Thursday, March 20, 2008

Birth story - the good, the bad and the (ugly) waiting game

One year on, I think that it's about time I finally published my birth story. Luckily I wrote a draft within a few days of the birth - by now I've forgotten a lot of the details, so it has been good to re-read it.

My 44 hr long labour might sound pretty awful, but I want to reassure anyone pregnant that is worried by it that it really and truly wasn't as bad as it appears (although pretty knackering of course). Hey, I actually enjoyed the first 22hrs labouring at home! It was a truly beautiful spring day; the sun was shining, it was warm outside and the daffodils were flowering and it all just felt so right. Plus I'd gone into labour overnight on the 7th/8th March exactly as I had long thought that I might. I was really pleased that I was able to cope with the contractions so well myself for so long (and with the amazing support of Karen & my mother of course - I really couldn't have managed anything like as well without both of them there to help me throughout it all). Even though it wasn't regarded as medically established labour, I view this time as my "true" labour, and have no regrets that I went through it, even thought I ended up having a completely different experience to actually birth our baby.

Having gone to bed at about 11.30pm on Wednesday 7th March, I awoke at 12.30pm needing the loo, but aware that I was experiencing a strange sensation - a kind of strong pulling feeling, rather like the feeling you are left with after you've peed when you have a urinary infection. I went back to bed, wondering if this was a contraction or not, and soon decided after a couple more of the same sensations that it probably was, so I got up at about 1.30am and went downstairs, to put my TENS machine on and start looking again at my birth plan/prompt cards.

It didn't feel like a great deal was happening at first (in fact, between contractions it felt like I was kidding myself that this might be labour, until the next one started), so it didn't seem worth waking Karen (or my mother) at this stage - I thought that it was far better to let them sleep. The contractions were a strong sensation rather than pain, but they were by no means unbearable, and I was easily able to breathe through them, with the aid of the boost on the TENS machine. I started timing contractions, and they were around 10 mins apart at first, soon going to roughly 7 mins apart. Suddenly around 3.30am, they jumped to being only 4 mins apart, and I thought that I had better wake Karen, as it looked like I might be in for a quick labour (ha!).

Karen came down and we rang the hospital, who then alerted our midwife team. It just so happened that "our" midwife Lisbeth was on call, so she rang us straight back. She teased us that Karen answered the phone saying "Oh, it's all so exciting!" rather than the more conventional "hello"! She came round to assess me, found that I was about 1cm dilated but said not to get all excited yet as my contractions were neither long enough nor strong enough to count for anything much. She left us to it, saying that we should go the antenatal clinic at the hospital for our 10.45am sweep appointment as planned, and that they would assess me again there. So we laboured at home until then, with contraction timings rather all over the place. They settled down to roughly 5 mins apart, until just before we went to the hospital, at which point they slowed again (and of course stopped completely on our way there).

A really awful maternity assistant at the antenatal clinic questioned why I was even there if I "thought I was in labour". Um, because I'd been told to come in? She didn't even know what the TENS machine that I had strapped to my arm was, which was worrying/astounding. She was so incompetent that it was funny in an appalling way. Anyway, I saw the consultant who examined me and assessed that I was 3-4cm dilated. He also did a sweep to try and move things along a bit. They asked if I wanted to be admitted, but I couldn't see the point at such an early stage (and I think that my midwife, who was round on the delivery suite by now, would have sent us home anyway if we'd decided otherwise - Lisbeth is nothing if not direct!). Lisbeth said to judge when to call the hospital again/come back in, by when the contractions became too difficult to bear with any longer. As soon as we left the hospital my contractions started up again, around 5 mins apart.

Once we got home, we decided to go for a short walk as it was such a lovely day. I kept having to stop for contractions, and found a lot of comfort in hanging around Karen's neck/leaning on her during contractions. At this point, I also started getting a stitch-like pain in my left hand side that was separate to the contractions (but caused by them) - it was this pain that was ultimately to prove my "undoing". We had some lunch when we got back (seriously comforting leek and potato soup made by my mother) and continued labouring at home, with the contractions gradually getting stronger and stronger during the rest of the afternoon and evening, as well as closer together, but without them getting established at exact regular intervals, something that we didn't realise was as crucial as it turned out to be. We thought that if the contractions were frequent and had been going on this long, then they must be achieving something; it seemed like requiring them to be completely regular was slightly pedantic.

Around 9.30-1opm, contractions were getting much stronger and required a lot more in the way of breathing/visualisation in addition to the TENS machine, so we thought that we might be getting closer to the real action and that we should get to the hospital. We packed the various bags (labour bag, post-birth bag, food and drink bag etc.) in the car and set off. Being late at night, at least we didn't have to worry about finding a parking space near the maternity unit (although Karen did drop me and my mother (plus bags on a trolley) off at the entrance - I wasn't about to walk from the car park!). On being admitted, we met with Pat, one of our team of local midwives (as opposed to the hospital midwives), who examined me and said that I was still only 3-4cm dilated - very disappointing after 22hrs of contractions. She then said that as she had been on shift since 8am, she wouldn't be staying with me overnight as there was obviously still some way to go. Around 11pm she handed me over to one of the hospital midwives, Hazel, and we were basically left alone to get on with it. I was still using the TENS machine plus breathing to get through the increasingly strong contractions, and I also found the rocking chair in the delivery suite was useful, rocking through the contractions and leaning forwards as they peaked.

When Hazel re-examined me at 2.30am, she said that dilation could be "up to 6cm", but that the cervix was still thick and the baby's head too high. However, by now, my discomfort (the word we wrote in the labour notes we made!) had increased, especially as by now I had fairly severe stitch pain down my left hand side with each contraction. We requested gas and air to help me through contractions - something I had been rather looking forward to, as I've always wanted to know what it would feel like to get a bit of a high! However, although it did help me get through contractions, it essentially just made me feel very fuzzy-headed and slightly sick/drunk. Plus the bloody equipment was half-broken and the breathing nozzle was stuck on to the supply tube with a whole load of sticky tape, and often came apart at the crucial moment!

By now we were all a bit spaced out (not just me from the gas & air!) due to lack of sleep, and Karen in particular kept falling asleep as she sat by the bed. I vividly remember yelling and kicking her to wake up on several occasions to get her to pass me the gas & air as a contraction started. Labour was punctuated by the necessity of frequent trips to the loo - necessary but dreaded, as each time it made the contractions much worse. However, I didn't ever really feel that the contractions were "painful" as such; it wasn't as if they didn't hurt as labour progressed, but I saw it only in terms of degree of strength and bearability.

At 6.45am Hazel came and checked me again - I couldn't believe it when she said that I wasn't any further along, as the past 4 hours had felt like pretty tough going. At this point, we agreed to having my waters broken. Unfortunately the amniotic fluid had a very slight tinge of green, indicating some meconium content, so I had to be continuously monitored from this stage on, which meant being stationary on the bed in a semi-reclined position (not that I really had the energy to move around much by this point). The monitoring equipment was also pretty useless and kept falling off, but (when working) it did reassure us that Toby's heartbeat was always good, strong and consistent. Also around this point, Hazel went off shift and I was passed over to the lovely Pam, head of the hospital midwife team - in hindsight, she was the only midwife we actually had real confidence in during the labour.

Breaking my waters didn't have much effect on the labour itself, but it did make the not-quite-regular contractions even more intense and re-inforced the agonising stitch-like pain in my left-hand-side (which we think was caused by Toby resting on a nerve) that became increasingly unbearable as I ended up with no let-up between contractions (I was able to cope OK with the contractions, as it never felt quite like "pain", or at least not in the sense of when you hurt yourself; plus each time I knew that it would soon be over). What also didn't help at this point was that I was re-examined and told that I was probably still only 4-5cm dilated (the number of different midwives examining me did not add up to consistency!), plus I could hear the woman in the room next door absolutely screaming her head off while being told to push, for what seemed like hours - I was so knackered by now, I was virtually in tears at the thought that I probably had some time to go before getting to that stage, let alone how I would find the energy to get through it. Another of the midwives from our local team, Stephanie, came on duty at 9am, but Pam also kept an eye on me for the rest of the day.

After a further 3hrs of strong contractions, I was both exhausted and quite literally beside myself with pain from this "stitch" (I could only speak to yell for hot cloths to press on my side as they were the only thing that marginally dulled the pain) and asked for an epidural (to take away the pain of the stitch rather than the contractions). The pain was so severe that it actually pretty much stopped my contractions - when the anaesthetist came in to assess me for the epidural, he took some convincing to agree to it, as he didn't believe that I was actually in labour! After 29 hours of frequent contractions, if I had had any energy left and wasn't in searing pain, I would have quite cheerfully throttled him. It was a bit scary having the epidural (I was terrified of the thought of paralysis), but I would have done almost anything to try and get rid of the pain I was in. We also opted for a Syntocin drip at this stage, to bring on regular contractions. By this time, all thoughts of our desired natural, non-interventionist birth had long gone out of the window - it was clear that my body just wasn't going to do it on its own and I needed help if we were ever going to get the baby out.

I certainly don't have regrets about having taken any of these intervention decisions; we just wish that once we started down that path, the whole thing hadn't ended up being drawn out for quite so long (13hrs from membrane rupture to delivery) when I'd already been in labour for so long, albeit not "established" labour by the hospital's standards. I'm pretty sure that this is where my "natural birth" plan backfired on us, as I'm sure that at each stage, they held back from intervening further, to try and give me the birth that I wanted. However, as I'd been having contractions at intervals of 3-7 mins ever since midnight on Thursday 8th, without any real let-up, it had been quite a tiring process.

Once the epidural had taken, it really just became a waiting game (we realised at this stage that I was extremely likely to end up with a Caesarean). We were all absolutely exhausted after having had virtually no sleep for nearly 2 days by this stage, counting from Wednesday morning - only my mother & Karen had had a few hours sleep on Wednesday night before I woke them after I'd been contracting for 3hrs on my own.

Following the epidural, I was only assessed every 3-4hrs for progress, but my contractions did become regular, and I did eventually fully dilate by 6pm (42hrs in!). By now, I felt very out of sorts with the numbness induced by the epidural, and was worried about the effect on my back of being in one position for so long - little did I realise that I was going to end up being in the same position for about 2 days in total before I was able to get up after the C-section! My legs, in particular my left leg, felt like horrid dead weights - I could still feel them, but it felt like I had a really bad case of pins and needles rather than any other form of sensation. Our midwife Stephanie assessed me and said that she thought that the baby's head wasn't in the right position, having turned slightly sideways, but she couldn't be sure, so we tried 2nd stage labour pushing for an hour. Very bizarre when I couldn't feel a thing (and at first I honestly couldn't remember where my bum was/how to bear down as if having a poo!). And totally pointless as it turned out. After an hour of pushing, the registrar came in for the first time to assess me, and to decide whether we should go for an assisted delivery (i.e. ventouse/forceps) in theatre, or a C-section.

I was so relieved when she said a C-section was necessary due to the head position, although she said that it might be quite hard to get the baby out as they thought that he was further into the pelvis than he turned out to be (his cord was also around his neck, although they couldn't tell that at the time). I just wanted it all to be over, and for us to be able to hold our baby at last - it felt like far too long a process before we were able to meet him.

We had a brief respite while they prepped up (and Karen gowned up) - I even got to listen to that night's episode of The Archers on Radio 4! We then went in to theatre, and once they'd topped up my epidural, they got Toby out within a matter of minutes at 8.02pm (weighing 8lb2oz) and into Karen's arms where he calmed immediately - truly miraculous to witness; he really did know who she was. I wasn't really able to hold him properly with the screen being in place, and lying on an impossibly narrow bed, so I couldn't put him to the breast as soon as I would have liked. As his head was covered by a knitted hat, I also didn't realise until I saw photos later that he had a cone-head!

My uterus wouldn't contract back into shape for them to stitch up as it was so exhausted, so they had to use all kinds of drugs to make that happen, which took a while, and I lost about 1 litre of blood. The operating theatre nurses had warned me that although I wouldn't feel pain, the C-section would feel like someone was doing the washing up inside me - a very accurate description. What with all the pushing down on my abdomen to try and get my uterus to contract, it also felt like I was like a sofa cushion someone was trying to knock back into shape.

Eventually I was sewn back up (I think that I was in theatre for about an hour total), then wheeled off to recover for a further hour before being taken up to the post-natal ward for the night at 10.40pm, after which Karen & my mother went home for a much-needed bottle of wine, some pizza and sleep. I desperately needed rest too, but didn't get a lot of it what with being on a hospital ward, and having a hungry baby with latching issues. I think that I became almost delirious, and certainly a little manic through lack of sleep over the ensuing days. Toby & I were in hospital until Monday afternoon - we got to go home on Karen's birthday.

My labour and birth weren't at all how I had wanted them to be, but it was certainly a learning experience. Being a bit of a control freak, it made me realise that something as fundamental as labour cannot be controlled, however much you plan ahead of time. Looking back though, I don't regret how it turned out - our beloved Toby was born hale and hearty, albeit to a knackered Mummy and Mimzy (which didn't help us cope well with the first couple of weeks of his life). Next time though (hopefully!), I won't even bother with a birth plan - we'll just go with the flow!