Wednesday, July 17, 2013

What Happens When Your Water Breaks and You Don't Deliver Within 24Hours: Part 3: Birth Story

"This birth is cursed!" I announced after hanging up the phone and then commenced sobbing dejectedly. Almost three whole days since my water had broken, and I STILL wasn't in labor. Less than twelve hours and I wouldn't have a single study to back up that my baby was not really at risk. Three days of believing in my body and that all I needed was time and good energy and thoughts and my body was still letting me down! Now, I call our doula to let her know we were going to the hospital (the drive of shame I called it nastily in my head) only to find out she had just fallen and possibly broken her ankle. (No way she could drive or be on her feet for my labor all day.) Because she's an amazing professional, she'd already arranged a back up doula to cover us, but the thought of having another stranger there to witness my possible failure (my chances for a successful vbac were about to be a bit decreased by the introduction of pit at the hospital), was too much. I just couldn't stomach having a stranger there. (Now I kind of wish we had had her there for the pushing stage, but hind site is 20/20 and who knew that alone would last over four hours?)

The hour and twenty minute drive to the birth center seemed like an eternity since I wasn't in labor like I had planned to be on the drive. For someone who had worked really hard to not be "in her head" so much this labor, having almost three whole days to do nothing but think and wait had been agony. Because my natural coctractions were so strong, I went ahead and sat in the back seat so I could kneel or squat whenever they hit, but my last minute hope that active labor would just strike like lightening during the car ride was not to be. We arrived at the hospital, went up to the birth center floor, and went directly to triage, a place I had sworn I would skip because I would be in such advanced labor before I even left the house, where I was tested to see if the fluid really was amniotic even though it had pretty much stopped flowing over twenty four hours before (we think it was a high leak and the baby moved to block it). It was positive (duh!). I was an emotional mess. I cried before the midwife and midwifery student even had a chance to get more than "hello" out. My heart rate was high because I was so upset. (Once I did some hypnotherapy on myself it dropped right down.) I felt humiliated and like a failure. Suddenly, having another c-section and a hysterectomy no longer seemed like far off possiblities. I kept most of those fears to myself and tried to dispell them as best I could.

Something I am grateful for is the completely non-plussed attitude the midwives had about how long my water had been broken. While my OB during my last birth had panicked because it had been fifteen hours since my water had broken and my contractions were steady, but I was not in completely active labor, my midwife took for granted that my body was fine. I had no signs of infection. My baby showed no signs of distress. No cervical check was done. Just the swab for the amniotic fluid and that was all. In my distress, I had even forgotten my birth plan, but my midwife had already scanned in a copy, so they just printed one out from their computer. They were also very respectful of me. They not only got me into a tub room and found me wireless monitors (I was only being monitored because of the pit) so that I could be as active as I wanted to be and get into the tub when I was ready, but they also found me a birth ball and gave me a chance to eat a meal before hooking me up to pit.Normally they encourage mothers to eat as much as they feel they need to during labor, despite hospital policies to the contrary, but when on pit, it's clear liquids only. At every turn, whenever they knew they were veering off my birth plan, they apologized and made sure that I gave the final okay for everything. It was made clear to me that although the circumstances of my birth were not as I had planned, this still was my body and my birth. I felt safer being treated with so much respect. I remember a moment when my husband left the room to check on our son and the nurses left the room to get something before finishing hooking up the pit and I could almost hear my heart beating out of my chest and the waves of shame that I was going to "need" pit to have this baby washing over me. I decided in that moment that there was no more room for shame or for fear in this birth. I actually decided to "bless" the pit and let it know what I did and did not need from it before it could enter my body. It felt a little silly, but equally important because I wanted to feel in control of my birth again. So, I said a quick prayer and then I said, "Okay, pit. I just want to let you know where we stand. I know that I cursed you as an enemy in my last birth, but you are going to help bring me stronger contractions so that my baby comes to me a little more quickly and for that I thank you. For every wave of pain you send my way, I will thank you until my baby is in my arms. You are here not because I am broken, but because my water has broken a bit early. I do not need you, but I welcome you. You will not give me contractions that are too strong for me, because I am stronger than you. My body gives you your power and it will give me my baby. God is with me. You will not over power me."

They then hooked up the pit and because I am a VBAC, they told me that they would use very minimal doses and up them every half an hour or so until I was in active labor. It took two hours and four doses before the "pit" contractions became anywhere close to my natural contractions that were still occurring randomly. My husband and I walked together around and around the circular birthing center, and as I walked the contractions got stronger and closer together. I tried to teach him how to give counter pressure on my hips during the contractions. After three hours on pit, the contractions were two minutes apart, were lasting at least a minute each, and were powerful enough that I needed to vocalize to get through them (they would continue at this pace for the rest of my labor . . . another twelve hours). The wireless monitors were also running out of juice, so we had to return to the room and I sat on the birth ball or got into different squatting or all fours positions to get through the contractions. It was at this point that the midwife shift was about to change and the midwive coming on was none other than *my* midwife. The midwife I had seen exclusively at her one day a week shift at the location closest to where I lived (about 45 min from my home). I was so glad to see her, I almost could have kissed her. She was the one thing that seemed to be exactly right. After she came on shift, I requested my first cervical check, just to see if I was far enough along to get into the tub. She checked and I was at a four. A four!?!?!? A four. I know women who get to fours without ever feeling a contraction and here I was drowning in powerful ones and I was only at a four. Not even half way there. My labor still felt so fragile at that point, so ephemeral. My VBAC in general seemed so illusive I couldn't stand it. I had wanted to feel the power of my body, to get caught up in birth, but despite the power, intensity, and regularity of the pit contractions, I still felt that at any moment it all could be over and I could find myself in surgery. The perfect trust I had had in my body all during my pregnancy had been shattered by my days of waiting after my water broke. In fact, I had received a text shortly before going into labor in which a well meaning loved one had meant to assure me that the birth that needed to happen would happen and that I should not hold myself to blame for whatever did occur, but the words that had been used were "some women are just broken and need help in birth." The word "broken" just reverberated in my soul. When I heard I was only a four; I heard that word "broken" repeating in my ears again. I started crying. My husband couldn't understand what was wrong; my midwife couldn't understand what was wrong. My doula who continually kept calling to check on us and was a nervous wreck waiting for news told us that the first four centimeters are always the hardest. Still, I pressed on, but fear had started creeping back in. It wasn't until about twenty to thirty minutes later, that something happened that forever changed the trajectory of my birth and made it possible for me to have a successful VBAC despite the obstacles and challenges that were still to come.

I was sitting on the birth ball, breathing and vocalizing through my contractions. I was using an "ahhh" sound this time to relax the back of my throat and the sound that came out actually became (through no direction of mine) a bit of a song. I would sing my way through my contractions for most of the rest of my labor. Suddenly, I felt the baby drop and shift just a tiny bit and I felt pressure in the back. I knew that I was not far enough along to push yet, but it was a sensation that I had never felt in all 29 hours of labor with my first child. Suddenly, right in the middle of a hellishly strong contraction, I found hope. I felt that bit of pressure and I thought, that's it. That's the right position. This is new. This is different. This VBAC is going to happen. That was the moment that made it all possible. Come what may.

Just an hour or so later, I started showing signs I was in transition and I moved into the large birth tub to help ease the pain. There I sang through every contraction and sniffed lavender and other essential oils my midwife prepared for me. I also drank some raspberry leaf tea. From here on out, I become pretty unsure of times, but I probably entered the tub around 9 or so and exited a little before midnight. While I felt pressure, I still did not feel it was time to push quite yet. My midwife eventually asked if I was willing to leave the tub and give another position a try. I tried laboring on all fours in the bed, but the midwife suggested maybe I should try lying on my side and rotating from side to side every other contraction. I think she wanted to get the baby in a little bit better position and it must have worked because fairly soon I did feel pressure to push. At some point, she had checked and I was at 9 1/2 centimeters which it felt awesome to hear because that was further than I had gotten in my first birth. Laying on my side had really hurt, but it seemed worth it. (I would not feel that way the next time I was on my side.) Feeling the need to stand I got up from the bed and tried leaning against my husband and the nurse, but when the next contraction hit, I found an urge to squat through the contraction. The midwife suggested making my song's notes go lower more like grunting to help power the energy downward. She suggested I go ahead and try a push if that's what I felt like doing. (I did!) Pushing felt amazing. It was such a relief to work with my body rather than against it. Because it was not yet midnight, I foolishly dreamed maybe I would only need to push a few times and the baby and I would share a birthday. Alas, that was not to be.

After a few pushes, my midwife got a little bit of a worried look on her face and said she thought I migh
t have a cervical lip, so she tried to hold it out of the way during the next push, but it was stubborn. A veteran of over twenty five years, she seemed like she knew what she was talking about so when she told me that it seemed particularly "spongy and stubborn" and that I should stop pushing and lay down, I listened to her. In my first birth, I had reached a dilation of 8.5 and then after bearing down too much, too early I had started undilating and had ended up with my ceasarean. I did not want history to repeat itself. I had come to far to do that again. So, I consented to laying on my side again this time with my legs closed and rotating some more to keep the baby in a good bithing position. I have been through a root canal, I have had two molars pulled with only partial pain relief, I have been through (a collective total of both of my births) over 30 hours of un-pain medicated pit labor, I have gone through two abdomen surgeries (a c-section and gall bladder surgery) with no pain medication after the initial surgery except ibuprofen and tyenol and I have never felt pain like the pain I felt lying on the bed after pushing. To fight to relax my body after being able to work with the pain of the contraction was incredibly painful and holding my legs together felt impossible. I felt like my body was going to shake apart from the strength of those contractions. Adding to the misery, there was absolutely no respite from the pain. In between contractions, because of the position of the baby I was in a solid block of pain that was only intensified during a contraction. The best way I can think to describe it is being stabbed by a knife and then having the knife almost slid out to relieve part of the pain, only to have it plunged back in. I shudder thinking about it now, four months later. It was at this time, I finally broke and started crying. I just wanted a short respite from that pain. I didn't think I could continue without some sort of a break, but here's the thing. I did. It was bearable. Even though, in the moment, I was afraid it wasn't. It was. I was stronger than that incredible pain.

Finally, I felt that if I didn't push I was going to die, that the contractions would simply break me in half and my baby would come out that way. I begged the midwife to let me push and she offered to check, but I could tell by her voice that she didn't think my cervical lip was gone, but to her surprise, it was. She told me on the next contraction to push. I was so relieved. I glanced at the clock and realized that it was past midnight. The baby had chosen to wait for his own birthday to be born. I had been on pit about 11 hours. The nurse and midwife installed the squat bar over my bed and with the next contraction I pulled myself up and pushed. Although it hurt, it felt much, much better to push. As the baby squeezed low under my pelvic bone, my hips began to burn like nothing I had ever felt before, but then the baby would slide back. I would push into the pain and then the baby would slide back, peek a boo. The midwife helped me learn how to direct my pushes so they could be more productive, but still the baby was not coming out. This went on for hours. I want to note that I was not panicked. I was not under the impression that I could not do it. With every push, I felt like this was the one that would get the baby's head out, but each time, it wasn't.
After awhile, I noticed my nose felt runny like it sometimes did when I went to the gym and I was a little embarrassed about that, but since nothing could be done, I just pushed through it. I noticed my husband starting to look worried, and I tried to be reassuring, but that was hard when all my real energy was on pushing. I noticed drops of blood all over the bed and thought it was from the pushing, but I learned later the blood was from my nose. It turned out that every time I squatted to push, my nose would gush blood. When the midwife (who was going between rooms because another mama was pushing as well) returned, she told me she wanted me to lay down to push for awhile, but didn't tell me that it was because my nose was bleeding so much. I would lay to push the rest of the time. (This is VERY unusual for my midwife practice, but was done simply because of the stress I seemed to be under vertically.)

I am uncertain exactly how this next part happened, but eventually I realized I was having a lot of trouble breathing. My lungs felt really tight and no matter how deeply and slowly I tried to breathe there was never enough air. I was so focused on living push to push that the sensation sort of snuck up on me. It was a little surreal because I was too focused to even panic about it. It took me a long time to even vocalize that it was happening because the two twin goals of pushing and breathing were so all encompassing that it was all I could do to keep up with them. Talking was too difficult. The midwife and the nurse could tell something was wrong, though, my heartrate was going up and my oxygen (although it stayed pretty high) became a little erratic. Eventually, I was put on oxygen, but that did little to help. I remember just feeling completely washed in the sensation of drowning; I was lost in a sea of pressure, pain, and pathetically little air. I became aware that I was becoming very foggy. Again, I did not panic, the sensation as strange and horrible as it was had something familiar about it that I couldn't put a name to with all my focus on getting the baby out. I began to wonder if I was going to be able to stay concious, fighting for every breath the way I was and struggling to stay aware. Still, the siren song of the need to push kept calling and I was powerless to resist. Even when my midwife began to tell me that I was pushing too hard and I needed to take every other contraction off from pushing, my body just could not obey. My contraction would come and my baby would call and my body would push, with or without my help, so I would take the deepest breath I could and I would push myself as hard as I could because to do otherwise would have been to waste what precious energy I had left and I, even in my foggy, dissassociated state, knew that I would run out of energy eventually. The only point where I did get a little panicky happened after what I guess was a particularly hard push in which I had a very brief break with reality and momentarily lost where I was and what I was doing. I remember looking around and thinking: where the heck am I and what in the world is going on? I think I may even have attempted to say it outloud because I remember seeing everyone look at each other really concerned. I thought at the time I might have passed out and came to quickly, but eveyone present swears I was awake the whole time. Fighting to breathe and fighting to push, I was in no position to argue with anyone if someone had said that a repeat cesarean was necessary. I was completely at the mercy of my provider. Looking back, I am very happy that I was so picky and insistant about finding a provider I believed in and who I thought would support and believe in me. As much as I wanted to be powerful, in charge, and independent during my birth, my breathing difficulties and my fatigue made it impossible. I told myself that I was going to push on and on and on and on until I had a baby in my arms or I passed out and woke up in an operating room. I could not assess which would be my outcome, but my midwife saw strength and resiliance in me that I could not see in that moment. She saw me as a powerful woman facing only seemingly insurmountable trouble and she told me I could do it. I couldn't even hear her voice, but I knew she was in my corner and had not lost faith in me. So, on I pushed and pushed and pushed. Each time amazed that I could still rise to the contraction's call even as the air seemd to grow thinner and thinner. (The baby's stats remained strong throughout no matter my distress level.)

Sometime later (an eternity? an hour? two?), the head was finally emerged enough that I could touch it and remembering I had expressed a wish to do so, my midwife encouraged me to feel my baby's head. She had what seemed like an endless supply of hot evening primrose oil and it seemed to me that she was doing everything she could to preserve every micrometer of progress I made with my pushes. A few pushes later, she told me that if I wanted it, she would perform an episiotomy just to help me get the baby out faster. She stressed that it was my choice and she was only offering it because I seemed so distressed. I told her "yes." Anything to make this eternity of airlessness and pain come closer to an end. (I learned two days later that it was only the second episiotomy she had ever performed in over 25 years of being a midwife and the only one she had performed because the mother seemed distressed.) She performed it and the very next push my son was born. Although I had always been told the shoulders were the worst part and the ring of fire was something to behold, both sensations were nothing compared to the pain of laying on my side trying to get rid of my cervical lip or the burning my hips felt as I pushed the baby out. In fact, I never felt the shoulders at all. As soon as the head was birthed, I did not need to push again. The baby fell out and was quickly placed on my chest. Although he would remain there only seconds as we both breathed raggedly, stunned to finally be there, it is a moment I will never forget.

It was at this point that we veered yet again from my birth plan and the baby was whisked to a pediatrician who had been called in because I had been in such obvious distress while pushing. His umbilical cord stopped pulsing mere moments after birth and as soon as it was cut, he was taken over and examined in the incubator. My breathing was becoming easier, but I could hear that his cry was strange and his breathing seemed "off" somehow. I birthed the placenta without even pushing and as the midwife stitched me back together, the pediatrician on call (our doctor was back in the town where we lived almost an hour and a half away) came over with my still crying baby and told me that the strange cry I was hearing was because my baby might not be "tolerating the conversion to gas oxygen well." He thought that the best course of action for the time being would be for me to give him lots of skin to skin and to suction him as much as possible. He would return in an hour to check the baby's progress unless the baby seemed to get more distressed in the mean time. He encouraged me to nurse whenever the baby seemed interested and ready and that he would not take the baby from me and into the NICU unless he got worse. It seemed that there would be no respite from worry in this birth.

However, an hour later found the baby still crying, freshly nursed, but breathing better. Another very thorough sunction from the pediatricican and I finally saw my baby at peace. We lay together, skin to skin, heart to heart, battered lungs to battered lungs, both a little shocked, amazed,and thankful that we were there, together, and still breathing. Exhaustion washed over us both and we slept.

Two days later, it hit me why the sensation was so familiar. My struggle breathing had been an asthma attack. Because of the noise of the baby's monitor and, later, the whir of the oxygen tank, no one could hear the tell tale wheezing of my lungs. Having an asthma attack while in labor is exceptionally rare; less than one percent of asthmatic women ever experience it. Yet another crazy statistic in this crazy birth. I talked to my midwife about it and she was relieved to hear what had happened had an explanation. She felt awful for not recognizing the signs for what they were, but she had never experienced any patient having an asthma attack during labor, either. "Next time, if there is a next time, I'm going to put it in your chart. Puff and then push". I couldn't agree more.

There is line from a Margaret Atwood poem that ends "I don't want this/but I want this also." In the hours and days after my second son's birth, those lines haunted me. After I looked up the poem, I realized why they haunted me, although the poem is ostensibly about the love the speaker has for her lover whose body has been broken. I realized that it perfectly encapsulated how I felt about my body after birth. I was not the birth warrior/goddess I had always thought I could and should be, but I did it anyway. I was adequate and adequate was all we needed. I don't love this story I have written for you. I wanted something different. It is not full of power and self assurance and victory the way I imagined it would be, but I love and want this also because it is the story of how my son came into this world and how I birthed him with my imperfect body that was still enough.

Final Stats: 
Second baby boy born 82 hours after water broke
7 lbs 8 oz
20 1/2 inches long
On his due date the day after my birthday,
5:11 am March 10,
15 hours after pitocin introduction

Thank you for reading,


Vanessa said... [Reply to comment]

Thank you for sharing your birthing experience and congratulations!

Shawna said... [Reply to comment]

Thanks, Vanessa!

NatalieAE said... [Reply to comment]

Wow, what a powerful story of perseverance and strength! Don't sell yourself short on this one, momma. You have the right to not love it, but I'm in awe of your achievement!

Jenna Bouchard said... [Reply to comment]

Wow you ARE a birth goddess & warrior. I've never heard a tale of someone fighting so hard as your birth story. It will be in my heart as I prepare for my second birth, coming up in a few weeks. My first son's birth was very difficult for me but your story is an incredible illustration that we can make it through anything for our babies.

Shawna said... [Reply to comment]

Thank you, everyone! I hope everyone achieves their desired VBAC. The recovery difference alone is worth it. I just hope that everyone's goes more smoothly!

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