Wednesday, June 29, 2011

The birth story of my mini-me (aka adventures in high blood pressure)

This is a long detailed story but the important points are:

1) Being at a birthing center, with midwife-centered care, was the most awesome fantastic wonderful decision I ever made. I fully believe that if I was at any other facility I would have ended up with a C-section.

2) I love doulas, I loved my doula, everyone should have a doula

3) Having a well prepared, well educated, partner to advocate for you during the many decision making points during the birth process is critical

4) I wanted a natural birth but was prepared to roll with the punches, which was good, because NOTHING went as expected

On Thursday I went in for my 41 week check-up with the nurse practitioner midwives that I have been seeing through out the pregnancy. They checked my blood pressure (BP) which was normal, then did an exam and determined that I wasn't very dilated or effaced (maybe 2 cm) and finally listened to the babies heart rate which was normal. However at this point the midwife was worried that maybe the baby was breach because of how high in my belly was and how difficult it was to find the heartbeat. 

This of course totally freaked me out. Not to mention after this statement we went over the induction procedures and that we should start considering them. So it was with a lot of worry and agitation that I made my way over to the birthing center for an ultrasound to determine my amniotic fluid levels and a non-stress test (where the monitor the babies heart rate and my BP for 30 min). 

The ultrasound revealed that the baby to be head down and my fluid levels were normal, Baby's heart rate was normal but my blood pressure was high for quite a few of the readings during the half hour non-stress test. I really thought this was because the midwife had freaked my shit out with the news of a breach baby and all the talk of the induction. However the OB/Gyn on duty thought that just to be safe I should do a 24 hr urine catch and run some labs on my blood. The concern was that I might be developing pre-eclampsia .

Pre-eclampsia is when hypertension develops during pregnancy, it is associated with high blood pressure, high amounts of protein in the urine, swelling of feet/hands, and decreased function of kidneys and liver. It is not clear what causes it but the only known cures for it are caesarean or induction of labor. If left untreated it can lead to seizures and loss of oxygen to both mom and baby's brain. So you know some serious shit, but I really didn't think this was what I had because this was the first time through out the whole pregnancy I had high BP. 

So I go home collect urine for 24 hrs (which is super fun!) and bring it in the next day around 4 pm to the birthing center. They said it would be a few hours while they did testing so I went home to eat dinner and really didn't think anything of it. I got a call around 6 pm asking me to come in right away as I had significant amounts of protein in my urine. 

Anything above 300 mg is pretty high and I had 680 mg. I am mildly concerned at this point but still don't think anything is *that* wrong, since my labs were normal. So I go back in and they do another non-stress test in which the baby's heart rate is fine but all my blood pressure readings were high for the whole 30 min. Now it is about 7 pm Friday night and my husband has joined me and we are both pretty worried because it doesn't look like we are going home and I really really really don't want to be induced. My fear is that pitocin will lead to an epidural which will lead to a caesarean all of which basically equals me freaking out. I watched a video of a caesarean being done and am petrified of the idea of being conscious during a surgery.

At this point the midwife comes in and explains that I am no longer at risk of pre-eclampsia I have been diagnosed with it and because I am already a week late they really would like to induce me. However because my cervix is not "ripe" (not effaced or dilated) the first need to ripen my cervix and then induce labor. So the plan now is to ripen my cervix by inserting a misoprostil pill vaginally and if it isn't ripe enough after 4 hrs inserting a second pill. This will take us to morning and which point, assuming I am 'ripe' enough I would get induced. There is the possibility that the misoprostil will jump start my labor but the midwife thinks that this is unlikely because of the lack of dilation/effacement so she doesn't want me to get my hopes up. The pill should cause mild to serious cramps and some early contractions. 

8:00 pm Friday 
I get my first dose of misoprostil and my husband heads home to get our supplies and pack our bags since, apparently, we are having baby. I call the team (our doula, and my three girlfriends) and let them know what is happening and that probably tomorrow they will be needed. Then I pretty much just sit and wait. 

10:00 pm Friday
I am having cramps but I am otherwise fine, mostly just bored and still freaking out about the whole being induced thing.

12:00 am Saturday
I am having pretty serious cramps and occasional contractions, the nurses come in and monitor my contractions and decide I don't need a second dose of misoprostil and that I should be ready by morning for induction. They offer me ambien to help me get some rest tonight since it is obvious I am going to need my energy tomorrow. 

1:00 am Saturday
I take the ambien and lay down to rest. The nurses tell me to let them know if my contractions get any stronger.

2:00 am Saturday
There is no way I am sleeping! The contractions are getting way stronger and more regular. We call the nurses in and they confirm what I have figured out at this point which is that I am in labor. We call our doula but figure we will call the rest of support team in a few hours, because early labor can take awhile. My husband and I head to the shower to give me some relief. While we are in there I pretty much reach the "I can't talk through the contractions" point and turn to my husband and let him know from here on out I am counting on him to take the lead on the decisions because I am losing my ability to process anything besides "holly shit pain"

3:00 am Saturday
We are out of the shower, I have puked my guts out, and our doula has just arrived which I register barely. I think someone had turned the lights down, I am standing leaning over a table when the nurses come in to take the fetal heart rate and my blood pressure. Baby, as usual, is totally fine however my blood pressure is really high. I have no idea how high but the nurses immediatly tell me I have to lie down on my left side "RIGHT NOW". 

I don't want to do this because it just makes the contractions so much more painful but I am not really given a choice at this point. I won't be allowed to stand again for two days. My doula and husband are asked to keep all stimulation minimal as the fear is if my blood pressure goes any higher I may need an emergency C-section. I think it is at this point that it is decided that the support team will not be called because more people = more stimulation for me.

The midwife and some other people come in, there is some discussion, some of it with me which I don't really remember very clearly. Remember I have had an ambien and I am experiencing contractions like a m*therf&cker. 

This is the kind of pain that I feel like I am losing consciousness at the peak.  I start saying that I can't do this and begging for pain relief. Cyndi and Brian are doing all they can but laboring on your side, in one position, sucks about four different kinds of ass. Around this time my cervix is also checked and I am now 6 cm dilated and 100% effaced so I am reassured that barring any unforeseen circumstances I will get to have a vaginal delivery. 

4:00 am Saturday
I get some pain relief and an IV since I can't keep any liquids down. I am given Nupain which is a narcotic that takes the edge of the contractions and makes it possible for me to breath through them with the help and support of my doula and husband. I no longer feel like I am going to die but I am still puking and I start to feel very dizzy. 

5:30 am Saturday
My blood pressure apparently spikes at this point to something like 170/100, I don't exactly remember but it brings a whole bunch of people running into the room. I am given a Magnesium drip IV to bring my BP down and an epidural is recommended to decrease the pain of the contractions and the strain (and spike in BP) they are causing. 

I am told this is necessary and I agree immediatly because I really can't process anything at this point and if someone told me stick my head in the toilet because it would get the baby out I would do it.

But at this point my fantastic husband steps in and starts being a really awesome advocate for me. He asks if there are other measures we can take first, other pain meds, whether we should wait for Magnesium to take effect first etc. 

In the end when the anthesiologist arrives he basically agrees with my husband saying that they have given me too many drugs at this point and need to wait and see if they have an effect first. He also says he doesn't think I need one since I seem to be handling the labor just fine. I am AMAZED that anyone thinks that I am fine. 

Later, after the baby is born, I am grateful for this man and the fact that he just didn't rush in and put an epidural in but actually evaluated the situation and was experienced enough to know what a good and bad labor look like.

6:15 am Saturday
I am given a second dose of Nupain to help manage the pain and the spike in BP contractions cause. The second dose is no where near as effective as the first.

6:30 am Saturday
I start getting the urge to push and my water breaks (almost all over husband, who is handling all this like a champ). I start pushing soon there after. Unfortunately the Magnesium is a drug that actually slows down labor so as the baby is making her way out and I am pushing... the contractions are starting to decrease in intensity which is pretty much the least helpful thing that can happen. Actually doing something feels fantastic, pushing takes all the pain away, and I feel like I am accomplishing something.

7:00 am Saturday
The doctor wants to give me Oxytocin (Pitocin) to increase the contractions and help with the pushing. She is worried that I am too tired to push the baby out. Again my husband steps in and really argues for less interventions for me. The doctor says I need to push for 10 seconds for at least three pushes, if I can't do that, then I get drugs. 

So my husband starts counting for me and I start pushing like there is no tomorrow. At this point the contractions are negligible in intensity so it is sort of will power for me and the pushing. I am not feeling any pain or any contractions so I am unconvinced that the baby is actually moving and keep needing reassurance that something is indeed happening. I am so tired that I am almost falling asleep between pushes. The doctor and my husband compromise, so that I get an extra 30 min of pushing before they start the Oxytocin. Through out all this baby's heart rate is normal and healthy.

7:40 am Saturday
I am still pushing and get my first very small dose of Oxytocin which really doesn't do much. 

8:10 am Saturday
I get more Oxytocin

8:24 am Saturday
Baby girl is born, 6.5 lbs 19 inches. My husband's response "Baby you gave birth to an alien, a really cute alien". The crowning is pretty much the only time I felt pain while pushing and even that wasn't very intense for me and I have to say that pushing was my favorite part.

Despite being exhausted I felt so powerful. It was so good to finally do something instead of just endure more pain. Baby girl is whisked away by three nurses because she is all high on drugs like her mom. She isn't initially breathing but no one seems particularly concerned. In fact the nurses who were working on her are laughing at getting peed on, which I find reassuring. They wouldn't be laughing if something serious was happening right? 

So first she peed, then she pooped, then she breathed.. girl had priorities. They give baby girl an anti-narcotic to combat the effects of the Nupain and bring her over to us for some skin to skin time. Where she promptly poops again all over me. I have some minor tearing but am otherwise okay. The doctor tell us she is very impressed that I got baby girl out since I was doing 95% of the work without the help of contractions. We attempt to breast feed and once she is within a few inches of my nipple she clamps on and starts sucking like she a professional. No breast feeding problems for us it seems.

I have to stay on Magnesium for 24 more hours which totally sucks because the side effects of the drug are pretty harsh. I felt like I had a fever with shakes and sweats. Plus the Magnesium makes all my muscles super sore and shaky. Because they are worried about my dizziness and lack of muscle control I get a catheter too (fun times!) so I don't have to leave my bed. Add to that a newborn who is just as cracked out as mom and needless to say our first night together was not ideal. Once I am off the Magnesium I have to stay for another 24 hrs to be under observation, this night goes a little better, but at the end of the day we have a newborn so sleep is not going to be happening anytime soon. Monday morning we are finally released and come home to start the adventure of being parents.

1 comment:

  1. And I thought my birthstory was bad! Wow that was just ouch x 100000000