Cold Spaghetti

To read the full birth story, please click on the “Read More” link below. (Sorry that those are showing up in all the posts — I’ll work out that blogger kink when I get a chance!) For those who want the Cliff’s Notes version, the bullets are below!

We had a lot of complications:
– Stenotic cervix causing intense labor pain but no cervical progress
– Posterior, asynclitic position causing increased pressure and pain with slow progress
– Aminotic fluid leakage with meconium staining
– Spikey, irregular, intense contractions
– Slowed heart rate outside of contractions indicating baby not doing well with labor
– Extensive scarring, evidence of infection, and organ mis-placement from previous C-section
– Umbilical cord presentation preceeding baby into the pelvis

This lead to a repeat Cesarean Section. A reminder to my disappointed but accepting heart: “No matter how it happens, birth is a miracle.”

The Story of Kate’s Birth

The weekend before Kate’s birth was filled with the excitement of early labor. I had contractions of various levels of intensity that came and went irregularly. On Sunday, I finished the majority of Will’s “First Year” Scrapbook – leaving blank pages for the few moments I had left to cover. I took it easy: swam in the pool, watched “Mean Girls,” let others bring me snacks in bed, and just tried to rest. On Monday, I had more energy and wanted to tie up loose ends. After Paul finished his work day (around 3pm), we went out for some errands. We picked up my Dad’s drycleaning, stopped by Michael’s for a few stickers needed to finish Will’s scrapbook, and bought a copy of The DaVinci Code. We did all this despite the fact that I was cramping all through the day with increasing intensity. By the time we made our last stop, it was a struggle for me to get out of the car and walking was increasingly difficult. We made it back to my parents’, I got upstairs and settled in to start reading. I didn’t make it more than 15 pages in the book.

Very shortly after arriving back at my parents’ house, my need to be in the bathroom became intense. I began to pay attention to my contractions, both in the interest of timing them and because they were suddenly requiring my complete attention. Although they were just on the edge of the time I knew was necessary for true cervical change (40-50 seconds), the intensity was so strong and climbing so quickly that I began to believe that my labor was simply different. At this point, my contractions were still following a strange pattern (one contraction approximately 45 seconds long, never really abating and going into another, more intense, contraction lasting about 30 seconds. Then I would have a break (roughly 2-3 minutes) before the cycle began again. I noticed dark discharge “oozing” out during contractions and figured that it was bloody show (it looked a lot like dark brown/reddish menstrual spotting.) After seeing the show, Paul and I decided it was time to call Vicki (our midwife). Although we knew that she wanted us to call when contractions were 50-60 seconds long, less than 5 minutes between them, lasting for at least an hour – the intensity of what I was experiencing seemed to indicate that things were moving along quickly, even if the timing wasn’t what it needed to be to indicate that I was truly in labor.

I felt strongly that I had to go to Pensacola. In listening to Paul talk to Vicki, it seemed to me that they weren’t as sure about whether we needed to go, but Paul stressed that I was pretty insistent on leaving and there were concerns about rush hour tunnel traffic. I didn’t think that anything was necessarily wrong (yet), but the rising intensity of the pain I was experiencing made me feel like I needed the relaxing environment of the birth center in order to handle the pain. I wanted to get there; it was all I could think about. I thought that getting there would mean that we would be able to track my progress (which seemed to be going incredibly fast) and better handle my pain; I was eager to help labor along in a supportive atmosphere.

We were in the car by 7pm. Once in the car, I fell into a “ritual” breathing (sort of a low moan) that helped me control and get through the contractions. I used my training: I relaxed my body, I worked through the contractions with deep, easy breaths (the sounding helped with this), and focused on my body. I know I was laboring well. I couldn’t help by compare what I was experiencing with other births I’ve seen – and felt strongly that what I was experiencing was intense labor nearing transition. I honestly felt that we would be pushing out a baby soon after our arrival; I thought it was likely that she would be born before midnight. I chalked up the strange pattern and irregular timing to evidence of the wide range of labor and put trust in my body. I was not afraid, I was excited, and I wanted to get to the Center and start the work of getting the baby out.

We arrived at the Birth Center around 8pm. Vicki and Donna (her assistant and the woman who would serve as my doula) were there and had prepared the birthing room – it was warm, the tub was filling with water, and the bed and floor were covered by protective sheets. Even with all the “sanitary” additions, the room felt homey and comfortable. After getting through a couple of contractions, I made my way to the bed where Vicki examined me. The exam was surprisingly painful. Then Vicki asked, “what birth control have you used?” “Pills,” I answered, “for six years.” “Yup, you sure did,” said Vicki, in her sarcastic way that usually indicates a coming unpleasant twist.

The situation: My cervix was hard and long, absolutely no effacing. I was only 2 centimeters dilated (less than I had been a few weeks before). But the complicated bad news: Vicki explained that I had several inches of scar tissue in “rings” around my cervix (a stenotic cervix). This is of great surprise as I have never had any irregular pap smears (and therefore no crytotherapy or other related causes). There is a link to use of Depo Provera with cervical scarring, and apparently, with use of birth control pills as well – although it is really a mystery and quite rare. So what was happening? My contractions were facing resistance at the cervix and was quickly rising the intensity of the contractions in order to break away at that resistance. This was causing, as Vicki would later call them, “contractions from hell.” I remembered hearing of another woman who had experienced this labor complication with Vicki: Vicki had applied evening primrose oil to her cervix over a couple of hours and used her fingers to slowly break up the scar tissue. She applied some evening primrose, tried to loosen things up a bit (yeah, uncomfortable!), and said that we should chill out. She seemed a bit annoyed and expressed that things would probably just slow down or stop completely. At this point, I was praying that this would be the case. I didn’t know how much more of this level of intensity I could take. It was about 8:45pm.

I continued to want to be on the toilet where I continued to have show. When the tub was ready, I hopped in – instantly, the water helped. Paul was very concerned about my eating and drinking and wanted to show that we were serious about moving labor along by getting me to walk, squat, etc. Being in the tub helped with this immensely – I was better able to squat and open up my pelvis. The water definitely helped relieve the incredible pressure I was feeling in my abdomen. While the water did help some (especially in the first few minutes of being in there) the contractions did not noticeably slow down and still seemed to be gaining in intensity. This is not what Vicki had said would probably happen. At this point, I wasn’t experiencing much in terms of back pain (that I recognized), however, pressure on my back felt great. Paul wasn’t able to press on my lower back (sacrum) when I was in the tub, so eventually, I felt the urge to get out and in a position where I could better relax my whole body and have back pressure.

I should say that neither Paul nor I regret using the Birth Center or Vicki – we highly recommend both. However, I do want to point out that at this point in the labor, we were feeling a bit let down. Paul sensed their annoyance more than I did and kept trying to make excuses to leave the room “to call my parents.” I didn’t want him to leave and no matter how he pressed, Donna would not relieve him. What I didn’t understand at the time was that he was trying to pull Vicki aside to talk to her. He felt that they thought I was being dramatic and it worried him because in his experience, he knew this was not the case. He wanted to express to them how he’s seen me blow off or work through significant pain almost to a dangerous point (he calls me “stoic”). In the future, we think that couples should maybe arrange some code language with birth providers to allow that kind of private conversation when necessary.

When I got out of the birth tub, I went down on all fours (another favorite position of the night) and then down on a side/tummy lie right on the floor. This allowed Paul to rub my back and allowed me to completely rest and relax every muscle in my body. I hadn’t been lying there long when Vicki and Donna came back in to check on me. I got up to go to the bathroom before being examined again. In the bathroom, I noticed more show and saw that some had dripped down my leg. I did not hear the commotion going on outside. Apparently, when I rose from the floor, I left a large pool of green/brown liquid. Donna tested it with something and showed it to Vicki, who said, “I’d call that a positive, don’t you think?” Paul took note of this and says that once this happened, their demeanor totally changed. (We learned later that this was positive for both amniotic fluid and had some meconium staining.)

The change in demeanor I definitely felt. I came into the bedroom and laid on the bed for Vicki to do the exam. It was much more painful this time around. Vicki used more evening primrose, but said that the rings had only receded a small amount and very little progress had been made. Adding to the bad news, the baby was completely out of the pelvis. When she went to try and break up some of the tissue, the pressure and pain was so incredible that I begged her to stop. (I have never begged for anything due to pain.) At this point, I began to feel fear. My gut instinct was that something was very wrong. There was too much pain, it was not a good pain, and it was not going away. I felt that I needed help and felt that we needed to go to the hospital. At the same time, I didn’t want to ask to go to the hospital and honestly did not have the energy to ask – I felt overwhelmed, it was taking all of my thoughts and energy to get through each contraction and recover enough in the short time between to prepare for the next.

Vicki and Donna put pressure on my back (heaven!) and I began to feel much more supported. I kept saying that I felt like such a “wimp” and that, truly, these contractions were what I would have expected for an advanced labor and were almost beyond what I was able to handle. I immediately felt better and calmed a bit when Donna touched my back and said, “we believe you.” It was a relief to finally feel believed.

After the exam and with me lying on the bed on my side, Vicki took the baby’s heart rate. It was down. (It had been a happy 170 and had fallen to 150.) She also said that they had tested my fluid and found that I was leaking amniotic fluid and that the fluid had a light meconium stain. This was all I needed to hear – I was ready to go to the hospital. In my mind, something was wrong and it was time to go. I didn’t care about having another Cesarean at this point: the pain was too much, the baby was showing signs of not doing well with the labor, and my gut instinct was saying it was time. Vicki and Donna seemed to be thinking the same thing, although they didn’t think that we were there yet – offering to give us time to “talk about it”. (This would be really thoughtful with another couple, but I was definitely already in motion and needed no time!) It may have surprised them when we were so quick to mobilize to the car. Vicki called Baptist Hospital and paged Dr. Maher – to all our surprise, Dr. Maher offered to come in even though he was not the OB on call. (Dr. Maher is the neonatal specialist who backs up Vicki’s births and who checked me out to clear me for the VBAC; we liked him a lot and it made a great deal that he was going to be the one meeting us at the hospital.)

We left the birth center a little before 11pm. We were calm, but I wanted to get there fast. Not out of fear – I was in pain and was ready for it to stop. The staff at Baptist Hospital were champions – they flew me to Labor and Delivery, where I was in a bed, gown, and bracelet by 11:30. The contractions were killer. Being hooked up to the machine backed this up – strong, spikey, irregular contractions came through the print out (Vicki’s comment: “These are some seriously funky-ass contractions.”) More disconcerting: the baby’s heart rate was falling not only with each contraction (which would be normal) but between them. This is not a sign of a good labor.

It took a good 30 minutes for the epidural. The staff did their best to hurry along blood work and other necessities. Paul and Donna helped provide pressure to my lower back for each contraction. Paul told me later that he sensed “something serious” from the way people were looking at the contraction and heart rate print outs. I don’t remember much of all this. My eyes were closed the entire time and all I really was capable of saying was “is the epidural here yet?”

It took three tries until the epidural was in my spine. The anestheologist (a very nice woman named Tricia) felt terrible – you could hear it in her voice both times when she discovered that the tube in my back was not giving spinal fluid. I did my best to not think about the procedure (epidurals totally freak me out) and work through the contractions while she tried to get the medicine in my back. The third try was the charm and once in, I had only a few more contractions before the medicine was working.

Dr. Maher arrived just as the epidural started kicking in. I was relaxing and ready to talk a bit – what was going on with my body? Vicki asked if it would be okay for Dr. Maher to do another pelvic, I echoed that I would like him to – we both wanted his take on what was going on with my cervix. His exam was very different from Vicki’s! He found that I was easily 80% effaced and at least 5 centimeters dilated. Apparently, my contractions had worked through the hard tissue and my cervix quickly gone into labor action. It made me feel so much better, validated maybe, that I was actually in labor and the contractions worked through the scared tissue. Dr. Maher also noted that the baby seemed to be in a “strange position.” There was a moment when I thought we were going to discuss the option of not having a section and delivering vaginally with the epidural, but with the meconium, “strange position,” and strange labor patterns, I felt funny about it. The section honestly felt like the thing that had to happen. Even so, I was holding back tears (this was very emotional for me) and was dreading the exposure, helplessness, and strain of surgery.

Paul and Vicki went to the car for Paul to get the camera and call our parents. I was rolled into the operating theater for prep. Once in the operating room, I learned that once born, the baby would be taken out of the room to the Nursery to be examined. This gave me incredible anxiety: the “anesthesia shakes” that had started turned into full-on tremors. I pressed for help: could Paul stay with the baby, what could be done to speed up the tests, did all tests have to be done in the Nursery, etc. I asked that they not administer Vitamin K (and re-signed a statement in this regard) and requested they hold off administering eye ointment until the end of the recommended 2 hour window so that we could have some family bonding time. I was told that hospital policy was 1 hour – fine, I said, but please hold off until we had an opportunity to hold her. I was choking back tears with the horror of Kate having to go the Nursery, out of my care, for who knows how long after birth. Early bonding is a big deal to me and not being able to have it was a lot for me to bear. Since Paul would go with the baby to the Nursery and I would still be in surgery, I asked if Vicki could be present in the operating room so that there would be someone there with me after Paul had left. This had to be cleared through the two physicians: Dr. Maher (who wasn’t in the room at the time) and the head anesthesiologist. The anesthesiologist, a short, snobby guy who never introduced himself to me, patronizingly responded: “No Ma’am, only one person is allowed in the operating room, and that’s our rule.” What a jerk. My shaking increased 10 fold and I started to cry. I also reminded the nice anesthesiologist (Tricia) that, no matter what, I did not want any kind of mood altering medication.

It took awhile for the cast of characters to be assembled. I think the surgery began around 1:20am. I was pretty weepy and shook through the entire process. Paul was limited to how close he could be to me, but his hand on my arm was the most effective thing to control my shaking (I found that I could be almost still with human touch and without it, I shook terribly.) In the course of the surgery, Dr. Maher found several interesting and alarming things:

– Kate was posterior (OP), meaning that she was looking in the direction of my navel – not in the less painful, easy to deliver anterior (OA) position.

– Kate was also asynclitic, meaning her head was “cocked” to the side.

– Kate was swimming in thick meconium. The stress of the labor had caused her to poop more than we realized; because I had only a small leak of fluid, we had no indication of how extensive the meconium was.

– I have extensive, “severe” scarring indicating that I’d had an infection in the post operative phase of my first C-Section. I had no idea. Interesting note: when we were re-admitted to the hospital when Will was 4 days old, the stress and strain on my body caused me to begin to bleed a substantial amount more than I had been post-op. I actually called down to the UM midwifery floor (where I had received my care) and was blown off. Apparently, it was actually a serious concern; I had an infection scarring up my insides.

– I also have other surgery related scarring – chalked up to a poor quality C-section. So much for UM quality residents!

– My bladder was tacked much too high in the previous surgery. I cannot believe the difference in how much easier it is to use the bathroom now. I would have never known or even thought to ask. Bottom line: those UM residents butchered me and I had no idea!

– BUT THE MOST SERIOUS: Kate’s umbilical cord, not her head, was in my pelvis. Had we continued with labor and Kate’s head somehow straightened itself to get into the pelvis, she would have pressed down on her cord.

The bottom line: this needed to be a C-Section. This was a true – no messing around, no other way, baby is not coming through the pelvis, not a normal situation – we need surgery birth.

So Kate was born via C-Section at 1:49am, Tuesday morning, May 9^th. 8 pounds, 6 ounces. Head and chest circumference were both 14 inches. Apgars were 8/9. By all accounts: a beautiful newborn with lots of hair (red, blonde, dirty blonde, light brown – everyone had a different opinion about it’s color), great skin tone, and nice pink color.

It took a long time for the surgery team to reach her due to the intensive scarring inside me. Had we waited until it was a true emergency with minutes to spare, my scarring would have caused substantial problems. As it was, Dr. Maher did not use standard procedure: taking out the uterus for inspection and placenta removal. He vacuumed out my insides. The placenta came out in pieces. It probably went to pathology (standard for meconium babies). I never saw it and although asked for it directly before the surgery, did not get to take it home. I didn’t have the heart to ask about it later because I know no one was watching out for this. (I thought Vicki would advocate for me since this was a key part of my birth plan and something that I specifically mentioned during several prenatal visits and even brought up within the context of a C-Section – but she did not pull through on making sure that the surgery team saw my birth plan, nor did she share any of my concerns with them… this was a major let down!) This is still difficult for me; I wanted the placentas I shared with each of my children. For me, having Kate’s placenta would allow me to come full circle with my pregnancy and her birth and help me get through the tough emotions post-partum. It may seem like a silly thing, but it was very important to me and carries great emotional weight.

Paul left with Kate a few minutes after she was born. I got to see her briefly before they left. The rest of the surgery was uncomfortable; I asked Tricia to hold my hand to help with my shaking (which was severe at times) and talked to the doctor toward the end, which is when I found about all of the complications listed above. Dr. Maher was really nice and spoke well to me; considering how he had my major internal organs in his hands as we talked. I was out of surgery by 2:30am.

The next day was a blur of tears. Kate had no meconium in her lungs (thank goodness!!) but had inhaled enough to warrant a series of tests. In the meantime, she was breathing too fast to be let out of the nursery; her respirations were in the 70s (they need to be steady at around 60). This meant that she was breathing too quickly to nurse. I was not allowed to see her. Updates came slowly over several hours while I was in recovery. I was alone in the room, I could not move, and Paul was with the baby. Nurses came in periodically to give updates. Around 3am, I found out that Kate was doing really well because “she pulled out her IV and they had to put in a second.” This is when I really began to fall apart. Paul came in a few minutes later. He’d seen her pull out the IV and he could not take her cries as they put in the second. I cried and cried and cried. I asked Paul to stay with her and kept asking why they wouldn’t let him be in the room with her. The whole morning is a blur of me asking for updates, crying, Paul coming in and checking on me, and crying. One part I do remember is when one of the nurses asked why I was so upset, that everything was fine and I should “enjoy the quiet.” In a moment of clarity, I pulled it together enough to say: “NO. Everything is NOT alright. The only way my baby can know that she is not alone right now is by human touch and human voice. The little touch and voice she is experiencing right now is connected to painful pricks and tests. There is one person in the world who can provide the comfort she needs to feel safe right now and that person is me. And I am not there. So, no. Everything is NOT alright.”

This same nurse arranged for me to be wheeled through the nursery on the way to our room to visit with Kate. I was incredibly thankful; they let us stay with her for over 15 minutes. I was able to touch her, talk to her, and talk to the staff. It made a huge difference.

We were able to visit Kate a few times during the following afternoon, once my catheter was removed and I was given the go-ahead for walking. We spent every moment we could in the nursery with her – we were there for some tests and for her first bath. I think because of our strong feelings regarding wanted to be together and our bonding the night before, the staff truly let up on some of their restrictions. We were aware of how flexible they were being and were very thankful. I never saw another parent in the nursery.

I got to nurse Kate for the first time the following night (the night of the 9^th), around 10pm, roughly 20 hours after she was born. (Her respiratory rate had to be steady at 60 for over 6 hours before I could nurse her.) I ended up nursing her almost the entire night: once she started, she didn’t want to stop! Finally, around 3am, her blood sugar had risen enough that she no longer needed the IV. The nurse allowed me to take her back to the room! From then on, Kate was with us.

The remainder of the stay was wonderful. The post-partum nursing staff were angels. The day nurse, Mary, took such great care of me – I have never felt more cared for and looked after (outside of my Mom and Paul). We since found out that Baptist Hospital has one of the highest rates of patient satisfaction in the country – and is even studied by other hospitals in this regard! We agreed that it would be worth the three hour drive to Pensacola from New Orleans if we needed serious care: we really liked the hospital.

In sum, we are now home with a beautiful, healthy baby girl. I am so thankful for the choices we made… I shutter to think what would have happened if we had not left for Pensacola when we did, or if we had let Vicki send us home since we were not technically in labor when we arrived, or if I had not leaked fluid that caused our providers to start to pay attention, or if we had decided to stay at the Center and work through the scarred cervical tissue, or if we had further delayed the C-section and Kate had inhaled meconium into her lungs… so many possibilities. It makes me feel like we did very well: we had a situation which was dangerous and complex in ways that we could not have predicted or imagined, and made good, instinct driven decisions that lead to a very positive outcome. Further, Paul and I advocated well for ourselves and Kate and did so in a way that those around us sought to help us in our efforts.

Kate is wonderful and we are so happy she is here!