Saturday, March 20, 2010

Story Time: Why I love my OB and the evils of pitocin.

**ETA, my timeline on Bug's birth was a bit incorrect - How am I supposed to remember the time, I was laboring? ;)  Please see the above post for a more accurate description of times.

Forgive me for a random, babbling post.  It's very late, but I had the urge to share these thoughts with you and there's no time like the present to do so. ;)

My births were both induced.  For those who don't know the stories, I'll attempt to Reader's Digest them for you.

My pregnancy with Kinder Major was uneventful.  It was even pretty enjoyable, complete with the wonderful magic that most first time mothers experience.  As we hit week 38, though, life became hell.  In stepped prodromal labor. It wasn't too bad at first; dilation without effacement, strong but irregular contractions.  As week 38 progressed, those contractions moved to my back and I tasted hell.  At week 39, the provider of the day stripped my membranes without telling me.  No big, after I was informed 12 hours later what was done, and that the bleeding resultant was normal.  However, the emotional stress from that reversed some of the good dilation I had going and made the back labor worse. At that point I was desperate for forward movement - I bounced on my birth ball, I knelt on all fours, I masturbated to orgasm, I did various yoga positions, I took Evening Primrose oil both orally and vaginally, and I used black and blue cohosh religiously.

My goals were two-fold: reposition my daughter to move the pain out of my back and to go back to the forward momentum I had briefly experienced.  It was somewhat successful.  At a late-night triage episode due to extreme pain at 39w6d, I begged for an induction.  I'm bipolar, and I hadn't slept (and I mean literally, no REM sleep,) in nearly four days.  The risk at that point of a manic episode and the potential for post-partum psychosis was frighteningly high.  After a third practitioner during that visit alone checked my cervix at 7 AM, it was announced that I was dilated back to four and 25% effaced.  As long as there was no backwards movement of those numbers after an hour of walking, they would induce me.  In her immortal words, "Wow, that's a big head.  Actually, that's a really big head."

And so, the induction began.  I was put in a labor and delivery room, got my epidural, got hooked up to IV fluids for dehydration, started on pit, and I blissfully slept for almost 12 hours while my body did its thing with a little help from pharma-nature.  By 4 AM I was fully dilated and effaced, and my epidural had almost completely run out.  I wasn't upset about that, and when I was informed that the on-call anesthesiologist was busy in an emergency section, I told them not to bother calling him.  I liked being able to feel what was going on, and it fulfilled my original desires to have a medication free birth, even though it truly wasn't.  Three pushes later, and my beautiful 10 lb, 21.5" long redhead daughter greeted the world at 4:36 AM on Valentine's day of 2005.  I never felt the dreaded pitocin contractions, or had any of the shockwave effects.  My after-birth complications of 3rd degree tear, violent and painful placental tractioning and post-partum hemorrhage were a combination of practitioner error and my body's little bleeding disorder secret.

With Bug, my pregnancy... well, it sucked.  I spent almost half of it total on bedrest, dispersed through different intervals.  Severe pubic symphysis disfunction, blinding headaches, overpowering fatigue, and in the end pre-eclampsia that landed me on in-patient bed rest due to BP spikes that reached as high as 210/125 as well as abnormal kidney function tests and severe proteinuria were the main factors to the utter suckage.

This is where I tell you why I love my OB.  He was new to me, as I had spent Pregnancy One in a high-risk clinic affiliated with the local university-based teaching hospital.  I can count on one hand the number of times I saw the same practitioner.  I cannot count how many different ones I saw.  The person who delivered me (and fucked up royally) was someone I'd never met, who couldn't remember my name during delivery.  I Did. Not. Want. That. Again.

So, I ferreted out a doctor that met my base criteria:  Professional yet approachable, compatible with my personality, low c-section rates, delivers at the OTHER hospital in town.  I interviewed three before him, and stopped after his interview.  He was absolutely the one.

While his internet reviews often stated "Poor bedside manner," "quick to suggest interventions," "cold" and "doesn't take time to explain things," I found him to be quite the opposite.  What he IS, however, is quick to get annoyed with bullshit, expectant of his patients in regards to self-education, unwilling to allow a potentially dangerous situation to become fatal to fetus or mother, and somewhat sarcastic.  This suited me perfectly.  He's also a horse person, which was more than awesome.  We got along fabulously - he recognized that I wasn't stupid and actually knew what was going on with my body and my baby, and he respected me far more than I think he would have had I been clueless, or even somewhat confused by the process.  The questions I did have he answered thoroughly, he respected my desires and opinions and discussed and implemented them when we both deemed it to be appropriate, and more than anything, he made me comfortable and kept me laughing.  His perceived poor bedside manner and coldness was simply a low threshold for ignorance and whining.

When it became obvious that simple bed rest wasn't cutting it, we started magnesium at a low dose.  Then came 36w5d.  I woke up that morning and knew that something wasn't quite right.  It wasn't emergent, it wasn't obvious, it was just a feeling.  When he rounded that morning, I looked him in the eye and told him very plainly that I wanted to have my baby that day, that there was just something not right.  After going back and forth a few times, he agreed.

By then I was 5 CM and 90% effaced, so we broke my waters before starting the pit.  I had also decided that I was going to hold out on my epidural, and see if I really needed it.

My waters were stained with meconium when they were broken - there had been no pit, nothing to otherwise cause distress.  My hunch that *something* wasn't right had been correct.  Still, though, apart from a few random decelerations, there was no real sign of distress from my son.  We chatted and a scalp electrode was placed.  Alas, though, I'm getting ahead of myself.

Now I tell you why pit is evil.

It is evil because it is so damned deceptive.  Yep.  Deceptive.  I didn't experience these contractions with Kinder Major because I opted for the epidural before the pit was even started, so that I could get the sleep I so desperately needed to avoid post-partum mania.  I had no idea.  Pitocin takes a standard contraction and ramps it up, we all know that.  What no one talked about and warned me about, though, is the nearly irresistable urge to push that comes with it, even when only dilated to 8 CM.  My brain was saying "NO PUSHING, IT'S NOT THE RIGHT TIME YET" and my body was saying "I DON'T CARE IF IT'S AS LITTLE AS FIVE, YOU'RE GOING TO FREAKING PUSH."  No amount of breathing or vocalizing or focusing or meditating can relieve that urge to push that comes along with a full-swing pitocin contraction.  Pushing then would have been frustrating, fruitless and exhausting.  At that point, I broke down and asked (okay, maybe begged,) for the epidural.  I wasn't angry, I wasn't scared, I was tired and knew that the process was... out of sync.  There's nothing I hate more than a liar, though, and pit certainly is/turns your body into one.

While it is evil in its deception, it definitely did its job quickly on my body that was quite ready for its help.  Seven hours from the time the pit was hung and three hours after the epidural was in, my son was born after four good pushes at 9 lbs. 7 oz. and 19.5" long, at 36w5d on Nov. 11th, 2009 at 8:16 PM.  Yep, you read that right - a 36 weeker preemie was over 9 lbs.  My OB (who, btw, was AWESOME through the entire thing, laughing with me and trusting me when I told him what I felt and when, as well as never once doubting my ability and never even entertaining that I might require forceps/vacuum, let alone a section,) had to actually pause his efforts to repair the minor tearing I experienced to go over and look at the scale for himself.  Everyone was quite shocked about Bug's weight.  The niggling feeling that something was wrong proved to be a couple of things.  The cord was wrapped tightly around his neck, albeit once, and he had some respiratory issues of which the cause was not readily apparent.  He was also jaundiced to the point of remaining nearly purple for two weeks after his birth.  My doctor and Bug's doctor both agreed that had delivery been delayed any longer, the lasting effects would have been far more severe.

My minor bleeding disorder came to light after Bug's delivery, as I experienced a hemorrhage without the violent placental tractioning I blamed for the one I had after Kinder Major's delivery.  Were it not for the exceptional capability my OB possessed and his exemplary management of the minor crisis, I would have lost far more blood than I did.

While granted, my need for a transfusion wasn't recognized until a good four days after we were released, I don't blame him.  I saw the labs myself - at the time of discharge, the numbers of my CBC did not indicate such a need.  Again, he exhibited trust in my instincts and did not belittle me when I informed him I thought I needed a transfusion, instead he supported my decision to go to the emergency room, and checked in on me daily while I was admitted for the transfusion.

These are the things that give me hope in our physicians.  Knowing that he is out there practicing leaves me with the confidence that there are docs like him available for those who need them and are willing to look. 


  1. You didn't beg for an epi, I was there, you just told Ginny you were ready for it :)

    As for being shocked about weight, I had to ask the nurse to repeat it--TWICE. That's when Dr. Cotter went to look at the scale himself, lol.

  2. Your OB sounds very similar to mine -- she was very no-nonsense and right to the point, and moved along. I was never really touchy-feely about my pregnancy, and that worked well because she wasn't the touchy-feely kind of doctor.

    I found it very reassuring, but a friend of mine had her after my son was born, and found her abrasive and cold and absolutely hated her. It's interesting how perception changes between people like that.