My pregnancy with Bug sucked. A lot. First trimester saw a placental abruption and restricted activity. Second trimester brought SEVERE SPD and blinding headaches, which resulted in off and on bed rest. Third trimester brought pre-term dilation and effacement (4 CM and 50% at 30 weeks,) and severe pre-eclampsia, with home bed-rest and in-patient bedrest.
I was already being followed by an obstetrician due to prior medical conditions that precluded anything but a hospital birth, so this was all taken in stride and quite well managed.
I was a week exactly into an in-patient session of bedrest and monitoring due to extremely high blood pressures and abnormal kidney functions, and 36w5d. We were desperately trying to hold off until at least 37w3d, but preferrably 38 weeks. My OB and I got along great - it wasn't uncommon for him to come in at 6 AM to drink his coffee and keep me company as I ate my breakfast. We had been chatting off and on all week about the potential for induction - my pressures were rising and the edema in my legs was becoming so severe that the skin was beginning to crack.
That morning, though, I woke up and something just wasn't... right. It wasn't something that was an emergency, just a gut feeling.
When my Doc came in, I told him that I had this feeling. He reviewed my BP readings from the night, and checked my cervix, which had dilated another cm and almost fully effaced overnight, bringing me to 6 cm and 80%. His reaction to this was to "Hmmm" and tell me he'd be right back.
When he came in again, he greeted me with the word "Waffles." I naturally replied "Belgian" and then arched an eyebrow, which produced the response of "You have a doctor that waffles." He then checked the BP strip again, checked my legs, and wandered back out. Bug was making his entrance that day.
The induction went well. My faithful birth companions were my mother and a dear friend of mine.
When my waters were ruptured, they were decently stained with meconium - that hunch was correct. SOMETHING was stressing my little man out. Not enough to show up on the CFM or Doppler, but enough to cause the staining.
After my waters were ruptured, the pit was hung. I had decided that I was going to push things a bit and see how long I could tolerate pit contractions. I did well - got a few hours worth in - before I asked for the epidural. I also had magnesium going at this point.
The atmosphere in my room (after some initial misunderstandings and a few tears from all parties,) was more like a slumber party than an induction. We laughed and joked around, the nurse and doctor joining in the fun when they came in to check or adjust. I was relaxed and content and joyous. Never once was the confidence in me and my body doubted, never once was a c/s even hinted at. I was informed that if my labor stalled, we'd simply wait it out, give my body time to work it's magic.
I requested my epidural mid-afternoon. I had been finding a lot of relief through centering myself and vocalizing through contractions, but pit contractions are evil. They make you want to push (and push hard,) when conditions are not ideal. Pushing at that stage (7 cm and 90%) would have been exhausting and fruitless, and I knew that. I knew my body, I knew my limits. Still, though, I was laughing going into contractions, and laughing coming out of them. I was still quite happy and content. No one looked at me askance when I made jokes in the middle of a contraction. No one was disparaging or disbelieving when I smiled through them, even though the pain was intense and fast.
Epidural in, we turned the mag sulfate down to see how I'd tolerate it. At this point, I was in that dreamy transition state, due in part to the relief of no longer feeling the pit contractions, and in part to being... well, in transition. ;)
I remember more joking and laughing, but the memories here are in watercolor instead of snapshots. I dozed off and rested, and when we turned the mag sulf back up, stripped down to minimal clothing and dozed and rested some more.
As evening approached, my faithful and awesome nurse was due to go off shift. By then I was nearly ten cm with just barely a lip of cervix left. I desperately wanted her to be there for Bug's entrance, so Doc and I agreed that a few trial pushes might just get me to ten and finish my effacement.
Totally didn't work. My pushing was self-directed with a little help from my cheerleading squad (we were rowdy and boisterous, I'm not gonna lie.) Since I was still feeling the epidural pretty well, I did request being informed when there were contractions starting, but I didn't need pushing counts and direction - it was in my hands.
A few pushes in, it was apparent that we weren't ready, and that was it. I tearfully bade my nurse goodnight, and welcomed her replacement.
I liked her replacement far, far less. Still, I didn't let her distract me. The party was still going. :) I requested that the anesthesiologist come in and top off my epidural, he teased me about not having had Bug yet. I grinned and told him that by 8 PM, we'd have a baby. (That was at about 7 PM.)
During this time, I took the opportunity to get myself into a better position. I moved the bed up, re-adjusted my legs (with help) into more of a squat, and decided it was time for another practice push. We didn't call Doc in right away - I still had that darn lip that hadn't effaced. I gave one push, and we went "Okay, time for the doc!"
He came in, complained a bit about things not being ready (did I mention I wasn't fond of the new nurse,) we made some snarky comments to each other about said new nurse, laughed quite a bit, and commenced with the pushing.
Push one, cheerleading squad rooting for me, stop. Bug's head cleared my cervix. I rested, re-adjusted again because I wasn't quite as squatty as I wanted to be and I was feeling it in my back, and we moved on to push two. Cue cheerleading squad, bug's head descended further. Push three, cheerleaders, brief laughter from me about a goofy comment made, and then I orgasmed as I continued my pushing efforts, which was when he crowned. Push four, I delivered his shoulder and Bug was born! At 8:16 PM on Wednesday, 11/11/2009, my beautiful (and BIG) boy was placed on my belly. (Photo below jump, NSFW birth photo.) I pulled him up to my breast and began stimulating him as he was suctioned.
He did need further suctioning and resuscitation, so they took him from me to weigh him and get him moving. We didn't get to delay cord clamping like I would have preferred, because...
...I ended up hemorrhaging again, which was no real surprise. My Doc handled it quickly and efficiently - I firmly believe that his pro-active approach to it saved me a whoooole lot of blood. I was in and out during that time - vagal responses are a bitch, really.
I was conscious and alert enough to catch his measurements as they were called out - 9 lbs. 8 oz (or 9 lbs. 7 oz, depending on who you ask.)
Yes folks, you read that right. My 36 weeks and change baby was nine and a half pounds. We were expecting it, though. We were expecting as high as 13 lbs had he been term. No, before you ask, I had no sugar concerns. I just have robust babies, with my first having been ten lbs. at term. (ALSO a vaginal birth.) Still, expecting it doesn't always mean you REALLY expect it, and Doc actually did a double take, pausing his efforts to stitch my mild perineal tear to check the scale himself. ;)
Bug spent a few days in the NICU lite, AKA the "Special Care Nursery" for continued respiratory issues and severe jaundice. During that time we did more mag sulf to bring my pressures back down to a safe level, and I convalesced.
We were released four days later.
I am living testimony that not all obstetricians are bad, and hospital births can be beautiful, laughing, orgasmic things. Be informed, be assertive, and be picky about your care providers.
P.S. In case you were wondering about the nurse that no one liked, an official complaint was lodged. The manner in which she treated the family I requested to have around me, as well as her ineptitude were simply inexcusable. I'm unaware as to what disciplinary actions were taken, but I did receive a formal apology from her.
Showing posts with label pitocin. Show all posts
Showing posts with label pitocin. Show all posts
Monday, March 29, 2010
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.
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.
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