Ahmet's Birth Story
We planned for months, since we first discovered we were pregnant. We planned for a homebirth, in water, with only our family and friends present to welcome this new soul into the world.
After weeks of nightly prodromal labor, contractions started in earnest around 4 am on Tuesday, March 13th. I knew this was the real thing, I could just tell. Something about the strength and location, as well as how I was feeling told me that this was it. Ekrem wanted to go ahead and fill up the pool, but I didn't want to get in too early and stall things, so I told him to wait. Meaghan was already staying home from school, recovering from a nasty cold, so she was put on alert that today may be the day. I did pretty well, moving around as needed, trying to sleep in between contractions because I was so very tired--Meg had passed her cold on to me. I spent some time on the birth ball, bent over the couch, lying down in bed, and leaning on the kitchen counter. I tried the shower, and that helped some, especially squatting with the water spraying on my back. I read and posted on MDC occasionally, trying to keep people updated. As the day wore into night, I was getting so tired that I prayed for the contractions to slow down a little and let me rest. During it all, I felt the baby moving around inside and knew that he was okay. I listened to his heart occasionally and was reassured that he had some good accelerations during a contraction and no deceleration afterwards. Our neighbors came over to visit unexpectedly and Emine was tickled to discover that labor had started. She was planning to help out at the birth and had been calling or coming over every few days to find out when this baby was coming. Before they left, she said that she would sleep with the phone next to her head and to call any time I wanted her to come over.
Not being able to reach my cervix to check dilation was bothering me, so Tuesday evening I had Ekrem don sterile gloves and poke around to see what he could find. He wasn't sure, never having done it before, but he felt something hard that he thought was the head. I asked him questions about what he was feeling, trying to figure out baby's position for sure, but he didn't feel any soft spots or any other landmarks that I could identify, so I started getting worried that maybe baby was presenting forehead first. I spent Tuesday night on the couch, sleeping between contractions, doing what I could to relieve the pain when they hit. I spent the night sleeping in 15 minute increments. Ekrem slept upstairs in bed; I figured at least one of us should get some sleep. I had told him earlier in the evening that if there was no progress through the night, I would consent to see the doctor the next day. Wednesday morning, I asked Ekrem to check my cervix again to see if there was any progress. He described the same things that he had felt before, so I knew that I wasn't making any progress. He was convinced that what he was feeling was the head--it was so hard, that's what it had to be. Ekrem called our friend Ilhan for the number of the doctor that he had recommended--we had somehow misplaced it when we moved things around getting the tub set up. We talked to Meg and asked what she wanted to do--go to school or go to the doctor with us. She decided to stay with me, bless her heart. I tried to eat some breakfast, I think I managed to choke down some tea and toast with jam between contractions, which were still coming regularly, every 7-10 minutes or so and lasting at least 60-90 seconds. Ekrem called the doctor and we started getting ready to go see her. I managed to get clothes on, but knew that I was in for a rough ride to get to the doctor's office in Kartal. What should've been a 15 minute ride turned into nearly an hour, thanks to road construction and general traffic.
Ilhan had already filled the doctor in on my situation, what my background was, and how I wanted to have a homebirth. She wasn't exactly supportive of it, but didn't think I was nuts, either. Her lack of support had more to do with the infrastructure of Istanbul's roads and how quickly we could get to emergency personnel, just in case. She didn't think that there was anything inherently wrong with homebirth, just that it's not practical in Istanbul unless one lives next door to the hospital, and even that is a risk. So we went to the exam room and poor Meg had to wait in the waiting area because there just wasn't enough room. It's probably just as well, because it was a very uncomfortable exam and I cried out several times as it felt like the doctor was inside me up to her elbow. She found my cervix to be high, hard, tight, and closed with the mucus plug partially intact. I think she tried to strip my membranes while she was in there, but the cervix was so hard that she couldn't do it. She did end up pulling out bits of my mucus plug on her glove, which helped it to be expelled later that day. After the exam, she hooked me up to the fetal monitor. The strip was lovely, good heart rate, good accelerations, no decels, and strong contractions confimed, both by strip and palpation. She said that if she hadn't felt my cervix, she would've expected me to be just about ready to deliver. After the 15 minutes or so of monitoring, she unhooked me and we went to the UltraSound room. She did a quick US and said that baby looks really good, but the placenta was starting to calcify and the amniotic fluid was low--both normal for a post-date pregnancy. The good news was that the baby was left occiput anterior (LOA), the best possible position for birth, with a nicely tucked head. She gave me the options as she saw them: go home and labor longer, go the hospital for Pitocin and an epidural, or have a cesarean. I chose to go home and labor longer. She asked us to call her the next morning (Thursday) to give her an update.
The car ride home wasn't nearly so bad as the ride to the doctor's office, and I only had to suffer through a few contractions in the car. We got home and I puttered around, doing what I had been doing before to cope with the contractions. Standing, leaning on the counter or over the table, leaning over the back of the couch. At one point, we thought that laughter might help, so we sat down to watch a couple of Ron White videos. I laughed between contractions as I bounced on the birth ball. Unfortunately, it didn't seem to help things much, so after the videos were over, I went back to what I had been doing before. Wednesday evening passed in this way, with Ekrem and Meg taking turns putting counter pressure on my back while I tried to keep my noises in the low register, talking to the baby, telling him to come down, move down, it's time to come out. I tried talking to my cervix, telling it to relax and open. I spent the early part of the night walking around downstairs, lying on the couch to sleep, and leaning over the back of the couch, kneeling on the cushions to get through contractions. Ekrem and Meg slept upstairs and I tried to stay as quiet as I could, keeping my moaning and laboring voice low. I was so tired, though, that I decided to take some Tylenol 3 to help me relax, maybe slow down the contractions, and get some rest. I'm not sure that it helped, because contractions continued and I only managed to sleep in between them. Somehow I got through another night and the next morning, Meg went on to school. We promised that someone would come to get her if it looked like the baby was actually coming.
Thursday was a little rough. I was wearing out. Even though I'd slept a bit between contractions, I was working hard and the cold was sapping my strength. I wasn't really able to eat anything and going to the bathroom to urinate was getting very painful. Every time I tried to pee, it would start bladder spasms. Ekrem ordered some soup from Yilmaz for me and I managed to eat that and some salad. I didn't really want anything, but I knew I had to keep up my strength. I had been going at this for so long! I would eat a few bites of soup, then have to stand up for the contraction while Ekrem rubbed my back. I was getting desperate and I know my vocalizations showed that. Ekrem kept asking what I wanted him to do, and all I wanted was for him to be supportive, to not mention the hospital, to tell me that I was doing okay, but he couldn't do that. He seemed to think that he needed to do something, rather than just be there for me to hold onto. He was diligent about timing the contractions, but I wish that he'd thrown the watch out the window and watched me instead.
I got through Thursday, just as I had Wednesday, with intermittent sleeping, walking, birth balling, and bath/showering, still with contractions coming regularly. Sometime on Thursday afternoon, I lost a huge glob of brownish-mucus--the mucus plug was out. I was sure that things would move in the right direction after that. I started getting things ready--the herbal after-birth bath, the sterile instruments, the baby blankets and towels. Around 10:00pm, I asked Ekrem to go ahead and fill the pool. The pain was becoming so unbearable that I needed to have something more than the counterpressure on my back. I was hoping that relaxing in the water would help my cervix to soften and open as well as to relieve some of the awful pain building in my back. Meg stayed with me while Ekrem filled the pool. I draped myself over the birth ball and she pushed on my back with all her might during a contraction. I floated in and out between contractions during the time it took for the pool to fill--about 40 minutes. Once it was filled, I got in and felt almost instant relief with the next contraction. It wasn't painless, but it didn't have the sharp edge that the contractions on land had. Meg stayed with me, handing me my cup of Gatorade after every contraction and holding my hand. Ekrem timed them as they came about 5 minutes apart and lasted 90+ seconds. I tried different positions--on hands and knees, semi-squatting, kneeling and leaning over the rim of the tub. In between, I managed to drift off and dream for a few minutes before the next one hit. Meg wore out about midnight and went to bed. Somewhere in there, Ekrem checked my cervix again, no change. We knew now that he wasn't feeling a head but my cervix. I sat in the tub and cried for a while and we discussed what we should do. I agreed that if nothing happened in the night, that I would go to the hospital in the morning and meet the doctor. After about two hours hours in the pool, I thought I should get out and see how things would go. I dried off, put my jammies back on, and walked around the bedroom for a while, pausing to lean over or pull on the bed posters during contractions. I started pushing a little bit during contractions and that eased them a little bit, but I was afraid of causing my cervix to swell, so I tried not to do it too much. I went downstairs to the living room to pace and think about what was going on. By this time, I realized that we had a problem, but I hadn't lost hope yet for a vaginal birth. The contractions were continuing to come around 5 minutes or so apart, and were quite difficult to get through out of the water, so around 3:30, I decided to get back into the tub and just stay there until morning.
I stayed in the tub, working through contractions and sleeping in between, and woke Ekrem around 7:30 or so. I told him that nothing had changed during the night and that I was becoming afraid that the baby wasn't going to come out. He asked what I wanted to do and all I could say was "have the baby." I didn't want to admit defeat (which is how it seemed) and ask to go to the hospital, but eventually I said it. He called the doctor and made plans to meet her at Acibadem in about an hour. We told Meg what was up and gave her the option of coming with us or going to school. Of course she chose to come with her mom. I sat in the pool and directed Ekrem what to pack in my bag--I knew this wasn't going to be an in-and-out quickie visit, I was going to have this baby in the hospital one way or another. At the very last possible moment, I got out of the tub and dressed, finished my Gatorade, and slipped on my shoes.
Once again, a miserable car-ride, heavy traffic, and no way to get comfortable during contractions had me screaming all the way to the hospital. Once there, we went to the L&D triage area where a nurse (who was expecting me to be ready to push!) checked my cervix and told us that it was high, hard, and closed. The monitor showed strong contractions, which were palpated by the nurses. There was no question of contraction strength. The doctor came about 20 minutes later and did another vag exam and told us that there had been no change in my cervix from Wednesday, but baby seemed a little lower now. We discussed the options, including augmenting with Pitocin in hopes of "blasting" my cervix open, but that could have some serious side effects for the baby. I've already had one Pitocin labor, not an experience I was keen to repeat, especially with no gurantee it would work. The other option was surgery. I have to give the doctor a lot of credit, she did not try to persuade us in any direction. She didn't try to tell us that surgery was our only "real" option, or even imply it in any way. She was very respectful of us and our choices, and my experience as a healthcare professional. She left us alone to talk about it for a few minutes. We cried. This was so not what we had wanted, was so far from our birth plans it was as if someone had just dropped us in the middle of Oz. I had to agree that with 3 days of labor and nothing happening with my cervix, the likelihood of a vaginal birth was out the window . We made the decision for a cesarean, one of the hardest decisions I've ever had to make. They brought in all the papers for me to sign, all of them in Turkish. Talk about informed consent! But if anyone is informed about the risks of cesarean section, it's me, so I had no problem with signing them. They did talk to Ekrem to make sure that one of us had all the need-to-know info. Meaghan was every bit as upset as we were, she cried about the decision and was keeping her friends at school updated via cell phone.
After the doctor came back into the exam room, we talked about what I wanted for the surgery. I initially wanted an epidural so that I could be awake, but I was already having doubts about my ability to tolerate it due to chronic back pain. She asked if I wanted a catheter, and knowing the pain level of post abdominal surgery patients and the amount of diuresis after birth, I said yes. Then I asked her what kind of closure she normally uses for the uterus. She was surprised when I asked for a two layer closure and asked me why, because the trend is a single layer closure. I told her that I had hopes for having a vaginal birth someday and that single layer closure is associated with a higher incidence of uterine rupture for VBACs. She agreed to do a two layer closure. The anesthesiologist came in, and he turned out to be an old colleague of my late father-in-law's, who was thrilled to have the opportunity to see Ercument Bey's grandson come into the world. He talked to me about the epidural, asked if I wanted to go over the risks, etc., but I declined. I felt I was pretty knowledgeable about those--after all, I'm the one who is usually counseling people to avoid them! Once we had the details worked out, I was stripped of my jewelry & nail polish, loaded onto a gurney, and wheeled into the OR.
The trip to the OR was fairly quick, but when I looked around and didn't see Ekrem, I panicked. I started to cry and was nearly hysterical. I couldn't imagine that they would take him away from me at a time like that and I still resent it. Fortunately, there were two people in the OR who spoke English, including the anesthesiologist, so it wasn't as bad as it could've been. They moved me onto the OR table and had me sit up on the side to place the epidural. Although the anesthesiologist was as gentle as he could be and the other woman who spoke English (don't know who she was--a nurse?) held my hand, I just couldn't tolerate him poking on my back, it hurt so bad. After three days of Ekrem and Meg putting counterpressure there, as well as the strength of the contractions, I just couldn't do it. I cried and cried, knowing what that meant--general anesthesia. The worst part of it was when the woman ridiculed me and said "I think Turkish woman are stronger than you are, they don't put up such a fuss." Yeah, right. Find me a Turkish woman who tolerates 80 hours of labor and three days and nights of sleeping in 5 to 15 minute increments. Bite me, lady. After three tries, finally I told the anesthesiologist that I just couldn't do it and to go ahead with the general. He asked me if I wanted to talk about the risks, and I told him that I am well aware of them and accept them. In just a few minutes, I was unconscious.
When I woke in the recovery room, I remembered where I was and why I was there immediately. I had a vague remembrance of the doctor inserting the catheter and then extubating and moving me to the recovery room. I was in immediate pain, but no one in the recovery room could understand what I was saying. My belly hurt so bad and so did my heart. All I wanted was to see my baby and I felt somewhat better when they told me that he was with Ekrem (which I found out later wasn't true, dammit). The anesthesiologist came and asked me how I was doing and I told him that I was in a lot of pain. Fortunately, he'd brought the PCA (patient-controlled analgesia) with him and hooked it up. He gave me the administration button and I started pressing it immediately. I asked him how the baby was and he said that the baby was fine, but he didn't know how much he'd weighed or anything. After some time in the recovery room, they took me to my hospital room, where Ekrem and Meg were waiting for me. Poor Meg looked so worried, bless her heart. I asked them if they knew how the baby was, how much he weighed and all that, but they hadn't seen him, either. I got moved from the gurney over onto the bed and that was incredibly painful for my poor belly. The nurses rolled me around to take the sheets out from under me and replaced my pads (all modesty gone at this point) and then left us alone for a little while. Later, they brought the baby in to me and he was just beautiful. That was when I found out that little Ahmet Mazhar Kopman was born at 11:54 AM on 16 March, weighed 3850 grams (8 1/2 pounds) and was 52 cm long (20 1/2 inches). As worried as I was about the possible effects of general anesthesia on him, his Apgar scores were 9 and 10.
So why did I labor for 80 hours with no progress or change in my cervix? I've had several abnormal pap smears, which have been treated by various means--cryotherapy in 1989, a cervical conization in 1990, several biopsies before and in between, and then a LEEP (loop electrocautery excision procedure) in April of 2005. After the cone in 1990, the doctor warned me that I may have problems with my cervix, but his warning concerned an incomptent cervix which would need to be treated with cerclage and bedrest to maintain a pregnancy. No one ever mentioned that there was a chance that my cervix would become so scarred that it wouldn't open at all. I even used Evening Primrose Oil for weeks beforehand, just to ward off such a complication. I took it orally, as well as vaginally and had Ekrem use it as a lubricant when he checked my cervix the first two times. The doctor remarked later to Ekrem that she actually had to manually dilate my cervix to allow passage of normal postpartum blood flow.
Post-op life with a babe is difficult, to say the least. When they finally brought the baby to me, it took a great deal of help to get us both into a position where we could try to nurse. Ahmet was still very sleepy from the surgery and I was obviously in a good deal of pain, despite the Fentanyl PCA. Meg was really great and stripped Ahmet down to his diaper so that I could hold him skin-to-skin, which seemed to bother the baby nurse quite a bit. She tried to tell Ekrem that Ahmet had to stay in the baby clothes for at least two hours for warmth, but Ekrem knows as well as I do that skin-to-skin contact is much better to keep baby warm, as well as to help bring in my milk. I'm not sure exactly what he said to her, but I'm sure it was a polite version of "bugger off." For most of the next three days, Ahmet stayed naked (except for the diaper) and next to my skin, nursing when he could.
I was a bit perturbed that they wouldn't give me anything to eat the first 24 hours in the hospital. How was I supposed to feed a baby if I wasn't allowed to eat? Ekrem received courtesy trays while he was there, so he fed me from those and went to the cafeteria to get me something to eat the first night. The next day, he brought me yogurt after I called him at home early in the morning to complain that they were starving me. I hadn't had anything substantial to eat since Thursday afternoon, and it was now Saturday. Fortunately, they managed to send an English-speaking nurse into my room and I gave her grief about the whole starvation issue. An hour later, I had a Turkish breakfast in front of me.
Shortly before 11 am on Saturday morning, my PCA ran out. They are supposed to last for 24 hours, give or take. I was still in a great deal of pain and kept asking for pain medicine. Imagine my surprise when they wanted to give me an IM injection! I am horribly terrified of needles, IMs in particular. I've had too many bad experiences and just don't see the value of hurting someone to give them a pain reliever. I refused the injection and requested something via IV--which they apparently don't have. Shortly after that, our friends Ilhan and Deniz showed up to visit--he's an anesthesiologist, she's a nursing instructor. I explained the problem to them, they talked to the nurse, someone talked to the doctor (Ekrem?), and eventually the nurse showed up with an IV bottle of what turned out to be basically Tylenol (Paracetamol--acetaminophen). Yeah, that's helpful for post-op pain. NOT! I don't think it helped a bit. Ilhan and Deniz only stayed for a little while and a few minutes after they left, here comes the nurse wanting to remove the catheter. Yeah, right. Like I'm in good enough shape to walk to the bathroom to pee. I refused, telling her that I can't breathe comfortably, let alone get out of bed to the bathroom! Later that afternoon, still no pain meds on board, another nurse comes and wants to walk me to the bathroom. So with her help and Ekrem's, I did. It was the most painful experience of my life, bar none. It took forever just to get up on the side of the bed and they both kept trying to just swing my legs around and pull me up. The pain was unbelieveable with each tug and I had to yell at them to quit, I would do it myself, but it would take a while. It probably took at least half an hour to get me to the bathroom and back, by which time I was sobbing in pain, unable to stand up fully, holding onto my belly for dear life and coughing from the after-effects of the intubation and inhaled anesthesia, plus the cold. I remember telling Ekrem, "I know we wanted another baby, but I can't do this again. Please don't ask me to ever do this again. I've never hurt so bad in my life." Ekrem begged me to accept the injected pain medicine and I sat on the side of the bed crying because I needed something so bad, but have this awful fear of injections. Finally, I said that I would take it. I will admit that it didn't hurt as bad as I had anticipated and it did help with the pain. Of the four or five injections that I had while I was there, at least one of them hit a nerve and now I have nerve pain in my left hip. WTF is wrong with Percocet?
By Saturday evening, I was feeling a bit better. The pain was a little better controlled and I was getting tired of being in bed. I was able to sit up on the side of the bed with minimal assistance and they had finally been feeding me real food. Ahmet was still very sleepy and a lazy nurser, but I was waking him up and trying to get him latched on as often as possible. My nipples were sore, but Wish Garden Nipple Cream was helping with that a little bit. Late Saturday evening, I consented to have the catheter out, since I felt that I could safely get up and go to the bathroom on my own, so the nurse came and walked me to the bathroom where she took it out. Holy cow, that burned! I had some bladder spasms the first few times I peed, but nothing like what I'd had during labor. My belly still hurt and I was coughing even more, thanks to the cold that I'd managed to get earlier in the week, as well as the after-effects of the anesthesia. The doctor came late Saturday afternoon and changed the dressing on my incision. She said that it looked really good, but for some reason that didn't make me feel any better.
Sunday was better. I was still hurting, but finally able to get around a little bit. I wan't getting the IV antibiotics any more, so Ekrem asked the nurse to take out my IV. I was feeling really gross, not having had a proper shower since Wednesday, birth pool notwithstanding, so I decided to take a shower and wash my hair. It was painful to lift my arms over my head and I had to go really slowly, but it was worth it in the end and I felt much better. Ahmet was nursing better by this time and my milk was starting to come in. His bilirubin had been a little high, but we expected that with a blood incompatibility--I'm O+ and Ekrem is A+. I thought that I might have to fight the Pediatrician on the jaundice issue, but she told me to nurse as much as possible and sit with Ahmet in the sun by the window. Exactly what I would've told someone to do! I was impressed that she didn't push formula supplementation and bili lights.
We went home Monday afternoon. Ahmet turned out to have the suction power of a Hoover once he was good and awake, and my nipples were getting very sore to the point that I asked the nurse for a pacifier. I managed to explain why in my broken Turkish and she came back with a nipple shield instead. What a wonderful nurse! I had no idea that they had nipple shields here and I was thankful when I started using it. It saved my nipples for sure. I was scared going home to a house with four flights of stairs, but I managed to get up to the bedroom and vowed to stay there. It was good to come home and get into my own bed--exactly where I wished I'd been all along.