I am 35, a long-time wheelchair user, partially paralyzed, and have a neurological condition that can cause dangerous spikes in blood pressure in response to pain. I had been seeing a high-risk OB group at a large tertiary care center throughout my long-hoped-for pregnancy. Although philosophically I would have preferred to be at the local crunchy-granola birthing center, because of my health problems I always knew I'd need to have a highly medically managed birth at a place geared toward interventions. However, I really, really wanted to have a vaginal delivery—that was my biggest wish going in.
I had been happy with my OB care during the pregnancy. I felt the OBs and the anesthesiologists were very much on top of my medical issues while open to discussing things like alternative positions for the birth. They generally listened well and frequently said things like, "You'll need to give us guidance because you're the one who really knows your body." There is a midwifery group in the hospital, and I know the head midwife. Towards the end of the pregnancy I discussed having her be involved in my care if appropriate, and the OBs welcomed this as long as I was medically stable. They told me she would be a great resource for positioning issues.
At about 33 weeks I started having problems with my blood pressure, breathing, and mobility. They were mild at first and I managed them OK, but over time I was feeling worse and worse. By 37 weeks I was having a hard time managing and really concerned that I was heading towards a health crisis. My doctors agreed, and although we had previously discussed induction at 39 weeks we decided to induce at 37w 6d.
I arrived at the hospital on a Monday morning. The first order of business was to start an IV and epidural. Probably because of my unusual anatomy, the epidural took two tries. We then spent an hour or so testing it and fine-tuning the baseline dose. Next, the perinatologist did an amniocentesis to check for the baby’s lung maturity. Fortunately, the numbers came back favorable for us to proceed to the induction.
At this point it was late afternoon, and finally I got settled in a labor & delivery room. Once in the bed, I fully realized that I wasn’t leaving until I had a baby or a C section. Although I could see my wheelchair parked in the corner, there was no escape! The OB resident came to check me and I was 0cm and 50% effaced. She put in a tablet of misoprostol vaginally and wished me patience and luck, then left. The day perinatologist, my midwife friend, and the day nurse all checked in and counseled patience. When the night perinatologist came on, she checked me again—still 0cm and 50%--put in another misoprostol, and wished me patience and a good night’s sleep. My blood pressure was checked every 10 minutes, and they had me on fetal monitoring for an hour, then off an hour… not actually a recipe for much sleep, but I did doze. We repeated this cycle another 3 times, into the next day shift. Finally I got to 1cm, and then—just when we were about to try a Foley bulb for mechanical dilation—I went to 3cm and started contracting on my own. I started to have some mild problems with my blood pressure, so the anesthesiologist came and adjusted my epidural and I stabilized and felt much better. Contractions continued for a few hours at every 2-4 minutes, but then spaced out by evening of the second day. We then decided to start pitocin at the lowest dose. It was bumped up a little after another hour of no progress. I started contracting regularly again, as I had been before. Once on the pitocin, I had to be monitored constantly per the hospital’s protocol.
Throughout this time I was finding the labor bed very uncomfortable—too hard and narrow. My nurse found an egg crate to put under my butt, and she or my partner helped me shift around to get more comfy a few times an hour. They straightened and/or changed my linens every 1-2 hours all day. These measures helped a lot to keep me more comfortable, but it still wasn’t great.
All during this time I had had lots of good support and welcomed interaction. Many people called or sent texts. Several friends had been in and out, visiting, as well as my sister. One close friend was working at the hospital, and she hung out whenever possible and answered pages from my room. I had a big private room, and the staff were very tolerant of my breaking the rules on number and timing of visitors. My partner had been there all during the days but had come into the labor exhausted by work and moving and remodeling our new house, so we’d agreed he should go home (three blocks away) to sleep the first night while my mom stayed with me. He looked so much better the next morning that I was glad he’d gone. The second night I was at 3cm and with the same contractions as I’d been having since afternoon, so at about 11:30 I sent several friends home and my partner home to sleep again, and tried to settle down myself.
The night perinatologist came by and we agreed to turn off the pitocin to see if I’d keep contracting on my own and, if not, possibly give me a break. We did, and the contractions kept coming. At about 12:30 I was suddenly very uncomfortable, so with a lot of help I turned over to a child’s pose. This was tough due to my many “tethers”—IV, epidural, blood pressure cuff, pulse oximeter, and two fetal monitoring bands—and because the epidural made me extra paralyzed. In the course of turning I pulled the epidural catheter from its line and lost the placement of the fetal monitor on my belly. The anesthesiologist came to fix the epidural, and I rested on my front feeling better. After a time I felt restless and the nurse was getting anxious about the fetal and contraction monitors being off, so I turned over again. I was so amazingly uncomfortable, restless and oddly achy though not having any specific pain. Everyone eventually left except my friend, who was working overnight and doing paperwork by a small light, and my mom, who was asleep. I watched them and felt like I was going to jump out of my skin. This period of time was probably only half an hour, but the minutes just crawled by. Suddenly I felt a gush of fluid, and called the nurse and doctor to say that I thought my water had broken. The doctor came and confirmed it. There was no meconium, and the baby’s heartrate was looking textbook perfect (as it had all along). She checked me and said that I was 7cm and 70% effaced. It was 1:45am. I called my partner and said just, “I’m 7 cm…” before he got off the phone. He was there before two.
About an hour later I started feeling a lot of pressure in my rectum, as if I really had to poop. There was no pain as such, but the effort of “not pooping” was intense and accompanied by a slightly panicky feeling—like being in a foreign country with a bad case of traveler’s diarrhea and no bathroom in sight. The nurse called the doctor, who came quickly. When I explained I felt the need to poop, she checked and said, “No, that’s your baby!” The doctor got gowned and gloved, and everyone bustled around getting organized for the birth. They asked me whether I wanted to change position because I’d said earlier that I didn’t want to give birth on my back, but in the moment I was happy with my semireclined position and some “knee stirrups” for my legs so I stayed put. The doctor and nurses coached me in pushing in very calm and clear voices, and I pushed as best I could given my weakness. The doctor—who’d earlier said we might need to use a vacuum depending on how pushing went—sounded so excited as she said, ”You’re doing it!” I felt great. My breathing felt easier than it had for weeks because the baby had moved down, I didn’t have much pain, and I was filled with a sense of purpose and the joy of effort. I could feel my little boy moving deeper into my pelvis. I pushed through 4 contractions, being coached on going slowly to stretch my perineum. On the 5th, the doctor said, “Next push and his head will be out!” and I felt steadily increasing pressure and its easing off. On the next push, I felt my baby’s body come out as if he was a little seal swimming through my body. It felt as if he and I were working together, me pushing gently and steadily and him kicking and stretching. There was such joy and relief that things had gone well in the room. I felt like everyone there was so excited to support me and welcome my son. I had initially had wanted to cut the cord, but it was very short and I couldn’t reach. My friend ended up cutting it, crying a little because she was so excited and moved. They handed me my baby for a bit and then took him to a warmer because he was slow to breathe. After some suctioning and a few minutes of oxygen, he was fine. His Apgars were 6 and 9. He is so beautiful! The placenta came out without a problem, and I enjoyed looking at it. I had one small 1st-degree tear in my vagina and another by my urethra, and the doctor stitched these up.
My partner, who is generally a great support to me, is also anxious by nature, had good reason to worry about me, is uncomfortable in hospitals, and very queasy at the sight of blood. We had agreed that he would be at the hospital for the birth and accompany the baby constantly once born, but that he should find his own comfort level in terms of how much he wanted to interact and watch the birth. My request was for him to take care of himself and not “infect” me with any anxiety. He ended up staying by my head but being very engaged with the process of birth, and calm. He declined (ahead of time) to cut the cord, but took amazing pictures and engaged with his newborn son right away. It has been a pleasure to watch him bond with the baby, and to enjoy each other as part of a family of three.
I stayed in the hospital for about 36 hours after the baby was born. My epidural was run for 24 hours after the birth and then discontinued without a problem. I felt good—actually much better than I had for the last months of my pregnancy. The baby stayed with me the whole time except when my partner went with him for his security tags and hearing test. No one gave me the slightest grief about not circumcising my baby or deferring his Hepatitis B shots. They asked about these things (whether we wanted them) in a neutral way, and then noted our answers and didn’t ask again. We have had a tough beginning to breastfeeding, and had two visits from the lactation consultant and one from the midwife for breastfeeding help while in the hospital. We continue to find it challenging at home, but we are improving.
I feel like this birth was all I could have asked for. I had my vaginal delivery, and my son is amazing. I am grateful that the epidural was available to me and that it allowed safe medical management while I was conscious and felt totally engaged with the birth process. I had great support, and feel like my baby came into a calm and loving environment despite the medical setting and both of us needing some interventions.