Ramona: A labor of labor

...also love, but mostly 23 hours of labor.

Now that I've had a chance to do crazy things like take a shower and eat a complete meal, it seems like it's time to share the birth story.  This post is all baby, no food, and potentially gross depending on whether or not you tend to get the vapors about things that involve bodily functions.  (Interesting aside: apparently only women could get the vapors, because having a penis totally means that one is immune to hysteria. ::insert eye roll here::) Moving on... This is quite long and almost more for Colby and me so that we can remember this, but I wanted to share it here.

I suppose we should start this story in the beginning.  My blood pressure started to increase towards the end of the pregnancy.  My OB noted this and was mostly okay with what they were until it started to rise towards the 135/85 level.  Combined with the fact that I no longer had ankles, I had been getting headaches, and was excreting protein in my urine, it all pointed to pregnancy-induced hypertension.   This is just a fancy way of saying that I was getting pre-preeclampsia.  My pregnancy troubles actually began even earlier, with pregnancy-induced insulin resistance (aka pre-gestational diabetes).  Gestational diabetes and preeclampsia both warrant an early induction.  Even though I didn't technically have either one, my super anti-intervention OB team and I decided that my body was pretty much done with being pregnant and that I should be induced at some point during the  39th week.

We still wanted to do this as intervention-free as possible.  Colby and I had taken a Bradley Method course , which very strongly emphasizes natural birthing and the use of relaxation techniques instead of drugs and procedures that lead to unwanted outcomes like c-sections and vacuum extractions.  One of the least invasive ways to induce labor is to do a membrane sweep, which consists of a doctor inserting her finger in the cervix and lifting the amniotic sac off of the cervix.  This releases oxytocin, the multi-purpose hormone that helps the uterus to contract during labor.  I went in for a membrane sweep on Monday February 27.  My blood pressure was on the high side, though not technically at preeclampsia levels, so my doctor sent me to labor and delivery to be monitored and possibly induced right then.  Fortunately my blood pressure went down and I was sent home on orders of modified bedrest for the rest of my pregnancy.  The induction was scheduled for the next day for many reasons, not least of which naively included avoiding a leap year baby. 

those peaks on the bottom plot are contractions

After a rather sleepless night, we made it to the hospital at 6:30 the next morning and by 8:45 AM, the doctor broke my water in the hopes that it would jump start active labor and finish dilating and effacing my cervix.  After that, we ate breakfast and started walking the halls in hopes of making the contractions work better.  Every half hour, a nurse came in to monitor the fetus, my contractions, and my blood pressure.  Around noon or so, my contractions became a bit more regular and a lot more painful, but I was using the Bradley relaxation techniques to get through them.  Unfortunately, my blood pressure continued to rise, so I was confined to the room so as to not increase it.  After a couple hours, the contractions got much stronger and my ability to relax through them greatly declined as my blood pressure steadily rose.  It didn't help that my uterus hurt between contractions as well.  They checked my cervix again and I was only dilated to a 6 after hours of pain.  I kept scream-crying through the contractions for another hour or so when the doctor checked again and found that I was only dilated to a 7.  At that point, my blood pressure was in the 150/90 region and every time I had a contraction, it was worse.  We started to talk about pain management because every time I had a contraction, my blood pressure went scary high.

I opted to take fentanyl, a fast-acting narcotic that would "take the edge off" the contractions.  It definitely worked right away and my blood pressure stabilized.  The downside was that it only worked for about an hour before the painful contractions started up again.  Fortunately, it can be taken once an hour, so I got a second injection.  It turns out that repeated use of the drug makes it less effective, and this one only lasted about 30 minutes before the scream-crying started again.  At this point, Colby may or may not have been punched in the stomach for saying, "It's okay, you can do it" one too many times. *ahem*.  I got a third injection which worked for about 15 minutes and then when my blood pressure reached 175/115, the jig was over and we needed to do something a lot stronger for the blood pressure.

My doctor offered the option of magnesium or an epidural.  Magnesium works to regulate the blood pressure, though it offers nothing for pain. It also has a whole host of side effects and requires you to have a foley catheter inserted after birth in order to make sure it all gets excreted through the urine, or else other complications arise.  The epidural, aside from pain relief, also works to lower the blood pressure.  At many hospitals, the amount of medicine administered makes it so that the blood pressure drops too low or the mother can't effectively push through contractions.  This often leads to c-sections and is one of the biggest reasons why I didn't want one.  Also, the idea of someone dicking around in my spinal cord isn't the happiest idea ever and things like epidural headaches that last for weeks and paralysis aren't high on my list of things that I'm okay with.  However, something needed to be done about my blood pressure and pain relief was an added benefit.  The biggest immediate downside I faced was that I had to remain in the bed, though at that point, I couldn't really move anyway from all the pain.  They catheterized me, but took it out before the pushing stage.  The doctor made Colby sit down so he wouldn't faint.  Apparently some people pass out from watching.

After a couple hours, I started getting a headache and my nurse gave me some tylenol.  I could still tell when I was having contractions, but they were no longer painful.  My blood pressure was dropping and it seemed like things were going well, but I still wasn't dilating as quickly as they'd hoped, likely because my uterus was tired.  My biggest objection to pitocin is that it can make the contractions way more painful and that sometimes causes people to get epidurals.  Since I already had the epidural, I was on board with speeding things along because at that point, it was late and I still wanted to avoid the leap year baby.  Midnight passed and it seemed like that wasn't going to be an option.  The nurse took my temperature and saw that I had a mild fever.  Since I had taken tylenol earlier, it masked what was likely a higher fever from an infection called chorioamnionitis, which is an infection of the fetal membranes and often happens when your water has been broken for a long time.  It's easily taken care of with antibiotics, but the biggest risk is that it can be passed to the fetus.  Because of this two things needed to happen: after birth, the baby needed to be taken to the NICU for her own course of antibiotics and evaluation and I needed to progress to delivery soon or else we'd have to start talking about c-sections.

After upping the dosage on the pitocin (and the epidural), I was finally dilated to 9.5 cm, with an anterior lip, meaning that my cervix was unevenly thinned.  At this point, we were also afraid that she was going to come out "sunny side up", but the doctor I talked to the doctor about having her do some magic while I pushed and she agreed.  We wanted to try to get my cervix to fully dilate and make sure that the fetus wasn't under stress, which was starting to happen.  Around 6:30 AM (24 hours after I arrived at the hospital), I started pushing and managed to get my cervix ready and the baby turned.  They were a bit concerned because the fetal monitor showed that the heart rate was high, but then they realized that it was MY heart rate that they were monitoring, which was higher than the baby's.  I pushed for 30 minutes and at 7:00 AM, we welcomed Ramona Dolores into the world.  I was pretty dazed and was adamantly demanding to breastfeed, until someone pointed out that she was still attached, via umbilical cord, to the placenta and that it was still inside me.  Colby cut the cord, she was placed on my chest, and I tried to breastfeed and generally spend time with her for her first hour of life.  She was then taken to NICU to be evaluated and then administered antibiotics to ward off any infection she may have caught during labor.

in the NICU

Meanwhile, I knew that something was wrong with me.  It turns out that I began to get "red man syndrome" from the vancomycin they administered during labor for the infection.  Somehow, they gave it to me too quickly and my hands were burning and my face began to swell.  Eventually the swelling subsided, I was taken from the delivery room to the normal room and then FINALLY allowed into the NICU to see the baby.  I got to feed her for real this time and hold her while not in shock.  It was quite surreal.

In fact, the entire experience has been surreal.  I'm not sure if this is from all the postpartum hormones or the lack of sleep.  Things definitely haven't gone the way that I imagined they would, but we're adjusting and growing together.  The goal of the Bradley method is to have a healthy baby and a healthy mom and aside from some jaundice that lingered a bit longer than we would have liked and a contact rash from the tape they used to hold the epidural in place (seriously, what the hell?), that was our end result.  Thanks to everyone for the well wishes and support!