Tuesday, August 17, 2010

Labor Story: Part II

I went to sleep fully expecting for some contractions to wake me up so when I did wake up having some nice regular and intense contractions I was really glad I had finally gone into labor. I decided I would try and sleep in between them so I could get as much rest as possible. So I was a little disappointed when I woke up the next morning and realized that I had slept through the rest of the night and nothing had happened :-( That meant we needed to head to the hospital to confirm that my water had broken.

During the pregnancy I had mused over how the drive to the hospital would be. With Quinn we were in New haven and delivering at Yale. All we needed to do was drive less than 5 minutes down one street to the hospital. With James we were delivering at St. Raphaels which is also in New Haven and on average about 15 minutes away. However, the freeway can get really busy with rush hour traffic and so I had hoped we would be heading to the hospital at a time when there wasn't a lot of traffic. What do you do if you are stuck in traffic and are in labor? Do you honk a lot? Do you drive down the shoulder? Maybe you just have the baby in the car???

Thankfully it was early on Sunday morning and I wasn't in labor so we didn't have to worry about that one. It felt kind of surreal driving to the hospital knowing we were going to have a baby but without actually being in labor.

We headed up to Labor and Delivery and they hooked me up to the monitor to check the baby's heartbeat and to measure any contractions. Nancy's shift had ended by the time we got there but Melanie was now on call. I was really glad.

The practice we went to had four midwives that you saw for your prenatal visits. I loved all of them except for one. Not that I didn't like her just this particular midwife we had only seen once and that was to confirm we were pregnant. She was nice enough but we just didn't really click. We randomly rotated through all of the midwives throughout the pregnancy but it just so happened we never saw the first midwife again except at the hospital tour where again I didn't feel a great connection. She had also delivered a friend's baby who didn't have the best experience with her. Then there were three other midwives that worked at the hospital, one of whom I had only met briefly at the hospital tour and had never seen for prenatal visits, so there was a chance that there could be a woman we had never met with previously delivering our baby. We were really pleased to hear that Melanie was there and that she would be on call for a while.

After they had monitored me and the baby for a while they checked to if my water had broken. And the test was positive. There was no turning back now. Melanie explained to us that in general when you water breaks you have 24 hours to have the baby. Now that there was a hole in the amniotic sack there was a high risk for infection. However the doctor that was currently on call was more of the opinion that you had 24 hours to go into labor. So that meant we had some decisions to make. I could go ahead and be induced then and there with Pitocin. Or we could try a more mild induction called Misoprostol. Or we could try walking, massage, sitting on the birthing ball etc to get things rolling. As I wanted to have as natural a childbirth as possible this seemed like a great option. I had been starting to have a few contractions and was hopeful my uterus would realize it was time to start working harder. We were officially omitted and started walking!

And walking and walking and walking....that hallway was not very long and it wasn't the most exciting walk. At one end there was the NICU, on the other the OR. Now normally I would be super excited about both of those places...from a medical point of view. But not today, I didn't want me or James ending up in either one of those rooms. ( I think that they should have an indoor track on the Labor and Delivery floor. )

It turned out to be a pretty fun morning. We walked, talked and laughed and then alternated the walking with resting, massage and sitting on the birthing ball watching some football. The contractions would start to pick up and be nice and strong and then they would stop again. Then they would be pick up and then die down. At some point in the morning Melanie came back to check how things were going and as we weren't having much luck asked if would like to try 'breaking my water" some more to see if that would help get things going.

No one really knows what causes a woman to go into labor but one thought is that the change in pressure from the loss of fluid when your water breaks can trigger it. As I really just had a tiny pinprick there hadn't been enough of a shift in pressure to get labor going. I was all for trying this. Sadly it didn't work. James' head was so low down that even though there was a tiny bulge of the amniotic sac in front of his head it was hard to get to. And man did it hurt! After trying to get it for a few minutes Melanie announced that she had gotten through the first layer, the Chorion but not the second, the Amnion. She said that hopefully though the procedure had released a few prostaglandins (the hormone is released when your membranes are stripped) and that even though she hadn't been able to let out any more fluid that maybe the hormone would get things going.

Around 1:00 we decided we would need to try something else. We were getting close to 5:30, the 24 hour mark, and so we thought we would step it up a notch with the Misoprostol. When we checked in I was at 2 cm and about 50% effaced. We hoped that the Miso would help me dilate a few more centimeters and become more effaced so that if we did need to induce with pitosin I would be more ready. The Miso seemed to get things going. The contractions became a little more regular and more intense. We kept walking for a while and then they put me back on the monitor to see how things were picking up. Melanie came in and said that things were looking very good.

And about 20 minutes later the contractions died down again. It was now 6:30. You can do Miso once every four hours and in general it takes about 2-4 rounds to get things going. You also can't be having too many contractions to be able to have it. By this point we were getting very tired and emotionally drained. If we kept doing the Miso it could be another 12 hours before anything happened and we didn't want to be so tired that we couldn't get through labor. That and for no other reason than it just felt right we decided it was time to try Pitocin. This was a big decision, Pitosin really scared me.

Now I have to mention the nurse that was assigned to us during the afternoon. As I want to be a nurse I have tried to make a mental log of things that I like about the nurses I have had and the things that I don't. The first nurse we had was great. Friendly, interested in us, good at what she did but kept a professional distance. The second nurse was nice but super opinionated. After hearing we were from Utah she made some very rude and snotty comments about our religion. This left me feeling uncomfortable around her. I didn't think she needed to agree with us or believe as we did but here was a person that might be helping bring our second son into the world yet obviously didn't respect us. Later on she bluntly told me that she thought way too women receive epidurals. Pain management during labor is a very personal thing, I don't think there is any right or wrong to it. Every labor and person is different and you have to make the decisions that are right for you. As a health care provider you should never express an opinion like that. I was a little offended. I was hoping to go through labor without an epidural, but what if I decided to get one? I didn't feel she would be very supportive. After we made the decision to start the pitocin she asked why we had made that decision in a tone obvious that she didn't approve. There I was feeling feeling very nervous about being induced with pitocin and she is questioning that decision.Thank goodness her shift ended a few minutes later. Compare her to Kira our third nurse of the say, who was completely supportive, was friendly and made us smile, spent time getting to know Peter as well as me (I feel husbands are often neglected during labor) and a great labor coach who stayed an hour after her shift ended to see things through to the end. I hope I am a Kira one day.

1 comment:

Melanie said...

Liz! Congrats! Jenna just forwarded me your blog. He's beautiful! I'm so glad the girl named Melanie helped you...and that you liked her! Our blog is private, but I'd love to send you an invite. Just send me your email address at bostwick0106@hotmail.com.