Sheesh! Clearly, she would take her time - like her dad and I, she is also a Capricorn....
After a high-risk (chronic low platelets), but uncomplicated pregnancy, my lovely OB decided at my 40 wk appointment (which was actually almost 41 wks) that it was time to induce - he said that safety-wise it was appropriate, and I had had a feeling this was on the horizon anyways. He and my other fabulous OB had discussed and contemplated it earlier, but decided to hold off until there was an obstetrical reason & not just because of my horribly low platelets (24K at this point - on mega doses of prednisone - zero effect, tried 2X round of IVIG - zero effect). Where I live, it is mandated by law that pregnancies are only permitted to go to 41w3d before induction begins... and with my tanking counts & no impending signs of labour, it was anyone's guess how long the induction might take....
I was pretty nervous about it all because I had heard so many stories about how horrible the pain is with inductions - and because my platelets were so low, there was no option of having an epidural.
I got the hospital the morning of the 5th for the first dose of Cervidil. They checked me prior to inserting it, and there had been zero change in my cervix from my last few OB appointments - a "tight 1cm" (depending on who's fingers - LOL), and my cervix was about 2 cm long. In other words "not favourable". Off to antepartum I went to see what would happen. My partner and I hung out and went for walks and watched TV (because I was high-risk, it was decided that I would be in the hospital until I left with a baby - so they could monitor me, etc. and keep checking my platelets). I had a few cramps, but nothing to write home about. I had really been hoping to be one of those ladies who gets a single dose of Cervidil and delivers a baby 3 hours later...Not my reality, sadly.
I was pretty sure it had fallen out of place, because when I went pee, the string seemed inordinately long...I talked to the nurses about it, but they said "those things have long strings...". After 26 hours, they checked me, and sure enough, it hadn't been properly applied to my cervix and had done nothing. *Sigh*. They plugged another one in, and decided to count it as the first one as the first one had obviously done nothing.
About 8 hours later, as I was hooked up for my 20 min of intermittent monitoring, the baby's heartrate dipped under 100 a few times - bounced right back. The entire pregnancy, her HR had never done anything except exactly what it was supposed to do, so this felt a little scary. I called the nurses, they had me stripped, into a gown, and Cervidil removed in about 20 seconds flat - within 2 minutes I was in L& D triage for closer monitoring.
The resident came down and decided since I was being monitored more closely, it would be okay to put another Cervidil back in, because I still hadn't changed much - and because of my platelets, everyone was trying to avoid putting me in a situation where C-section was the only option (lack of platelets puts you at a much higher risk of bleed-outs, etc), so Cervidil was still our best plan. After this insertion, I started to have some pretty regular contractions - and she started having a few blips of low HR - each time I would have a few hours of regular fetal monitoring strips, they would decided to send me back to Antepartum, and before they could do it, she would drop down again and bounce back. All things considered, I was in triage for 9 hours - no sleep, no food, overnight. The nurses were amazing! They were really straight up with me about what was happening, etc. and I felt surprisingly calm about the situation.
At about 9am, the resident came down and decided to check me to see if they could rupture my membrane or not. She determined that it would be possible, so they found me a room on L&D, and off we went to have a baby.
They broke my water, stuck me in mesh underpants and a gown and gave me a nurse. I thought she was a bit over-bearing, but looking back, I think she was probably just bad tasting, but necessary medicine. She was a little afraid of my ITP, I think, and terrified by the baby's weird HR dips - (they had decided they weren't true decels - but considered them to be "anomalies" because when they dropped they didn't stay low, and there was no pattern to them - more of a stressful mystery, especially to my nurse). Between her and my partner reminding me to not tense up and to just keep breathing, I was doing okay. They started pitocin after an hour.
Unfortunately, it became clear, pretty quickly, that when I started to move, walk, sway or sit on the birth ball - the baby's HR was responding negatively. Holy smokes - movement had been my pain management plan. At this point, I was allowed to lay on my back, and move (when I was told to) from side to side - they suspected cord compression, or something, but everyone was nervous at this point, so I did what they asked, hard as it was...My back felt like it was on fire. Breathing worked really well as pain control, I must admit...
They offered me gas and a fentanyl pump on demand (not usually permitted, but I got a special exemption because they were inducing without an epi), as well as narcotics -by the residents, not my nurse - I think she understood how I felt much of the time without me saying anything about it - but I was really afraid that I would forget how to breathe if I used any drugs. I just kept breathing and breathing. My lips got chapped quickly because I was breathing so much.
My doula had, sadly, left on vacation the day before the induction, and had left me contact info for the back up doula (whom I had never met). All of a sudden, after paying scandalous amounts to have labour support, and my partner had been a bit offended by my thinking he may need breaks and support himself, I sort of spiralled in, and got super private about my pain and couldn't handle having anyone else attend. Besides, without being able to move around, and having a nurse who was actually pretty amazing at talking me through contractions, (and my partner who was so much more amazing at it than I had ever suspected he could be), there didn't really seem to be the space for another person...Plus, I was really afraid that there might be an issue between the nurse and doula (since I had never met the doula, I wasn't sure what her attitude would be towards me being flat on my back, without much option), and I wasn't in any position to worry about interpersonal conflict. I never called her to come in. I never used the tens machine. I just kept breathing.
Between contractions was okay - I could still have a laugh, conversation, tell stories...
This all continued, about 6 hours - they checked me - I had dilated at this point to a 2. WTH?? A 2?? I was a little bummed. The baby's heart kept playing silly buggers with us, and decided that it was time to try something to help with that. An amnio catheter was the plan - to put fluid back into my uterus to see if that would help the suspected cord compression, plus they put a sensor in that would accurately monitor contractions, getting me off at least part of the external monitor. Then all of a sudden, I had yet another IV pump, up my ladybits, pumping me full of heated saline (? I assume that's what it was). My only comment about the whole thing, as it was installed during a contraction, was "Can I get out of bed now?" and they said "Oh no - now you're on a bed pan" to which I yodelled out " FOR F*** SAKES" and made a joke about how that was the first f-bomb I dropped. There were probably 8 people in the room at that point, and they all had a giggle. I was pleased I hadn't lost my sense of humour...
I had to pee, and couldn't remember how. They put a bedpan under me, and I just kept saying "Everything down there is confused and I can't pee". I felt like my abdomen might explode too - as the fluid hadn't started to come back out of me (turns out baby's head was too well applied to my cervix at this point to allow any fluid back out) - I started to get a little panicky, because I really felt like I was going to bust open. Finally they stuck a catheter in (never had one before, was terrified of the idea - pretty much one of the best experiences ever - or so it felt at the time! Such relief!) and drained almost 1.5 L of pee. I felt better, but still too womb-full. I kept repeating over and over that I was too full and it hurt. I was also having series of contractions - the worst was 7 minutes long - and while it wasn't a single 7 minute contraction, it never really went back down to the baseline at all in that time - I couldn't even catch my breath.
At this point, they had been trying to get the attending OB in to have a look at the monitoring strips and assess what was happening, but there had been a few emergency C-sections. When he finally came in, he was totally disgusted - I think because I was in so much pain and everyone was trying to do the right thing - which I still agree with - which was to keep the baby's heart rate happy - which despite my agony, it was in a beautiful range with all the water back inside me - and immediately ordered them to shut off the pitocin, and stop the fluid, and to try to drain it out.
They checked me at this point - and I was a "2 or tight 3" depending on who was checking, and the baby's head was "capping" my cervix - because I had been contracting so hard, but not progressing. Her little head was a little mottled from it when she was finally born - my poor little peony :(
I finally had a chance to catch my breath. The baby's heart rate was great after the pitocin stopped. The fluid started to drain out. I was laughing and breathing and felt like I might survive this whole thing after all. The doctors left to figure out where to go next. There had been a shift change with the nurses and my new nurse was a beautiful angel from heaven.
I asked what would happen next. She said they may decide to turn the pit back on. I said I didn't think I could do that. I asked if I could ask for a C-Section. She said it would likely be much easier to ask for it before it was an emergency, and from her experience, my having been in labour for 10.5 hours at that point, with such little change, a vaginal birth wasn't looking very likely. The doctor came back in and said "What do you think about a C-Section??" And I said "Let's do it!!" (and would have given him a high-five had the opportunity presented itself). Then, second only to my beautiful child's face, I saw the most amazing thing happen - I watched them dump the rest of the bag of pit down the sink. It brought tears to my eyes.
I had about 45 minutes to sit around and chat before surgery. It was all really relaxed. I had a consult with anesthesia - the section would be under general because of my platelets, and they ordered platelets and blood to be on hand for me in case of any problems (which there were none!!). When I got to the OR, everyone introduced themselves to me (and I to them "Hi, my name is Stik, I'll be having a baby tonite") and they explained to me what would happen, and how it would happen. I felt really good about it all - relaxed, everyone was in good spirits. My amazing nurse held my hand until I went to sleep, and then was there when I woke up.
My partner got to watch the surgery (which they don't normally allow when under general, but I guess he seemed keen...?!), and the baby was so robust, he had her in his arms in under 3 minutes. She was born at 9:22pm (12.5 hours since rupture of membranes) and I came to at about 10pm.
We spent an extra 4 days in hospital (6 in total with induction) - 2 for my c-section, and 2 because her platelets were on the low side (they could have released me and sent her to the NICU, but they didn't - again, props to this hospital!!!). I had the best nursing care a person could hope for. I fully credit our current breastfeeding success with the amazing support we received. It wasn't an ideal situation to wind up with a c-section, but our beautiful, healthy child is my ideal situation. (And my excellent health!). The first couple days were a bit physically & emotionally rough - I had to page the nurses to pass me the baby, change the baby, needed so much help breastfeeding, had a couple meltdowns and a quick trip to the NICU - yikes! But the support we received from the staff was unbelievable - they talked me through my breastfeeding fears - she cluster fed and I was sore and exhausted and scared she wasn't getting what she needed... They presented me, again, with my options, and supported me when I said "No formula! No pacifiers!" and instead took her to the desk for a few hours so I could sleep, and brought her back to breastfeed when she needed to....So amazing.
The end result of all of this is that this was my absolute perfect birth. I am recovering beautifully, our baby is healthy and perfect, we are breastfeeding like champions. I got to be an active participant in every decision that was made about this birth, and I don't feel like anything was done "to" me. There really isn't enough gratitude in the world to describe how good this all feels. It's an amazing feeling.
Oh - her stats - Born January 7, 2013 at 9:22pm, weighing in at 7lbs5oz, 20.75"long. Amelia!