The birth of TER - LONG version

Right around 4 in the morning, Ant let out a few cries that woke me up. I wasn’t able to get back to sleep again because I was having contractions – the first time that they really felt different from the Braxton Hicks contractions I’d been having since 12 weeks. I timed a few of them and they were 3-5 minutes apart, and lasting around 15-20 sec. So, I figured I’d get up, finish off a last few things for work, have something to eat, and see what happened.

Similarly to what happened when I woke up with fairly close contractions at 35 weeks, once I was up and about they slowed down and spaced out, to about 10-15 minutes apart. I still wasn’t sure if this was really it, but I was thinking it might be – and at 39w6d, to boot. So much for my predictions of 1-2 weeks late! It seemed even more like it might be the day when I went to the bathroom, and had some blood-tinged mucus on the TP when I wiped. Big smile on my face!

Mark came down not too long after that to ask what was going on, I told him that I thought we might be having a baby that day. He inquired as to whether he should go to work, I said probably not. Good thing, too, given how the rest of the day played out!!

I was supposed to have my routine 40-week checkup that morning at 9:45, I figured since I was most likely in early labor that there wasn’t much point in going in, so tried to call the doctor’s office – of course that was the day that they don’t open until 9:30.

I then spent a couple of hours doing some last minute stuff for work, as well as sharing taking care of Ant with Mark until the Rinaldis showed up to look after him, and trotted him off to a farm for the morning, after he’d had his breakfast. The contractions during this time were still nothing terribly painful, although more crampy feeling than my BH had ever been. I was feeling them low in my uterus, sort of down around my hips and below.

At 9:30, I called my doctor’s office to say that I was in early labor so I didn’t think I needed to come in. The nurse said I should come anyway, but backtracked a little when I said I wouldn’t be able to make my apt time because I live 25 min or so away. The plan we came up with was that I would come in at around 1:30 (I think she was thinking that I may be in false labor as my contractions had spaced out, and that I should be checked if that were the case), but call at around noon to confirm if I was actually in labor or not.

I finished with all my work stuff at around 10am; at this point the contractions were closer together, around 4-5 minutes apart, but still not lasting that long, about 40 seconds. And I could definitely talk through them with no problem; maybe a little more concentrating on my breathing but that was it. I figured it was time to start thinking about getting ready, so I headed off to take a shower – which then turned into a bath, because that sounded like a nice way to relax for a bit.

I hopped into the bath at around 10:15, and relaxed and lounged in it for quite a while. I only had three or four contractions while I was in there, so I thought for sure we’d be around for a while yet. It took me a bit by surprise when I stood up to rinse off that the contractions were quite close together and more uncomfortable than they had been, to the point where I started using the technique recommended by the Bradley method in early-mid labor of leaning against something and letting your tummy muscles relax as much as possible, so that your uterus can do its work. I had to lean against the back of the shower 3-4 times during the time it took me to wash my hair and finish rinsing off.

When I got out and dried off, I told Mark that he should probably shower too, as we might be going in a bit sooner than I had thought. Although I was really thinking that the contractions were just so close together because I’d been lying down and relaxing for a while, and that they’d surely space out soon. Especially because they were only 20-30 seconds long by my “one little second two little second” count. I should actually try doing that now and see if my estimate was off!

I picked out some clothes, undies, etc, going to the chair in our room every 2-3 minutes to bend over and relax through each contraction. I would bend, hold on to the seat of the chair, let my tummy sag, and think about taking deep breaths, just as the Bradley method taught.

At about ten past noon I remembered that I was supposed to call my doctor. I spoke to a receptionist at 12:15, and had a bit of difficulty making her understand what I was trying to say – which was that I was definitely in labor, so wouldn’t be making it to my 1:30 appointment, I’d just go to labor and delivery when I was ready to come in.

My doc had said that I should come when the contractions were 5 minutes apart and 60 seconds long, according to the Bradley book one should go to the hospital for a first baby (which I was thinking this was since my first had been a C-section, so this was the first for my cervix) when they’re 3-4 min apart and 60 seconds, and you’ve reached the “serious” emotional signpost. As mine still weren’t approaching anything like 60 seconds, I definitely didn’t feel like I was serious about working through the contractions yet, I was still thinking we had a while to go.

Eventually, I just asked the receptionist if I could speak to the nurse, and was told she would call me back in a few minutes.

At that point, I finally started feeling like I did need to lie down for the contractions, so I lay down on our waterbed where I had been putting my things to take to the hospital. The second contraction after I lay down, I felt a distinct POP, and a big gush of fluid. I actually started giggling it was such an odd sensation. I called out to Mark that my water just broke and to bring a towel so that I hopefully wouldn’t wet the bed. He ran in with a towel and stuffed it underneath me.

The nurse called back (12:31) while I was lying on the bed. I told her that my water just broke, and she said that we should come in right away. I was still waffling, because I didn’t feel like the contractions were long enough yet, but she was quite firm, and I decided that she was probably right. So I let Mark know, and we went into high gear. Well he did – I was still lying on the bed.

Another couple of contractions later when I felt like most of the water was out of me, I went into the bathroom to change my bottoms and put a pad in. I did already have a light-days pad in my undies because of the bloody show – when I pulled my pants down, there was a big glob of brown on that, and the pad itself was saturated with a yellow-greenish fluid, so I thought there might be meconium in there. I held onto the pad to show the nurses, and went back to lie down on the bed again. The contractions were feeling quite a bit stronger at this point, and coming pretty much on top of one another

Mark had everything together about ten minutes later, so we headed down to the car. I reclined the seat, got in, and tried to close the door. Of course, it got jammed on something over on the side of the garage – I started trying to get out again to lighten the load so I could close the door, but Mark said to stay put and he’d take care of it. I laugh now that I was still trying to act as if everything was perfectly normal!

We left the house at 12:48, after Mark had to get out of the car and fix the garage door so it would close properly; it’s been acting up recently. Not the most opportune time! I told him not to drive too fast, still thinking that we had plenty of time.

We made a couple of calls on the way in, to the Rinaldis who were watching Ant, to my mom to let her know we were heading in to the hospital. The contractions were about 2 minutes apart (another place where the Bradley method was wrong – they were supposed to slow down when we were en route because of the adrenaline!), and I was doing quite a bit of panting through them, I think, rather than taking normal natural breaths. Mark kept reminding me to breathe normally, which was a big help, although I found it hard to do in a not terribly relaxing position!

We got onto Storrow Drive, at which point we should have been less than ten minutes away – but hit bumper to bumper traffic! At this point Mark was getting a little worried that we wouldn’t make it to the hospital based on his assessment of how I was doing – he asked if he should beep the horn and flash lights to try and get through. I said I didn’t think we needed to, but perhaps we should call smartraveller to see what was going on. Fortunately it was just a work crew at the BU bridge, so we did get through pretty quickly.

While we were waiting in the traffic, the contractions felt a bit different again, and I started spewing more amniotic fluid. Fortunately Mark had thought ahead and brought some towels (although we should have been more forethoughtful and put one underneath me), so handed me one which I kinda shoved between my legs. Mark and I were debating which garage at MGH we should park in, or if he should drop me off out front. By the time we got there, we had determined that we should probably just leave the car if we could – I was definitely feeling like the contractions were pushing more, and really right on top of each other. I didn’t think I could walk, and I didn’t want Mark to be away from me for that long!

We arrived at the hospital at around 1:20, Mark pulled up right in front and said to the guy waiting there, “We’re having a baby!”. He actually sounded relatively calm to me, although I’m not sure he was feeling exactly that. The guys there were great, pulled up a wheelchair and opened the door for me. I couldn’t get out right away as I was having a contraction, but once it was over I managed to get out and sit on the wheelchair, keeping the towel between my legs. He wheeled me quite fast, Mark right behind him, and had actually radioed ahead so there was someone waiting at the elevator to whisk us right up to the labor and delivery floor. Which turned out to be 14, not 9 as Mark and I had thought! He had a medical emergency card, so the elevator bypassed anyone who was waiting, and they had told everyone at the first floor that we needed the elevator, so we headed right up.

They wheeled me in to L&D, where the receptionist started asking us if we had my blue card and insurance card. I had thought we didn’t need that stuff as I’d filled out all the paperwork in advance, so I hadn’t brought it with me. I had to tell Mark my number through a contraction! She was not feeling nearly the urgency I thought she should, taking her sweet time, so I said that my contractions were only 1-2 minutes apart. After a couple of minutes she said she would go and get someone; I felt like we waited much longer than we should have – a nurse even came by to take someone else in first! At this point I knew that I was much closer to delivering than I had thought even at home, so I was feeling a bit neglected!

In a few minutes more, we where wheeled into triage, and the nurse had me put on a Johnny. I had two contractions right on top of each other, barely time to breathe in between, then got up to change. I dropped the towel, and she said that “we definitely passed the towel test” – it was quite soaked. It was definitely greenish, so I said that I thought it might be meconium. I stripped then and there – modesty totally out of the window I just wanted to lie down again!

I hopped up on the table, and almost immediately felt my uterus pushing. I said, “I need to push!” The nurse said that they needed to check me first. I had no idea that it would be so blindingly obvious when the pushing stage came – my uterus was doing it whether I was going along with it or not. A midwife ran in, checked my cervix and said, “fully dilated, +2 station”. At which point they raced me down the hallway to the delivery room, and said that I should start pushing. After a few of the docs introduced themselves. I was in no state to pay any attention to that!

They were all very helpful, they did have me use the sitting squat position that is recommended by the Bradley method as well. I think I was holding my legs up, but there was a nurse on one side and Mark on the other, I think they were helping too. The contractions were still right on top of each other – no time for the one breath two breaths, three breaths and PUSH that I had practiced! It was pretty much breath and push push push push, breath push push push, okay legs down for a few seconds next one is coming breath push push push. I was definitely panting; the nurse was very helpful telling me to breathe more deeply. The pushes hurt, I could feel stretching burning in my perineal area, but it wasn’t as bad as I was expecting. That may just be because there wasn’t time for me to even think about being in pain. I wasn’t screaming, nor grunting, maybe a combination of the two that was all about the exertion of the pushing. After a little while, they told me to try and push gently and then relax, push and relax – I guess this was the point when the baby was crowning and they were trying to avoid too much tearing. They asked me if I wanted to feel the head, so I did – but I think what I was feeling was actually my parts and not the baby’s head, not sure. Felt too squishy to me to be the head. They also asked if I wanted to look, but I couldn’t even think about opening my eyes I was too far immersed in just trying to control my breathing and the pushing. I thought I was doing okay with the gentle pushes, but then they started saying that the baby’s heartrate was dropping and we had to get it out NOW which was by far the best motivation I’d had. The next contraction came, I took a deep breath, and PUSHED. I remember saying “OH MY GOD”, I’m not sure if it was this push or one before, there were a couple that were quite intense. The feeling when the baby came out was so strange – all of a sudden I felt the head come out, and then the body just slipped out right behind. I have to say, the idea of finding out whether Fwed was a boy or girl did not enter my head for even one second during this process.

Or even after, until Mark said, “It’s a BOY!” – none of the medical personnel did, unlike what you see on TV. Thought that was amusing. They whisked Timmy away because of the meconium; the pediatricians intubated him and aspirated his lungs. That seemed like it took a couple of minutes although it may have been less than that – when they were finally done they gave him some oxygen, slapped him around, and he started yelling at them. Ironically I was so wrapped up in what was going on with me and the docs that I didn’t even notice that he hadn’t cried until he did. Which I’m glad of because I would have been really worried had it occurred to me that he wasn’t making any noises. In any case his Apgars were 8 and 9, so everything was looking good!

In the meantime, the docs pushed and pulled to deliver the placenta. I asked if we could just wait until it came out on its own; they said that there tends to be more bleeding that way, so they prefer to help it out. The happy clappy natural birth books all say that you should deliver it on your own – but I really have no idea what the truth there is, so I just went with what the docs said. They also gave me a shot of pitocin to help my uterus contract – I had been planning on having a hep-loc, but obviously there hadn’t been time for that!

I did get to look at the placenta after it came out, I thought it was really neat. Apparently when they pull it out it is inside out, so the doc showed me the back side, flipped it back right side round, and showed me the membrane that was also attached to it. The best comparison to something I’ve seen before is that it looked like a piece of liver.

The next order of business was stitching me up. I had a second degree perineal tear that required a few stitches, and some labial tears as well. A number of shots of lidocaine were needed to desensitize me – all the poking and prodding at that point was honestly worse than the delivery itself. The pains were much more sharp, as opposed to the crampiness of the labor and work of delivery. At the same time they were mashing my uterus. I’m not sure if that was to get it to contract more quickly, or just to feel and make sure that it was doing the appropriate thing. Quite astonishing how rapidly it got smaller – even just a few minutes after the delivery it had gone from watermelon to maybe canteloupe sized. After they were theoretically done with the stitching, the doc was still looking concerned, and said that there was still more bleeding than she was happy with. Nothing serious, I wasn’t hemorrhaging, but there was still blood coming from somewhere not normal. So I got another shot, this time of methergen, in my other thigh. Lovely. They’d also put in an IV by this point and were dripping in pitocin as well.

The doc found a couple more places on my labia that were “oozing”, so she put a few more stiches in to try and close those up. STILL oozing. More stitches. After those still didn’t stop the bleeding she said we’d try applying pressure, and also get a consult from another OB to see what he thought and maybe get another pair of hands in there. At this point, I *finally* got to hold Timmy – I think by this stage it was almost an hour and a half after he was born. So much for immediate contact after a natural delivery.

Unfortunately the application of pressure didn’t work to stop the bleeding. The second doc came in and took a look, thought maybe we could try a small vaginal pack to see if that did anything, and if not, they were recommending that I have a spinal and go into the OR so that they could use retractors to see what was actually bleeding, and stitch me up without me feeling every little tug and pull. I agreed in a second; as I said, the aftermath was so much worse for me pain-wise than either the contractions or the pushing. Having the vaginal pack put in was no walk in the park either, the doc really stuffed the gauze in there; I had to give Timmy back to Mark while they were doing it because I didn’t trust myself to hold onto him and not squeeze too hard.

Vaginal pack didn’t work either, so off to the OR we went. Although it took about three hours to get in there as there was an emergency C section that bumped us. (Which I don’t have any problem with at all.) At least during this time I got to hold Timmy, nurse him, call a few people and generally be a happy new mother!

So finally at about 7:30 I was wheeled into the OR for round 2. The anesthesiologists were really fun, we were doing lots of chatting and laughing, which was nice. The main doc had introduced himself to me as I got into labor and delivery, which of course I didn’t remember. I know someone had but I wouldn’t have been able to pick him out of a two person lineup. He was joking with the nurses that I had the baby at home – which isn’t too far off! The spinal didn’t go as smoothly as I remember it doing with my C section – he apparently hit a nerve so I felt a sharp pain shooting down my leg. It took about 30 seconds to dissipate, and I was quite worried, but the anesthesiologists didn’t’ seem to think it was a big deal. A few minutes later they did get the spinal in in the right place, and laid me out on the table. There were two poles, one on either side of the bed, that had loops hanging from them for my ankles to go into. They looked more like medieval torture devices!

Forty minutes later, they were finally done. It turns out I had a vaginal tear in addition to the perineal and labial tears they had already repaired, so that’s where the bleeding was coming from. I asked if it was normal to have tearing there, and what it might come from. The docs said that it does happen from time to time, most likely just some part of the baby that got caught a little and ripped me open. They were saying that because I didn’t have an epidural the pushes are harder to control, so there tends to be somewhat more damage after a natural birth than one with pain meds. I felt like saying, you folks are the ones who told me he needed to come out NOW, so that’s what I did!

So at about 8:30 pm I was finally all fixed up. Finally got to really relax and enjoy Timmy as I waited for the spinal to wear off and be allowed to go down to recovery.

Now for some editorializing! I was really taken by surprise by this labor and delivery – I thought I was well prepared having read and practiced the Bradley method, as well as umpteen other books, both about natural birth and standard deliveries. The ‘emotional signposts’ that the Bradley method discusses made so much sense to me, I was really planning on using that as a mark of when we should be heading to the hospital. According to them, the initial response to early labor is excitement, followed by getting serious when the contractions are more intense and have to be worked through, followed by self-doubt when you’re about to transition into the pushing phase. Well. I definitely felt the excitement. But I was still fairly calm and relaxed even when the contractions were 2-3 minutes apart – in fact, just before I called the doc and subsequently had my water break, I was telling Mark I wanted to take some last pictures of my belly. (Which did not end up happening). But that is not something I would think someone ‘serious’ about working through the contractions would be saying. The other thing that totally threw me was that both the Bradley book and my doctor were saying that I should come in when the contractions were 60 seconds long. Which mine never were, at least not until we were in the car and on our way. So that was another reason I thought we still had a while to go. Finally, the Bradley book said that if you’re a “speedster”, delivering after just a few hours, you’ll typically find that the pain of the contractions is a very hard one to work through. So because I was not finding the contractions unmanageable, again, I thought that I still had a long time to go.

The other thing that really took me by surprise was how fast the pushing stage went. Again based on the Bradley book, I was imagining that I’d have time to think about what position I wanted to push in, what felt comfortable and what didn’t, that I’d have a few minutes in between contractions to relax and take in the wonder of it all. Not so much. I had to be so focused because the pushes were so close together that I really didn’t experience any wonder at all. It was just my body doing it’s thing, and my mind trying desparately to keep up! I almost might consider having an epidural if we end up having a third child – experience yet another aspect of labor.

The last thing I wanted to mention is that despite all the tearing and stitching, and “piles”, my recovery really has been so much easier than after my C section. I was bounding up and down stairs the first day I was home, versus taking quite a few minutes to walk up the stairs into the house when I arrived home after Ant was born. I went for a half hour walk yesterday during which my quads and glutes felt a bit tired going up hills, but it was much longer than I could manage after the C. I can pick Ant up with no problem, jump up in the middle of the night to check on Timmy when I hear a funny noise, and manage nursing him and changing diapers without Mark’s assistance at night. “They” say that recovery is easier after a vaginal birth, but it was just hard for me to imagine until I experienced both myself. Which I am so incredibly glad and grateful that I did.