Wednesday, January 4, 2012

avery's birth story

i'm mostly writing this so that i don't forget how amazing and terrifying this experience was. 
i'm also hoping that it will remind me why i need to look for a new doctor and place of delivery for any future children.  
but mostly, i want to write this so that i can remember just how lucky we are to have a healthy baby girl.  things definitely could have turned out differently and i'm so thankful that they didn't. 

my due date was december 7th.  all throughout the pregnancy i was expecting to be late, probably because statistically most new moms are.  however, i still started thinking "any day now" at 37 weeks, which meant by the time my due date arrived i felt like she was already 3 weeks late.  my plan had always been to work until i had the baby, and i felt very fortunate to have a job that was willing to let me take it one day at a time.  for a few weeks people weren't sure if i was showing up the next day, which i'm sure was a little difficult for them.  it's made a huge difference to me though because instead of wasting 2 weeks of maternity leave waiting for a baby i was able to save it all for when she was here.  

i had always assumed that if i was pregnant at my 41 week appointment then my doctor would induce me.  he had made it very clear all along that he didn't want me to go past 41 weeks because after 40 weeks the placenta gets 'old'.  although, i wasn't sure how i felt about that.  i know that there were many people who delivered late and had healthy babies and i really wanted to give my body and this baby the time they needed.  i also wasn't thrilled about having an induction and was concerned about an increased risk of a c-section if i had to be induced.  at my 41 week appointment we did a non-stress test on the baby and i opted out of an ultrasound to check amniotic fluid levels.  the baby did fine on the non-stress test and when i met with the doctor he basically told us that there was no advantage to being induced at that point versus waiting another week to see if i would go into labor on my own.  he was also leaving to go on vacation so at that point i knew that whoever was going to deliver my baby was going to be someone i had never met before.  while i had never been thrilled with my doctor, it was a little unnerving knowing that the doctor making decisions with me the following week would be someone i had never met.  

i went in for my 42 week appointment and met a brand new doctor who was pretty clean about the fact that she wasn't happy that a) i hadn't been induced the previous week and b) my previous doctor had 'dumped' me on her.  she made it very clear that despite the fact that the baby passed the non-stress test again at 42 weeks, i should have been induced the week before.  her advice was that i should go into the hospital that night to be induced, although she said we could wait a few more days if we really felt strongly about it.  at that point, i felt like an induction was inevitable and decided to go into the hospital that night.  the good news was that i liked her better than my previous doctor and she was the doctor on call that night, which meant at least i would know who was going to deliver my baby.  

charlie and i spent the rest of that monday, december 19th, running errands and trying to keep relatively busy.  we gave the dogs baths, cleaned the house, i tried to nap knowing that i wouldn't get any sleep for a while, and charlie made my my 'last meal'.  we dropped the dogs off with a friend around 9 pm and headed to the hospital for our 10 pm induction.  once we got to the hospital, i met our labor and delivery nurse for the night (who i didn't like at all) and i was hooked up to an IV, a blood pressure cuff, and fetal monitors.  while, i was expecting all of the following once they started administering pitocin, i wasn't prepared for being hooked up to the monitors as soon as i went in.  i definitely was having a hard time because i knew that this meant that regardless of what drugs i would receive i was essentially bed bound.  they then gave me cytotec, which was supposed to ripen my cervix.  the plan was to give me 2 doses of the cytotec, each four hours apart, and then start pitocin in the morning.  the first dose of cytotec essentially induced labor.  i started having contractions about a half hour after the first dose and never received the second dose.  about an hour after contractions started the baby's heart rate dropped to about 60 bpm.  since i was on an external monitor, the nurse spent the next several hours in my room adjusting the monitor and then instructing me not to move.  they also put me on oxygen which i wasn't able to take off for the next 14 hours.  the baby seemed to do much better when i was on my right side, so i was told not to move from that side.  at this point the contractions were getting stronger and more frequent and being stuck in one position made it even harder to deal with them.  they were definitely a lot more painful than i had anticipated and knowing that i had at least 12 more hours of them was mentally exhausting.  

after about 8 hours, i decided that i wanted the epidural.  i know charlie was hoping i would do it naturally, but i was exhausted and only about 3 cm dilated at that point.  also, the fact that they kept losing the baby's heartbeat and dealing with not being able to switch positions was making them even more difficult.  when they came to do the epidural, i was having a hard time relaxing enough during the contractions so that they could actually get a needle in my back.  once they finally got it in it took about 3 contractions for it to completely set in.  i was expecting the epidural to dull the pain but i wasn't expecting it to completely take away all of it.  after a bit charlie would watch the monitor for when i was having a contraction and ask if i could feel it, and i felt nothing at this point.  the best part was that i could sleep a bit, however after the epidural they hooked me up to even more monitors, a pulse monitor, heart rate monitors all over my chest, my blood pressure was being taken every 5 minutes and the cuff got so tight that i literally ripped it off twice because it wasn't loosening. 

after the epidural, they were still having problems with the baby's heart rate.  it would be fine for a bit and then drop again.  previously, the nurse had been concerned enough that she got the doctor twice.  i remember telling charlie that i thought i'd end up with a c-section that night because the heart rate kept dropping.  instead, they kept adjusting the monitors.  at one point after the epidural, the heart rate dropped and then the monitors lost the hear beat.  within minutes we had 6 nurses and the doctor in the room and they were all frantically trying to find a heart beat.  at this point they ripped off the external monitors and inserted internal monitors.  after the internal monitors, they weren't able to find the connection piece to the machine and were all running around trying to locate the correct wire while there was still no way to track the heart beat.  at this point the doctor got pretty annoyed and i remember thinking that if i wasn't so exhausted i would have been a lot more worried.  they finally found the heart beat, but it definitely made me nervous.

when they give me the epidural they also started a pitocin drip.  however, when the baby's heart rate dropped again they had to turn the drip off since you can't use pitocin when there are any signs of fetal distress.  luckily, once labor started my body continued to have contractions and progress.  once i got the epidural i was progressing at about 1 cm an hour despite all of the other issues.  the doctor had basically told me that it was a race to see who would win first either my body (as in i would progress enough to be complete and start pushing) or the baby (as in it wouldn't be able to handle the labor any more and would have to be delivered via a c-section).  she also made it very clear that the reason that i was having all of these issues with the baby's heartbeat was because i had waited too long to be induced, therefore the placenta was too old and wasn't able to supply the baby with enough oxygen.  she told me that when i delivered she was betting that the placenta had calcifications all over it and even at one point came up to me and said "repeat after me: for my next baby i will schedule an induction at 39 weeks".  despite being out of it, i remember saying "39 weeks? that seems a little crazy".  the nurses all made similar comments to me about waiting too long to be induced.  let me tell you, there is nothing worse than being in labor, repeatedly watching your baby's heart rate drop, and then having the entire medical staff blame you for the drop in heart rate.    

despite all of the heart rate issues, i continued to progress and was at 10 cm around 11 am the next day.  the doctor water the baby out as soon as possible, but there was a small part of my cervix that was still in the way and it didn't recede when i was pushing.  they decided to give me another hour and see if it would disappear before pushing.  at this point i was feeling a ton of pressure, and despite the epidural it felt like the baby was coming out on it's own.  it had dropped really low at that point and i remember the doctor saying that she could actually see the hair on it's head.  after an hour the nurse came and checked me and found that i was ready to push.  unfortunately the doctor was delivering another baby at that time and since there had been so many issues with the baby's heart rate they didn't want to start without her.  at this point she left to get my doctor, the baby's doctor, and other staff and charlie started to flip out.  he was already nervous after all of the previous issues but was really angry that we were waiting on staff to deliver the baby especially considering she wasn't handling labor terribly well.  

when the doctor came in she told us that she thought the baby was going to have a difficult time during delivery and that we didn't have much time to get the baby out.  she also said that if the heart rate dropped again we would need to make a decision between having a c-section and using a vacuum delivery.  i opted for the vacuum delivery if everything else was still okay.  i pushed for about an hour at which point the baby was about to crown.  it's heart rate dropped right as it was crowning, the doctor grabbed the vacuum to use through those last few pushes.  the vacuum popped off at one point but the baby's head was essentially out.  once it's head was out they found that the cord was wrapped around the baby's neck 3 times.  the doctor cut the cord right away and blood went flying everywhere.  i pushed one more time and she came out.  they laid her on top of me for a minute while they rubbed her and hearing her cry was definitely reassuring.  charlie was essentially speechless, when he saw the cord wrapped around her neck and her face was all blue (something he didn't realize was normal) he thought she wasn't going to make it.  the nurses had to tell me that it was a girl before he recovered enough to talk.  they took her right away and monitored her for a bit.  despite the cord issues she was fine, and had apgar scores of 7/9.  they finally gave her to me and told me her stats:  19.5 inches and 6.0 pounds.  she weighed less than i was expecting, but for some reason was bigger than i was expecting.  

as it turned out my placenta was just fine.  the reason for her heart rate dropping consistently was the cord that was wrapped around her neck 3 times.  we delivered at a pretty small hospital and it was clear that this was a big deal to them.  i had doctors and nurses coming in and talking about how they heard all about her delivery.  

i am so thankful that she was born healthy.  the combination of sleep deprivation, drugs, and being hooked up to so many monitors was so overwhelming that i didn't really realize how scary the situation was until after she was born.  on one hand it's a good thing because it meant that i was relatively calm during the whole process but it's also scary looking back and realizing how serious the situation was.  

a few other things:  

1.  i am very thankful that i was able to have a vaginal birth.  despite the epidural i was up and walking that evening and never took anything aside from motrin for the pain.  also, at two weeks postpartum i'm cleared for any type of activity and feel a hundred times better than i did when i left the hospital.  

2.  during labor they pumped me so full of fluids i left probably weighing more than i did when i came in.  because of the epidural and the baby's heart rate they ran fluids into me really fast trying to keep my blood pressure up (which was never a problem and keep her fluid levels up).  by the time she was delivered they had given me 7 bags of fluids.  during the delivery my feet were so swollen from all of the fluids i couldn't even bend them.  in fact they were more painful that night and the next morning than recovering from the actual delivery.   

3.  i declined the flu shot this year, just like i do every year.  there are many reasons for this, but in addition to the usual reasons there was an article that came out that showed that this year's vaccine had much higher levels of mercury than other years.  i figure that's a good thing to avoid all of the time but especially when i'm pregnant.  everyone at the hospital was asking me about the vaccine.  my doctor, avery's doctor, each nurse that i had (7 shifts), and each nurse that avery had.  i wanted to make a sign for our door:  "yes, i declined the flu shot.  yes i know what it does.  no i don't want to get one now."

despite everything we ended up with all we really cared about: a healthy baby.  yes, i think i'll probably look for another doctor.  i definitely don't think that the way i was treated regarding when to have the baby was professional but more than that, i was being blamed for a decision that was essentially recommended to me by a partner doctor.  i also think i'll look for another hospital.  the one we delivered at was fine, and i really liked the majority of the staff, but it did seem like they couldn't get their shit together when it actually mattered and ideally i'd like to deliver at a larger facility that sees some of these things more often.  i realize it's not that common to have the cord wrapped around her neck three times, but the fact that we were being 'talked about' makes me think they don't see these things very often which also means they're probably not as good at dealing with them.  but the bottom line is that we're both healthy and happy and right now, that's really all that matters. 

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