On Sunday morning, March 15 (my predicted due date!), just past 5 am, I got out of bed to go to the bathroom. As I stood up and out of bed, I felt a gush of warm water leaking out. I paused like a deer caught in headlights and then said "Oh!" and realized that my membranes released. I told my husband, "I think my water just broke" and then I sort of half ran to the toilet because more fluid was leaking out. My husband got out of bed and I asked him to turn on the light in the bathroom. And then I saw that my amniotic fluid was filled with dark green meconium. I had learned about meconium by reading my books and in childbirth education classes and was disappointed to see it because I knew it meant more constant monitoring at the hospital. I called my doctor's office and waited for the midwife on call at the hospital to phone me back. While I waited for the midwife to call (about 25 minutes), I packed the rest of my hospital bag (slippers, pillow, etc.), updated my Facebook status (:-)) and got dressed. When I talked to the midwife, I told her about the meconium and she said that we should come to the hospital right away. We left the house around 6 am and I could feel some contractions starting. At my insistence, we first dropped by the library and returned all the videos I had taken out. We had a very easy drive to the hospital because it was early Sunday morning with no traffic and perfect weather and we arrived in the valet parking area around 6:30 am. We checked in at obstetrics admitting and given that we were already pre-registered, went directly up to labor and delivery. I sat in the waiting room in labor and delivery for about 10 minutes. There was one other couple there and the woman was apologizing to the receptionist because she was leaking fluid on the chair. I remember the receptionist saying, "Honey, don't worry about it. It's not the first time someone has leaked on that chair and it won't be the last!" A nurse then took me to my private labor and delivery room. I did not need to go to triage first (as we had learned on our hospital tour) because I had meconium in my amniotic fluid.
In the room, I changed into a hospital gown and the nurse connected me to a monitor (Intervention #1). One monitor was following my contractions and the other monitor was following the baby's heart rate. We asked for a telemetry monitor so that I could continue to move around and to jump-start my contractions, my husband and I took some laps around the hospital floor. About 40 minutes later, the contractions were getting very strong and painful and we retreated to my private room. The contractions kept coming and around 11 am, the midwife (Sophie) finally did an internal exam. They were trying not to examine me too much because my water had already broken and the risk of infection was higher. It turns out that I was only 1 cm dilated and the midwife couldn't even feel the baby's head. The midwife brought in the OB/GYN and they did a quick ultrasound to confirm that the baby's head was even pointed down. It turns out that it was pointed down, but he just STILL hadn't engaged. Knowing that the baby wasn't breech, I continued my labor process. I was shocked at how fast and furious the contractions kept coming. I had learned in my reading that you get a break in early labor, but I would have 3 contractions right on top of each other without any rest in between. The midwife suggested that I go into the shower and I took her advice and headed into the warm cocoon. I sat on a birthing ball and pointed the warm water on my abdomen. My husband sat outside the shower and reminded me to breathe and relax. I kept my eyes closed, but I could hear his voice and it was very reassuring. He told me later that he felt very powerless and unhelpful, but I couldn't have done it without him there. He also reminded me to tip back on the birth ball every now and then so that the shower drain could work. ;-) While in the shower, I got very nauseous and ended up throwing up twice into a white bucket. I remember thinking, "there goes all the cheerios I ate this morning" and I remember thinking, "I CANNOT believe I'm puking." Apparently, 50% of women in labor throw up due to pain and hormones. After 1 hour in the shower, I got out and headed back to bed. I proceeded to labor on my hands and knees and the nurse started an IV to help me with fluid retention (Intervention #2). The midwife performed another vaginal exam and I had gotten to 3 cm dilation and the baby had descended to a -2 position. This was at 2:30 pm and I had been laboring without pain relief for over 8 hours. I realized that it was going to be a very very long day since after 8 hours, I was only 3 cm dilated and at this point, I asked for pain relief.
I was trying very hard to avoid having an epidural and so asked for the Nubain shot (Intervention #3). I waited the 15 minutes they said it would take for it to be effective and when 20 minutes went by, I was very upset and felt ZERO pain relief. They said it would take the edge off the pain but it did nothing like that. I only felt just slightly fuzzy-headed but continued to feel EVERYTHING. I then broke down and begged for the epidural. My husband did not try to convince me otherwise - he could see just how much pain I was in - and we waited for the anaesthesiologist. It took what seemed like forever for them to arrive. I think once I broke down and made the decision to get pain relief, I wanted it to be immediate. The anaesthesiologist came in and started the procedure (Intervention #4). The worst part about all of this is that my contractions never let up. I didn't have any time in between contractions for them to do the procedure. So for 2 very strong contractions, I had to sit on the bed, staying still, and let the doctor place the catheter. It was very very very hard to do this. Prior to this, I was able to rely on changing positions and rocking to help me through the pain. But I could not do this while the doctor was near my spine. So the midwife held my hand and my husband held my hand and I groaned a lot and didn't move and made it through. It then took another 20 minutes for the epidural to take effect and I FINALLY had pain relief at 3:30 pm, 9 hours after starting to labor.
The next part of labor was pretty nice. I was able to lie in bed and rest. I could tell that I was having contractions, but there was no pain. If I started to feel pain, I was able to press a button that delivered more medication through the epidural. The midwife connected me to a slow pitocin drip (Intervention #5) and I also got connected to IV antibiotics because my water had broken and I had meconium (Intervention #6). Vaginal exams showed that I progressed from 3 cm dilation to 6 cm and then to 8 cm. And the baby was descending too - he had made it to the 0 station. And I think I was able to sleep during some of this time and my husband was also able to get some rest and relax.
At some point, the baby started showing some distress. My pattern of contractions had never changed...I kept getting 3 contractions right in a row, followed by a longish break and the baby wasn't tolerating the 6-7 minutes of constant contractions. The midwife didn't like the monitoring that she was getting from my belly and suggested that we use an internal probe to monitor the baby's heart rate. I really didn't want to do this because it basically involves a fish hook in the baby's scalp. So I was able to put it off for a bit and convinced the midwife it wasn't necessary yet. I also started to feel a lot more pain. The epidural did not appear to be working anymore. I pressed the button over and over and the pain got worse and worse. It was probably around 2:30 am when this happened. I was very frustrated at this point because I didn't expect the pain relief to go away. So after so many hours in labor, I was feeling all the pain again and I was very tired and very drained. The anaesthesiologist came in and after poking me with what looked like a toothpick, he determined that the epidural was, in fact, no longer working properly and needed to place a new one (Intervention #7). My legs were still quite numb at this point and so they were able to place the second catheter while I was lying in bed on my side. In order to give me instant relief, they gave me a combined spinal/epidural and within 1 minute of the spinal, I got instant relief. I was told that this is the amount of medication they use for C-sections and that it would wear off in about 40 minutes and the epidural would take effect. This was amazing. My legs were COMPLETELY numb, but it felt amazing to feel no pain.
The midwife (Biddy) continued to allow me to labor after this, but began preparing me mentally for the idea that I might need a C-section. I begged for a bit more time as long as the baby could handle it because I felt like I had been making progress, albeit it slow progress. The midwife agreed but wanted the baby to have the scalp monitor. At this point, I did agree to this procedure (Intervention #8) if it meant I could still have a vaginal delivery. The midwife checked my progress again and I had made it to 9 cm dilation and the baby had descended to the +1 position. Unfortunately, 2-3 hours later, I had completely stalled at 9 cm dilation and +1 position. I felt the urges to push - it felt like downward pressure in my rectum - but I had to relax through them. They told me that if I pushed at 9 cm, I not only would not get the baby out, but I would cause swelling. In addition, the baby needed to be at +2 position for me to be ready to push.
The baby's heart rate continued to show that he was in distress through my rough contractions. They had to shut off the pitocin drip because my natural contractions were already strong enough. But this meant that they couldn't use pitocin to regulate the contractions. I was told that my uterus never got "organized." Too bad I couldn't organize my uterus along with my house! By 4:30 am, the call was made for me to have a C-section and I agreed (Intervention #9). The doctor was busy with another delivery and we waited another 1 hour, at which point the C-section became quite urgent. At 5:30 am, they wheeled me into the operating room and my husband had to stay outside while they prepped me. This was the first time all day I had cried. I was tired, I was drained, I was upset that I wasn't having the vaginal birth that I had predicted and it was a bit scary lying there on the operating table without my husband. At some point, he was allowed to come in and I felt better.
The doctors put the screen up so that I couldn't see anything and they began their work. I felt a lot of pressure and tugging. At one point, the doctor leaned over the screen and said, "Do you exercise a lot?" And I said "Yes." And she said, "Well, we can tell because your abdominal muscles are very tight!" So I guess, if you have to get cut open, it's nice to have a compliment about your strong ab muscles! The doctor commented two more times about how strong my ab muscles were. I think she was having a very hard time pulling out the baby. My husband peeked over the curtain once and said that it looked like the doctor was using all of her strength to pry me open. The anaesthesiologist videotaped my baby's arrival into this world. I watched it - it's very cool, like something you would see on the Discovery channel.
They took the baby and informed me that I wouldn't hear him cry right away. They did not want to stimulate him to breathe because they wanted a chance to suck away the meconium that was in his air passages so that he didn't aspirate it. It seemed like forever. I then I heard "1, 2, 3" and "1, 2, 3" and got concerned because I realized they were doing CPR. They needed to "jump start" his breathing. But then I heard his wonderful cry. It was pretty gargled because there was meconium left there, but it was a good cry nonetheless. And that's when I cried for the second time during labor. It was amazing to hear him cry. His Apgar score at 1 minute was a 2, which is pretty low and scary. But his Apgar score at 5 minutes was an 8, which means he really bounced back very quickly. I got to see him only very briefly before he and my husband went up to the NICU where he received IV antibiotics. I was then stitched up and wheeled back into the labor and delivery room to recover. I made a couple of phone calls to my parents, to my husband's parents, and to my sister and my brother. I tried to talk and sound brave even though I was shaking very badly and uncontrollably from the labor and anaesthesia. Roughly 2 hours after my baby was pulled out of me, I was finally able to hold him. And that felt really good. I finally had my baby. Ian Ravid was born on Monday, March 16 at 6:11 am. He weighed 8 pounds, 6 ounces, was 20 inches long and was absolutely beautiful.
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