This was my third baby and the fear of labor and birth is not what I had to talk myself through. This pregnancy was immediately followed by two miscarriages. It began with a cautious optimism. We didn't want to walk on egg shells, so to speak with this pregnancy, as the previously two losses taught me that I can do everything right and still not have things turn out the way they were planned.
I'd already been blessed with two beautiful daughters. I had endured hyperemesis graviduram (severe nausea and vomiting) and the doctors warned me with my first child that it doesn't go away and tends to grow more severe with each pregnancy. Because of the two losses maybe I was hoping that this disorder would pass me this time, almost like I expected my body to grant me the favor of a peaceful, easy-going pregnancy. It owed me right? To my dismay, like clock-work, nausea hit me like a Mack truck around six weeks. It was father’s day weekend and the girls and I had just told my husband about the new baby. We celebrated by eating a big breakfast at our local cafe with the kids. By that evening I could barely consider dinner and by morning I could barely get out of bed. I forced myself to attend church with the family, only to make it through half of the service. I excused myself and sat reclined in the car with the windows open for the remainder. I did not attend church for another seven months.
This began a horrible cycle of being in the bed for days at a time barely keeping liquid down, going into the emergency every other day for IV fluids because of dehydration. I tried several prescriptions of Reglan, Zofran and other combinations. Nothing seemed to help this time. The hyperemesis was so bad we checked three times for multiples. There was always only one baby. A baby I feared for daily. I had a picc line (A peripherally inserted central catheter) inserted and home health care set up. My husband and I were taught how to give me IV fluids twice a day totaling seven hours of being hooked to medical equipment. At least I was home, I absolutely hated the hospital. In between the administering of IV fluids we were to give me shots of Zofran which lessened the nausea but not enough to eat adequately.
At this point eating was a secondary. For me and the baby's sake I had to stay hydrated. I had to check my ketones throughout the day and every day they were high, even with the iv fluids. Having the presence of ketones means your body is in starvation mode and it starts to create a toxic chemical in your body which is not only life threatening for an adult but also for an unborn child. This was concerning. My body was in starvation mode for weeks that turned into months. My husband took time off of work because I was unable to care for neither our four year old nor myself. The most I could do was get up to use the restroom and even that I sometimes needed help. I felt helpless, hopeless, depressed, frightened and alone. All I could do was lie in bed and pray that I could get through another day. At this point all I could think about was surviving and wondering if we could make it through this. Because I was on the smaller side and had lost 15 pounds in two weeks I did not “show” until much later than usual (about six months). It made it easy to forget why I was experiencing what I was experiencing and often forgot that a beautiful child would await me at the end of all of this. Or would there be? Sometime I couldn't even think about that because it brought on more fears. To help ease our concerns I had bi-weekly viability checkups for the first two trimesters. Baby was doing well, mama wasn't.
I have to mention that I was seeing an ob because of the picc line. I am a big fan of midwives and had planned on choosing a midwife as my provider during the pregnancy. Having a picc line that needed to be managed with home health care was out of the scope of practice for midwives here. I was hopeful that the symptoms of hg would improve around 6 months like it had in the pass. So I interviewed and chose a pair of home birth midwives who I saw simultaneously with the ob.
By the end of the second trimester I was able to incorporate a few items into my system other than IV fluids. They were often short lived (nausea and vomiting was still a nuisance) but I was willing to try anything because at that point it was either eat or be fed food through the IV.
Around 30 weeks, right when I was starting to eat more but still couldn’t keep fluids down (fluids are usually the last thing to be tolerated with hg)it was the midwives and the home health care nurse who noticed my blood sugar levels were starting to be elevated. I did not want to take the glucose test when it was offered because I thought the drink would make my h.g. worse and my ob didn’t insist. I appreciated that. I never tested positive for gestational diabetes in my previous pregnancies, I was healthy pre-pregnancy and my two previous babies were small (6-7 pounds). We both agreed to skip it.
However, because of the increased glucose levels the midwife recommended that I test and chart my levels in the morning and an hour after meals for a week. I did and they were sky high (around 200 after meals and over 150 for a morning fast). I tried to manage with food. This was difficult because even entering my third trimester there were only so many things I could keep down. Ironically these things were doing a number on my pancreas. I was too physically weak because I wasn't taking in enough calories daily and exercising was hard because of this. I shared my findings with my ob who immediately diagnosed me with gestational diabetes and sent me to the diabetes clinic nearby. Within an hour of testing and counseling I was giving stacks of paperwork to chart, insulin, a glucose meter and explained why treating this was critical to my baby's health and my own in the long term. I was frightened and sat in the office and cried for an hour. This changed everything. No homebirth (once you are on insulin it is out of the scope of practice for midwives.) My birth was becoming more and more hospital/intervention based with eight + weeks to go.
My midwife offering to be my doula was a relief because she knew what I did and did not want and how to help me convey that to my ob and the nursing staff. She listened when I cried with my heart break and would offer encouragement with any fears or concerns I had. Concerns and fears I had plenty of. My ob began to immediately start talking induction, possible c-sections (always mentioning the possibility of a big baby), more ultra sounds and bi-weekly biophysical‘s of the baby.
I chose my particular OB because I had attended births with her (her clients were my doula clients). I liked her bed side manner and she appeared to be patient with the birth process and slow to intervene. I was seeing a different side of her when became diagnosed with gestational diabetes. She became a little defensive when my husband and I questioned the medical necessities of more ultra sounds and the biophysicals. Were they medically necessary or just routines? She knew how I felt about unnecessary interventions and tests and I believed she had me and the baby’s best interest in mind. However, there was something about her reactions to our questions that made me get on the defensive and to make sure that I was the biggest advocate for this baby. My husband also rose up as papa bear a few times (very attractive) to let them know to not treat me as another pregnant patient but as an individual and to listen to my concerns and work with me.
We came to an agreement that I would do one more ultrasound to check on fluid and baby’s weight, (I kept in mind that there is a large margin for error). Baby was measuring large (at 32 weeks he was measuring 7+ pounds) and she kept talking induction by 38 weeks. I hated this whole process. I was at this point having bi-weekly appointments again and also 2 stress tests a week. I was having very strong contractions that they were detecting on the stress tests. I was already on a modified bed rest and still doing about 3.5 hours of IV fluids. At this point I was drinking maybe 8-16 ounces orally of fluid.
The Point of No Return
Call me superstitious, but I was never one to get the nursery all set up months before my baby’s arrivals. It was less about me worrying that something bad would happen but more about it causing more anxiety to sit and stare at a prepared nursery and wondering, “When is the baby going to come?” Also, we wanted to wait to find out the sex of this baby so I didn’t want to buy of lot of green/gender neutral cloths. It had also been four years since our last baby so things were still packed away. We aren’t prepared; we had nothing except a onesie that our oldest bought at Babies-R-Us after we told her about the baby.
A few nights prior I woke up and said, “We need to get ready (we still had about 6 weeks left), let’s go looking for a crib today, a car seat, supplies, etc.” I had this strong urgency and energy to clean and that’s what I did. I stormed through the house like a tyrant. Cleaning every inch of the house, top to bottom, organizing, de-cluttering. The night my water broke I’d sent my husband and kids to my in-laws so that I could rest peacefully but all I did was clean. When they came home later I was on my hands and knees picking lent off of the stairs.
I woke at 3 am with what I could only describe as an air bubble in my stomach. For some reason my first thought was, "Oh no. I could be having an amniotic anabolism." Oddly the weeks previous to this happening, I felt strongly that my water would break while I was in bed sleeping but I am not sure why an anabolism would be my first concern. Those fears were immediately silenced as a trickle began to flow. I was confident that I knew what was taking place. I lay in bed trying to calm myself as I was afraid to move. I’m only 35 weeks pregnant.
So I lay in bed, trying to calm myself as the amniotic fluid begins to flow heavily. I have quickly replayed the last few months in my head. I quietly tap my husband and tell him that my water just broke. He stretched, rolled over and said, “Oh yeah, what does that mean?” He is clearly out of it and I tell him that it’s the point of no return. He jumps up with the biggest smile until he realizes that it’s too early. He sits back on the bed and asked what we should do. I went over the plan which was to go to the hospital and make sure everything was okay with baby. I didn’t want to go because I know that once you are there they try to keep you there. I called ahead and let the maternity floor know we’d be coming in and also mentioned that if everything was fine with the baby that I’d want to come back home and labor at home. Like I expected she mentioned that once you are registered and checked in that they wouldn’t encourage me to leave, especially since I had premature rupture of membranes, baby was early and I was insulin dependent. I took my time going; I showered, packed, refreshed up on the Thinking Woman’s Guide to Birth, printed out my birth plan and made arrangements for my two girls. During this time my contractions started as mild cramps and began to build from there. They were irregular but they were what I remembered with my two previous pregnancies. This baby was coming, ready or not.
I arrived at the hospital about 5:45am. I was checked in, assigned a nurse and agreed to let them do fetal monitoring for 15 minutes to check on baby. Baby was doing well and was still head down (via ultrasound), fluid was flowing like a river, my vitals were fine. My chiropractor came in (per my request) and adjusted me to help with my pelvis which was always yanked out of alignment. I had breakfast as I waited for the on-call doctor to come in and discuss a plan. We agreed on a “won’t stop- won’t start” plan. If labor continued to progress we wouldn’t stop it with drugs, but we also wouldn’t try to speed things up. The longer baby could stay the better it would be. They did a test to see how mature the baby’s lungs were and they were still pretty immature. This isn’t uncommon for gestational diabetes baby’s. They are large but their lungs are the last to catch up with the rapid growth.
By the afternoon I noticed meconium coming in big chunks when I used the bathroom. I knew immediately that the only way for it to be coming out that much (or at all) was for him to be butt down. I actually felt it so strongly in my spirit that I sat in the bathroom and called Steve with tears in my eyes. I told him, I think the baby is breach. I showed him the meconium that was still coming out. I had the nurse come and look and she suspected the same thing. They tried to feel where he was on my stomach but couldn't tell for sure. The told the ob who was on call and she ordered an ultrasound. The ultrasound technician came to me because it was slow that evening and showed me how my baby was sitting straight up, his head was between my breastbone and his little bum was resting on my pelvis. My heart sank with this confirmation. I was heartbroken because I knew what was to follow. My ob called me in my room and softly and humbly explained my situation. They know from my relationship with the nurses from being a doula and from my birth plan that if this were to happen that I would like to try to deliver the baby breach. The only problem was (as she explained) that none of the ob's in the practice were trained to deliver a breach baby. At least they were not comfortable with trying to do so. The plan was to continue to keep baby in as long as we could and try to get baby to turn while we still had time. I contacted Gail Tully, founder of Spinning Babies (she's also a local midwife and we had met because of the birth community). I also contacted my doula (former midwife) and explained to her what was going on and she offered her encouragement and some things we could try. That night I quietly sobbed. Time stood still as I felt so incredibly alone. All I could hear was the sounds of the machines I agreed to be attached to. Other than that the maternity floor was very calm. Every hour a nurse would come in, stroke my arm and wipe my tears and ask me if I wanted something to help me sleep. Remember, my water broke at 3am the previous morning. I haven't slept. It was going on 24 hours and I was physically and emotionally exhausted. I kept denying their offers of something to help me sleep. I know that being exhausted is counterproductive when you are in labor. But up until this point I was trying to restrict any unnecessary medications for this baby. By 5am I finally agreed to some Tylenol because my head was hurting so bad from all of the crying. The relief from the headache allowed me to sleep for a few hours.
The next morning the nurse came in checked my vitals and asked me if I was aware of how strong my contractions were (she’d been watching them from the station). I was. I noticed they increased in intensity and felt like they were getting closer together. I told her that I forgot to mention that my baby’s start slow but fly out when they are ready. My first stalled at 4cm’s for a few hours, the nurse checked me and said no change, went to get me some ice chips and baby was crowning by the time she came back. My second baby “stalled” at 6cm’s and same story. They went to get the midwife because I said I felt like I was going to explode and by the time they came back baby was crowning.
I wasn’t exactly sure what would happen with a breach baby but I thought they should have some kind of game plan should baby follow his/her sisters. The nurse agreed and spoke with the ob on-call. They wanted to check me to see if I had dilated at all (I refused any checks before then because of risk of infection). They checked me and I was only 3cm’s. This was a surprise to all of us because of how intense and close the contractions had been all night. I ordered breakfast and went to take a shower. My husband helped me and washed my back. I sat on a stool and started to cry. He asked me if I was afraid of a c-section and I nodded yes and began to sob uncontrollably. I’m not sure what he said after that but I knew it was full of love and comfort. I was still nervous but I wasn’t as afraid. It was almost like the release of the fear and tears gave my body the go ahead to finish laboring because by the time I stepped out of the shower I could barely walk. The contractions were hitting me so hard and fast it took him and a nurse to get me from the shower to the toilet. I wanted to sit on the toilet because it helped with the contractions but the nurse kept trying to get me back in bed. This baby was coming like a runaway train and the toilet was speeding it up. It took my husband and two nurses to get me to the bed. I did not want to go to the bed. The contractions felt worse there and I felt out of control there. My husband managed to separate long enough to call my doula Sara (previous midwife) and ask her to come in right away. The nurse called the ob and in a blink of an eye there was a team in my room prepping me for surgery. My doula arrived and my husband gently passed me to her. I was contracting so hard that I could barely breathe through them. I bellowed and called on Jesus so loudly I didn’t care who heard me, I didn’t care if it scared the other laboring women. I began to slap the hands of the nurses because they kept trying to get the monitors on me and make me lie back. They backed off and my doula Sara began to speak gently with me and help me breath through the contractions.
Within five minutes they cut my gown off of me and had me drink an antacid. They wheeled me into the operating room where the ob was along with the anesthesiologist, two neo-nurses. My nurse, my husband and doula joined me. The anesthesian gave me an epidural which was hard to do because the contractions were on top of each other. Can you imagine having to be still while getting an epidural during a transitional contraction? It was brutal. My husband was by my head and my doula was in the corner. My nurse began to explain every step which eased my concerns about the process. I couldn’t feel anything but pressure. I kept my eyes closed as I breathed through the surgery and within 10 minutes our son was born. He looked so much like our youngest and we both began to weep. They brought him over to me and I so badly wanted to touch him but all I could do was throw up and shake. I turned my head away from him because I was so sick. My husband took the baby to the neo-natal room and Sara came and sat with me. She held and stroke my hand as tears streamed down my face. This part was worse. I could feel him putting things back into place and I so badly wanted it to be over. I was there may be a half an hour and brought back into my room. Sara explained what was going on with our son as Steve stayed with him. The nurse came and explained what the rest of the day would look like. The catheter, pain meds, etc. I felt so out of it. Everything felt like a world wind but I was so happy that it was over. My heart was aching because I didn’t have my son in the room with me, on my chest like I’d imagined. He was going to need to be in the nicu so they could check his blood sugar which was low.
When Steve returned he was floating on air. He was beaming about our little guy and asked if our family could step in and say hi. The visits were short which was fine because I was exhausted. After every one left (except Sara) the nicu nurse “snuck” the baby in to see me which brought on another wave of tears. I was in so much pain but I sat up, took my gown off and placed him on me. He immediately latched on and began to nurse. It was absolutely beautiful. We didn’t have a name yet because we did not know the sex of the baby and he was early so after my doula left my husband I am searched online for a name that would suit this little guy. We agreed on Elisha which means “God is my salvation”. I think that is very fitting looking back on the pregnancy, labor and delivery. It was certainly God who I held on to during all of this and my prayer is that Eli will do the same when life doesn’t go the way you plan it.