Today we have Beckett’s birth story from Mama of 3, Georgia. This story brings tears to my eyes every time I read it. If you are facing an induction this story will show you that it is still possible to have the birth that you are hoping for. It may not be the birth you planned, but at the end of the day, holding your sweet baby is worth the change in plans!
“Do you have a birth plan?” asked the night nurse. I laughed as I glanced at the IV pole next to me. The Pitocin was now dripping through the tube into my veins at a rate of 20 milliunits per minute, generally considered the maximum dose. Wires snaked from belts strapped around my pregnant belly out from under my gown to a box that wirelessly monitored my contractions and my baby’s heart rate, both of which were displayed in one of several small squares on a computer screen in my room. “I did,” I said. “It did not include any of this.”
You see, I thought I was done with the whole difficult labor thing. My first son was born in a birth center, after pushing for five hours. My second, another boy, came so quickly that I barely made it to the hospital. So clearly, this one should be even easier.
I had a pretty uneventful pregnancy for the most part, save for the flu at the end of my second trimester. Around that time, I started to notice that this very active little one inside me, was also very small. My previous two boys had been 7#9 and 7#13, and I could tell this one was nowhere near that big. I mentioned it at my 30 week appointment. I hopped on the table, my belly all but disappearing when I laid back. The doctor pulled out a paper measuring tape and measured my belly, from pubic bone to the top of my uterus. “29 centimeters. Still measuring normal. “We can do an ultrasound if you want,” he said. “No, its fine,” I said. Rule #10 in Samuel Shem’s House of God: If you don’t take a temperature, you can’t find a fever.
Of course I compulsively measured my belly for the next few weeks. Always normal. I relaxed a little. Until my next appointment, that is.
“You’re measuring a little small for 35 weeks,” the doctor said. “I’d like to do an ultrasound.” The tech squirted warm green goo all over my belly. “We don’t want to know the gender,” I told her. She scanned around for bit before announcing, “Thirteenth percentile. Not too small. 4#8.” I knew that it wasn’t considered growth restriction until the tenth percentile.
“We should send you to Maternal Fetal Medicine, just to be sure. Do you have time now?” “Sure,” I said. I had worked all night and gone straight to the OB’s office that morning. I was exhausted but my husband, John, was leaving for Africa the next day, and I wanted to be sure everything was okay before he left. At the MFM office, the doctor joked, “What we have here is a case of acute tofu toxicity,” poking fun at my veganism. He said we would just follow up with another growth measurement in two weeks, which happened to be a few days after John returned.
Over the next two weeks, I religiously did kick counts. Growth restriction increases the risk of stillbirth, but this baby was always moving. I never had to wait more than 30 minutes to get kicked ten times. John returned on a Sunday and my next ultrasound was Wednesday. The same tech did my scan. She didn’t say much this time, but I could see on the screen that the measurements were less than the tenth percentile.
“It’s actually less the fifth, severe intrauterine growth restriction (IUGR,)” the MFM said. “There is also evidence of cranial sparing,” meaning that there was more blood flow going to the baby’s brain. That happens when the blood flow to baby is restricted, and the baby’s body begins protecting its most important organ. Knowing that I wanted to avoid induction, she said, “We can monitor you twice a week until 39 weeks. Then I’d recommend induction.” My heart sunk. I don’t do induction. I do natural childbirth. I felt torn. I knew all the risks that came with severe IUGR, with cranial sparing, and with induction. I also knew that most babies do just fine, most inductions go well, especially in women that have had babies before. We had opted not to have testing for Down Syndrome, etc; what if the baby had some kind of problem? The ultrasound was normal, sure, but they can’t see everything, especially not at this stage in the pregnancy. John and I are small people; it was probably just a small baby, right? Right?
I polled every MFM I could find. They were split on what to do. Some said deliver immediately. Some said monitor. I went over my ultrasound in detail with one of them. “The cranial sparing is non-specific and meaningless at this gestational age. However, the average weight gain at this point is 250 grams a week. Your baby gained 200 grams in two weeks.” My baby’s growth was not just overall small; it was also slowing down.
At 37 weeks and one day, I woke up feeling that my very active little munchkin was not as active. I made the decision to move forward with induction. I couldn’t justify a stillborn just to avoid induction. So I went to work Thursday morning, rounded on my patients, and then checked myself in for my first induced labor.
I chose to stay at Greenville Memorial, instead of Greer as planned, just in case there was a need for NICU. I knew it was very unlikely, but I just didn’t know what to expect. I also knew that I would be able to have more control over my care since I worked there. I could handpick my nurses and doctors depending on the situation. It just so happened that my two closest classmates were working on Labor and Delivery at that time, one on days and one on nights. I knew which attending doctors were on call, and I was happy with who was available. I was able to request the ‘waterbirth room,’ and I even called in one of the nurses from home to take care of me. She is also a midwifery student, so I knew she’d be on board with all my natural requests.
My friend, Jill, checked me in that morning. It was amusing to see her in that role, asking the details of my medical history, all professional in her white coat. This is the same girl I drink mojitos with on Wednesday nights. She checked my cervix and I was about 2 centimeters dilated. We agreed to start Pitocin. Since it was an induction, I had to be continuously monitored, which I had never had before. The nurse hooked me up to the monitor, stretching pink and blue straps around my waist. I was able to use the ‘telemetry’ monitors, which meant I could walk around and the heart rate and contractions would be wirelessly sent to the computers in the nurses’ station.
My hubby arrived soon after I was checked in, with a duffel bag that included my pink nursing gown that I had worn during my other two labors. I have to say that wearing my own clothes has always been something that was extremely important to me. Up to that point, I’d been wearing a hospital gown, which was stiff and itchy and, well, not mine. I didn’t want to feel like a patient; I wanted to feel like me. That familiar pink nightgown helped me do just that.
I think I had my first contraction at about 9 am. I have always heard that “Pitocin contractions are so much stronger than natural contractions”- they hurt more and they stress your baby out. Not the case for me. The contractions, though they looked big and beautiful on the monitor, were almost imperceptible. Sure, I knew they were there, but not painful, not uncomfortable, and certainly not stronger than natural contractions. I thought maybe if I walked, I could help the contractions along. So I walked. And I walked. I walked with my husband, I walked with my mother, I walked with my friends. Around the circle of rooms that make up Labor and Delivery, I went. Familiar faces smiled as I passed again and again and again. The other residents, the nurses, the janitors, the private doctors, the anesthesiologist (who I told to stay away,) all encouraged me as I walked. I felt a little like a marathon runner, with people cheering me on and giving me little cups of water.
Of course, there were no little cups of water. I did sneak peanut butter and apple juice throughout the day though. I knew it was going to be a long day and I would need some energy. Each time Jill came to check on me, I told her the same thing. “My contraction pattern looks great on the monitor, but this is not labor.” I remember feeling rather jealous of the patient in the next room. It was her first baby, and she showed up 9 centimeters dilated. She was there less than an hour before I heard the baby cry. I did that once, I thought. This is my third baby; why can’t I be 9 centimeters?
Around 5pm, Dr. Tyson, one of my attendings, came by to check on me. I always ask his opinion on my patients, and now I wanted his opinion on me. We discussed different options, depending on what my cervix had done over the past 8 hours. If it hadn’t changed, we could stop the Pitocin and try something to ripen my cervix overnight. If it had, we could stay the course. We could also think about breaking my water. I was very hesitant to artificially rupture. First, I felt that that was why my first delivery took so long. Once the midwife broke my water at 9 centimeters, I could not stop pushing, even though it was probably too early. Second, once your water is broken, you are “on the clock.” It is more important to go ahead and deliver because now the barrier to infection is gone. If this was going to take a long time, I didn’t want to put myself at risk of infection, arrest of dilation and of course, C-section. Third, I have artificially ruptured enough women to know that, rarely, the umbilical cord prolapses and then an emergency C-section is immediately necessary. No epidural means general anesthesia, means a faster (sloppier) surgery, means no hubby at delivery, means I don’t see my baby until I wake up, means breastfeeding is delayed, means…obviously, its hard knowing all the possibilities.
Jill checked me around that time and I was actually 5 centimeters! That Pitocin had been doing something, even if it didn’t feel like it. Hubby and I talked about what to do next and we decided to continue Pitocin. I had been walking for hours and was pretty tired, so we decided it would be best to try and get some rest. At shift change, Jill left and my friend Megan was now on call. She was 31 weeks pregnant herself. She came in and met my parents who had stopped by to visit. But after that, she pretty much let Dr. Tyson, who had stayed after his afternoon OR case, take care of me from then on. The night shift nurse took over, and she had a student with her. When she asked about my birth plan, I pretty much told her “the usual”- no episiotomy, delayed cord clamping, immediate skin to skin, etc. That’s all routine really in the water birth room.
Dr. Tyson came into my room at about 9pm, and suggested we check my progress. I still was in the same contraction pattern, beautiful on the monitor, but definitely not labor. I was still 5 centimeters. So we decided to break my water. I felt the warm fluid gush out of me, and then labor finally began. I looked at my husband and said, “This is it; it’s real now.” The Pitocin was turned off, and I moved from the bed to the birthing ball. My feet flat on the floor, I rolled my hips in a circle while on the ball, leaning my torso over the side of the hospital bed. I welcomed the familiar pain low across the front of my belly and focused on the downward pressure. The nurse periodically came to adjust the monitor strapped to me, reminding me why I declined continuous monitoring with my previous deliveries. Distractions bring tension which brings pain. The nursing student tried to check my blood pressure right in the middle of a contraction one time. I held up a finger, telling her to wait, but she didn’t understand and began to try to wrap the cuff around my arm. My husband, in his quiet, even tone, said, “She wants you to wait. She’s having a contraction now.” I love his attentiveness and his familiarity with my process.
I’ve been told that I am a quiet laboring woman. I don’t feel quiet. In my head, I talk to myself constantly, saying things like, “this is terrible. Why do you insist on going natural?” But also encouraging myself, “you are doing a great job. Look how amazing you are.” In my mind, there is a constant monologue. I’ve done this enough times to know that, when I hit the “I can’t do this” stage, the end is near. And that was the moment I got in the tub.
Gown off. Belts off. IV tubing unhooked, arm wrapped in plastic. I instantly felt better. Maneuvering myself into the large blue inflatable tub was not easy. The sides were high and I have short legs. It reminded me of my three year old getting in and out of the bath. His legs are too short for one to touch the floor while the other touches the bottom of the tub, so there is some straddle time over the edge of the tub when neither of his feet is touching the ground. I had some straddle time too over the edge of this pool, only I’m less nimble than a three year old as a thirty year old pregnant woman. There was a little inflated step inside the tub, which I decided to use as a seat. I sat just on the edge of it so my legs were in a kind of squat position. There were handles on either side of the tub, which I used to keep me stable.
The warmth of the water was great. It took the edge off. I was able to relax a bit more in the water. It wasn’t long, though, before I started to push. Now, I hear a lot of talk about the urge to push. Well, I have no urge. It just happens. It feels just like vomiting to me, completely involuntary. I don’t have an urge to vomit and then make a decision to vomit. I feel it coming and then its happening. Same with pushing. I felt it coming, so I asked my nurse if she wanted to check me. She said, “would it change anything?” I guess not, as I cannot stop my body from pushing.
Dr. Tyson came in a few minutes later, and I told him I was pushing a little. “We should probably check you then,” he said. I laughed to myself, because he was thinking the way I was thinking. You check patients when they feel like pushing to make sure that the cervix is completely dilated. So I stood up, awkwardly leaned over, and he checked my cervix. “You’re probably about eight centimeters,” he said. In the end, the nurse was right. It changed nothing. I still pushed.
This was the only point that I know I made a sound. As the contractions built up, I would repeat, “ohgodohgodohgod,” until the need to bear down made me close my mouth. I pushed maybe a handful of times. My need to know how close I was to delivering took over and I checked myself a few times near the end. I could feel the wrinkled skin of my baby’s scalp just a couple centimeters away from the outside. My husband sat on one side of the tub, and Dr. Tyson on the other. I pushed gently until I felt the burning, the ring of fire. That’s when I knew if I pushed hard enough, the baby would come out all at once. So I pushed as hard as I could, just wanting to get through that pain. And, in the words of Dr. Tyson, my baby ‘submarined’ out of me and into this world. Only an hour and a half had passed since my water was broken. I scooped up this little tiny body and held it close to mine. “It’s a boy! I saw it. It’s a boy,” my husband said. Three boys, I thought. I’m never going to have a clean bathroom.
I studied his little face. I was so thankful. All my fears, all the what if’s, all of the unknowns were washed away. He was small, but he was perfect. He stopped crying for a moment, and looked up at me with surprise. “Well, hey!” I said. “I’m your mommy.” After John cut the cord, he held the baby skin to skin while I delivered the placenta, got stitched up and cleaned up. His weight was 5 pounds, 4 ounces, his head bigger than his body. I tried to nurse, but his mouth was so small, getting him to open wide was difficult. I kept him skin to skin almost constantly while we were in the hospital to help him regulate his temperature a little better. Because he was small, they had to check his blood sugar, which was low. I ended up pumping and doing finger feeds, and then supplemental nursing until he got the hang of it. His weight was down to 4 pounds, 15 ounces when we left the hospital, which was not bad at all. He’s still small for his age, but his brothers are making sure he can handle anything that is thrown his way. Literally.