Friday, May 22, 2015

Labor and Birth Story- Bryce Allen Hofmann

I went on maternity leave right at 40 weeks, hoping that the as of yet unnamed baby would make his appearance any day, as I really wanted to avoid induction. We spent the week getting little house projects taken care of, and I tried what I could to try to encourage natural labor. I'd had my membranes swept at 39.3 weeks, had acupuncture appointments at 39.6 and 40.1 weeks, tried nipple stimulation with my breast pump, did a lot of walking... Nada.

On Tuesday May 12th (at 40.1 weeks) we had an NST appointment at the OB, and while everything looked fine we got sent over to the hospital for a full BPP "just in case." Baby looked perfectly fine, passed all tests, and while I had to explain my decision not to induce a couple of times, we went home still hoping things would progress naturally. On Thursday, May 14th we had another NST and OB appointment. This time the NST was a little weird. Baby had been super active all morning and his heart rate was running high and a little tachy. Basically they couldn't decide if his heart rate baseline was high and the lower points were deceleration (a problem), or if the low points were his baseline and he was running too fast (less of a problem but still a little concerning). We got sent over to the hospital for another BPP, and while he passed the untrasound portion just fine, the hospital NST showed the same thing.

Dr. Auffant was the doctor on call at the hospital Thursday, and she was one of two doctors at the OB that we really liked. We also knew that the other Dr. we really liked, Dr. Wolfe, was going to be on call Saturday. We had already been considering inducing later that week cause they were going to push really hard for it at 41 weeks anyway, but our biggest argument against induction was evidence of baby's health. Since he was looking a little weird, and since the doctors we liked were the doctors on deck, we decided to agree to the induction that day. I was 2 cm dilated and 50% effaced, with baby at -1 station.

I was admitted around 3pm (we'd been at the hospital since about noon and were at the doctors all morning before that). I was still hoping to kickstart labor without Pitocin, so we started on Cervadil at about 6pm. It did start some contractions, but they were irregular, but the worst part was how sore the Cervadil made me. It was difficult to sit, or move, and since it was an 'intervention' I had to stay on the monitors which limited my motion anyway. I could move around but only as far as the wires would stretch which limited me to the bed, the two feet between the bed and the couch, and the couch. I was also having awful lower back pain, from back labor and the fact that the labor bed was really the most uncomfortable thing in the world. I got very little sleep that night, only a couple of hours on the couch. They took the Cervadil out the next morning and checked me, which was the most painful pelvic exam I've ever had in my life because the Cervadil had irritated everything, and found out that the only thing that had changed in the last 12 hours was that I was now 3 cm dilated.

Dr. Auffant switched shifts with Dr. Cacciatore, and we discussed options with him. We could have tried another prolactin, a pill that would work kind of like the Cervadil and would last 4 hours, but after discussing things we opted to go ahead and start a low dose of Pitocin. Our reasoning being that the likelyhood of labor starting naturally in those 4 hours was practically nil, and the pain the Cervadil caused made me leery of doing another 4 hours of something similar for no real gain. Dr. Cacciatore agreed with us that we wanted to take the Pitocin slow and easy, not wanting to push too hard too quick and still hoping that my body would adjust and take over on it's own.

I was on the Pitocin all day that day (Friday, May 15th), and was having pre-labor contractions but again, nothing super regular or productive. At about 8pm, I still hadn't really progressed and was measuring around 3 cm dilated, about 60-70% effaced, and baby still at -1 station. Dr. Cacciatore stopped the Pitocin, and let me off the monitors all night so we could get some sleep and try again in the morning.

At 4 am we started the Pitocin again. I slept through it for a few more hours and then settled in for another long day of watching TV and waiting. Dr. Wolfe was on call now, since it was Saturday, and I was really hoping that this would be the day since he was the doctor we preferred. The contractions got a little more regular and closer together, but still barely hurt. At the worst I was just rather uncomfortable and achy.

I was sitting on the birthing ball watching HGTV with David and Mom at about 4pm when, out of the blue, there was this loud popping noise and a sort of snapping sensation. I honestly didn't know what had happened, and my Mom hit the call button for the nurse. I stood up, and abruptly realized that it had been my water breaking, which the nurse confirmed a couple of seconds later when she came in. She checked me and I was 5 cm dilated, still around 60-70% effaced, and baby was still at -1 station. I was ecstatic that my water had broken naturally, and that things should start progressing quicker.

I'd said from being admitted that I didn't want an epidural, and I stuck to that, but I did find that the contractions after my water broke were much more intense and were starting to get quite painful with active labor. I'd expected the pain level to ramp up gradually so I would have time to adjust, but it had instead gone from them barely being uncomfortable to suddenly hurting quite a bit. I discussed options with the nurse and Dr. Wolfe and agreed to a round of IV pain medication to help take the edge off until I could adjust to the new pain level.

The next several hours are a bit of a blur. We turned off the TV and Dave put on my labor music. I spent some time laying on one side or the other, but found that it wasn't really comfortable. The Nurse suggested sitting up with my legs in frog/butterfly and letting gravity help, and that actually made the pain much easier to manage. With Dave or my Mom helping to provide counter pressure to my lower back, occasionally switched up with a heated rice pack against my lower back that I could press back against during a contraction (the suggestion of another nurse), I was able to hit a sort of meditative zone for several hours. In between the contractions I sat straight up with my eyes closed, lost in my music, and during the contraction I would push my lower back into the counter pressure and try to breathe steadily and picture things dropping and loosening.

At some point, probably sometime around 9 or 10pm, I decided I needed to use the restroom and would like to try standing up. I found the contractions to be suddenly much more painful while I was on my feet, and had two or three in a row which were hard to manage and made me feel like pushing through a little. The Nurse asked that I get back in bed so she could check me and I had progressed to around 7 cm dilated and 100% effaced, and the baby had dropped a lot and was now at 0 station. On the one hand I was glad things were progressing well, on the other I was suddenly aware that I was probably in transition, and I had fallen out of the nice zone that had been helping me manage the pain. I asked for and got another round of IV pain medication, still determined to do this without an epidural. I managed the next several hours with more of the same coping mechanisms. Standing hurt too much with gravity pulling the baby down through contractions, but side laying was also not helpful. Sitting up still seemed to work best, although having Dave press into my lower back and hug across the front of my shoulders through a contraction was an absolute necessity. I couldn't get back into my zen mode, but I managed and held onto the fact that things were going well and couldn't last forever.

I started having a fairly intense feeling of needing to push during a contraction, and was checked again at about 1am. I was 9.5 cm, 100%, and 0 station. Almost ready to go but not quite. The Nurse made it very clear that I needed to try and not push, since there was still some cervix in the way and if I pushed before I was fully dilated, it would swell and cause problems.

The next four hours I hardly have the ability to describe. We went into it with the expectation that any moment now I would be ready to start pushing, which for a while made things bearable even though trying NOT to push during a contraction was excruciating. The nurse even went about setting up the room. But every time I was checked after that, which was about once an hour, I still hadn't progressed that last little bit. I hovered at about 9.5 cm dilated. I lost all sense of time, because all I could focus on was the next contraction, the not pushing, and the blessed moments of relief in between. I started to really dread each contraction as it came on, even though I knew tensing would make it worse. Sometime in the first hour the charge Nurse coached me through letting out my breath in little 'ha ha ha's at each exhale. She said this would help with the not pushing, which it did. But after a couple of hours it didn't seem to help enough. Dave had to start to be mean with me and tell me 'no' everytime he saw me me start to tense up, bear down, or try to push. His voice was the only anchor I had during a contraction, and him telling me no always helped me to stop. Honestly, without him holding onto me and saying that, I don't know how I could have done it. As it is, I know I pushed some even though I was trying so, so hard not too and the not pushing hurt so very bad.

Sometime in the 3am hour the nurse got my attention and said that while she knew I had said that I didn't want it, she was going to offer me the epidural just once. Since I was still at 9.5 she thought we might have a small window for it, even though I had assumed that we were past the point of no return long before. It was very, very tempting but I used the logic that at worst, I just had more of the same to look forward too and I had already been dealing with it for a couple of hours. And I still felt that any minute now I would be 10 cm and we would move past this, as much as it sucked at the moment. Looking back I wonder if she offered because she was tired of seeing me in pain. I know Mom and Dave were at that point, and her voice sounded strained to me when she offered.

By 4:30am Dr. Wolfe came in and I knew pretty much as soon as he started checking me that something was wrong. He said I was still not fully dilated, and there was a lot of swelling. He had me try a couple of practice pushes, which was a relief to be able to push finally. But even with him physically holding my cervix out of the way, the baby wasn't moving and the baby's head wouldn't clear my cervix.

At that point we talked c-section. I had been stuck at 9.5 for almost four hours, was exhausted and in an excruciating amount of pain. Dr. Wolfe wasn't sure why the baby wasn't descending. His head seemed to be at a good angle but he could be big or his shoulders could be at an awkward angle and stuck somehow. The baby's heart rate wasn't showing any signs of distress, but Dr. Wolfe's worry was that by trying to force things we could risk shoulder dyscotia or some other complication with the baby, or damage to me since I was already exhausted and my cervix wasn't taking things well. His recommendation was to do the c-section now, while baby still looked good and the outcome had the best chance of being a good one for both of us, rather than waiting until one of us was in real trouble. He was also concerned that I was getting more exhausted by the minute and that at this point the longer we tried to force things naturally, the greater the risk to me and the baby. Dave and I asked a few questions about risks and complications, but it didn't take us long to decide.

They pulled me off the pitocin and the contractions started to subside almost immediately, which was a huge relief.  This was also my indication that my body had never taken over and gone into natural labor and all the contractions I had been having were because of the pitocin. I was prepped for surgery while David and Mom packed up the room because we would be going from there to recovery. Mom was going to have to wait in the waiting room, but Dave could join me in surgery once I was prepped.

They rolled me out. In surgery I got a spinal block placed and while it felt a little weird, the blessed lack of pain was the best thing ever at that moment. I was prepped, and the anesthesiologist made sure that she could cut back my gown for skin time once baby was born. Dave came in and they sat him near my head. He had the option to stand up and look over the screen to see the moment that the Baby was pulled out, which he took advantage of.

Bryce was born at exactly 5:43am, Sunday, May 17th 2015. He was 7lbs 14oz, and 20 inches long. Not too big, right on track with estimates, but broad shouldered and barrel chested which may have had something to do with things. Dave said that almost as soon as they pulled him out he started trying to lift his head, and even managed it. We tried skin to skin with me as soon as he was weighed, but the angle was awkward and it wasn't working too well, so I told Dave to take off his shirt and they did skin to skin instead.

Once in recovery we did skin to skin time and Bryce had his first breastfeed, and has been latching like a champ since.

Some take aways from the experience:

While I hadn't wanted to be induced, and I hadn't wanted a c-section, I don't regret either decision. In both cases we made every effort to do things naturally and find alternatives, but in the end made informed medical decisions for the health and safety of all involved.

I know there is no medal for labor, but I'm proud of myself that I didn't get an epidural. I have no doubt in my mind that had things progressed normally, that I would have been able to have Bryce without it. If I could somehow manage those last four excruciating hours of not pushing, then I'm sure I could have managed actually pushing when the time came since that's actually what my body wanted to do. Add to that the fact that they were pitocin fueled contractions the whole time, so especially painful and strong, and I'm rather confident in my ability to have handled a natural birth.

On the flip side, I definitely see a place in the world for c-sections. I didn't want one, and tried to avoid it at all costs, but I am very glad that the option was there for me when I needed it. After the pain of stalling, it was a blessing and a relief, and a much more positive experience than I was expecting.

And finally I am glad that if we had to go down that road, that it was Dr. Wolfe that was on call for it. From the beginning he was supportive of our plan to have an intervention free natural birth, and did everything he could to try and help that happen. But he was also realistic and gave us the best advice and information he could. The trust we had developed with him helped make the c-section decision an easy one to make, and if I had to go that route I'm glad that he was the OB who performed the procedure because I trusted him to take care of me and make it the best experience possible.

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