Now that we're all home from the hospital, here's the update on my mom's post.
Claire Marie - born 3:26 AM on 6/21/08, 8 lbs 7 oz, 20 inches long. (41 weeks 2 days)
Background: I had been planning a hospital VBAC with my family practice doctor. She ended up being out of town this week and had, much to my annoyance, assigned a resident who seemed very clueless to be her "on call" person for the week. I had my 41 week appointment with Clueless and at that point panicked because dealing with this woman for the birth would not work. I finally had decided that if I went into labor before my doc came back that I'd see whether one of the hospital MWs could attend the birth instead of calling Clueless.
On Friday 6/20 I had an appointment for a non-stress test and AFI check since I was over 41 weeks. That morning I woke up with crampy contractions every 10-15 mins apart starting around 5 AM but since they seemed to be going nowhere fast we figured we ought to keep the appointment. The NST looked great but they were only able to detect one small pocket of amniotic fluid, which concerned everyone. Lots of phone calls to OB and Family Practice later and they sent us straight over to Labor and Delivery and basically said that we needed to have the baby in a timely manner. There was lots of talk of induction, risk of uterine rupture etc etc. Not fun.
As it turns out the family practice doc who was on call that day was *GREAT*. (Maybe even better than my own FP doc) He checked me around 2:00 when we got to L&D and were trying to figure out our plan - at that point I was around 3-4 cm and 75% effaced. My contractions very quickly picked up to every 3-6 minutes and it seemed like things might just go on their own. We agreed that I'd stick with the family practice folks as my primary doctors and have the OB folks keep an eye on the baby. (At that point my main concern was to make sure they left me alone if everything looked good and to quickly identify and respond to any real problems).
So we headed into our room around 3:00 and had a great nurse who was extremely helpful. Because the telemered system for the fetal monitoring was broken (which I knew ahead of time - nothing I could do about it) and they were worried about the baby I wasn't able to use the nice tub they had. I ended up sitting on the birth ball with my mom rubbing my back and coaching me for almost the entire time we were there. Our nurse brought hot packs for my lower back (I think we must have gone through a dozen of them) and at some point even gave me a couple of her sweet tarts (which I had a craving for - plus I desparately needed some sugar since I'd missed lunch).
The agreement I had with Family Practice was that as long as I continued to progress and the baby looked good they would leave me alone. We agreed that if nothing was happening by 9:00 PM we'd break my water to speed things along and if that didn't do anything we could talk about some more agressive measures. Shortly after we came to that agreement the OB chief resident came in to talk to me. She had basically *no* bedside manner... said, "So we've all looked at the situation and we agree that you need to be augmented. So here's what we're going to do..." At that point I interrupted her and said, "no actually I talked it over with my doctor and since I'm having contractions 5 minutes apart right now we're going to do nothing and wait and if I haven't made any progress by 9 tonight we can talk about augmenting." At that point she said ok and left. Fortunately everything seemed to work out well - I was 5 cm around 6:00 (my doc came back in to see whether they could check and keep the OB folks happy). I got really uncomfortable and needed to change positions a couple hours later. We tried hands and knees on the bed, leaning against the ball on the bed, standing near the bed... I finally ended up back on the ball but with my head and shoulders resting on a stack of pillows on the side of the bed. I was semi-cursing the monitors at this point because that tub sounded really appealing, but since it wasn't an option I just tried to concentrate on breathing through each contraction. At this point contractions were getting more intense and I was starting to sigh lightly to get through them. I got up to pee and noticed my mucus plug in the toilet (Dennis was very excited to see the fabled mucus plug). At some point shortly after that I started feeling really nauseus and managed to barf up everything I'd eaten since God knows when. It was mostly water (and a LOT of it - who knew I'd drunk that much?) and I felt much better after I was done. I think I got my mom's shirt, definitely got part of my pillow, and lots of the floor. In retrospect it was probably a good thing we skipped lunch that day. Anyway, we figured that was a good sign that things were really moving at that point.
When the doc and his resident came in to check around 11 I was 8 cm and at that point I told them to go ahead and break my membranes to see if we could speed things along. I was half expecting this to hurt (though logically I couldn't think of why it would) - it didn't. No meconium, which kept everyone happy.. My contractions got a lot more intense (and wet) after that and I was signing loudly with each breath to get through them. I found that counting my breaths seemed to be the best way to focus through them at this point - it usually took around 15 to get through a whole contraction. It took *forever* to go from 8 to complete - at around 1:30 AM I still had a rim of cervix that was too thick to push out of the way, though I was occasionally feeling like I needed to push mid-way through the contraction.
At this point OB chick kicked me off the ball because she was having trouble seeing the baby's tracing (I guess they kept getting my heartbeat instead of the baby's). Again, no bedside manner - she walks in and says, "You need to get off the ball and into bed. We can't see the baby and I can't be responsible for anything that happens if I can't see what's going on." At this point I couldn't have cared less... apparently there was more that was said but I just hauled myself off the ball and into the bed and sat up as much as I could. So I labored the rest of the time on the bed and tried to rest between contractions (I was getting really tired). They were really excruciating if I had one while laying back so every time I felt one coming I would grab my mom and Dennis's hand and they'd pull me up to sitting so that I could deal with it. At this point things were really intense and I was sighing loudly to get through each contraction and squeezing D's hand and focusing on my mom's mouth as she talked me through them. I have no idea what she was saying, but it worked. One step at a time, right? I felt like me pelvis was being pushed open from the inside (which it was, of course) - my hips ached with each contraction. I felt a little pushy during each contraction but I decided I would wait until I felt *really* pushy before saying anything. As I got closer and closer it dawned on me that pushing was NOT going to be fun. All of those birth stories where women talk about pushing feeling great... I guess it maybe would feel great in the same way that barfing felt great - that is, at least you can give in to an irresistable urge, but I could tell it was just going to intensify the pressure in my pelvis.
Around 2:30 the OB folks started to get concerned that the baby's heartrate wasn't looking so good and suggested we put in an internal monitor. I suggested that they check me again since I was feeling like I could push more often than before. I still had a small lip but it was small enough that it could get pushed out of the way. They agreed to skip the internal monitor but basically told me I needed to push the kid out in a timely manner since they were still concerned.
I had read and read all about how upright positions were good for pushing, let gravity do the work etc. But I felt like my instinct was failing me here so I asked what a good position to push in would be. OB Chick suggested I lean back, have my mom and husband hold my legs, tuck my chin in and push that way. She was about to go into the whole count to 10 thing when I stopped her and said I would give it a shot without any counting. After one contraction's worth of pushing OB Chick left and I never saw her again - apparently I was a decent pusher so she decided her work was over. Every time I pushed I peed. After a couple of contraction's worth of this (I figured peeing was better than pooping, which I was fully expecting to do at some point) my doc said that it looked like my bladder was pretty full still and was actually keeping the baby from descending as fast as it could. They suggested they drain it with a quick catheter. I hadn't peed in a long time and couldn't really feel my bladder anymore so that sounded fine to me - apparently they drained about a cup of urine. After that when I pushed at least I didn't pee all over the place. I felt like every time I pushed it was like pushing my insides out. It was weird and uncomfortable and I guess satisfying in an odd way. I reached down and touched my baby's hair as her head started to become visible - it was so soft it was hard to believe it was a head! That moment when her head was out but not the rest of her body had to be about the most unpleasant feeling - but with one more push Claire was born. In total I pushed for about 1 hour. As soon as her shoulders were out I reached down and pulled her onto my chest. What a great experience catching my own baby! She was unbelievably soft and slippery and squishy and warm. I had completely forgotten how SOFT babies are. No muscle tone at all. Dennis put a blanket over both of us and gently dried us off and checked to see her sex (since we didn't know). I ended up with one small stitches-optional tear (I opted for them) and a little skid mark, but otherwise felt pretty good.
I can honestly say that that was the hardest thing I've done in my entire life - and worth every minute of it. We should be proud of what amazing strong women we are!
pictures at http://picasaweb.google.com/karentroy/ClaireSBirth