Healing from birth...
Ella was born 9 weeks ago and while I had a rough birth experience, none of it seemed to matter because I was so in awe of my little girl. I was in a state of complete euphoria. However, while by no means have my feelings for my daughter changed (being a mommy is the best thing in the world!), over the past couple of weeks feelings have surfaced surrounding Ella’s birth. I feel disappointed to say the least, and during my most “down” times, I feel completely traumatized by the experience. This is my first attempt at thoroughly explaining Ella’s birth so forgive me if it’s broken up over time, or jumps from thought to thought. I’m hoping with time it will flow… if not here then in my memory.
Having worked in the labour and delivery unit of the province's only women's hospital, I had a deep appreciation for the power of the human body, although I had also experienced how the medical world can undoubtedly influence the course of a child’s birth… for better or for worse. Some of us (being the nurses and physicians) encouraged and supported women in their quest to birth naturally, while others were total interventionists. I remember one co-worker stating, “I can help any woman get through it without drugs.” I loved the simplicity of her statement and I idolized and looked up to her as a nurse who would really support and encourage a natural birth plan. On the other hand, a nurse who became a good friend of mine believed in IV’s, epidurals, c-sections following previous c-sections and often raised an eyebrow at written birth plans. I watched some amazing births, some medicalized, some not… it totally depended on what mattered to the woman. What I did realize (as I was pregnant during part of my time there before I changed jobs), was that I knew the different outcomes and I wanted a natural birth. Women who laboured without drugs and gave birth vaginally just seemed so much better off in the end (or rather the beginning J). I wanted this for myself and my baby, but in the back of my mind I always had a feeling it wouldn’t go that way… maybe I sabotaged myself, but I didn’t have any trouble picturing the upcoming experience. The only trouble was, I always pictured myself in the OR being cut open rather than the nice vaginal delivery I was hoping for.
There are two pieces to my birth story that I cling to… things that make me feel better about the experience. I went into labour spontaneously at 41 weeks and 3 days (an induction was planned for the following day!) and my water broke on it’s own.
That was sad to even write down. I only feel ok about two pieces of my beautiful daughter’s birth. Hmmm… thoughts aren’t flowing anymore, I’ll pick up later.
As I mentioned, I was scheduled for induction early on November 10th - a round of cervadil, followed by more cervadil or pitocin if I was “favourable”. Having worked in L&D I had watched the pitiful success rate of women being induced from a stand still, and I went home on the 9th hoping I would go into labour on my own… well, actually I went shopping to buy a baby swing, and then to my in-laws’ house because they were closer to the hospital (DH and I live 2 hours away). So after the quick shopping trip, we went to DH’s parents’ house and got settled in. Somewhere between Survivor and Grey’s Anatomy the painless contractions I had been having for the past week really picked up. After several hours they were about 3-5 minutes apart and I really had to work through them, although I felt totally calm and very proud of my body for doing what it was meant to do. I had avoided the induction I didn’t want! Eventually, DH suggested we go to the hospital and I agreed, hoping with all my might that I’d be more than a fingertip dilated and I wouldn’t become of the women I had all-to-frequently sent home to walk.
After a not-so-fun car ride to the hospital I arrived at the birth unit’s early labour assessment unit. I was five centimetres, Yippee!! I started getting some nausea, but I felt in control and empowered that I had made it to that point with no desire for drugs. My natural vaginal birth was in sight. At that point I was able to envision my birth outside of the OR. I pictured delivering the baby and holding her to my chest… and my nurse’s brain even envisioned the stitching up of a tear.
I was admitted to a room and I was left alone to change into a hospital gown. In the bathroom I had the strongest contraction yet. I squatted on the floor and worked through it (squatting seemed to be a nice position). I left the bathroom and felt my water break and gush down my leg. I was so excited. It was all going so smoothly.
Something I haven’t mentioned yet - the nurse who met me in the assessment unit was the same nurse I had made friends with and the same interventionist I described in my previous post. On one hand I was comforted by a familiar presence, on the other I knew her ways and dreaded the inevitable. She would offer a ton of interventions, and she was pushy about it by nature. This was the first time I should have made a different choice. I should have requested a different nurse. I needed that nurse that could “help any woman through a drug free labour”, but I didn’t request the change out of fear that I would offend my friend.
So my water broke on it’s own… and that was the last moment during Ella’s birth that I felt in control and excited.
I know this doesn’t follow the actual sequence of events but, last night I was laying in bed and thought about how grateful I am that breastfeeding has been successful. Ella was given formula in the NICU because her sugars dropped. I was in recovery at the time and they gave DH the option of formula or an IV. He opted for the formula of course, but why didn’t they offer to allow me to breastfeed? Or even give me the option of feeding her the darn formula? She was only there for observation, why couldn’t they “observe” her in recovery while I fed my baby? I was just so glad to have made it out of the OR that I didn’t have the presence of mind to request these things.
After I left recovery, they wheeled me into the NICU to see my baby. I was touching her through the little hole in the incubator when the nurse asked if I wanted to hold her.
Of course I did. The NICU nurse even said something about breastfeeding, but quickly followed it with something about her sugars and that formula would bring them up faster or she would need an IV. So I could choose to breastfeed and she would get an IV, or she would get formula. Not wanting to feel like a selfish Mommy, I agreed to more formula. So before I held my precious one, they topped her up with formula and she promptly spit it back out. Of all the pictures my DH took of our princess, he didn’t take a single shot of her getting formula and I’m so grateful. I feel sad when I look at the pictures, and it would only add insult to injury to see me 2 feet from my baby and she’s getting a bottle of formula she didn’t want. So after an amazing few minutes of getting to snuggle my wee one,
I was taken to the post-partum floor and wouldn’t be allowed out of bed until 8 o’clock that night (she was born at 10:52am). However, once I was made to go to the bathroom, I immediately asked for a wheel chair and the nurse and DH took me to the NICU where I got to breastfeed my baby. She was a wonderfully eager little nurser, and it felt soooooo good to finally feed my baby. She had received 3 bottles of formula that evening and her sugars were still low; after I fed her throughout the night they didn’t give her another bottle of formula. With the assistance of my DH, we travelled the 2 floors down to my baby 3 more times that night to feed her. The interesting part is, she was supposed to come to my room at 8:30pm, but they couldn’t get a hold of her doctor to release her. So all night, between my trips to feed my baby, every little sound in the hallway woke me up because I thought it might be Ella coming from the NICU.
As I started, I am so grateful that breastfeeding has been successful. I had some issues with blisters when she was 5 days old, but with some guidance on her latch they healed within 24 hours. Without being able to feed my baby in this way I think the birth would have totally robbed me of my femininity and my identity of what makes me a woman.
Returning to the birth, once I was changed into a clean gown and settled in the room (at about 1am) my nurse, lets call her April, wanted to hook me up to the fetal and contraction monitors for a strip to make sure the baby was fine following my water breaking. As I lay in the bed, the contractions worsened. Why couldn’t she listen to the baby with a Doppler while I did my own thing out of the bed? I was doing well as long as I was able to squat and breath… well, moan… through the contractions. I’ve just realized as I’m writing this, that for the rest of the labour and birth, I didn’t leave that bed until I was rolled onto the stretcher in the OR. She hooked me up to the continuous fetal monitoring about 10 minutes after I entered that room and I remained laying down for the next 19 hours. How did this happen you might ask? Well… as I mentioned, once I was laying down the contractions worsened considerably and it brought on a wave of nausea and vomiting. April spouted off that the anaesthesiologist was busy doing a section and was lined up for another section following the current one. She said she could likely get him to come between the two surgeries to start an epidural. I told her that I was fine so far and didn’t want drugs. She barely acknowledged what I said and pulled out the IV supplies stating, “well, I’m going to get this started so it’s already up and running when he’s ready.”
It makes me so sad to write about this part, I believe it was the turning point of my labour and I’ve spent the last 2 and a half months believing that I ruined Ella’s birth because of it. I stuck my arm out for the IV and the slippery slope of a medicalized birth had begun. With the increase in intensity of the contractions since laying in the bed, along with the nausea and vomiting, in this moment of weakness when all I needed was a firm “you’re doing great, keep going”, April said, “Do you want something for pain?” And I said yes. She gave me IV fentanyl. It dulled the pain for one or two contractions, but all it really succeeded in doing was making me faint and groggy and unable to get up and walk. The nausea worsened and therefore I was given at least 2 different kinds of antiemetics through the IV. These made me drowsy and edgy at the same time. She brought IV fentanyl twice more (or three times?) as soon as I was able to have another dose. All of this to someone who rarely even takes a Tylenol, and has never even sniffed a gravol. This point of the labour I barely remember, everything was a fog as I drifted in and out of consciousness. I know my husband was beside me and April was flitting in and out of the room talking about things I was barely able to process. The whole thing reminds me of a spy movie where the main character is drugged into submission and made to do and say things to the liking of a “bad guy”.
And then I remember the red cart being brought into the room. The red cart is filled with all of the anaesthesiologist’s supplies to start an epidural. “Good News,” says April, “I got the anaesthesiologist to come between his two c-sections, and he will be here in a minute.” At this point I was thinking, didn’t I say I didn’t want drugs yet? But there I was, pumped full of man-made morphine, and to tell you the truth I was slightly relieved at the thought of the epidural, at least my head might clear a bit if the fentanyl stopped.
The epidural was a hell all of its own. It took him dozens of jabs, three separate catheters and 2 and a half hours to get it started. This is two and a half hours of being told to “hunch over” and “be still” while contractions are coming every 2 minutes. In hindsight, why didn’t I tell him to take his epidural and kindly let me be? Eventually he got it in the right spot I guess, because the pain of labour went away… and so did all feeling from my armpits down. Most women have heaviness in their legs but can still move them, not me. I could wiggle just one toe on my right leg. I had to be moved around the bed by my husband and the nurse (a new nurse at this point, April left at 7am at shift change). I was absolutely dependant on the people around me to lift my legs and help me around the bed, how pathetic is that? And to top it off, I had 3 separate in and out catheters to drain my bladder.
During the whole epidural process, my dilation had stalled at 6cm. Why do you suppose that was? Could it have been the complete inability for me to relax? No, it was apparently thought that I was stalling because of a lack of hormones. My contractions were still strong and coming every 2 minutes, but at one point I looked up at the IV pump and there it was… pitocin. They had felt it was necessary to start pitocin. It dripped for about 20 minutes before some late decelerations in the baby’s heart rate gave us a scare and they turned it off. My innocent little baby, who depended on me for the last 41+ weeks was under attack from a barrage of narcotics and antiemetics, and she was letting us know that the pitocin was just a little too much. I didn’t even take a Tylenol when I was pregnant, and at this point during labour I was definitely making up for it just when she truly could have done without it.
By about 8am on November 10th I was fully dilated, but not experiencing any desire to push or increasing pressure. The baby’s head was still high after 2 hours of being fully dilated and I was subject to a rough manual exam by the doctor on call. She announced that the baby was OP (facing up) and that was the reason that she wasn’t descending. She then allowed her medical student to repeat the exam for experience since I couldn’t feel it anyway. How humiliating. So then I was given their options to proceed. I could go have a section, or I could try pushing and then likely end up with a section anyway and possibly in a hurry because she was already showing signs of stress (drops in her heart rate and some meconium at this point too). I started to cry and the medical student asked what was wrong. I could only muster saying, “I’m just so disappointed.” I tried a couple of pushes but I was so frozen that my legs were flopping off of the bed without someone holding them and I couldn’t feel anything. I agreed to the section.
Quite a bit of time has passed since my last entry. I've had time to process a lot of the birth, and I don't think about it as often as I used to. It was a disappointing, scary situation, but I have learned to accept it and I am moving on by planning for my next child's birth (I don't know when that will be, but I know I want more children). I have confidence that my next birth will be vaginally, and if something goes wrong, and I end up with another c-section, the birth is going to be on my terms. I will be far more pro-active and assertive in my desires. The next birth will be a positive experience. (telling myself this over and over helps in the healing process.)
Now, to continue with the birth story... warning! may be a little graphic...
After agreeing to the section, it was only a matter of 30 minutes before I was being wheeled down the hallway toward the OR. DH was dressed in his scrubs, and truthfully he seemed relieved that it would be over soon. I had to be slid onto the OR table because I was so completely frozen, and soon I was prepped and draped for the procedure.
After several minutes, I was finding it difficult to breath. I knew this was a common experience during a c-section. The spinal medication can make it feel like your chest wall muscles aren't moving, giving the feeling of not breathing. I was telling myself this in my head, but when it actually happens, it's very scary. This feeling passed a bit, only to be replaced by nausea and vomitting. By this time, the freezing had travelled up to my chin. My arms were falling off the table's arm rests because I couldn't feel them and I certainly couldn't move them, and my throat was paralyzed, making it impossible to swallow. Let me tell you... this was the worst part of the whole process. I was throwing up, but without the "heaving" because those muscles weren't working, so it was slowly trickling out. I could spit most of it out, but was breathing in some of it because I wasn't able to swallow, or cough it up. I thought I might choke to death before they finished the section. My dear sweet husband sat by my side with one of those suction tubes like the dentist has, and kept holding it to my mouth to suck out what I couldn't swallow.
Finally, they said the baby was out and I heard them say 10:52am. I heard one tiny, gurgling cry, then nothing. The pediatric team took her to the warmer and started to work. (I couldn't see any of this behind the drape). Later I was told (after much prodding), that her heart rate and oxygen levels were always great but she had to be bagged and given Narcan (counteracts morphine type drugs) to start her breathing. I called out, "why isn't she crying?" and they told me that she just needed a little help breathing. After what seemed like forever, she let out another cry and I knew that she was ok. She had an apgar of 4 at 1 minute after birth and an apgar of 9 at 5 minutes. They brought her over to see me before taking her to the NICU for observation. Maybe because she was all wrapped up... but I only remember really noticing her eyebrows and how perfect they were.
Her first good cry...
The first time I saw my beautiful baby... emesis basin and all...
I told DH to go with her, and he spent the next three hours while I was in recovery going between me and Ella, and he updated me on how she was doing. I must say, at this point I was on cloud 9. My baby was perfect and I was healthy (and could swallow again!). I even told DH that I wanted 10 more babies just like her.
Once Ella was brought from the NICU to my room the next morning, I was REALLY enjoying my lovely little baby. She was very good natured and an eager little nurser. DH roomed in with me for the 3 day stay, and helped with the baby. I'm thankful for him because I was in a lot of pain. After the first 24 hours I was taking only tylenol and ibprophen because the tylenol with codiene wouldn't let me sleep and made me feel dizzy when I closed my eyes. It took me a good 10 minutes to get out of bed and go to the bathroom.
Other nurses will likely understand this... as a nurse, it's always a little uncomfortable caring for another nurse. There's this fear that they may be judging you and your care. Having worked on this mommy/baby unit during nursing school, I knew their procedures and protocols surrounding care of the post-partum mom, the newborn and breastfeeding. During each 12 hour shift, the nurse is supposed to check for breastfeeding positioning and latch at LEAST once per shift, as well as checking fundal height and baby's vital signs. Well... I could check my own fundal height and firmness and I knew the baby was doing great, so it didn't bother me that they neglected these tasks. But, I could have used a little support in the breastfeeding department. My positioning and latch were checked once during my entire hospital stay and this was by a nurse doing a research study, not a nurse that worked on the floor.
During my last day in the hospital my left nipple was getting pretty sore, and by the next night (at home) I cried during one entire feeding. Thankfully, a wonderful woman who worked for the LLL happened to call during my second day home to check up on me. She came right away to help with Ella's latch. Something as simple as getting her mouth open a little bit further fixed the problem and my nipple healed within 24 hours. It has been breastfeeding bliss ever since.
It has been therapeutic to put my birth experience down in writing. I highly recommend it to anyone who is having a rough time dealing with their experience. As I mentioned before, something that also helps me is planning for the next birth.
Originally, my husband was not open to having a vaginal birth next time. He was afraid of all the things that many people believe are true of a VBAC. I explained to him the benefits of a vaginal birth... the decreased recovery time, better baby outcomes, etc.. I think the statement that began to change his mind was the fact that a planned cesarean still has a higher incidence of complications then a VBAC. With Ella's birth, he only witnessed the trouble during labour, and then the c-section put an end to it all. I think of the birth totally different. I see the labour as being perfect and the a cascade of medical interventions ending in the ultimate intervention (the section) being the problem. I think I've got him on my side now... but the true test will be when I'm pregnant again and the VBAC is just around the corner.
It scares me a little to think that things could end up the same next time. I could go through hours of labour, the baby could be unable to descend and start to show signs of stress, and I'll have another section. However, even if this happens, the birth will be on my terms. I'm not having a sceduled section before my baby is ready to come, I'm not giving in to interventions unless I deem them necessary, and I will be in control of the situation. No one will push me into anything I don't want. I've had a tough birth experience and I'm going to treat it as a learning opportunity. I learned how birth has been medicalized, and I know what I want done differently next time.
An older relative on DH's side said something strange today. She said, "You're young, I thought your hips would open right up and spit that baby out."
Not only was that a strange thing to say, but I was slightly offended. She went on to talk about her own labour and delivery, and how it lasted like 24 hours and she pushed for hours and hours after that and then her son was born OP or "face-up" just like Ella. And then she said that back in those days you didn't have a choice to just give up.
And how does this story help me? Maybe it helped by making me feel even more deficient in some way. Maybe I could have pushed my baby out if I didn't "give up". Maybe this story made me feel like crud 5 months after the fact. Thanks a lot lady.
I think I'm ovulating this week. Suddenly I want another baby. Oh the wonders of the human body! Career-wise, it would be a poor decision for me to get pregnant again so soon. I started my current job pregnant and I can imagine the gossip if I left for maternity leave shortly after returning.
However, while I know that I want more children, the current desire will likely pass. Since coming off the birth control pill several years ago, I've become very "in-tune" with my body and my cycles, and I find it amazing how much ovulation can influence a woman. I guess it's part of the reason why humankind has flourished!
So just in case my fertility is returning, I've started charting a little to see what's going on, and as a method of natural family planning. I actually loved charting while TTC, so I've been looking forward to starting up again. If af doesn't return within the next several weeks, I'll stop.
So here's my ticker...