It was a hot summer day so I decided to go to Wallum Lake with my girls and my cousin Alison (we make chocolate together). She asked if I had any clients due in March....."No", I said. She just smiled and asked "do you want one?" My jaw dropped, and then I got giggly excited. "OH MY GOD, Really!?" She really wanted a natural birth, and she did everything in her power to prepare for that endeavor. She got me on her side :), became conscious of her nutrition and ate well, got a care provider that respected her decisions and that she trusted, read books and watched birth videos that I lent her, took Bradley classes (which are a 12 week commitment). She was set to deliver at a hospital that is 10 minutes away from me, and that I had never experienced before as a doula. I was very excited to work at a small community hospital, instead of a huge teaching, city hospital....and excited that I didn't have to drive 45 minutes to get there.
Unfortunately, she has chronic hypertension. This was controlled with medication for most of her pregnancy, but in the last week was put on bed rest because it was too high, and no longer controlled (super imposed pre-eclampsia). It was decided that it was most beneficial that she get induced. The only thing that would take care of her blood pressure was to get the baby born. Her Bishop Score was only a 3, which meant that her chances of a successful induction was only 45%. Those aren't good odds, so I was a little worried that she was going to have a cesarean birth, which she very much wanted to avoid. They gave her Cervidil, which is a cervical ripener, overnight on Monday, and started Pitocin (synthetic oxytocin) on Tuesday. I joined her and her partner on Tuesday, and she had her IV, and her pitocin started at 2 then gradually increased to 20, the maximum (at that hospital), and the blood pressure going off frequently. Just a note- they never once took her blood pressure manually, it was ALWAYS a machine. Nothing changed, so they shut off the pit, let her shower and eat, then started again the next day. I went home and did the same. Wednesday was the same scenario, but the her bag of waters ruptured at 4:14 pm and she was 3 cm dilated, 80% effaced and -2 station. No painful contractions, and she was unhooked, allowed to eat and shower. Thursday the Pitocin was started again, and she finally started to feel some contractions that she had to breathe through.
The thing about Pitocin contractions is that when they do finally hit, they hit hard and fast, and don't seem to let up, or give you a break. Typically, when labor begins naturally you start in early labor where contractions come and go, but aren't painful (just annoying), and then build up to longer, stronger and more frequent contractions. You learn to cope with them as they gradually (usually but not always- there are those quick, hard and fast natural labors) increase in intensity, and frequency. It seems when one is on Pitocin, they go from not feeling much, to feeling long, strong, and hard contractions that are difficult to stay on top of.
She attempted to change positions frequently, and I did some acupressure. She was sitting up in the bed, sitting in the rocking chair, leaning forward, walking the halls, but anytime we walked her blood pressure spiked, so they wanted her to stay in bed. It was so hard for her to cope with the limited positions. The bed was used to the best of our ability, but to say she was exhausted is an understatement!
So Stadol and Phenegan were given so that she could catch some relief until she got her epidural. They wanted to do blood work before she could get her epidural, so she had to wait.
To add a funny note, the anesthesiologist asked if I was her mother...there's only a 7 year difference! She was doing so good, and got her epidural around 3:30 pm. She was also given a 20 mg IV dose Labetalol for the blood pressure, Magnesium Sulfate to prevent seizures, and IV Penicillan because she was GBS+ . The nurses joked that she was all hooked up like this because she is a nurse- Murphy's Law I guess.. Three hours later she was checked, and found to be 4cm, 90% and still at -2 station. Her labor progressed, but slowly. At 9:10 pm she was 6 cm, 90%, -1 station. 11:00 pm she was 9 cm, 90%, 0 station. I stayed throughout the night, and fell asleep in a very uncomfortable chair for a couple of hours. Friday March 12 was here, and at 7 am she was ready to push! She pushed for about 2 hours, and at 9:03 am Calvin Lukas was born with the cord wrapped tightly around his neck, a little pale, not crying, and somewhat floppy. This was a very scary moment! The cord needed to be cut by the OB, and they took him to the warmer right away. He saw Mom quickly, and then was brought to the nursery....so sad. I know it was disappointing for her, being unable to hold him right away. The doctor said it was probably due to the tight cord (no doubt) and the Magnesium Sulfate.... his APGARS were 6 & 8. She was able to visit him in the nursery. Finally getting him back about 4 hours later, and he weighed 7 lbs 2 oz and was 21 inches long.
The crazy thing is that his heart rate was perfect the whole time! According to the external fetal monitor his heart rate was always in the range of normal. The staff never seemed worried about the baby, only about her, and her crazy high blood pressure. I was very impressed with her obstetrician, he was more like a midwife in his philosophy. He didn't labor sit (and he didn't need to), but he was all for her using natural remedies like Raspberry Leaf Tea (for toning the uterus), Evening Primrose Oil (to ripen cervix). AND he expectantly managed the third stage of labor! This means that he didn't tug, or manually extract the placenta- he left it, and let it come out when it was ready, which was 33 minutes later. I asked him why more doctors didn't do it his way, and he said "I don't know, it makes sense to me to wait for it to be ready....you don't want to tear it off before it's ready and risk hemorrhage." I could have kissed him for reaffirming what I ( a mere paraprofessional, non-medical doula) already knew. Here's a great article regarding that issue: Leaving Well Alone.
The nurses were good, it's a small hospital with 2 nurses to one patient compared to the one nurse to 3 or 4 at the big hospitals. They were very accepting of me, and respectful of Ali's wishes. Being there for so many days, we really go to know some of these nurses. One said that I "had a nice way about me", and that she wanted my information to pass along to a doctor that would like to have "good doulas" to refer her patients to because she does get asked. Woohoo! The thing that I would like to change about this hospital is their policy regarding placentas. They pour some powdery stuff on it, and toss it in the trash! It was very sad, but it is my goal to change this ridiculous policy. Maybe if I get to frequent this hospital, I can reach the higher ups, talk some sense into them, and show them just how detrimental this policy can be for moms and babies.
In closing, I want to acknowledge that she did everything in her power to have the most gentle birth, but just as in life, you can't plan for everything....sometimes things happen beyond your control, and you have to adjust accordingly. Alison did just that, and I am so proud her! I'd like to thank her for allowing me to be there, and giving me permission to share her story...I learned so much, and I hope that I served her well. And thanks to my mother for taking care of my family while I was gone....I can't do this without her!
1 comment:
What a great story!!
Post a Comment