Alexander's Birth Story

I am posting this story in all the gory details so if you are faint of heart beware… Also b/c I had such a long labor it is a pretty long story.

Our story begins Tuesday, May 27th. I woke up that morning and found that I had lost my mucous plug- yeah for signs of early labor or so I thought at the time! So basically nothing happened all day Tuesday except that I had an appointment with the midwife and when she checked me I was a fingertip dilated, 25% effaced and -3 station. I also had an NST which looked good and an u/s to check for amniotic fluid levels b/c I was 41 weeks at that time, which was also fine. Since I was 41 weeks we scheduled an induction for the following week on Monday. After my appointment we went home and continued waiting and hoping for labor to begin.

Which it did the following morning! I woke up Wednesday morning having contractions, which continued mildly all day Wednesday. Plus I had bloody show most of the day. Looking back I realize that this was early labor but at the time I wasn’t sure if it was early or false labor. About 11pm that evening- basically as soon as I lay down to go to sleep my contractions picked up and were every 5-7 minutes. Again at this point it wasn’t too bad, uncomfortable yes... but I was able to relax between contractions, not enough to sleep mind you but I was managing. So as the night progressed so did my contractions and we headed to the hospital at about 4:00am on Thursday morning b/c my contractions were every 3 minutes.

When we got to the hospital I was checked again and despite having contracted all night long I was only 1 cm dilated, 75% effaced and -3 station. However, at some point during the night apparently my water broke (I vaguely remember a sense of peeing myself during a ctx but I never had a big gush), which meant I got to stay at the hospital. Because I hadn’t slept all night the midwife recommended that they give me some pain medicine and have me try to get some sleep. So I got a shot of morphine and phenergan and Frank and I went and passed out. Aren’t drugs amazing?!? I managed to sleep till about noon, then had lunch, and then went back to labor and delivery to get put back on the monitor.

By the time we did all that it was about 2pm and when they checked me I was 2cm dilated, 80% effaced, and -3 station! Talk about some seriously slow progress! I have to say at that point I was slightly discouraged and really it just went downhill from there! We decided at that point that we needed to help things along to get my contractions working more effectively. So I got a dose of misoprostol which is a cervical ripening agent to help get my cervix dilating. Of course getting the miso required me to go on the monitor for 2 hours to monitor the baby and to get an IV, which I had been hoping to avoid, but I was ready to get things moving. Well the miso definitely got things moving! My contractions got a lot more intense and a lot more painful so I got a dose of fentanyl to help me manage the pain of the contractions, which worked with mixed results.

So after my 2 hours on the monitor I got checked again and I was 3cm dilated, 80% effaced and still -3 station with a bulging fore bag of water. Apparently when my water initially broke it broke high and trapped a portion of the bag between Alexander’s head and the birth canal. Normally they want you to be at least 4 cm dilated before they let you get into the tub but I was so uncomfortable at this point I was desperate! Since I was starting to loose it at this point, they took pity on me and I got into the tub and was able to relax a bit. Unfortunately that only lasted a couple of hours before the really intense contraction began again.

That was the point in labor where I just thought I cannot do this anymore. I was having such intense pain during the contractions and even in between the pain wasn’t easing up very much. Up until this point I had been able to manage the pain- it hurt but I was making it through and able to relax in between but I totally lost my ability to manage. It just felt like something was wrong and instead of the pain working to get the baby out it felt dysfunctional. So they called in the OB and tried to give some Nubain to help with the pain, which for me did absolutely NOTHING!!!! Then the OB broke the fore bag of water which helped a bit although after that with every contraction I had a gush of fluid. I had no idea it was possible to have that much amniotic fluid. I swear I must have soaked the bed at least 3 times. All I have to say is thank God for Mel and Erinna and Marilyn b/c there I was screaming my head with every contraction and they were so calm and reassuring. And of course at this point the baby started to get tachycardic, which was most likely due to my anxiety level and a certain amount of dehydration so they started giving me IV fluids. Luckily that did the trick and he calmed down.

Now you have to keep in mind that even with all the pain and wildly intense contractions my labor was not progressing. I had only dilated to 3-4 cm, 90% effaced and the baby’s head was still at -3 station! I can’t even begin to describe how incredibly discouraging that was. Heck at that point even I was ready for a c-section! But in a last ditch effort to preserve my hopes for a vaginal delivery I got one more shot of nubain, which again did absolutely NOTHING for me, while we waited for the anesthesiologist to come and give me an intrathecal. An intrathecal is kind of like an epidural only it is a one time shot that lasts 4-6 hours and you are not paralyzed so you can still walk around and move during labor. I have to say getting the intrathecal was probably the worst part about the whole experience but boy was it worth it!

All I can say is thank you Dr Provost and I am sorry I was such a witch! The inherent problem with getting an intrathecal is that they stick a big needle into your spine and since they don’t want to damage your spine they have to be very careful about where they stick the needle. Now b/c of my pre-ecclampsia I had a lot of swelling, well that included swelling in my lower back which made it difficult for the doctor to find the appropriate landmarks. Plus they want you to arch your back like a cat and then hold completely still, which when you are pregnant curving your back around a big old preggo belly is not the easiest and when you are in labor having crazy intense contractions holding completely still is absolute agony! Plus the poor doctor had to listen to me screaming while he tried to stab me in the spine. After I think four tries he finally managed to get it and life got so much better.

I don’t know if it was simply the intrathecal or the OB breaking that fore bag of water or the fact that I managed to get the pain under enough control that I could sleep between contractions (b/c everything is just worse when you are tired) or if it was a combination of all those factors but labor became manageable again. Frank and mom went to get some sleep at this point and Marilyn, my doula, helped me get into a rhythm where I was able to breathe through the contractions and then actually sleep in between. At some point within a couple hours after getting the intrathecal, the midwife checked me again and I was still only dilated to 4cm, 90% effaced, and -3 station so we decided to start some pitocin to try to get my contractions more effective while the intrathecal was still in effect.

Honestly I was terrified of the idea of pitocin at that point b/c I was afraid that that dysfunctional pain was going come back. So we started really slowly and although the contractions did pick in intensity and pain level they were still manageable. So we kept going till about 8am, at which point a new midwife came on duty so she checked me and I was 6cm, basically100% effaced (I still had a rim) and -2 station. So progress had been made! I kept laboring for another few hours and around 10:30 am she decided to check me again b/c they were starting to see some early decels on the monitor which indicate head compression. Amazingly enough in those 2 hours I had gone from 6cm dilated to fully dilated, 100% effaced and ready to push! Before they let me push though the midwife wanted me to try peeing b/c it had been awhile. Of course I tried and tried and couldn’t pee so they put a catheter in and drained 650ml of urine! The baby’s head was still high even after that but I started to feel some rectal pressure so I started pushing.

I started out squatting by the side of the bed and then my legs got tired so I pushed on the toilet for quite awhile. In fact I probably could have delivered him on the toilet but they were having a hard time monitoring his hr so I moved back to the bed so they could keep a close eye on him. At some point they ended up putting on an internal fetal scalp electrode so they could better monitor his HR. I think the last 45 minutes of pushing were the worst b/c by then I was getting really tired and it felt never ending. It just felt like his head had been “right there” for so long and I was never going to be able to get it out! Plus I don’t think anyone can ever accurately describe the pain of pushing. They say it burns but that doesn’t even begin to describe it. Pushing into the pain is really just a lot harder than it sounds!

Things did happen very quickly at the end. I got his head about halfway out and then I was having trouble getting it the rest of the way. Needless to say he didn’t like that very much and he started to drop his heart rate. The midwife started talking about needing to cut an episiotomy, which when you are hurting like crazy and you look down and see a giant needle of lidocaine pointed at your vagina, you find new strength! Things got pretty tense as they were telling me to push, push, push!!!! Finally, after 4.5 hours of pushing, his head came out and from what I could tell the midwife practically yanked his shoulder out right behind. They quickly clamped and cut his cord and put him on my chest all the while rubbing him with blankets b/c at that point he hadn’t started to breathe on his own. He opened his eyes and looked at me before they whisked him away to the warmer. They gave him about 40 sec of ventilation, followed by some CPAP, and some blow-by oxygen to get him breathing and that first little cry was one of the sweetest sounds I have ever heard.

So after a rocky beginning, his 1 minute Apgar score was only a 4, he pinked up and the pediatrician on call gave him a clean bill of health. Within 10 minutes he was back in my arms and wide-eyed and alert looking right at me. It is a miracle how resilient these little bundles can be! We only even found out he was a boy b/c one of the nurses working on resuscitating him said “he’s doing fine” and Frank said, “It’s a boy?” Twenty-six minutes after he was born I delivered the placenta and after bleeding a little, they cranked up the pitocin and got my uterus to clamp right down. Amazingly enough I delivered him with an intact perineum and after that initial bleeding and cramping from the pitocin, had very little pain and/or bleeding. Frank did awesome! He held my leg for almost 2 hours while I pushed and he was right there in the thick of things when Alexander was born. Heck he only got a little woozy and had to sit down after the baby was born!
Within 2 hours I was up and going to the bathroom by myself. I walked from the labor and delivery room to our postpartum room and even took a shower that evening. I gave Alexander his first bath that night and luckily he was a good baby that night and slept a good part b/c I was so exhausted I am not sure I could have managed a fussy baby. So after more than 48 hours of labor and every intervention I said I didn’t want, it didn’t really matter b/c we ended up with a health beautiful baby boy!