Birth Plan versus Birth Reality Part 3

My Birth Story

**Warning- This post is as completely honest as I can remember all the events.  I'll try to get as many details as I can remember.**

My birth story starts about a week before Phillip was born.

Threatened with an induction due to gestational diabetes, I tried all I could to encourage baby to come on it's own (I refer to him as it here because at the time we didn't know his sex).

I spent a lot of time walking- about an hour 3x a day around our apartment complex which is up on a hill. 

During the evenings I would sit on my exercise ball and bounce around to help open up my pelvis.  I also would squat against a wall (with the help of my husband) and do pelvic rocks (on hands and knees) before bed to encourage baby to move down.

I was able to encourage my husband to massage a few accupressure points know to induce labor.  One of the most well known points is behind the ankle on the external part of the leg.  On the internal part of the leg, about 3 finger lengths above the ankle bone, right below the calf is another point. 

Alas, none of my efforts worked.

My induction was scheduled on 12/28 at 11am.

At 9ish in the morning the hospital called and asked if we could push it back to later that afternoon or evening because they were so busy. 

I said no problem! We called our Bradley Instructor since she was our "phone doula" to update her.  She suggested I try Castor Oil, a laxative, to encourage my uterus to start contractions on its own. 

My husband mixed 2oz of Castor Oil with 2oz of OJ.  It was NASTY.

We waited a few hours and nothing.  No contractions at all.

The hospital called and asked us to come in at 2pm- we told them we would be able to come in at 3 and they agreed.

Obviously we were trying to stall as much as possible to give natural labor a chance.

At 3pm I was admitted.  They were still running behind and the nurses told me that the resident OB would be by shortley to check my progress and start the medication, if needed.

4pm- Resident OB shows up and checks my progress.  

Now, if you read my previous posts you know I wanted an unmedicated birth. After he checks me he tells me, "Don't worry, the next time you'll be checked you'll already have the epidural." I told him no I wasn't getting the epidural.  His reply, "Are you sure? You know it's going to hurt more than that with a baby coming through there."

Jackass.  I wanted to kick him in his face.  That's not what you tell a woman about to get induced!!

Anyway, he checks me and I'm 3-4cm dilated and about 70% effaced.  Baby was head down and at a -2 station.

What does that mean?  Well, 10cm is the the goal for dilation (opening of the cervix), 100% is the goal for effacement (softening of the cervix).  Baby's station tells us how high the baby is, starting at -3.

-3: high

-2: head is entering pelvis

-1: head is in pelvis

0: head is in the center of pelvis, most narrow point.

1: head is at the top of the birth canal.

2: head is halfway through

3: head is crowning.

So based on that check from Dr. Jackass, I didn't need the medication at all.  They would just start me right away on Pitocin.

7pm- "Right away" when a hospital is busy means 3 hours later.  But I didn't mind.  We turned down the lights, lit our flameless tea light candles, sprayed our lavender room spray and took a nap.

When the nurse started the pitocin I asked to start at the lowest dose possible.  She agreed and told me it may be awhile before things start happening.

9pm- Contractions start but they aren't very consistent.  Some I can't even feel! We continue with our napping =)

We brought some music with us on our iPad but didn't use it.  The hospital had great TV stations- even a 24 hour family friendly comedy station!

12am- Active labor starts.  My contractions were now 2 minutes apart and peaking at 30 seconds.  I was hooked up to the telemetry unit so that I could walk around.

The telemetry unit is this piece of machinery hooked up to my IV that allows me to walk around the nurses station while still being monitored for contractions and baby's heartrate.

Complete piece of rubbish! My belts kept falling down which gave the nurses a false alarm, thinking they lost baby's heartrate.  I was constantly trying to readjust the belts while walking and dealing with my contractions.

However, it still beats laying in a bed!

With each contraction I held onto the rails in the hallway and would squat down to open up my pelvis and encourage baby to move further down.

My husband also applied counter-pressure to my back using his hands and a home made heating pad made out of a tube sock and rice. 

2am- Transition hits. 

Transition is the most painful stage of labor- and also the shortest!  It's the body's way of preparing the woman to push.

My lips began to turn blue.  I got REALLY cold.  At this point I'm back in our room and leaning over our exercise ball on the bed while my husband massages me. 

I started to get tired to I climbed back into the bed and laid on my side.  I kept asking for blankets but all they gave me were these small sheets.  Not a big help at all!

Contractions were really intense.  And because my labor was induced, contractions wouldn't just peak one time, but sometimes would double up on eachother- even triple peak!

At this hour I ask for the epidural.  I started to doubt myself.

My husband asked me to wait another hour.  He reminded me that I was in Transistion and that this is the shortest phase- we're getting really close!

3am- STILL in Transition.

I went back and forth between standing and rocking on the exercise ball and laying on my side in bed.

My husband's massage techniques weren't doing anything anymore.

Contractions were still triple peaking so I told my husband AGAIN I wanted the epidural.

He AGAIN asked me to wait- assuring me it would be over soon!

4am- It is not over.  It is still going.

I got up from the bed to use the restroom. 

As I climbed into bed, my water broke! It was the oddest sensation I have ever felt!

Then things went SUPER FAST.

My baby's heartrate started to drop.  And it got SCARY.

Nurses rushed into the room to help my nurse. 

I got an oxygen mask thrown at me and was told to put it on.

They kept trying to find baby's heartrate but were having trouble. 

They did another check-

Nurse announced I was at 5-6cm.

Did you read that? 5-6cm.

I was admitted 12 hours earlier at 3-4cm.

On average, a woman will progress 1cm per hour.  I should have been close to 8cm at least!

When I heard my progress, I looked at my husband and told him- "This is it.  I'm getting the epidural".

He agreed.  At this point my body needed to relax so that it could open up more, since it wasn't doing it on its own.

4:15- The anesthigiologist is called in- so we waited for him to arrive.

All of a sudden I had a really really HUGE urge to push.

The nurse called my OB and helped me breath against the urge.

4:30- My OB arrived and checked me. 

I'm was at 9.5cm!!

Within 20 or so minutes I went from 5-6cm to 9.5cm.  A process that usually takes HOURS took mere minutes.  No wonder I was in so much pain!

I told them to forget the epidural, I can do this.  I was sooooooo close and I knew that I could finish the job.

5am- My OB checked me again and tada! It's time to push!

Contractions kept coming but with the pushing they were no longer painful.  It was actually the biggest pain relief to push!

Contractions got a bit stronger and my body started pushing on its own.  All I really had to do was hold my breath. 

As soon as I let my body do it's own thing, it started pushing up and out like the nurse told me before.

I truly believe that if I got the epidural, I wouldn't feel my body giving birth to my baby.  I would have been left out of the complete experience.

Baby Phillip was born at 5:58am!

6am- We tried to get Phillip on my chest for skin to skin contact but my cord was too short.

We waited for it to stop pulsing and my husband cut the cord and announced to the room that it was a baby boy!

I held him to my chest and we started breast feeding immediately.  He nursed like a champ!

RECOVERY-

I was walking around within a couple hours.  It wasn't easy, but I  knew that walking would help my body heal.

In the end I'm ecstatic about how things went.  While I didn't go into labor naturally, I still got the birth I wanted.

Yes, I had to compromise on the IV- I received Pitocin, glucose, and penicillin through my IV during the labor process.  Glucose to keep my sugar levels constant and penicillin to kill the Group B Strep bacteria that I tested positive for.  Group B strep is not fatal to the carrier (me) but when the baby passes through it can cause complications.  Fortunately for us baby was 100% healthy!

I was able to walk around and be mobile, as well as use the pain management techniques I learned in my Bradley Birthing classes.

Total success!!

Birth Plan versus Birth Reality Part 2

My Birth Plan

So my last post I shared a bit about why I wanted an unmedicated birth and how I prepared for one.

After all my research and 10 weeks of birth classes, my husband and I were able to put down in writing what we preferred to happen once I was in labor.

Now of course we did have a few hiccups.  The biggest one was having Gestational Diabetes.  Because of GD, I was considered a "high risk" pregnancy and didn't have as much free reign over my options like I would have if I was a low risk pregnancy. 

But that was OK.  We made it work.

Below is what we drafted for my doctor (and he approved!) and shared with the nursing staff at the hospital.  I also added comments about why I wanted things a certain way.

**I included my birth plan so that my readers can have a base to start their own, if they wish.  I'm not offering any medical advice here, just sharing what I learned and what I preferred.  As always, check with your doc before insisting on any preferences or procedures.  I had my doc review this.  He also signed it and sent it to the nursing station before I was admitted.  It truly is a discussion that needs to involve the entire birth team**

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Birth Plan for Vanessa
Name of Hospital
Due Date: December 28, 2011 / Patient of Dr. Name of Doctor

We are very excited to be sharing the birth of our child with the wonderful staff at Hospital. We would like the opportunity to have an unmedicated birth and feel the staff at Hospital will be very supportive of us. We understand that complications do arise and we are fully prepared to be flexible with our preferences and work with Hospital staff to avoid any complications.
Pre-labor:

• We prefer to begin the birth process naturally and would like to try natural methods of induction before any drugs are used. We understand that with Vanessa’s diagnosis with Gestational Diabetes, induction will begin no later than 40 weeks. (Natural methods that I tried were Evening Primrose Oil to help ripen my cervix, exercises such as long walks and squatting to open the pelvis, Castor Oil, and acupressure.  Feel free to email me if you have any questions.  And as always, check with your doctor before trying any induction methods!)
• If there are no signs of complications (high blood pressure, high blood sugar, fetal distress), we prefer if Vanessa is allowed to carry to term (40 weeks). (Because due dates are estimates, most babies can be carried to 41 weeks without any health risks or complications.  In my opinion, it was better to carry baby longer than to be induced earlier.  I wanted to give baby the most time possible to grow and develop.)

Labor:

• For Vanessa’s comfort, we prefer to use dim lighting, light music, and aromatherapy in the labor room. (So I can be as relaxed as possible.  We used flame less tea light candles and a lavender room spray.  We didn't end up using music but watched TV instead.  Once active labor started, I didn't even pay attention to the sounds around me but focused inward on my contractions).
• We would like to be able to move around during labor, experiment with different labor positions, and use the shower for pain management. (Being active in labor is very important.  Lying flat on her back is one of the worse ways a woman can labor. Walking helps to open the pelvis and being upright helps baby moved down.  Different labor positions (squatting, leaning, rocking, being on hands and knees, lying on your side) help with pain management.  I didn't get to use the shower since I was hooked up to an IV.)
• We prefer no IV-hookup except for a hep lock for emergencies. We understand that if Vanessa’s blood sugar drops, an IV hookup of glucose may be required. We would like the option to use honey or honey straws before introducing glucose water intravenously. (Because I was induced, I had to have an IV hookup.  In Hawaii an IV is not required but a saline or hep lock is in case of emergencies.  Pitocin was administered through my IV but I was still able to walk around using a telemetry device offered by the hospital.  My blood sugar did get a bit low, but the nurse from the first shift allowed me to drink some milk to bring my sugars back up.  Usually I don't drink dairy but it was either dairy or more fluids through my IV, so I took the dairy. *Note* the telemetry device was HORRIBLE at tracking mine and baby's heart rate.  It caused a lot of false alarms! The nurses weren't panicked but I had to return to the room a lot so that they could readjust the monitors.) 
• Intermittent fetal monitoring is preferred. If continuous monitoring is required, we would like access to the telemetry unit so that mobility is not hindered. (Again, because I was induced with Pitocin, I had to be monitored continuously.  The telemetry unit was rubbish- the belts kept sliding around and baby was moving so it was hard to get an accurate reading, which resulted in a lot of concern from the nurses.  I'm glad they checked often but it was an added thing to worry about during labor.  And another thing to note** continuous monitoring has a strong correlation to C-Sections because of a lot of false alarms where the baby's heart rate drops on the monitor but really it's the sensors malfunctioning or the baby moving around.)
• Please do not offer pain medications. We will request them if needed.
• Vanessa prefers to push and breathe without a 10 second count (“purple pushing”). (Pushing past the point of comfort can lead to an episiotomy or tearing.  I unfortunately had a nurse that encouraged me to push as long as I can and then a few seconds longer to hurry and get baby out. I listened to her because I was in the moment and afraid of my baby's heart rate dropping.  Looking back, I wish I pushed as I had intended but either way I can't regret it because baby was healthy anyway!)
• Carl will support Vanessa and her legs if necessary.
• Vanessa prefers the use of pedals instead of stirrups.
• Vanessa prefers to not have an episiotomy. We would like to use warm compresses and perinneal massage before having an episiotomy. However, if an episiotomy is deemed necessary due to excessive tearing or a tear that goes upwards, she prefers a pressure episiotomy.(I did not want an episiotomy because sometimes a cut is actually deeper than a natural tear.  However, my doctor did use massage during the pushing stage but with me pushing beyond my comfort level, I ended up tearing anyway, in three places! Good news? I was virtually pain free within a couple days.  But still, tearing sucks!)

After Delivery:

• Please do not clamp the umbilical cord until after it has finished pulsating. (Cutting the cord before it's done pulsating prevents the oxygen rich blood from the placenta from reaching the baby.  All that blood needs to be in the baby.  The cord will actually start to constrict itself after pulsing the blood baby needs from the placenta.  Because of this, we did not donate or bank our baby's cord blood.)
• Carl would like to announce baby’s sex and cut the cord.
• We would like our baby to be placed immediately on Vanessa’s chest for skin-to-skin bonding. We request all testing procedures to be delayed until after skin-to-skin contact, breastfeeding, and bonding has occurred unless medically necessary. (We learned that the first hour after birth is the strongest window for bonding and breastfeeding.  My cord was too short so baby was put on my chest after the cord was cut.  I was able to hold him and breastfeed while being stitched up.  My husband also did skin-to-skin bonding until it was time to move to the recovery room.  Skin to skin helps baby regulate its temperature, heart rate, and breathing.)
• Baby is not to be separated from Vanessa and Carl at any time. If testing is necessary outside of the labor or recovery room we ask that Carl be able to accompany baby at all times.
• If baby is deemed to have low blood sugar and formula or glucose water is necessary, we prefer that the staff use a syringe versus an artificial nipple. We would like to avoid nipple confusion as Vanessa plans to exclusively breastfeed. (Breastfeeding is extremely important to me and I wanted to start off on the best possible foot.  Baby's sugar levels were great after birth and he did not need any formula or glucose water.  Baby was circumcised at the hospital and was given a small amount of glucose water in a nipple to distract him from the procedure.)
• Please no Hepatitis-B vaccine for baby at birth. (We chose to delay this until we spoke to our pediatrician.  We wanted as much time as possible to research the benefits and risks of both the vaccine and disease as well as have the time to discuss our concerns with our pedi.  We didn't want to consent to a procedure "just because" but wanted full understanding.  Our hospital didn't push the issue at all but did go over the risks of not vaccinating.  They did not give us the risks of the vaccination though- just food for thought)

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As always, if you have any questions or concerns or would like to discuss any part of my birth plan further, please email me.