held me steady. I remember the anaesthetist saying to me “now you must not move for any reason”, as she entered the epidural space.

She gives me some great advice - if I feel pain on one side, simply lie on that side and press the button for an extra dose of anaesthetic. They add oxytocin to my drip to ensure my contractions continue, and leave us to get a bit of rest. I need to switch sides every hour or so, otherwise my thigh muscles tense up like a terrible cramp.

From midnight to 8am, I manage to get a bit of sleep, though I max out the boosting button on the epidural. I can hear our baby’s heartbeat on the monitor, and I can relax due to the constant galloping noise that fills the room. I have to keep on moving the heartbeat sensor lower down, so I know that he is progressing. I am still really scared about everything - labour, birth, looking after a baby, so I try to just focus on the moment without thinking about the future.

Just before she leaves her shift at 8am, I tell her that the contractions are feeling lower and more painful. She checks me, smiles, and gets my husband. Shows him that the head has dropped, and he gets his first glimpse at our son. He holds a mirror up so that I can also see the head, and I think to myself that maybe I can do this after all. He seems so close to the exit that I feel like he’ll be here in no time. She asks me to stop pushing on the “extra” button of the epidural so that I’m able to feel each contraction.

At 10am, I call the next midwife and tell her that the contractions are now frequent and painful, and that I think the baby is ready. She agrees, and we do a few practice pushes. She tells me to push with each contraction, holding my breath and pushing with all my strength. She then gets into position between my legs. With each contraction she yells “allez allez go go go push push push like you have to go to the bathroom”. If it’s a strong push she yells “more more like that keep on going yes yes yes”. If it’s a poor push she tells me afterwards that I have to try harder. Surprisingly, one of the most difficult aspects is that my thighs start to cramp up with each contraction, and the pain of that blocks my ability to push with any strength. I find that stretching out my legs by placing them on the midwife’s shoulder offers some temporary relief. She gives me a strange look, but I don’t care.

After an hour of pushing, they tell me that they have to call in the doctor to use a vacuum, but they will give me ten more minutes first if I feel strong enough. I try for another ten minutes, but I feel defeated, I don’t feel like the baby has moved at all, and that all my pushing is for nothing. My husband is great, telling me that I’m doing a fantastic job, but I don’t really believe him. I only feel strong enough to push with every second contraction, and I can hear the disappointment in the midwife’s voice when I fail to be strong enough.

As the midwife is French, she often pokes my belly and announces “she’s still there” when checking for my contractions. In between contractions we have a conversation about the gender of French nouns, my husband comments that it makes sense that contractions are feminine, then I tell him that the gender of “vagina” is male - le vagin. Usually I’m too shy to bring up this example, but I figure it was appropriate in this context.

Another ten minutes of pushing, he’s still not out, it’s time for the vacuum. The doctor and the paediatrician arrive, and the vacuum is prepped. The midwife steps out of the way and is replaced by the doctor and her contraption. She attaches the vacuum, and helps me with each push. I am exhausted, and I feel like giving up. I don’t feel like I’m getting anywhere. I am tired, and I don’t want to push anymore, but the doctor tells me that I don’t have a choice at this stage, I have to keep on going. Suddenly I hear my husband’s voice telling me that he can see the head, that it’s coming out, and I get a new sense of energy. Only my husband’s voice keeps me going “I can see the head, he’s coming out, keep on going, there’s an arm, nearly there, great job sweetie”.

At 11:53 am, all of a sudden they plop this enormous purple bloody wriggling baby on my chest. I am astonished that something like that just came out of me. He had a very pointy head, though my husband tells me that by the time I saw him, it had already shrunk.

The then lifted him up to weigh him, and I watched him being checked by the paediatrician to ensure that he had not been overly harmed by the vacuum extraction. They told us that he was 4.4 kg and 54 cm. We later learn he has an APGAR score of 9 after 1 minute (white hand), and then 10 after 5 minutes. I watch as the midwife gave me an injection in my leg to encourage the delivery of the placenta and the doctor extracted cord blood for anonymous donation.

Somehow an hour past, and they told me that I had not yet delivered the placenta. They asked me to push a bit more, but that achieved nothing. The doctor told me that she would have to manually extract the placenta - reach inside my uterus and scrape it off by hand. They called an anaesthetist who injected several doses of anaesthetic straight into my epidural drip. He also told me that he likes to plan for the worst case scenario, and attached a second trip to my right arm, in addition to the drip on my left arm.

The manual extraction was by far the most painful part of the process, I don’t know how unbearable it would have been without the epidural. I called out in pain, and I was touched that the anaesthetist kept on apologising, saying he had given me the maximum dose, and he was so sorry it wasn’t working. No one ever said to me that this was childbirth, and pain was part of the process.

The doctor waited for me to get my breath, but she said it was critical that she finish the process as soon as possible. A few more minutes, and the process was complete. However, they told me that I had lost 2.5 litres of blood by then, and I needed a transfusion. My husband later told me that the bucket underneath me was filled with blood and tissue, the floor was a mess of red, and the sink was full of bloodied instruments. They ask him to sit down while holding the baby as they don’t want him to faint. Luckily he is very good with blood.

I start shaking uncontrollably, and they cover me with blankets and bring the overhead heater to beam down on me. I look up and see that I’m hooked up to four different bags of liquid on my left arm, including a bag of blood. On my left arm I have a saline drip. They ask me to take some tablets, the side effect being that my temperature will be raised. Now I am the one hooked up to a heart-rate monitor. They tell me I must stay here until I have received two bags of blood, one bag of plasma, and my heart-rate drops below 100. Everyone seems calm, though, and I am impressed by their quick response.

I am so glad that my husband was there to hold our baby, while I am laying there, my legs propped up on a block of foam. While we were waiting for all the infusions to finish, we try nursing Our baby for the first time. This was not very easy as I was laying flat on my back. Our baby made snuffling piglet noises that made us laugh, and he eventually found the nipple. The midwife squeezed my other nipple to show me that I was indeed making colostrum, which our baby seemed to enjoy.

Many hours later, at 8pm, I had stabilised and they announced I was ready to be wheeled into the maternity ward. We arrived into our room with a small single bed, no food, no bed for my husband, and down here the midwives only seem to speak French. I feel quite lost. After several requests, they finally bring a meal for me and a bed for my husband. It was the start of four unpleasant nights, with the night nurses barging in constantly and bringing criticism for whatever we were doing with Our baby at the time.

Four days later, our baby and I passed our medical tests, he started to regain weight, and we were permitted to leave the hospital. We walked through the park with him in his stroller, and arrived home, ready to start our new life with a child.

The past two weeks have been harder than I imagined. Thankfully the breastfeeding has been going very well, and I am so grateful that my husband does the majority of the work during the day, leaving me to rest and relax. Still, I am not yet feeling very attached to our baby as our interactions seem to be this three-hour cycle of feeding, changing, and soothing. He hates sleeping in his cot, which means that often during the day he rests in our arms, then spends the nights swaddled and complaining as we try to get him used to sleeping alone on his back.

I am so thankful that he is healthy and growing and thriving. I realise that I am so lucky, that there are so many people out there who would give anything to have what I have right now, but at the moment, honestly, it is not very rewarding. They say the first social smiles will start in another three weeks, to which I am desperately looking forward.

Monday, 1 August 2011

He's here

I have a sleepy little boy in my arms. Born 9.7 lbs after a vaginal vacuum extraction. Three stitches. Two liters of blood lost during manual placenta extraction. Apgar 9/10/10 - one white hand. He is exhausting work, looks a little like Churchill. Feeling accomplished. Husband marvellous during labour and also now. I have yet to change a diaper in his 48 hours of life.