Note: This blog is the second to last in the series on my labor and delivery. It was important to me to write it all out in detail as a way to process and remember what happened. Before reading this posting, it may help to review the events of labor leading up to the current point in the story in Pre-Labor and Prodromal Labor.
So, the story picks up with Ben and I being admitted to the hospital late Friday night (early Saturday morning). I remember writing 3:30am on the admittance form. That night Ben and I worked through every contraction using natural pain relief techniques, but this time with the aid of all our belongings. I tried to take comfort in knowing that this pain was to help bring my baby into the world. Also, the more frequent the contractions, the further along in labor I should be. By early Saturday morning, I decided to try soaking in the blowup tub we had brought with us to help ease the pain. I was disappointed to find that the water didn’t help as much as I had hoped. Even so, I would spend about 30 minutes in the water before the doctors came in for their shift change. This time the doctor on call was the OB I had been seeing for my prenatal checkups. When they checked to see how dilated I was, I was devastated to hear only 0.5 cm, maybe 1 cm if you were optimistic.
Another night without sleep and painful contractions, and I was only 0.5-1cm dilated? At this rate, the baby wouldn’t come for another week at least!
The OB talked to my husband and I at that point about the birth plan I mentioned in the Pre-Labor blog post. She was condescending at best, describing our birth like a movie we wanted to “direct.” She said that as doctors, they needed to maintain “a basic level of professionalism” and so couldn’t meet many of the few requests we had made. At the end of her speech, Ben and I felt like we’d been given a “talking to” by the school principal for engaging in critical thinking and doing things outside the box. I was upset because our “directions” were all research-based and to imply that they were fanciful requests of the entitled was insulting, especially in that high and mighty “I’m a doctor” tone she likes to use. And to think this woman might be the one helping me deliver this baby?
However, the bad news didn’t end there. It was about 8:30 in the morning at this point, and my contractions were again spreading back out. I was still only in prodromal labor.
Late that morning, the OB came back in and suggested that labor be induced. If you read the A Natural Birth blog post, you would know that an induction was the absolute last kind of birth that I wanted. First, inductions can fail and often do. In the case of using Pitocin (a synthetic version of oxytocin), if induction fails, a c-section is the only option available. Also, Pitocin can lead to contractions that are longer, more frequent, and more painful than any contractions your body would naturally put you through. People I’ve spoken to who had labor induced with Pitocin have said they would never let that happen again.
I honestly never thought I would have to consider having labor induced, especially before my due date. I thought this would only be a concern if I went past my due date by a week. On that Saturday, I was only 39 weeks and 3 days along. I wanted my baby to come when she was ready, but both Ben and I had now gone two nights without sleep. If you only counted the hours with consistent contractions, I was already at about 20 hours of labor across the two nights. However, I was barely dilated.
Ben and I asked for some time to think about our options. We contacted our two doctor friends for their opinions, and we went back to our Know Your Options Birth Course notes. In these notes, they talked about the Bishop’s score. This score looks at location, dilation, effacement, and firmness to determine how likely an induction is to be successful. There are two features of location. The first is which way the baby is facing. Many people know that you want to the baby to be head, not say feet or bottom, down. However, even if the baby is head down, the direction the baby is facing can also impact the birth. Is the baby’s face to your stomach, one side, or toward your back? It’s best if he or she is facing the back. The second aspect of location is about how about far down in your pelvis the baby has dropped. -3 would mean that the baby’s head is above the pelvis, while a +3 would be crowning. Dilation, effacement, and firmness all relate to the readiness of the cervix to allow the baby to pass through the birth canal.
Using these factors in a chart, one can quantify how likely it will be that an induction is successful. A score of 8 or higher means you have a good chance of success. When Ben and I calculated our Bishop score, we were looking at a score of 6-7. In our favor was that I was 80% effaced, and my cervix was soft. However, with me only being at best 1 cm dilated and the baby in a mid-position and at -3 station, there was a chance the induction would fail, and I would have to have a caesarian birth.
Fortunately, by the time the doctor came back in that afternoon around 3pm to ask for our decision, the contractions began to pick back up. Since they were regular again, we decided to wait on the Pitocin. The doctor agreed to see how things go, and if nothing else, she may try breaking my water (the amniotic fluid surrounding the baby) to see if that would help labor along. The argument for breaking one’s water to help labor along is that the baby’s head, unprotected by amniotic fluid, would now press down more on the cervix, ideally helping it to dilate. However, once one’s water is purposefully broken at this hospital, if labor doesn’t get quickly under way, they would start you on Pitocin after 2 hours.
The unfortunate thing about the contractions was, of course, that they were painful. As time passed, they again got increasingly closer together. Ben and I continued to work through every contraction into the late night. In the early morning hours, I was so exhausted I would fall asleep in-between contractions. Ben mentioned that this was painful for him to watch. Imagine excruciating contraction, breathing, counter-pressure, lavender as the pain builds, and then as it declined I would essentially pass out, only to be awakened 2 – 3 minutes later to do it all over again. I “slept” like this for 4 – 5 hours that night. Ben tried to get what sleep he could too, but he was there for every contraction. We were going through this labor together.
At around 2 – 3 am in the morning, my water broke on a trip to the bathroom. I also had what is called “bloody show,” and I lost my mucus plug. These were all signs that labor, I mean real labor should be underway soon. I started to get excited, even though I knew the coming contractions would only be worse without the amniotic fluid cushioning the baby’s head. I forgot all about the fact that if real labor didn’t get started in 6 hours, the hospital would start me on Pitocin. I was sure that this baby would be here soon.
So, you can imagine that when the doctors came in on Sunday morning to exam my cervix, I was deflated to find that I was a 2.5, an optimistic 3cm dilated. This was already my third full night of painful labor contractions, and I wasn’t dilated enough to even be accepted at most hospitals. Many hospitals won’t admit you until you’re at least 4cm dilated, some even as far along as 6cm. That morning, the doctors again asked if I didn’t want to induce labor or get an epidural. They stated they were concerned that when it came time to push, I wouldn’t have any energy left, forcing a c-section. I assured them that I had “slept” the night before, and that I still wanted to try for an unmedicated birth. They agreed and suggested that I get up and try to walk around a bit as it seemed the contractions were spacing out yet again.
Even so, by around 10:30am, the pain of the contractions had reached a level that was starting to exceed my pain tolerance. I had already tried bouncing on the birthing ball that morning, and Ben and I were walking very slowly around the hospital ward when I decided I had reached my limit. We went back to the room, and I told Ben that I needed an epidural. The pain was now beyond anything I could breathe or doing anything else through. I knew he would support me, but I also felt that a part of him would be disappointed as well. We’d already gone through so much pain, he probably thought we could continue working through each contraction as we’d been doing. I’m not sure what exactly went through his head at the time, but I know he had never seen me in so much pain. He trusted that if I wanted the epidural, then I needed it.
We called in the nurse and told her our decision. She then contacted the anesthesiologist, who was such a sweet man. His manner was very warm, and he explained everything to me slowly and gently in English. However, at this point, I was just like, “I KNOW THE RISKS, GET ME THE DRUGS.” At least, that’s what I was thinking on the inside. On the outside, I just nodded, stated that I understood, and told him I was sure I wanted the epidural. When he left the room, I broke spontaneously into tears. I knew consciously that I had nothing to feel bad about because I asked for the pain relief, but I was afraid that this would jeopardize that Golden Hour I so wanted. But I couldn’t endure any more pain. I was now at about 40 hours of labor, again not including the hours when labor stagnated and contractions came about 10 – 15 minutes apart.
At this point, the pain was truly excruciating, and I was having a very difficult time holding back screams, which I knew consciously was not helpful. I just didn’t have control anymore. The pain was wracking my body so intensely, I felt like I might break in half. This is the kind of pain they say you go through when you’re between 8-10 cm dilated, at the point of transition. Except, I was a mere 3cm dilated, and I didn’t know how much longer it would take to get to 10. I’m not sure if the contractions were just getting increasingly more painful, or if I was getting increasingly more tired. It was likely a combination of both. In any case, I needed the epidural.
The problem was that getting it so late meant having to try to sit still through mind-numbing pain. As the needle was going in, I felt another contraction rising. The nurses were trying to hold me to keep from moving, but when the needle went all the way in, I jumped. Ben told me his heart broke at that jump. He knew that this was such a delicate procedure, and I could easily be paralyzed. I prayed that jump wouldn’t lead to negative consequences down the road. It probably didn’t help with the precision because 20 minutes later, only one side of my body was really numb. I could still feel the contractions fairly strongly on the other side. After almost an hour of still struggling through painful contractions, I told the nurses that one side definitely hadn’t taken effect. Fortunately, the anesthesiologist was able to do something, I’m not sure what, to help with the pain on the other side, without removing and reinserting the needle. Even so, the pain on one side was still obvious. In fact, this type of epidural was not meant to numb me entirely so that I could still feel the contractions to help me with pushing. It did, however, take the edge of the pain, making it more of a pressure I was feeling. In that moment and looking back, I am so glad the epidural was an option. I had not, after all, truly slept in 3 nights, and I had been in prodromal labor for 40+ hours.
By early afternoon, the doctors came in and checked. I was 4cm dilated. It had also been 12 hours since my water broke. The fact that they were still asking me if I wanted to induce and not telling me they were going to was a kindness I really appreciated. At this point, I was willing to induce for a few reasons. The first is that our new Bishop Score was a 10, making our chances of success now quite good. The second reason was that I was on pain meds and less afraid of the intensity of Pitocin-induced contractions. Furthermore, I didn’t want to be on pain meds for too long while waiting for the baby to come. Finally, epidurals slow down the labor process, and I didn’t think I could stand it going any slower.
Before making a final decision, Ben and I talked about what we wanted, and he agreed with the reasons I stated above. So, at 3:30pm, we started the Pitocin drip. Keep in mind that I wasn’t actually numb with the epidural, especially on the side that didn’t take. Once the Pitocin kicked in, Ben and I were back to having to ride each contraction one at a time. Some contractions were as long as two minutes. To give you some reference, when your contractions are 1 minute in length and 5 minutes apart is when they suggest you head to the hospital. A 90-second contraction is considered long. Two-minute contractions are forever. So even though I was on an epidural, I still had to use my unmedicated pain relief techniques to get through the rest of my labor.
Fortunately, the Pitocin worked it’s magic, and I was fully dilated by 9:20pm. Going from 4cm to 10cm dilated in 6 hours is not that uncommon. I have a friend who was in labor for 7 hours total with her first child. However, by that point on Sunday, 6 hours seemed really fast to me. I was amazed and happy that it was finally time to push. The doctor looked at the clock then and stated that the baby should be there around 10:30pm. What an exciting time!
In my prenatal class, there was a whole segment on pushing and how to do it. They explain that hospitals will encourage you to hold your breath and push for 10 seconds, but this is not in fact healthy. Instead, you should push for 6-8 seconds each time. This will help you save your breath and your energy for the hours you might end up pushing. It can also help prevent tearing. So, I started following the suggestions from my class. However, the doctors and nurses were not happy with this and encouraged me to push for longer periods of time. There was so much energy in the room, and they were cheering me on. They could see the head already, they said. So, I pushed every time until the room started to blur from lack oxygen, then I’d take a deep breath and push again. And I tore, a second degree tear that would require stitches.
I didn’t feel any of it though as the epidural was still taking the edge of the pain, and the room was abuzz with movement. And then at 9:50pm, in only 30 minutes, I had pushed Alaya Marie Yixin Xie into the world. It was ominously quiet though. The cord was quickly clamped and cut, and the baby handed to the pediatrician as we waited for the first cry.
And when it came, I again broke spontaneously into tears.
She was here.
She’s here.
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