Saturday, May 1, 2010

From Nurse to Gentle Birth Advocate, Part Two, S.'s Birth Story

Fast forward about 2 years and I was planning the birth of my second child. The memories of J.'s difficult birth were still fresh in my mind, but I was hoping things would be better this time. At 34 weeks gestation I was sent for a routine ultrasound scan. The technician took a number of measurements. I discovered that S.'s head measured 97th percentile, and was instantly filled with dread. Strangely, I was measuring a bit small at that time and the technician also noted large fluid pockets on the scan. My obstetrician seemed a little concerned about the fluid pockets and informed me that he would like to have me come in for a weekly NST or Nonstress Test. He told me that sometimes the large fluid pockets can indicate some type of problem, but usually nothing is found. So now I was really freaking out.
I remember coming in for the NSTs. The first time, the baby seemed to be running away from the transducer. When that happened, I wasn't concerned because I could feel the baby moving vigorously as the nurse tried to locate the heart tones. Another time the baby's heartbeat looked very flat with little variability. The OB came in and studied the strip and then decided the baby must be asleep. He applied a loud buzzer to my belly to wake him up. S. woke with a vengeance, so we got the desired variability and I went home. The next time I came in, the room with the nice recliner for the NST was not available so I ended up stuck on a stretcher. I couldn't see the screen or the monitor strip very well, and I couldn't get the stretcher to the right angle for comfort. I was extremely uncomfortable and it felt like I was abandoned, chained to this monitor. By the time they came back to check on me I was in tears. Not that I got any sympathy from the staff, because apparently they were busy. The strip looked fine.

At my 37 week checkup I was 2 cm dilated, which surprised me. I was experiencing some back pain and general discomfort around that time, but nothing that really felt like contractions. I was still working a couple of 8 hour shifts per week in the hospital. The census was running low and as a float pool nurse I was being pressured to use my PTO which I was saving for after I had the baby. They were obligated to guarantee my hours, so I was assigned to "sit" with a patient on a 1:1, something normally done by the paraprofessional staff. So there I was, 9 months pregnant and crawling around on floor mats after a 3 year old with a tracheostomy. I complained about it to the nurse manager, who asked "What do you do at home with your son?" Well, I lie down on the couch and close the baby gates to keep him in the living room, you %$@#. That's what I do at home. No sympathy for the very pregnant nurse. After another shift with the same child, during which the ENT decannulated the child ON THE FLOOR without warning me, I decided to cancel my one remaining shift that I had booked before my scheduled leave.

The following Tuesday I was scheduled for my induction. We arrived at the hospital at 7am and went through admissions. When we got up to the floor, the midwife was assigned to do the some of the preliminary paperwork and such. She kind of slammed on the brakes and suddenly decided that she needed to do an ultrasound before the induction, to see if the baby was head down. Seemed a little late to be wondering about that, and I was kind of curious as to why should couldn't tell by where the fetal heart tones were located and by just feeling my belly. I knew that the baby was head down and very, very low at my 34 week ultrasound. The technician had a hard time taking some of the measurements because of how low he was. I think she may have even used a vaginal probe to check some of them. I really didn't think it would be possible for the baby to flip given how engaged he already was. The midwife also wanted to examine me to see if my anatomy was suitable for breastfeeding. I thought that was very strange. After she examined me and proclaimed my body met her criteria, since I did not have flat nipples, I informed her that my first child had taken care of that problem in the 23 months that he was breastfeeding.

The OB arrived at 8 am. I had expected that we would use cervidil again but when I arrived for the induction, the doctor said I was already 3 to 4 cm dilated and there was no need for cervidil. I was a little anxious about the Pitocin, but it was either that or go home. Because of my concern about having a difficult birth if the baby's head got too large, I opted to stay. I really thought I was doing the right thing by delivering before the baby's head got any larger. After all, the ultrasound measurement of his head was at the 97th percentile. I thought if I went to term the baby wasn't going to fit.

The next thing I knew he was holding an amniohook and saying "I'm going to break your water." Now, he did pause for a moment after he said it. I had a few seconds in which I could have screamed "No!" but not really any time to consider it. He broke my water. My husband called work to tell them he wouldn't be in that day. We weren't sure exactly what was going to happen up until the OB broke my water. With J. we came in twice and went home twice before I actually went into labor. But we knew that we were locked in once my water was broken. Although I just asked my husband what he remembered about this and he said his reaction was "What did he just do?"

After several painful attempts by the nursing staff, an IV was placed. I don't know why they can't listen when I tell them which veins tend to not work very well for me. I know which ones collapse and which ones have multiple valves that impede IV insertion. After all, I am a nurse. Shortly afterward I received my first dose of antibiotics in my IV and the pitocin was started. At first the contractions didn't feel much stronger than Braxton Hicks. I watched TV, even called a friend and chatted on the phone. The OB came back into the room around 9:30am and stated that if I could talk on the phone, the contractions weren't strong enough. That's when I decided that having an induction is a lot like being tortured by your brother. "Oh, that doesn't hurt?"

I had asked if I could walk around during labor, because the hospital was supposed to have wireless electronic fetal monitors. But apparently the one in my room was not wireless, and there was only 2 rooms that had the wireless EFM. Oh, and the nurses said they didn't work very well. Translation: "They take too much of our time to keep adjusting them when you move around." Only certain rooms had the wireless EFM, and they were full. Can we say "bait and switch" anyone? So I was stuck in the bed again and I had to have continuous EFM because of the Pitocin.

The nurse that was assigned to me had another patient in labor, and she was having a lot of difficulty attending to both of us. So I ended up with the charge nurse providing most of the nursing care during my labor with S. She was pretty nice though. Around 10:30 am the contractions were more intense and definitely painful. The nurse checked and found that I was 5 cm dilated. I wanted to try something for pain, but not the epidural just yet. Again, the only thing available was Stadol. She gave me a dose around 11 am and it did nothing. I reluctantly asked for an epidural, thinking I had failed again by not being able to cope with the pain. So she called for the anesthesiologist. And we waited. And waited. And I writhed around in the bed in pain. My husband was like "are you all right, you look like your eyes are going to roll back in your head?" I just gasped out "It hurts!" As noon approached I told the nurse that I was having a lot of pain that was not completely going away between contractions. She was in the room running my second dose of antibiotics.

It ended up being a blessing that the anesthesiologist never showed up. My obstetrician came back shortly after I was starting to have pain that didn't stop when the contractions did. He decided to check my progress and his jaw just about hit the floor. He said "You are complete. You have remarkable control for someone who is fully dilated." I guess he expected screaming and swearing. I know I heard some screaming from the last patient that he delivered in the next room. I'm more quiet in transition, just trying to keep it together. But when he said that, it was a ray of hope. I was almost done! I didn't need the epidural now, because I could see the finish line! Suddenly the pain became almost bearable. It wasn't going to take another 8 hours, and I would be able to push well because I wasn't numb.

And before I knew it I was pushing, and the baby was moving down this time. I felt the "ring of fire" and thought it would be easier to push without that sensation. So I asked for a local anesthetic. The doctor injected some lidocaine and the burning went away, except for one spot, near my episiotomy scar. But apparently, there was a tear beginning in a new spot, because when I pointed to where the lidocaine wasn't working, the OB started to say "I can't do anything about that" but then saw that I wasn't talking about the tear he was seeing. Too bad he didn't clue me in at the time, perhaps to suggest repositioning? I was sitting upright on the bed, thinking it was much better than the semi-reclined position I delivered J. in, but unfortunately it also meant that I was sitting on my tailbone. Which I think was the cause of the tear, as it pushed baby's head forward.

The main thing I remember about pushing was people counting to ten. And me feeling like my lungs were going to explode if I didn't take a breath. I started screaming through clenched teeth vocalizing more during pushing to try and get some air that way but when I did that it seemed to make everyone nervous for some reason. They kept trying to get me to quiet down. I tried to ignore them but it wasn't easy to do. And I don't construct sentences very well during that part of labor, I'm lucky just to get a few words out. After about 45 minutes I just decided I had enough of it and pushed with all my might. S. was born at 12:45pm, after approximately 2 hours of active labor. I felt elated, I had given birth without an epidural. Now I knew that I could do it!

I wanted to lift S. up onto my chest as he was born, as I had with J., and my OB reluctantly agreed. But as I grasped my son under his arms and started to lift, the doctor started yelling "Short cord!" He yelled it about 3 times before he got my attention. I was all set to lift S. up close to my face, it took a moment for his words to click. I put the baby on my tummy but I really wanted to look at him more closely, so I said to the OB "Cut it, then" and sort of shrugged. S. looked fine to me, he was breathing and looking around. I had never heard about the benefits of delayed cord clamping so to me, baby was out and breathing, why does he need it? My doctor paused for a moment, as if he were thinking about it, but he never said a word. He clamped and cut and I lifted my son up onto my chest.

I know I held him for a short time but I don't remember anything about looking at S. or talking to him. All I remember is the pain. The tear that the doctor probably knew was happening as I started pushing, now I could feel it. At least I could feel it as the doctor persistently poked and prodded at it as he was trying to decide whether or not to stitch it up. It wasn't a terrible laceration, more like a skin flap but it was a labial tear in a really uncomfortable location. My husband didn't take any pictures of me holding the baby right after birth because he felt like he couldn't avoid exposing things we didn't want in the photo. So I don't even have pictures to remember the moment. I quickly asked for my husband to hold the baby instead because I felt my arms tensing up and I didn't want to squeeze him. My husband would not hold him, I think because he had a longer section of umbilical cord with hemostats attached to it. He was afraid of hurting him, I guess.

So poor little S. was hastily brought to the waiting warmer and basically left alone. Of course my husband was watching over him and taking pictures but the nurse dashed back to my side because at that point she was the only one available to assist the doctor and there was again concern over bleeding. This time both pitocin and methergine were given. I was, again, not particularly aware of the delivery of the placenta, but I strongly suspect some cord traction was used. My husband recalls the time from birth to delivery of the placenta as being approximately 10 minutes.

Soon the bleeding was under control and the nurse began doing the routine newborn procedures as the doctor finished poking and prodding examining me.

7 pounds even and not too happy about it.

I got him back but he was mad! I had wanted to see if he could do the breast crawl and latch on without help, but there was just no way. He wouldn't calm down. Finally about 2 hours after S.'s birth, I got up, sat in the rocking chair with a pillow on my lap and put him to breast myself. He did nurse well for about 5 minutes on one side, then fell into a deep sleep for about 6 hours.

A significant portion of those early hours he spent on the warmer as we were moved to another room and tried to get comfortable. He didn't need the warmer, but the nursing staff was apparently too busy to switch it out for a bassinet. We were in a really tiny room, normally used for patients having gynecological procedures. Again with the bait and switch, as we were offered a "nice clean room." Yeah, one that is half the size. After family and friends came and admired the new baby, I decided I would like to hold him and maybe see if he would nurse again. He slept and slept.

The baby had some difficulty latching on, but nothing like my first baby. S. did NOT have a tongue tie, and the difference was pretty amazing. As for the rest of the short hospital stay, I'll just say it was annoying. They never brought me a dinner tray or a menu, and by the time I actually wanted to eat something it was too late to get one. They wanted to weigh my baby and test his hearing at 1 am. I was ok with a quick trip to the nursery but I ended up walking the halls trying to find a way to get him back. I could see into the nursery but no one was paying attention to me and I couldn't see where my baby was. Finally I had him back but I was up all night. I couldn't get the room dark and I could hear other babies crying nearby. We went home when S. was about 28 hours old. Even having a toddler in the home was better than dealing with the constant influx of every hospital staff member imaginable. Although the initial welcome was a little too exuberant!

Welcome home, S.

S. ended up having a rather sleepy start to life. He nursed enough and had the correct amount of wet and dirty diapers, but he was a very sleepy baby. I took him to the pediatrician at 3 days of age because of the sleepiness and some jaundice was noted but no blood test was done. We went to see a lactation consultant when he was 8 days old. He was just 2 ounces shy of regaining his birth weight. I was diagnosed with breast engorgement, hyperlactation, and plugged ducts. The baby was noted to be jaundiced. We saw the pediatrician the next morning and the baby's bilirubin was 17. We got a bili blanket delivered that afternoon, which brought his level down to 14.6 by day 10. This seemed to make him more wakeful. And a little cranky. Recheck on day 11 was 14.3.

S. would go on to develop other issues, including allergic colitis, low muscle tone, developmental delays, and eventually failure to thrive. He is now a healthy 5 1/2 year old with some mild hypotonia and slight delays in fine and gross motor development. Many of the challenges he experienced could possibly be attributed to his induction prior to term, cord clamping, intrapartum antibiotic use, lack of skin to skin care, and jaundice. My advice to other moms is to educate yourself and carefully consider the use of any interventions in the birth process to get the best health outcome possible for your child. I am thankful to Birth to 3, a very wise holistic IBCLC, and a DAN! naturopathic doctor for the progress S. has made to date. S. is a very sweet and affectionate child that has enriched our lives in many ways. I enjoy hearing him share his thoughts with me each and every day.


  1. What an amazing story. I loved reading about your experiences, and I love how many photos you have to go along. I don't remember there being a camera at my daughter's birth but there obviously was because there are a handful of photographs.
    I don't know if you'd be interested, but I have a Mothering feature happening at my blog with a linkup every Monday for posts about parenting. It's called Motherly Mondays in May, and I think this would fit in just perfectly.
    Of course, no pressure. :) I honestly didn't come to your blog looking to plug mine. I was just amazed at how great the timing is. :)
    Thanks again for sharing.

  2. Thanks for sharing your story! It's so awesome that you're so informed. =)