I've been feeling pretty good lately, other than being hot beyond all belief. I know now why everyone kept telling me last time that I was "lucky" not to be pregnant during the hottest part of the year here. Trying to keep my body temperature regulated is a constant struggle.
So I feel like it's finally time to talk about this birthing thing on the blog. I know I've promised to talk about it as we got closer and now seems like the perfect time since I've just recently discussed it with my OB again. It's difficult for me to know where to start with this. I guess I'll start by explaining how I feel and where I've been and then we'll go from there.
With my first pregnancy, my approach to childbirth was pretty simple. I wanted to trust and listen to my body to the best of my ability. There wasn't one specific birth technique that particularly rang true with me. I knew about childbirth (I'm the daughter of a nurse who grew up seeing the videos they use to teach nursing students about birth). I took the classes about delivery offered by a local hospital. But beyond that my most sincere wish was to follow what my body wanted to do. A woman's body is basically designed to carry and birth a baby. I felt like that meant my body knew what to do and would tell me if I could just be silent enough to listen. (Note I said that women are "basically" designed to carry & birth, not everyone or every experience will be the same nor is there anything shameful or lesser in that. Bodies, just like people, are individual which is a beautiful thing.)
I wanted to try to have a regular vaginal delivery that was as natural as was reasonable for me. I know that I don't deal with pain well, so I was pretty sure some type of pain relief would eventually be required. However, I planned to wait as long as possible for this. The other prior knowledge that I went in with is that women in my maternal line quite often have difficult, problematic, or dangerous births. We had quite a family history of problems. This includes that we don't always react well to the drugs often given to progress labor. Knowing this, I made my midwife aware and we talked about what this meant for me as an individual. Now certainly I understood that a family history of problems did not mean I was guaranteed to have the same issues. But at the same time I think it's wise to be aware of those who have come before and what that might mean.
As a related issue, I felt very strongly that pitocin (a drug often used in the induction and augmentation of labor) was not a good idea for me. Part of this came from a knowledge that women in my family seemed to have an even greater degree of trouble when they were given this med. But part of it was just a deep, gut feeling on my part. It just felt wrong for me. Again, I made this clear to my midwife and thought we were on the same page about my birthing preferences.
A day or so before my child was born, I started having contractions. Contrary to what we often see on TV, labor is often actually a multi-day process. Women can start having contractions several days in advance of a baby being born. I spent a full 24 hours contracting at right about every 6 minutes for anywhere between 45 seconds and 1 minute at a time. The contractions were not the most pleasant thing I've ever experienced, but at that point they were not too bad. I could easily breathe and talk through them. I did have to pause at times while moving around, but mostly it did not interrupt my normal function (well, except that it made sleeping nearly impossible). I also lost most of my mucus plug. Because this is sort of on the edge of where they suggest you go to the hospital, I finally called my care provider's office to ask for instructions. I was a little over a week (early) from my due date, and wasn't overly concerned but still wanted to check. The nurse I spoke with wanted me to come in for a nonstress test (NST) to be sure that the fetus was handling the contractions well. I would have to see the OB on call in the practice, but I thought that would be ok since I was just going in for a simple NST. Unfortunately, the on call OB was the one care provider in the practice that I did not particularly care for. Rather than having me hooked up for an NST, the doctor decided to do a pelvic exam to check my cervix to see how dilated I was. Now that was an uncomfortable procedure. I'd had my cervix checked about a week before and was only about a fingertip dilated (that exam actually was not bad). (I'd also had my Group B Strep test, for which I was negative.) However, when this doctor checked me, it felt like someone was trying to drive a car up there. It was painful and awful. I was only dilated a bit further than I had been at my previous appointment. I also believe that he stripped my membranes at the time (something I was not asked about nor did I consent to). Stripping (or sweeping) membranes is a procedure that is sometimes used to try to bring on labor. The care provider uses their gloved finger (up through the cervix) to separate the bag of waters from the side of the uterus. The OB sent me home, as I was not dilated enough to worry about. The contractions would either pick up or they'd stop, he said.
So I went home. I lost the rest of my mucus plug. And the contractions did stop a few hours later. I was lucky enough to get some sleep (though not enough to make up for what I'd missed the night before) and went about my day as usual. I had a few contractions here or there, but nothing I worried about. Late that night, my water broke spontaneously. I must confess, I found this quite amusing. Generally, water breaking is not the spectacular event you see on TV where a woman soaks everything in sight. Because the baby is generally moving down (or has already moved down) as this happens, it is often more like a trickle or small leak than this huge flood of fluid. Many women don't have their water break until much later in labor. It's even possible to have a baby be born without the bag breaking. In my case though, my little one had not moved down (though he was positioned correctly). Because he was still quite high in my belly there was nothing to block the fluid from rushing out. So my water breaking was fairly spectacular. It should be noted though that I was actually not contracting at all during any of this. In fact, once my water broken, I did not have any more contractions on my own. My partner & I called the midwife, then headed to the hospital as instructed.
Things started to go a bit sideways at this point. They checked to make sure that it was indeed my water that had broken, put me on a contraction monitor, started an IV, and said that my midwife had ordered a drug called cytotec to try to help soften my cervix and for them to start pitocin at 6am the next morning. I was a bit confused about this, because I'd been very clear in my desire not to have pitocin. After some small discussion, I consented to have the cytotec (this is an off label use for the drug, by the way) placed though. They assured me that the only thing it would do was soften my cervix (making it more favorable to dilate). I wasn't sure and had some doubt in my gut, but hadn't actually done much research on that medication specifically (something I later regretted). The nurse put the pill up next to my cervix and left partner and I to sleep. Within 5 minutes, I started contracting. A lot. I was contracting something like every 2-2.5 minutes for up to a minute at a time. And these were painful, not at all like my previous contractions. I did the best I could, trying to allow partner to get a bit of sleep, but after a couple of hours I could not manage on my own anymore. I felt awful. In an attempt to move things along, we started walking the halls of the labor & delivery floor (between my constant trips to the bathroom). I found that I did not want to be touched or talked to during contractions. All I could do was hang on and breathe. I'll confess, I wasn't a terribly nice person during this bit...I may have been fairly nasty to several people who were just trying to help me.
The process just went on and on like this for hours. The next day, they checked my dilation and I was only like 2 cm. I continued to labor, becoming more and more exhausted and in increasing pain. Eventually, that afternoon, I asked for the epidural (earlier than I'd wanted to) because I simply could not handle anymore pain. I was so far beyond my limits. Again they tried to get me to consent to pitocin (sometimes an epidural can stall labor), but I continued to refuse. Eventually, I asked to be checked again and was only dilated to barely 4 cm after laboring all day. Baby was also still very high up in my body. He hadn't dropped down into position at all.
Around 4pm that afternoon, we decided to ask for the on call OB (who was my favorite from the practice) to come for a c-section. My midwife and several of the nurses tried to convince me to "just try" the pitocin. I still felt that it was wrong for me and continued to refuse. I can't say what would have happened if I'd agreed to it. Perhaps I'd have had a vaginal delivery, perhaps not. But I could not shake the gut feeling that it was a bad idea. By this point, I was also almost out of time "on the clock" to get the baby out. In hospitals here, it's common for laboring women to be given 24 hours after their water has broken to deliver before they consider it an emergency situation. I did not want an emergency c-section. If this was the way it was going to happen, I wanted it to be as controlled as possible. While the midwife was not happy about it, she called the doctor, who came to assess the situation and eventually did my c-section.
Shortly afterward, I was wheeled into the operating room. They topped off my epidural so that I would not feel the procedure, and my son was born. I won't say it was pleasant or easy or not scary. Somebody was cutting open my abdomen while I was still awake. But the end result was still a baby being born. I saw him, gave him a kiss, and then he went off with my partner & the nurses to be checked out while they stitched me up. I was wheeled back to my room and reunited with baby just a short while later.
I'll be honest, I've left out a lot here. Some I'm not comfortable sharing. Other things I know have been blunted by the years since I had my child. But there are a few things that I know. At my core, I know that my body was telling me that I simply was not going to be able to birth that child vaginally. Once my water broke, I did not contract on my own. The baby never came down and into position. And I felt, so strongly inside, that adding further interventions would be a bad idea. I've learned over the years that it is important to trust my instincts, to trust that gut...but in this area I failed to listen as well as I should have. Now that's not to say that I think medications or interventions during labor are a bad thing. I know plenty of people who have been given pitocin or used other interventions and had better labors for it. I would not, based on the evidence, advocate them as bad things for everybody. Just that for me, I felt it was not right. Also, I think it's important to mention that c-sections are not easy nor are they the answer to everything. A c-section is major abdominal surgery. This has some pretty serious risks. It's a scary thing. It's not an easy recovery at all. I wasn't able to get out of bed right away. Moving around was difficult. Recovery took weeks. Like anything else, I think all pregnant women should truly educate themselves about it.
So there you go. I'm a c-section mommy who advocates listening to one's body. I realize this can be seen as a somewhat controversial position and that there are those who would argue that I didn't listen because I ended up in surgery anyway. But it was what it was...it was my birth experience.
For this current pregnancy, I'm going to have a scheduled c-section at just more than 39 weeks (assuming I make it that far). Today, c-section moms do have the option (in many places) of trying a VBAC (vaginal birth after cesarian) if they meet the criteria and are a good candidate. For many many women, this is a safe, wonderful option. Just a few years ago, this was usually not an option because it was believed to be dangerous to have labor and a vaginal delivery after a surgical one. However, new research has shown the outcomes are actually quite good. In my case though, I don't want this. For a variety of reasons, but in part because I'm still a believer in listening to my gut instincts. They tell me that next time would likely be like the last time, and I don't want that. So I'll schedule my birth with my favorite doctor and that is how this baby will be born. After research and reflection, I'm making the choices that I believe are best for me and my body. That's all that matters.