Wednesday, February 20, 2008

thinking about birth today...

I feel kind of wrong for complaining about my pain in that last entry. First of all it isn't always THAT bad - I was having a particularly bad day when I wrote about it, but there are times (occasionally) when it's really just a minor annoyance - although those times are getting fewer and farther between. There are bad days and not so bad days - the really bad ones being the days when my belly support belt is in the wash or I do too many things.

Also, I'm not really supposed to talk about pain or anything negative related to pregnancy or childbirth. I'm not supposed to even let myself think about pregnancy or childbirth in a negative way. I'm doing Hypnobabies for the second time, and keeping a positive frame of mind has been very difficult for me this time around - mostly, I guess, because of the way my first birthing went.

I've never written about Brandon's birth in any great detail here in my blog. I don't really know why. It's kind of hard to know exactly what to say. I can tell, and have told, the story in several different ways depending on my frame of mind at the time or what I choose to reveal about the details and the deeper meaning behind things. I think that in a way, I'm afraid of coming across as whiny or ungrateful. On the other hand, what a lot of people probably don't realize is that a birth doesn't have to be tragic or dramatic from a medical standpoint to be traumatic. I gave birth to a perfect baby boy with an Apgar score of 9/10, with minimal medical intervention. And yet, I was definitely traumatized by the experience.

I went into it with complete and total faith in my body's ability to give birth normally and easily. I believed with all my heart that everything would go perfectly. It didn't.

When I tell people I had back labor, a lot of them say, "oh, yeah, me too!" Which makes me wonder, because I know that what happened to me was not normal; how could it have possibly happened to so many women? Upon further research I realized that when you say "back labor" there are three different things you could be referring to. Feeling the contractions in your back is a normal variation. Then there's back labor, where the contractions are secondary to the pain in your back. Then...there's what I had. Severe back labor. The kind where not only are the contractions secondary to the back pain, but the contractions are practically nonexistant compared to the back pain - and you don't get a break between them. Feeling the contractions in your back is normal. Feeling the baby's head in your back is not.

What do I mean by that? I literally mean that if you put your hand on my back, you could feel the baby's head. Can you imagine what that felt like? To have something pressing so hard against my back from the inside, that my back was actually bulging out? The baby wasn't just posterior (facing my front instead of my back) - he wasn't just at a wacky angle and pointed in the wrong direction (which all posterior babies are to some extent) - he was stuck there. Like, really wedged in. And the pain...never...stopped. Not between contractions, never. So you can see why, when somebody smiles at me and says cheerfully, "oh, yeah, I had back labor too!!!" I just kind of think..."yeah. Okay. Sure ya did." I don't doubt that you felt some pressure, and maybe even some pain, in your back while you were in labor. Maybe the pain was intense. But if you can smile about it? Then you did not feel what I felt.

Anyway. I labored for about 24-25 hours (on two hours of sleep, after attending a birthday party and cooking a full Thanksgiving dinner) before I was dilated 5cm, the minimum required to be admitted to my hospital. Normally this policy is a very very good thing - the earlier you check in to the hospital, the more likely it is that you will end up with unnecessary medical interventions. They know this. That is why the policy is in place. So for a normal labor, this is an excellent policy, and one that I really liked the idea of, and still do. But I didn't have a normal labor. I was desperate to get into the hospital because something deep down inside of me was telling me that I needed help. Something is not right. This is not normal. In my conscious mind, all I was thinking was that I wanted to get into the big tub - the tub at home was not big enough and did not have jacuzzi jets and kept on getting cold. I wanted to be in that damn tub I kept on hearing so much about.

But they wouldn't let me in the tub. The midwife said no, it will slow down your labor too much. We don't want to slow it down, we want to get it going. Looking back on it now, I wonder why nobody realized, hey, if the contractions slow down a little, maybe she can actually get some rest???? Or maybe what she needs for labor to progress is the opportunity to relax a little?? It seems so glaringly obvious now!

It was a moot point anyway. I begged to be allowed to at least get in the shower, which was granted, and there was no hot water. I gave it my best shot but as I stood there shivering, I decided that maybe a shower was not the best idea. Which sucked because up until that point, water had been the only thing that really helped at all. For a while I figured that there was no hot water because it was the middle of the night and maybe they have solar water heaters there like we do in housing - we would often have no hot water when it's cloudy. But I realize now that no hot water in a hospital is not normal either.

My nurse was not very helpful. To this day I wonder how she was assigned to a midwife patient, because she really didn't seem to know how to help me. I mentioned at one point that I was having back labor because the baby was facing the wrong way and she said, "how do you know? Did they do an ultrasound?" Like I can't tell the difference between my baby's back and his knees??? And let's not forget that you could feel his head in my back! In fact, the triage nurse had told her this when they brought me into the LDR room: "She has a bulging back." You would think that if the L&D nurse didn't know what that meant, she would have asked. But she didn't. And it was a pretty important piece of information, if you ask me!

Well anyway, the nurse suggested I sit on the birthing ball because "that seems to work for some women". I had spent the first 8 or so hours on my ball at home but after a while it just got uncomfortable so I had stopped using it - but I was willing to try again. I sat on it for about 10 seconds and just couldn't handle it. It didn't feel right at all. The nurse, apparently, was out of tricks and didn't suggest anything else. In fact, she left the room and I didn't see her again for quite a while. Gee, thanks for the support.

So I had no hot water, a nurse who seemed to know pretty much nothing about how to help a woman through natural childbirth, and seemed to have never even heard of back labor before; a midwife who was more concerned with "getting the labor going" than with addressing the reason why I wasn't progressing; and a baby that was in an almost hopelessly bad position (which would be the reason why I wasn't progressing). After about 27 hours I was 5cm dilated (which hadn't changed for about 3 hours) with contractions 5 minutes apart (which hadn't changed for, oh, at least 20 hours). It had gone on long enough that there was no way for Brandon to turn around without some seriously deep relaxation on my part - he was really wedged in there. And I just couldn't do it. I was too tired to concentrate. In between every contraction, all I could do was cry and think about was how much I wanted to sleep.

So I got an epidural. (The nurse was amazing at helping me focus through the process of having it put in. She obviously had lots of experience in helping women get epidurals, but not with getting through natural labor - which again, makes me wonder how she got assigned to a midwife patient.) Almost immediately, Brandon turned around, my water broke on its own, I fell asleep, and in about two hours I was ready to push. (The epidural had already worn off. I have a very high tolerance for anesthesia and I suspect that they gave me a pretty low dose.)

The midwife had been trying to talk me into AROM (artificial rupture of membranes, aka breaking the water) to get things going and I had outright refused. I have a heart murmur and wasn't getting antibiotics, so I didn't want to do ANYTHING that could potentially increase my risk of getting an infection. But more importantly, it just didn't feel like the right thing to do. Then when I decided to get the epidural, she tried to talk me into doing it before the epidural was in place to avoid having it slow down my labor even more, which is often a side effect of epidurals. I refused again. I told her she could do it after, but not before. And thank God I did. I have done a lot of reading and research into back labor and posterior babies since then, and I know now that there would have been no way for Brandon to turn around without the cushion of amniotic fluid around him. So even after I had gotten the epidural and was able to relax enough for him to turn, he still would have been stuck. And I would have ended up with a c-section for cephalo-pelvic disproportion (aka, "baby doesn't fit") - which, more often than not, is caused by the baby being in an unfavorable position, NOT by a big baby head or small mommy hips like the doctors would have you believe.

At any rate, like I said, I got the epidural, he turned around, my water broke on its own, and I was complete within two hours. If there had been anybody supporting me who was knowledgeable about techniques for turning babies, maybe we could have taken care of the posterior positioning before he got so wedged in there, and my labor could have been much, much shorter. But instead I was surrounded by people who just weren't listening to me, people who thought I was being an overdramatic, underprepared, doesn't-know-what-she's-talking-about first time mom with no pain tolerance. Is it any wonder I hired a doula this time?

Even though the epidural had worn off, everyone assumed that since I had gotten one, I couldn't get into an upright position to push. I couldn't really tell how much it had worn off or whether I would be able to maintain a squatting position, so I didn't press the issue. I asked to push on my side. It was wonderful. I finally felt like something I was doing was making a difference. I felt productive. But apparently it "wasn't working", according to the nurse, so I got rolled flat onto my back. I was concentrating too hard on pushing to say, "hey, wait, wouldn't it work better if I was upright?" (it would have, of course). So I kept on pushing. It felt like I was trying to push the baby straight up out of the floor. His heart rate started dipping a little too much so they put an oxygen mask on me. Again - why didn't they just have me get into an upright position? His heart rate was dipping because I was flat on my back. (If we're not supposed to lie on our backs during pregnancy, because it cuts off blood flow to the baby, why is it suddenly okay during labor?)

I didn't feel the "ring of fire" - I didn't feel burning, I wouldn't even say that I felt stretching - but I felt the tearing. I tore in two directions - because I was pushing on my back, which puts pressure in all the wrong places and does not allow you to stretch. Brandon came out crying and wriggly, with an almost perfectly round head, practically no molding at all.

All was well, mom and baby were healthy. Another positive outcome, another positive experience, right? No. At first I was just disappointed that I had "caved" and gotten the epidural. Then I was angry about all of the circumstances beyond my control that conspired to make the situation so difficult. Then for a long time, I was angry at the hospital staff for letting me down.

I think I might finally be over it, though. I'm much more able now to look back and see the positive things. I can see what I learned from it. For instance:
  • hire a doula. You need to have somebody there who is knowledgable, experienced, and has no responsibilities to anyone but you.
  • trust your gut instincts, they are usually right. The hospital staff may have education and experience, but every woman is different, every baby is different, every birthing is different, and YOU are the one living in YOUR body. You are the only one who really and truly knows what is best for you and your baby.
  • It's okay to be assertive and stand up for yourself and say "no". If I had blindly gone along with what the midwife suggested, and let her rupture my membranes, I would very likely have ended up with a c-section.
So...that's why I've been having a hard time believing, really believing, that this time is going to be easy and wonderful and, well, normal, because I believed that with all my heart last time, and it didn't happen. Maybe the most I can hope for is that it's easier, and shorter, and a little less dramatic. And honestly, while many women would consider a 12-hour labor to be long and almost unbearable...I would welcome it with so much joy, relief and gratitude.

On the other hand...once Brandon got into a good position, the rest of the birthing went so quickly that his head didn't even have time to mold. So...maybe this time will go really, really rapidly. Who knows? Anything can happen.

(ps, for more info on back labor:


Mother Hoodwink said...

I waited as long as I could to get the epidural. I went without it a lot longer than I ever thought I would. The only thing that got me through my contractions was imagining I was on a tropical island and wading in the small warm waves of the ocean. I still cant believe how much thinking of water helped. I could imagine how much better it could have been if I was able to be in warm water. Here's to working plumbing the day you go into labor.

Kerry said...

Jesus Christ, Tara, is there no limit to how much we have in common? My "special safe place" that I'm using for Hypnobabies this time is Ke'e Beach, my favorite beach in Kaua'i...I imagine myself in the water. Are you really sure we're not actually the same person?

Mother Hoodwink said...

Well it has been a long time since anyone has seen us in the same room at the same time. Something to think about...

Sheridan said...

I am so sorry. I know that back labor can be so rough, sometimes an epidural is the best choice. I am SO glad that you were able to avoid the cesarean! Good for you for following your instincts! Also just remember, this is a new baby and a new birth. Hopefully this one will be in the ideal position. Have you visited for good ideas for facilitating that?
I hope you have a wonderful peaceful, comfortable birth this time!

Kerry said...

Thank you Sheridan!! I am following the advice at Spinning Babies as best I can, and I start seeing a chiropractor certified in Webster technique on Monday. And I've been feeling much more positive since I started putting the Affirmations on while I'm sleeping to make SURE I hear them every day!

Now I'm just worried that this one will go TOO fast and I won't make it to the hospital in time. It would be so like me to be that dramatic.