Letters from Pemberley

We came home yesterday afternoon and have been trying to adjust to our new normal.  Fortunately, my parents are here to occupy the big kids and keep things running, but I still found myself wiping down the toilet (which I delegated to Tommy once I realized what I was doing) and unloading the dishwasher.  That’s the difference between #1 and #4, I guess!

Obviously, since this was an induction, I knew that labor was going to be different, but the whole experience was totally unlike the other three.  I woke up Wednesday at 3:30 am with a hard, painful contraction like I’d had for days, but nothing progressed before we got to the hospital.  We got the pitocin drip started around 8:30, and five minutes later, my OB came in to check me out before going back for office hours from 9-12.  He had told me on Monday that we’d do pitocin “for awhile” and then break my water, and since I’d been strep-B positive with the first three and needed to be on antibiotics for four hours, I assumed that breaking my water would happen much later if it didn’t happen on its own.  But he broke my water right as he was checking my progress, right in the middle of a really painful contraction.  I didn’t know it was happening until he did it, or I would have asked him to slow down.  With both the other girls, I was ready to push right after my water broke, so I would have preferred to just go with pitocin for a while.  He told me he’d see me in a few hours.

As he left the room, though, the baby’s heart rate plummeted, and the nurse called him back in along with another nurse who had been in and out.  The next several minutes were really surreal.  They immediately tried moving my position to get the baby’s heart rate up.  I was really scared and remember thinking this was all because of breaking my water, that I hadn’t had any pain meds, and was I going to be having a c-section.  Shifting onto my other side didn’t help, so they got me on my hands and knees and got me an oxygen mask.  Dr Van Geem really did seem to be keeping his cool and had one nurse put fluid back into my uterus to give the baby some more cushion and the other one got a monitor directly on the baby’s head.  The heart rate stabilized enough for me to be able to turn back over and settle in on my back again, and around 9 or so, I got a terbutaline shot to stop my contractions for an hour and give the baby a chance to recover.  I was so frustrated, but the nurse told us at this point that the cord might be wrapped around the baby’s neck and that they’d noticed my amniotic fluid was discolored, so they’d probably have the NICU people in for the delivery.  (As it turned out, they ended up deciding the fluid was okay and not calling them up.)

The anesthesiologist came in to give me my epidural a little after 9, and he was very reassuring about the whole thing.  He joked about Dr Van Geem being impatient and breaking the water, but he said it looked like everything was stable.  Around 10 or 10:30, we started up on the pitocin again, and my contractions were pretty consistently 5 minutes apart pretty quickly.  I felt so nauseated by late morning (stress?  sleeplessness? adrenalin?) that they had to give me some zofran, too.  Around noon, I had a meltdown and told Derek that this was all a mistake, I was so frustrated by all the different meds I’d had in my system, and I hated that we’d had to stop and start things so much.  Between 12 and 1, though, everything intensified fast, and at 12:50, I gave in and called in for a bump on my epidural, because it just wasn’t cutting the pain anymore.  When the anesthesiologist came in again, he was super encouraging and said it looked like I was ready to go, gave me a “pushing dose,” and told me I’d meet my baby in a few minutes.  Dr Van Geem reappeared around 1 and told the nurse to get ready, but the boost hadn’t kicked in, so I was a little relieved when he went out again.  Next thing we knew, he had to go in and assist with an emergency c-section, so I had the familiar feeling of being all ready (and very uncomfortable) and having to wait.  (With Tommy, we had to wait for the doctor to get to the hospital; with Elizabeth, my OB had to take care of a similar emergency just as I reached transition…)

I guess the pushing dose of the epidural totally kicked in as I waited, because when Dr. Van Geem came back in at 1:40, I wasn’t feeling a thing.  Not a single contraction, no pain, and no emotion.  We all sat around for a couple minutes, and he told us that if it had been any other doctor on staff that morning, I would have had an emergency c-section.  Then he looked at the screen and said a contraction was coming and told me to push.  Having felt the pressure with Tommy, having had a reduced dose by pushing time with Lizzie, and having not had it kick in yet with Susanna, I was used to feeling the contractions while pushing, even with epidurals.  I think if I’d been able to push soon after my boost, I could have felt something, but because we had to wait so long, I was pretty much worthless.  I had three deep breaths through my first push, and they told me they could see a head of hair.  They told me to start pushing again, but as Dr Van Geem saw her head, he quickly told me to stop.  I really don’t remember if I did or not–apparently he was unwrapping the cord from around her neck–and I guess I must have finished pushing after that, because out she came.

With the other kids, there has been this huge adrenaline rush and elation when the baby comes out, but I was so out of it that I didn’t really feel it this time.  As Dr Van Geem pulled her up onto me and Derek said, “It’s another girl,” I mostly felt relief that she was safe and this thought that Tommy would be disappointed and noticed that she seemed very purple compared to the other ones.  The nurses were still pretty calm about suctioning her out, and they let her stay on my chest, but I felt like she took longer to start crying than the other ones did.  Derek disagrees–maybe I was just extra worried because of all the earlier drama.  Once we’d settled down and I’d been stitched up (Dr Van Geem said he’d clipped off my scar from the previous three tears, so that should heal up better than it has in the past), they told us about the cord but that her Apgar scores were fine, so we didn’t need to worry anymore.

My friend Ginny asked me that night if I’d recommend induction to others or would do it again, and I have to say that I certainly wouldn’t try to convince anyone to do it for no reason.  I still think going into labor naturally is the best way, but I think three weeks of unproductive pre-term labor was horrible enough that I’m so glad I’m done.  I definitely felt frustrated about him breaking my water (which was probably more because he had office hours that morning than because it was the best timing for me), but knowing afterwards about the cord and the pressure that Janie was under once the water broke, I’m glad that it happened in the hospital and not at home.  If I’d gone into labor at home and had my water break and put pressure on the cord around her neck before we had her on a heart rate monitor, we wouldn’t have been able to act quickly enough to resolve things.  I do know two families who lost full-term babies due to a cord around the neck, and I am so glad that we were in a hospital room with plenty of emergency equipment when we had the emergency.  In my first long sleepless night, I even realized that if I’d just been on pitocin like I wanted and my water had broken naturally at some point when just Derek and I were in the room, we might not have been aware enough to notice that the heart rate had dropped too far, or we might not have gotten help in fast enough.  Also, I didn’t really enjoy having to go through the whole labor with an oxygen mask on, but I’m glad we had the extra oxygen pumping through for Janie, since we definitely did notice that the hard contractions put enough pressure on her cord to drop the heart rate pretty frequently.  It wasn’t enough of a drop to be really concerned, but the oxygen was probably a good thing.  So while the most frustrating aspect of the labor was having my water broken unexpectedly, it might have been the safest thing in the end for Janie.

On a scale of most to least traumatic, I think the scare made this the roughest labor, though Susie’s was the most painfully unpleasant.  Tommy’s was so-so, and Elizabeth’s remains my ideal (talking poetry and philosophy with Dr Moses after napping through the first couple hours was really almost a delightful experience).  From getting admitted to having the baby, Janie’s labor took only six hours–only four hours once we got things started again.  And it was lovely to be strep B negative and come home after 24 hours instead of 48!