Sunday, December 19, 2010

Clayton James Pecunia: A Birth Story

Even though I am unlikely to ever forget the details of Clayton’s entry into this life, I wanted to make sure to record them while all is still fresh in my memory. Sorry it is a little long, but this is more for me than for anyone else.

After my pregnancy with Clara went two weeks overdue I was fully prepared to wait for this baby, but I wanted to avoid the 3 days of induction that I endured. So I was thrilled when my cervix ripened and started to dilate without medical intervention. And I was willing to wait if it meant avoiding induction... and wait I did. I waited 3 weeks past my due date for this little one.

By Monday, December 13 I was at 4cm and 90% effaced. I had been having mild contractions since Saturday night about every 10 minutes so I was hopeful that real labor would start soon. Wednesday, December 15th at noon I had another appointment with Jeri. She found me still at 4cm, and stripped my membranes in hopes of starting my labor. We also made an appointment to have my membranes ruptured at the hospital on Thursday morning if labor didn’t start naturally.

After my appointment I went to lunch with my mom, Mason, Amanda, and Clara. They were planning on going shopping so I had decided to go along to see if that would get my contractions going. I had been crampy ever since the membrane stripping, but nothing too bad. At the end of our lunch I had my first ‘real’ contraction since my OB appointment right around 3:30. We headed to Kohl’s right after that.

While we shopped around Kohl’s my contractions started to get stronger and closer together. I had to take breaks during them to rest or sit down. Clara was starting to act up so Amanda took her to the toy department while Mom and I helped Mason find some new clothes for school. Finally around 5:00 I decided I needed to go home because my contractions were coming about ever 5 to 8 minutes and were pretty uncomfortable.

Mason still had shopping to do so we left him and Amanda and Mom took me and Clara home. Clara put up quite a fight leaving the toy department empty handed, and I was not in a condition to handle it, but Mom managed to get her, kicking and screaming, into the car.

Once home, Clara fell asleep and I watched TV with Patrick while my mom went back to Kohl’s to finish shopping. By 6:30 my contractions had moved to every 4 to 6 minutes and came regardless of if I was sitting or standing. I called Mom and told her to get Mason and Amanda moving because she needed to come back to the house. By about 7pm they got home (after bribing everyone in the checkout line at Kohl’s to let them move ahead in line).

Mason and Amanda took over watching the then sleeping Clara while Patrick, Mom and I headed for the hospital.

I checked in at 7:20pm. Mom had to wait in the waiting room while I went through assessment. In assessment they had me put on a gown, give a urine and blood sample and answer a bunch of questions while they hooked me up to monitor to have my contractions and the baby’s heart rate monitored. My contractions were coming at about every 3 to 5 minutes and were peaking at about a 4 (on a 10 point scale) for intensity. A nurse checked my cervix and I was still at 4cm. Bummer… I really thought that 4 hours of regular contractions I would have dilated a bit more. Anyway, they decided to go ahead and admit me after about an hour of monitoring.

Once in my room, Patrick got our bags from the car and Mom came got join us. All of the excitement seemed to slow my contractions and I was starting to feel a little foolish for coming to the hospital. My nurse, Ray, came in to do my admit assessment, but she got called away because one of her other patients was ready to push. A second nurse came in and finished my admission then said I could go for a walk to try to get things moving. Oh, and I called Kelly. She was going to come down to be my labor coach, but Atlanta had suffered an ice storm so I told her to stay safe and stay home. She said that the forecast was for thing to melt off in the morning and she’d come down then.

Mom, Patrick and I walked around the floor for a while, then I was monitored again for about 15 minutes. My contractions were still about every 3 minutes, but not very strong. We repeated the walking and monitoring a couple of times, but by 11pm things hadn’t really picked up.

Mom and I told Patrick to go home. He had been working for half of the day Wednesday, and I thought that if he could go home and get some sleep he’d be better able to help out in the morning when they ruptured my membranes as scheduled. Plus Mom is more of a night owl so she could stay up with me and keep me company. Anyway, there was only one couch-bed so it seemed wrong to have them both stay and try to share it. We promised to call him if my dilation progressed.

At midnight Ray came in and checked my cervix again. Dr Barnes was on the phone and wanted to know if it looked like he could go to sleep. I was still at 4cm (damn). I figured this was a sure sign I was in for a slow labor. Dr. Barnes advised me, via the nurse, to stop walking and jus try to get some sleep. Sounded like a good plan. Ray said she needed to get one more monitoring strip in before I went to bed.

During that midnight monitoring my contractions became more uncomfortable… still not too bad, but they were harder to manage when I was strapped to the bed by the monitor. After the strip I went to the bathroom because sitting on the toilet helped ease the pressure in my back, and I kept feeling like my bowels needed to empty.

It was around 12:30 or 12:45 by now and the contractions had started to get much stronger. I found myself grunting and moaning during them. The noises just sort of came out and they seemed to give me something to focus on. Somewhere around my 8th very miserable contraction I decided that it was time for drugs. My goal was to have a natural birth, but being at 4 cm for 3 days with no progress was eating away at my determination… and now I was tired and in pain. All I really wanted was some sleep so I’d have the energy to handle the birth that I assumed was in my future for the next morning.

I asked Ray if I could get an epidural. She said that I would need to get IV access and a liter of LR on board first. “Fine. Whatever. I’m ready. Lets get the drugs on board.” So then she disappeared for a while. I assume to call the anesthesiologist on call and to get my fluids and IV set ready. But while she was gone the contractions kept coming. Steady and strong, about every 2 to 3 minutes and lasting about 45 seconds. It doesn’t sound that long, but they felt like knifes being shoved into my back. And all I could do was moan through them.

At 1:20 am Ray came back and started my IV. She also wanted to get another monitoring strip done, but sitting still on the bed was virtually impossible. Sometime during this another nurse, Christine, came to see if I was ok. She had heard all of the moaning. Most of the floor had probably heard me, but I was in a primal place where I didn’t give a damn about anything except getting through each contraction. Christine helped my with my breathing and encouraged me to try different positions. Nothing really helped ease the pressure in my back, but it gave me something to focus on while we waited for my LR to infuse.

By about 2am the anesthesiologist showed up to administer my epidural. Thank GOD! I had had enough by then and all I could think about was getting my drugs to make the pain stop. So much for a natural birth. By now I had been enduring about an hour and a half of miserable labor. And I just new I couldn’t do hours more… even minutes more sounded like too much.

The doctor asked me a bunch of questions about my allergies and medical history. I just wanted him to stop and give me the meds. Finally he was ready to put in the epidural catheter. Christine helped me get into position, but it was so hard to sit still during each contraction. I wanted to crawl out of my skin.

Finally the line was in and the doctor administered the test dose. No problems there, no relief either, but at least my blood pressure and the baby didn’t have any problems. More contractions came as they administered the full dose. Still no relief! Why?!?! Why was my miracle drug not working? I needed relief desperately. The nurse said it could take up to 10 minute to ready full effect, but with Clara’s birth I felt my epidural almost instantly. And after 5 minutes I still felt everything… my legs, the pain during contractions, and all of the pressure. I said so. The nurse and doctor seemed to perk up when I mentioned the pressure.

I didn’t think anything of it. I had been having pressure and pain at that magnitude for over an hour… hence the moaning and screaming… duh. The anesthesiologist then asked the nurse when my cervix had last been checked. Ray said I was at 4 cm 2 hours ago. He said to check me again. Christine did and sounding shocked said “she is full and at plus two station. Get the resident in here.” Mom asked how long we had and Christine said “maybe 15 minutes”. Then asked me not to push. I saw my mom grab her phone to call Patrick, and I saw everyone else jump into action.

A couple other nurses had joined Ray, Christine and my Mom. They were getting ready for the baby. I was between contractions, and feeling thrilled at the prospect of getting things over with. When my next contraction started I had to push against the pain and pressure. They asked me not to since the resident hadn’t arrived. But I couldn’t help it. Christine said to do what I had to do, told my mom that she had delivered babies before and could again if she had to. She also told my mom to stand to the side of me because my membranes were still intact and could rupture at any point.

After a contraction or two more the resident did show up. I never learned her name, but she was a young, black woman. She quickly got to work She ruptured my membranes. Luckily the fluid was clear. She then told me to push with the next contraction… as if I had any choice in the matter. When the contraction came, the baby’s heart rate dropped down. She said she needed to do an episiotomy to help get his head out and that otherwise I was going to tear in several places. I would have rather been allowed to tear, but at that time I wasn’t going to argue with anything that would help get the delivery over with. In fact, I even remember irrationally thinking that I would let her amputate a toe if it meant the delivery would be over.

So she made a cut, and then on my next contraction I was able to push out the head. They suctioned the baby, felt for a cord around his neck. There was none. Then on the next contraction I pushed out the shoulders and felt him slide the rest of the way out. The relief I felt at being done was amazing.

A few seconds later they must have cut the cord because I heard him cry out. To be honest I was so relived at being done with the contractions and pushing that it hadn’t even occurred to me that I hadn’t heard him cry. They carried him to a crib beside my bed for a quick assessment. About that time Patrick arrived. I felt bad that he had missed the birth, but again, the most powerful emotion I was feeling was still relief to be done.

My mom came over after taking a couple of pictures. She was crying. I remember thinking how silly that seemed. I was done. He was here and the pain was over. I was way too happy to cry. Sometime around then I delivered the placenta and the resident began sewing me up. My legs started shaking… the only effect from the epidural. I still had feeling in my legs, felt the lidocaine injection I was given just before the repair stitching began, and I had felt the whole delivery. I still don’t know they pharmacology behind the failed epidural, but I can attest that it didn’t work at all.

Anyway, to distract me from the stitching, they brought the baby over for me to hold. He was beautiful. He hadn’t been measured yet, but everyone kept saying that he must be at least 9lbs. He began nursing almost right away. The nurses also seemed impressed by the weight of my placenta. They were passing it around in a plastic bag, hefting it, and saying ‘wow’. They passed it to Patrick who looked a little squeamish and quickly passed the bag along to the next nurse. Dr. Barnes showed up just as the resident was finishing sewing me up. He told her to add a few stitches here or there, but otherwise did nothing. So glad that I’ve paid for his services ;) Oh, and I can’t wait to see the charge I’m getting for the non-functioning epidural.

So I wanted to have a natural birth before I went into labor, then during it I wanted the drugs, but as luck would have it I ended up getting the natural birth I had wanted. I am amazed and proud to know that I did it. I labored and delivered a healthy 9 lb, 5 oz boy without any chemical induction or pain management. I won’t do it again if I can help it, but it is a wonderful since of accomplishment, and Clayton James is well worth it.

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