Tuesday, June 19, 2012

The Arrival of Caleb James - Pt. 1

NOTE: This is a series of two very, very long and detailed posts. I've omitted the more gruesome parts (pretty sure I'll never forget THOSE details) but included everything else as best I can remember. I've written this out to share, but it's primarily for me to remember everything about this experience.

March 27th found me less and less comfortable, tired from long nights awake with false labor, increasingly impatient and 1 week past my due date. Throughout my 40th week of pregnancy I had contractions that graduated from Braxton Hicks to very real and sometimes painful contractions. Two or three times they got as close as 5 minutes apart but never lasted long enough to become real labor. Jonathan and I walked, and walked, and walked. I still enjoyed being pregnant but my belly felt like the turkey in National Lampoon's Christmas Vacation - swollen, overcooked and ready to explode should something sharp make even the faintest contact.

I had progressed on my own to 2cm dilated and 90% effaced. For not being in labor and a first time mom, that was a good sign. However, I was paranoid that I wouldn't go into spontaneous labor on my own and would have to be induced at 42 weeks. We were blessed with a very supportive OB-GYN who was understanding of our decisions and didn't put pressure on us to induce prematurely; in fact, she encouraged us to wait if we felt comfortable doing that. We went in for a checkup sometime during my 40th week. An NST (non-stress test) and BPP (biophysical profile, an ultrasound to check amniotic fluid, placental condition and baby's growth) showed that our little boy was doing just fine and my body was supporting him well. Even so, I couldn't shake the fear that an induction was in my future. Based on my progress and gestation, we decided to try a Foley bulb to help me progress to 3cm and, if my body was ready, encourage labor to begin. (The Foley is basically a catheter in the cervix, the end ballooned with water so that it sits and puts pressure on the cervix, encouraging dilation.)

We arrived at the Family Maternity Center (FMC) at 10:30am for the Foley to be placed. After signing in, they took us back to triage. I changed into a gown and got hooked up for another NST before the procedure. The NST took about half an hour. I was grateful that my doctor, Dr. Partida, was on call that weekend, so she could be the one to put the Foley in. They got me set up in a small room with only a little counter, exam bed and one chair for the doctor. Jonathan stood next to me and held my hand. At 11:50am, I wasn't paying much attention to what my doctor and the triage nurse were saying, but suddenly my brain kicked in and I realize that the word "water" was spoken. "Did you just say my water broke??" Dr. Partida confirmed that indeed it did, that in all the times she'd done the procedure, that was a first. I was very confused as I hadn't felt a thing, then I could sense the warmth. All that worry for nothing; my water spontaneously broke before the Foley was in. I looked up at Jonathan with a mix of shock and excitement. It was clear that for him it was 100% shock when he asked the nurse if there was somewhere he could sit down. Neither of us were expecting my water to break at that moment but it definitely hit him harder than it did me. After stepping out to sit and regain his strength, he came back in apologizing over and over for leaving me, but I promised him that I was fine and needed him to be ok too. And he was; he was an awesome coach throughout the rest of our experience.

Finally the water stopped flowing. Dr. Partida said, "If anyone ever asks how much water you had, tell them this," and she lifted the bedsheet and wrang out all the water. She wasn't kidding, there was a ton. She felt around my belly and guessed that our baby would be about 7.5lbs. That number sure sounded good to me! At 36 weeks I tested positive for Group B Strep (GBS). To reduce the chances of our baby contracting it during his delivery, I would have to receive antibiotics throughout the labor. This also meant that I was on a time clock from the moment my water broke. (It is hospital policy that if the baby isn't out by 24 hours after water breaking, a c-section becomes necessary.) For this reason, she went ahead and put the Foley in, hoping that the pressure from it in addition to my water breaking would protect me from the possibility of a section. It was no big deal - until I stood up.

I was immediately hit HARD by major cramping and contractions - or rather, one long contraction that never seemed to let up. Labor is known to speed up and get more intense when the mother's water is broken. Add to that the pressure of the Foley, and the pressure of the baby's head ON the Foley without the cushion of the water sac, and I was in intense pain. I could hardly walk back to my triage bed, and even then, laying down did nothing to relieve the pain. Dr. Partida suggested I order some lunch but the pain took away my appetite. They admitted us and showed us to our room, which I had to walk to. It was a very long, slow, agonizing walk. After they got me settled, Jonathan went out to call our families and I tried my best to breathe through the pain. I got up to use the restroom and the Foley fell out. Oh.My.GOSH. Instant relief! I couldn't believe how much better I felt. The pain stopped right then and there. That also meant I had dilated to 3cm.

Jonathan came back in. We chatted with the nurse as she put in my IV and strapped on the monitor. She started me on fluids and the first dose of penicillin for GBS. After a bit I felt a tingling sensation in my hand that morphed into burning, slowly creeping up my arm. Alarmed, I asked the nurse if that was normal. She said it was a normal reaction to the penicillin. The veins in my whole left arm, from fingertips to shoulder, tingled and felt ice cold and white hot at the same time. After 15 minutes it subsided and my arm was back to normal.

My monitor was portable so I put on my robe and fluffy slippers and we went for a walk through the halls. After several laps we went back to the room for something to drink. We walked in to find a tray of food which Dr. Partida had ordered for me even though at the time I didn't want it. I was grateful she did. I lifted the lid from the plate and... a tuna sandwich. Really? The kitchen sent tuna for a pregnant woman? (For those who don't know, tuna is one of the "no-no" foods for pregnancy because of the high levels of mercury.) I ate the other items on the tray and gave the sandwich to Jonathan. The nurse checked me and I hadn't progressed at all so they suggested starting Pitocin. My goal was to get to 7 or 8cm without an epidural, which I was afraid would stall my labor if put in too soon. I hoped to avoid Pitocin because I knew it would intensify contractions and increase my likelihood of requesting an epidural before my goal but time was ticking by and labor needed to move along, so we agreed to start the lowest dose. We walked around for a while and stopped at the FMC's kitchen for some jello. I looooved red jello during my labor. I can't even remember how many cups of it I ate.

At 3pm, they upped my pitocin from 2 to 4. Still very low, but when we hit the halls to walk some more, BAM! Hard contraction. I had to stop walking but I could still talk through it. The contraction subsided so we continued. A few minutes later, BAM! Another one, this time even stronger and I could no longer speak. We only made it another 15 minutes in the hall when I wanted to get back to the room. The contractions were very quickly becoming very painful and I didn't want to be on my feet anymore. On the way back I had to stop several times to lean against Jonathan, close my eyes, breathe and be silent. We got to our room and the first thing I asked for was the birthing ball. I found my rhythm as I sat and swayed my hips back and forth. During each contraction I leaned over to lay my head and arms on the bed, swaying as Jonathan sat behind me and applied counterpressure, massaging my lower back and shoulders and softly exhorting my efforts. Each contraction seemed worse than the one before and many were tandem - swelling, peaking, starting to come back down and then a second swell before the first was done. I felt relief in between the contractions, but the pain during was exhausting. Our day nurse was very sweet but she talked a lot and at one point she asked me a question mid contraction.  I could hardly hear her and speaking was out of the question. Jonathan knew this and answered for me. He became my voice while I labored silently.

The pain was a combination of aching, cramping, burning and pressure and the intensity continued to increase. I instinctively went inward each time I felt the swell begin. I moaned and mumbled something then leaned over onto my pillow, closed my eyes, swayed on the ball and focused on relaxing through the pain. Swell, swell, swell - peak - and slowly back down. I couldn't hear anything around me, completely unaware of the room. All I could think was, 'I can't bear another one of these,' but then the pain would subside and in my relief I'd decide that I could make it through one more. My coping methods eventually shifted. What once had been helpful became distracting. I remember in the middle of one contraction thinking that Jonathan's massaging was no longer helping me but I didn't have a voice to tell him, so I had to wait until the contraction was over. I stood up and tried leaning over the counter while Jonathan squeezed my hips together but that was MUCH worse. We tried a few more positions but the birthing ball was my friend so I stuck with it. Jonathan sat on the other side of the bed and during each contraction, I closed my eyes, rested my head, reached across the bed and held his hands. He gently suggested that I get in the bathtub but I was so uncomfortable that all the trouble of getting undressed and into the tub, then having to get out, dry off and dress again sounded like far too much work. (In hindsight, yeah, it really would have helped but in the moment I couldn't focus on anything but getting through each contraction and resting in between. I would have had to get in much earlier.)

At 5:30pm - 4 hours after starting Pitocin - I considered asking for the epidural. My contractions were literally off the charts and at least half of them were tandem. (The nurse was kind enough to give us a section of the printout as a souvenier; proof of my endurance.) I hesitated out of fear that I hadn't progressed enough. She offered to check me and call the anesthesiologist, who would take some time to get there. He would at least be on his way and if I changed my mind we could call it off. At this point they turned the Pitocin back down but it didn't make any difference. I got on the bed and laid down for the exam. Let me tell you, when women say that flat on your back is the worst position during labor, THEY AREN'T JOKING. The pain was unbelievable. I had to vocalize a little bit through a contraction and then nicely told the nurse to check me FAST before the next one hit. She did, and I was almost at 6cm. Not as far as I had hoped to be, but far enough that an epi was less likely to stall my labor. Getting onto the bed while laboring was an ordeal and the anesthesiologist was on his way so I stayed there while we waited. He came in and Jonathan continued to be my voice for me while the procedure was set up and executed. I had to sit on the edge of the bed and hunch over so he could see my spine. He kept telling me to lean over further. Hard to do when you have a giant basketball in your way. This also made breathing through contractions considerably harder. Jonathan stood in front of me so I could lean over and hold onto his shoulders through the contractions. At 6:45pm, the moment a contraction ended, the doctor put in the epi. I never felt a pinch or sting, only some pressure and then he was done. The whole procedure took 5 minutes.

It took about 15 minutes for the epi to kick in. I was restricted to the bed now and I laid with my left side slightly elevated by pillows to keep the epi line open. I first felt a little warmth in my right foot. It spread up my leg and torso and then stopped right at the top of my belly. Then I felt it in my left leg. Ahhhh.... such relief. My eyes came back into focus and I could see the room, think, talk, even smile and laugh. It was nice to see Jonathan's face and talk to him again. I did feel guilty for not thanking the anesthesiologist and realized I didn't even know what he looked like. (Apparently when I'm in pain my eyes are fused shut.) My right leg was completely dead weight but I had control over my left leg. I still felt a nagging pain in my lower left abdomen, kind of like a sideache, where the epi didn't take. I didn't mind it though. It wasn't terribly painful, just a little annoying, and I liked knowing when I was having a contraction without having to look at the monitor or feel my stomach.

The nurses had their shift change, so the night nurse came in and introduced herself. Her name was Agatha (pronounced a-GAW-tha, with the emphasis on the second syllable). She is from the Congo, has a wonderful accent and was God's gift to us that night. She was EXACTLY what I wanted in my delivery nurse, and I later found out she is also a Christian. The next day my mom told me that in conversation, Agatha told her that she hadn't worked in the FMC for a while and before her shift she prayed for God to put her with just the right family. He answered both our prayers that night. At Evergreen, laboring women have their very own nurses at night so Agatha belonged exclusively to us. She didn't have any other patients to check on and stayed in our room the entire time. I can't say it enough - we loved her.

My family had arrived a couple hours earlier and we knew they wanted to come say hello, so at 7:30pm I sent Jonathan out to bring them in for a bit. We chatted and told them about our day. They stayed about half an hour then left to get dinner and let me sleep. I was exhausted and at the same time exhilerated from the absence of pain. I closed my eyes and drifted off, resting and regaining my strength before the hard work began again. Jonathan tried to sleep but couldn't, so eventually he went out to the waiting lounge and spent some time with his parents who had recently arrived. By 11pm I was awake again. Jonathan brought his parents to the room to say hello. We visited for a bit then they left when Dr. Partida came in to check me. We were beyond thrilled when she said, "You're complete!" meaning I had reached 10cm and was ready to start pushing. They broke down the bed and covered everything in plastic. (Are you familiar with the Pemco Insurance ad about about the "Blue Tarp Camper"? That was kind of what our room was like when they were done.) Dr. Partida went over pushing positions but because of the epi I really just had one option with a few variations. The stirrups came up, I scooted down, and a tingle started at the back of my jaw. Someone brought me a little kidney-shaped bowl and I threw up, just once. I don't know if it was transition or nerves, but I didn't feel nauseous before or after. As soon as I was done, I was ready to get this show on the road. At 11:30pm, the birthing part of our labor began.

(The story continues with part 2)

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