Saturday, March 5, 2016

Caleb's Birth Story

So I had to go back and see how long it's been, to know where to start this time. It has been 7 months. Wow. Who knows how long it will be before I crack this thing open again, but I really wanted to make sure our second child's birth was written about.

So, we found out the second was a boy, as you may have already guessed. We were really quite shocked, even though we didn't really have a preference, turns out we thought we were having another girl more than we realized.

This time around, I was induced at 39 weeks and 2 days. I've known since Sophia's birth and the complications with it, that I would not be going past due with the second. My midwife told me that in the delivery room. I was also advised to cut "white" carbs in the last trimester of this pregnancy to avoid any unnecessary weight gain. Basically, Sophia almost didn't fit, and so this time I needed to have a smaller baby. Which is tricky because subsequent babies, and boy babies, tend to be bigger. But, I managed to only gain about 5 pounds total my third trimester, so I did good. And I didn't gain an unhealthy amount overall either (23 pounds).

At 35 weeks I had a full ultrasound to check health and guesstimate weight. At that time he was running average, putting him on track to be 8.5 pounds at 40 weeks. At my second to last appointment, when we got serious about setting a plan, I was actually offered a scheduled cesarean. Apparently this is something they're required to counsel you about, because mothers who have experienced a shoulder dystocia are at higher risk for recurrence, and the only definitive way to avoid this is to avoid a vaginal birth. I declined the offer, wanting to at least give my body and baby a chance.

By 39 weeks even, I was 2cm dilated, and around 80% effaced, but still at -2 station (head was not engaged in the pelvis aka baby hadn't "dropped"). So I went in at midnight for a Cytotec induction. I was pretty familiar with this routine from Sophia's birth. When they placed me on the monitors, I was actually already having contractions, but they weren't really painful and some I couldn't even feel. I had my medication and then we proceeded to try and sleep.

At my 6am check, there was really no change. In fact the nurse thought I was more like 60% effaced. She had said this when I checked in. No big deal, these things are an estimate and vary upon the person doing the exam. I was contracting regularly, but still not particularly painfully. So, a second dose of Cytotec was placed and again, we tried to rest.

Some time around 7am John went and got breakfast and snuck me some too. My midwife came and did my 8am check. Still no real change. I was borderline that they could even give another Cytotec because I was contracting so much. I could feel them all at this point, but they were still manageable. Like a 4-5 of 10 on the pain scale. They decided to place a third dose. My midwife remarked that I have a "stubborn body".

At my 10am check, still no change. Things were starting to get concerning. We made a plan to get up, walk the halls, sit on the yoga ball, try and get his head to descend. So I did that for 2 hours. My midwife came by on her lunch hour and checked me. STILL no change. At this point we discussed options. I asked if we could try Pitocin. I was advised that that wasn't really a great option because A) I probably couldn't get an effective dose because I was already contracting so frequently and B) My cervix still wasn't ripe/favorable. That was the intention of the Cytotec. I asked about getting an epidural just to see if my body wasn't relaxed and that was hindering things. I was told again because my dilation was so minimal, and epidurals slow things down, that I would just likely stop any progress I might make. We were basically down to A) Keep going how I was and wait another possibly umpteen hours to see if  I would progress B) Go home and see if things progressed naturally and if not return later for another induction and C) A cesarean.

Because Cytotec is given every 4 hours if needed, I had until 2pm to decide. It was frustrating to be having regular contractions that were ineffective. John and I discussed it, and with a peace in my heart, we decided to proceed with the cesarean if there wasn't any progress. We had kind of "been there done that" with an extremely long, painful, exhausting induction before. We had also gone home and returned for a second induction before. Neither of those did us any good. I continued to walk, rock, sit on the ball. My contractions ramped up just a little in intensity, and in fact I started to feel them a twinge more in my back than my front, but sitting on the ball and leaning on the bed made them bearable.

So the moment of truth arrived. My midwife's attending physician came in. The felt my belly and agreed they did not think this was an overly large baby. However, I had still not really made any progress. His head was still very high. Then the doctor/surgeon gave us the big talk. He again reiterated our options, that this was not an emergency, and we could go home. Without any hard numbers he told us "We can try and deliver you vaginally and you probably will not have another shoulder dystocia. Or we can do a cesarean and you definitely will not have a shoulder dystocia and it's highly unlikely that you will have any complications. Unfortunately we have to do hundreds of cesareans to avoid one devastating shoulder dystocia." My midwife also advised me that since I am not a first time mom, my body should have responded to the medication, but it did not. I actually had a better response to it the first time around than I did the second. By now, my body should be able to more easily produce the hormones needed for delivery, but it was not.

At this point, I got a little shaky in our earlier decision. I didn't want to go home, but I didn't want a cesarean. I also didn't want to labor forever only to again have complications at delivery. Now the surgery was staring me in the face, and my providers wouldn't help to sway me with a personal opinion. The decision was solely in my hands and I would be responsible for the repercussions.

After talking with John again, and having a cry of fear about surgery and the loss of my hoped for vaginal birth, we decided for the surgery. The anesthesiologist came in and because I could only say for certain that the last time I had water and ice chips was 2pm, my surgery couldn't be done until 4pm. And I had to take an AWFUL medication called Bicitra. It's a liquid and it tastes absolutely horrible, and you can't have any chasers. Thankfully I didn't vomit right then and there.

Then my nurse began prepping me. IV fluids, antibiotics, a shave (that was a surprise to me!), a hospital gown, and sequential compression devices (leg squeezers to prevent blood clots). I was asked to get in bed for all of this, and about 3pm when they were all done, we were left alone. It was weird in comparison to all the checks I was getting before. Well, the bed was the most uncomfortable place during contractions, which were still coming very frequently. I tried to be compliant, but about 20-30 minutes in, I got back on the ball. The pain was starting to really localize to my back again, and leaning forward really helped that. My midwife came in just before the surgery, and by then I was breathing through contractions. Things were intensifying. I told her these were beginning to feel like the horrific contractions I had with Sophia.

She offered to check me one last time. Just to be sure I wasn't rapidly changing. Nope. She said his head was in "North Dakota". So off I went for my surgery.

I walked into the operating room and got up on the narrow table. I had a sweet woman for an anesthesiologist who was like a mother figure. That turned out to be such a blessing. They put in my spinal. I felt some shooting pains into my butt and down my back a few times, but it wasn't too bad. Then the numbness set in. I wasn't prepared for just how numb you are. My only experience was with my laboring epidural for Sophia. Of course for surgery they want you completely numb, and I appreciate that; it just took me by surprise. It's a very surreal experience.

Then they laid me down and things got intense. They started scrubbing my belly, putting in my foley catheter, getting me hooked up to all the monitors for anesthesia, propping me tilted just slightly to one side. There were a lot of things being done to my body at once and I had no control over any of it. I started to freak out. I started talking about how I was feeling- because talking was the only thing I really could do of my own free will. I told them I felt really weird. My midwife asked if I was nauseous? I wasn't sure. Then a minute later I was sure. They gave me meds for that. Then I felt like I couldn't breathe. My sweet anesthesiologist was stroking my forehead, and explained to me that the spinal makes my rib muscles numb, so that my brain is not aware they exist and are rising and falling as my lungs work normally. I was concerned because I even felt tingling all the way to the underside of my arms, down to my fingers. She again assured me this was normal. She told me what I knew- they were monitoring all my vital signs and they are normal.

At this point I felt so bizarre and "out of body" that I asked if they could just put me out. My midwife said "You want to be awake to see your baby." I told her I did not. I told her I thought this was supposed to be the "easy way out" to have a baby. I said a lot of things. It was quite an experience.

Then, the surgeon and John came in. I immediately grabbed his hand. I was in desperate need of some normalcy and comfort. Then the surgery got underway. John watched a little. He said he couldn't watch it all because it's different when the person they are cutting on is your wife. My midwife warned me just as they were about to deliver him that I was going to feel like she was standing on my chest and I couldn't breathe, but it would be ok. Thankfully I did NOT have that sensation.

And then- they pulled him out. Crying and flailing. The surgeon brought him around really quick. I cried a little. It was odd to hear him come out crying, because Sophia was silent due to her circumstances. I knew in my head he was born, but I was so overwhelmed with all the feelings going on from the surgery that I couldn't really focus on him too much. John went over to the warmer, re-cut his cord, took some photos, watched him get weighed and checked out, etc. My surgeon and midwife proceeded to do all the uterine checking and cleaning. I heard my midwife ask the anesthesiologist if I had Pitocin infusing. I did. They continued their work and she asked again about Pitocin and the anesthesiologist said it was running "wide open". "She's boggy" my midwife said. Being that I'm an RN and have worked in women's health, I got concerned. I just said "Jesus". My midwife heard me and said "It's ok". Then the anesthesiologist gave me an injection in my arm. I knew it was Methergine. Things were fine after that and when they were doing all the sponge/needle/instrument counts and calling out all the facts of that case they said my estimated blood loss was 600ml. That was within normal limits.

John came back and they brought the baby to see me. I kissed him but didn't feel prepared to hold him. I was still very inwardly focused. All the staff were talking about how cute he was. I was proclaiming to my midwife that no one should dare ask me about a third child. She said "But they're so cute when you have them".

John went off to the nursery with him, and the staff got me transferred back into a bed. Oh my, it feels so unsafe and like they are going to just roll you right off the table onto the floor. I knew in my head that was not the case, but it's still how it felt. They wheeled me just across the hall into recovery. I started having the post-op shakes. Oh man that was the pits. I had them for two whole hours. On top of that I was feeling super drowsy from the Duramorph spinal, plus they also gave me Benadryl IV in surgery for my second bout of nausea. The Duramorph also made me mildly itchy. But I asked them not to give me any Benadryl for that because I was already so zonked.

During some of my post-op checks the nurse had to massage out some clots. Let me tell you how fun it is to get a deep tissue abdominal massage right above a 7 inch fresh surgical incision. It is NOT. She was very empathetic about it and I knew it was necessary, and I managed to resist the urge to swat her hands away.

Things got better as time passed. The nurses brought the baby and tried to help me breastfeed him, but he was sleepy and so was I. I think I held him. That period is a little foggy for me from all the drugs.

About 6pm John went and got Sophia. Oh my it was so sweet her meeting "her baby brother". John helped her hold him and he was sleeping. She said "I thank the Lord he maked my baby to sleep". She ooohed and ahhed and fussed over him. She almost had a complete meltdown when John told her she had to leave me and Caleb at the hospital. That part was bittersweet.

So, that is my recollection of how Caleb came into this world. For the second time the birth did not go as I hoped or planned, and for the second time I brought home a healthy baby anyway. This birth thing is tough!

Caleb E. White. February 5, 2016. 4:35pm 7 pounds 14 ounces, 19.75 inches

Sophia and Caleb meet for the first time

Proudest big sister

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