Tuesday, June 24, 2014

Birth Story #4: The Scholar

Our fourth son was born on Monday, June 16 at 9:26 a.m. after about 12 hours of labor, at 39w1d or 39w5d gestation (depending on whose due date you like best). He was eight pounds, eight ounces, 19.5 inches, and had an unbelievably full head of hair!

So I almost went into labor at 36 weeks, but didn't. By the time 39 weeks rolled around, I was finally starting to get a little antsy. I was in quite a bit of pain, most of the day, as is normal for me at the end of pregnancy (and probably most people? I don't know, no one else I know seems to complain as much as I do). Baby was in a posterior lie, which meant that my belly button was being stretched to hitherto unknown dimensions by little feet. My blood pressure had been slightly elevated at my most recent prenatal visit. And on top of the physical distress, we had scheduled my induction for 10 days hence at my most recent prenatal visit. This was, of course, accompanied by the threat that "if anything else happens or your blood pressure hasn't improved by next visit, we're going to move that date up." So I was really anxious to go into labor spontaneously and avoid the somewhat more painful and difficult process of a pitocin induction. (So helpful to be anxious when you're blood pressure's already high).

On Father's Day, we had one of my husband's friends and his family over for dinner. The two other times I went into labor spontaneously, we'd just finished a nice, relaxing meal, so I secretly hoped that might happen this time, too. And sure enough, we got cleaned up, I sat down, and I started to feel contractions that were...different. Unlike other episodes of contractions I'd had in the last 6 weeks, these were more consistent. They were more frequent. Some of them were longer. No matter what I did, they didn't go away. But I could also tell that we had a little bit of time, because they weren't yet especially painful - only a short twinge of pain in the middle of some of them. So I told my husband I'd lie down, and if they didn't go away, I'd like to go to the hospital as soon as possible. They didn't go away, so we went to the hospital. We even got through the intake procedures this time, and I received my first dose of IV antibiotics for GBS positive results from the 36th week of pregnancy.

On the way to the hospital, I was making a great effort to be calm and relaxed. I was making a great effort not to give into the fear and anxiety which childbirth often inspires, but I just couldn't quite shake the fear of what I was about to undergo. I made mention of this to my husband, and he said, "That's completely natural. Even Jesus asked for a way around the pain He knew He would suffer during His Passion. There's nothing wrong with that fear. Perfection is submitting to God's will in spite of the pain." That consoled me. I continued to pray "Thy will be done" throughout all of labor, knowing that in God's will, childbirth almost always includes pain. But love is often proved in pain, and I knew how much I loved this baby. As St. Maximilian Kolbe said, "Let us remember that love lives through sacrifice and is nourished by giving. Without sacrifice, there is no love." So I was mostly able to maintain peace throughout the night with this thought in mind. Jesus, I trust in you, in spite of the pain. Thy will be done, even if it means pain.

Right around 4:30am, I was pretty tired for not having slept all night. The contractions were slowing down and becoming slightly less intense. My water had broken, but just a slow leak with each contraction. While I had been very relaxed and peaceful up until now, I began to lose my composure. I knew they would start to do things to move me along. And as I expected, my doctor came in and called for pitocin. Ugh, I thought. I could see some value in it, to get things moving so that I would have a baby before an infection set in or before I was even more exhausted than I already was. But I also sort of wondered if they left me alone, maybe I could rest and labor would go more smoothly when it resumed? Oh, well. My OB has often intervened when I wish he wouldn't, but nothing terrible has ever happened because of it. Jesus, I trust in you, even when it's not clear what the best way through this is. Thy will be done, even when I have to submit to someone else's judgment.

I received my second dose of antibiotics, and right about 7:30am, my husband mentioned to the nurse that things were starting to heat up. I noticed it too. I had progressed to 7 centimeters, and baby's descent was noticeable. I had also begun to have the dreaded back labor because of baby's posterior lie. I mostly suppressed the back pain by adopting the same position I have in every other labor: sitting up in the hospital bed with the back of the bed raised. I have done this four times now and I seriously cannot figure out how it is ever comfortable to do hard labor in any other position. The thought of having to hold my body up on my hands and knees, or squatting and making it more likely that the baby will just fall right out, or trying to actually use my legs to stand up? I keep waiting, thinking that one of these labors, I will find these activities or positions appealing, but it still hasn't happened yet. In any case, these new back pains were distracting, largely because I worried that it would affect the progress of labor. I know a posterior position from the baby can sometimes make labor stall, and I worried it would. Plus, I worried it be make labor more painful. But no...there's no energy for worrying about these things. Jesus, I trust in you, even if labor stalls. Thy will be done, even if it means this takes forever and hurts more than usual.

The nurse who came on at the morning shift change was pretty chatty. Some of it was helpful, some of it was not. She told us how bad parents don't vaccinate their kids. She was extremely pro-bottle-feeding (but not anti-breastfeeding? One couldn't quite tell). One thing we discussed was how, in my last labor, I came very close to not tearing, but I finally did when I pushed out the shoulders. I rushed that part because the attendants in the room during the last labor seemed a little panicked, and I picked up on their fear and pushed too hard. She told me she had learned about slow pushing from a doctor she worked for in Illinois, and she seemed very convinced that slow pushing would make it possible to avoid tearing. At some point she was telling us about the importance of Kegel exercises. Somehow it seemed either a little too late or a little too early for that conversation...For the most part, however, I avoided responding to her conversation, hoping she would get the message that I was doing some pretty hard work and would rather concentrate than converse. She didn't seem to pick up on the hint though, or she ignored it. Maybe she was nervous? No, probably not. But I can hardly stop talking most of the time, too, so I'm hardly one to complain about that particular fault. Just move on, she's just trying to take care of you. Jesus, I trust in you, even when the people you've placed around me are annoying the heck out of me. Thy will be done, even if it means overlooking the irritating habits of others.

At this point, I thought that perhaps I could will myself into a state of transition, the part of labor where you really think you can't do it anymore but you're actually almost done. I kept purposefully saying things to my husband like, "Wow, this really hurts. I'm not sure I can do this much longer." But apparently he saw right through it, and a little part of me knew I wasn't really there yet, too. At some point, though, it really did hurt so much that I was beginning to suspect that I might not be able to handle it. That was the unfortunate moment when my doctor walked in and checked my cervix, only to pronounce, "she has more work to do." Terrible, terrible words for a psychological moment in which I was tottering on the edge of losing it. I was only 8 centimeters.

I swear, all my own efforts to will myself into transition failed but that one statement actually made it happen. Suddenly, I cried out in an almost involuntary way, "I don't think I can do this anymore!" The nurse asked me what I wanted, and I said, "I don't know." She offered an epidural, but that wasn't what I wanted. My husband said I didn't need one, and that made her mad. Secretly, I knew there wouldn't be time for one. I could tell my husband and the nurse were having a tense, silent struggle over the epidural. I didn't know what I wanted but I did want her to go away. She then offered to change my position in the bed, but I couldn't imagine moving my body enough to do that, either. Finally, someone offered ice chips. YES, SMALL BITS OF FROZEN WATER WHY DIDN'T I THINK OF THAT BEFORE?! OF COURSE THAT'S WHAT I WANT. Jesus, I trust in yougggghh...YOU DIED ON A CROSS, MY GOD, THAT MUST HAVE HURT.

I was, in fact, thinking in the mental equivalent of caps lock at this point during labor. And fortunately, the ice chips did just what I needed them to for the next two contractions: distraction. And as it turns out, I was right: there would have been no time for an epidural. I must have dilated a full centimeter with each of those next two burning, hurting, burning, hurting contractions. Then, with the third contraction, I started pushing because I couldn't not push anymore.

I informed them of the laboring-to-pushing change, but they were still having to tell me to slow down and not push when the next contraction came. Fortunately at least the medical student had his gloves on, and I'm pretty sure he was the only one ready to catch the little man's head. On the fifth contraction after I said I couldn't do it anymore, and about 6 minutes after I started pushing, our baby was all out! His lie had been posterior, but he twisted just enough during his descent to come out facing sideways. I can't say it felt all that different, except the part where my doctor had to dig around inside for the last part of the placenta (NB: the digging around sans epidural is still not more painful than labor, just a painful surprise after you thought you were finished with the most hurt-y part).

And you know how much I struggled with the minor irritations of our nurse? Well, in spite of all the things she said and did which got under my skin, I will always be grateful for the help she gave me at a crucial moment while pushing. She and I both remembered that bit of conversation we had about the doctor in Illinois and the pushing slowly. At exactly the right moment, some time during the two contractions when I was pushing, she said, calmly and slowly, "Remember what we talked about. Gentle and slow." It worked, and in spite of baby's awkward position and my difficulties in accepting her other advice, I experienced no perineal tear. Jesus, I trust in you, and I suppose the annoying people you put around me often benefit me more than my first impression suggests!

And since this is a blog about diabetes and natural childbirth, I suppose I should mention something about my diabetes here, too. Funny how diabetes seems to be less and less of an issue with each pregnancy I go through! My blood sugars were completely normal during this delivery, as they magically seem to have been during all of my labors. My blood sugars stayed in a pretty good range, even during my first and longest birth (30 hours). But I will note that the hospital staff has a little bit of trouble keeping track of what I'm doing. They basically let me do my thing, and they just ask me to tell them when I do something (check my blood sugar, give a bolus, or drink juice). I think we've all figured out that it's not a good idea to wait 10 minutes for them to come check my blood sugar if I feel low or worry that I'm going high, so it makes much more sense for me to just do it myself. But then they're not there when I'm actually doing my diabetes thing, and they forget to ask when they come back in the room. Owing to the fact that I'm in labor at that point, I never remember to tell them, either. So then their records are filled with holes about what my blood sugars were and when and how they got there and even though I'm 100% fine, they've got ants in their pants about all the information they don't have. This same pattern seemed to continue postpartum, too. I felt a little bit guilty about their confusion, but I decided that I have more than enough on my plate to make sure I'm healthy and push a baby out on the day of birth. I'm going to let them sort out how they want to maintain their own records from now on!

Baby had a basically healthy but very uncomfortable first 48 hours, which I will write about in another post. We came home last Wednesday. I swear he's the cutest baby I've ever seen, except for all my others. We love being a family of six!