Monday, June 16, 2014

Eden's Birth Story, Part II: Scheduling a Hospital Induction

[Missed Part I? Click here!]

I woke up Tuesday morning refreshed from deep sleep. The emotional end to the previous day felt like a distant dream now that the sun was up. Yet, I was still a little nervous about the non-stress test ahead of me. I followed my midwife's advice to eat or drink something with a good amount of caffeine or sugar, as monitoring the baby while he or she moved was the main purpose of the test. I enjoyed a large iced coffee in the car on the way to the clinic for our 10:00 appointment.

41 weeks and 6 days pregnant, the day of our non-stress test
We didn’t have to wait long to be seen. The nurse led us back to a small examination room where she hooked me up to a fetal monitor. We immediately saw several bouncing lines start scrolling across a computer screen. Pointing, the nurse explained that a particular line recorded the baby’s heartbeat. She handed me a small wand with a button on the end. When I felt the baby move, I was supposed to punch the button. The frequency of the baby’s heartbeat was supposed to increase immediately following movement.
And then the nurse left, saying she’d check up on us in about five minutes. Jon kept Jadon occupied with snacks and an app on his phone. I waited for the baby to move, but felt nothing. Five minutes passed.

The nurse returned, took one look at the screen, and said, “Baby must be sleeping, huh?”

“Yeah, looks like it,” I replied.

Then the nurse offered to get me a glass of apple juice, as that usually gives a sugary burst of energy to the baby. I accepted the offer.

When she returned with the cup of juice, I asked how long this test usually takes. “Well, it takes as long as it takes for your baby to move,” she answered.

I downed the juice. “And what if the baby doesn’t happen to move?”

“Then we may have to send you over to the hospital for some closer monitoring.”

Great. Exactly what I was afraid of. More tests. I knew that my baby was fine, and that he or she had been moving plenty that morning already. However, if the baby wasn’t moving during this test, I was out of luck. I literally couldn’t make this baby move, and I couldn’t leave until he or she did.

Thankfully, just minutes after drinking the juice, I felt a nice hard kick. I immediately pressed the button, joyfully telling Jon that the baby moved. I saw relief fall over his face. The heartbeat line on the screen steadily climbed, and then gently fell back to the normal frequency. Then the baby moved again. And again. And again! The heartbeat peaked after each movement, and always returned to that healthy, steady rhythm.

When the nurse reentered, she looked at the screen, smiled, and remarked that the juice seemed to be working. Since there was plenty of data to see, she left again, this time to get Dr. W.

“Wow, your baby’s a rock star!” remarked Dr. W as he glanced at the screen. “But, I thought I wasn’t supposed to be seeing you folks again! I guess your baby’s pretty comfortable in there, huh, Alison?”

I laughed, glad that he seemed to be laid back about going later than we expected. He explained to us that the non-stress test looked excellent, but he also wanted to get a quick look at the baby on the ultrasound screen to make sure the fluid levels were appropriate, and that the placenta looked healthy. Even though we prefer having only one ultrasound performed at twenty weeks, we agreed that a quick ultrasound was wise and would give us peace of mind as we continued to wait.

Our entire crew shuffled to another examination room with the ultrasound equipment. It took less than five minutes for Dr. W to see what he was looking for.

“Okay, let’s see…well, baby is head down…now I'm looking for a fluid pocket…fluid pocket…here’s one…but the cord is present in the shot, so I’m not allowed to do a reading on that one…another fluid pocket…it's a nice size, excellent size…okay, now for the placenta…it’s still nice and high, away from the cervix and your scar tissue…wow, it’s really in excellent shape, only slight traces of calcification near the edges, which is wonderful at the 42 week mark…well, that’s all I need to see…everything looks great!”

As I cleaned the goop off my belly, Dr. W reasoned with us about the days ahead. He explained that there was no reason to induce simply because I had reached the 42-week mark, especially when the baby and I were both in such good health. However, he continued to say that the probability of unexplained stillbirth rises exponentially between 42 and 43 weeks, and that he really wasn’t comfortable letting the pregnancy continue past the weekend. He proposed that we come in for an induction on Thursday, only two days away, and one day past 42 weeks.

At this, my husband piped up. “Doesn’t it make more sense to come in for another non-stress test on Thursday, and then consider an induction on Friday, especially if the non-stress test isn’t as favorable as the one we had today?”

Dr. W paused, but agreed to scheduling an induction for Friday. I had a lot of questions about what would be allowed if I was to labor in the hospital. I found out that I would be allowed to walk the halls and move around the room during my contractions, and that I would not have to push laying down on a bed. However, I would have to have a wireless fetal monitor on me at all times, and an IV saline lock in my arm in case they needed to administer fluids or medications. He saw in my face that I didn’t like the idea of continuous monitoring, or the IV. Then he said, “I know how much you want to have a home birth, Alison, but how important would you say it is for you to have a vaginal birth?”

“Having a VBAC this time around is probably my top priority, even if it has to be done in a hospital.”

“I am committed to giving you a VBAC, Alison,” Dr. W said earnestly. “This means that I won’t be giving you any kind of timeline if you are laboring in the hospital. If you arrive on Friday morning, I know that you may be here all day Friday, and Saturday, and maybe even Sunday. As long as you and the baby continue to look healthy, I want you to have as much time as you need to have the VBAC.”

So, we scheduled the hospital induction for Friday morning at 7:30 am. My heart was heavy, but I was grateful at the same time. I knew that not every doctor would be as gracious as Dr. W in allowing the pregnancy to continue at all! Furthermore, doctors are notorious for putting time constraints on labor, especially if a woman’s water has already broken. Yet, as generous as his “no time limits” offer was, I knew that chemically inducing my labor complicated my hopes for a VBAC. Pitocin-generated contractions are a lot harder on the uterus, and scar tissue, than contractions stimulated by the body’s own natural oxytocin. Continuous monitoring could show “distress” or other issues that were actually caused by the induction itself. 

The more I thought about a hospital birth, the more resolved I became to have this baby before Friday morning.

On the drive home, I texted Pam (my midwife) and Alison (my doula) to share the good results of the non-stress test, and the ultrasound. I also told them that we had scheduled an induction, but that I would be taking some more castor oil when I got home. This baby needed to come out.

Stay tuned for the final Part III, coming soon!

Saturday, June 7, 2014

Eden's Birth Story, Part I: Waiting for Labor

I was pretty confident that I would be “late” with my second child. My mom carried all of her children well past their due dates: all three girls were a full two weeks late, and the two boys were exactly ten days late. My own firstborn also took his time in making an appearance; Jadon’s birth occurred twelve days past his due date. I was sure that I would be late with Baby #2, but I didn’t know how late.

While I wasn’t worried about being “overdue,” I was very aware that being late with my VBAC (Vaginal Birth After C-Section) status could make doctors, friends, and family more nervous, even more so because I intended to birth at home. I knew that I wanted the freedom to go into labor on my own; however, I also knew that I was willing to help things along “naturally” in order to avoid a hospital induction.

To make myself feel like I was doing something productive, I repeated some of the "natural induction" tricks I used at the end of Jadon’s pregnancy: eating pineapple, going on daily walks, and doing “pelvic rocks” on all fours, etc. To be honest, I don’t think any of these methods had any effect on the timing of Jadon’s birth. At the end of this pregnancy, I also tried a few new tricks, like eating Eggplant Parmesan (with three days of leftovers!), and doing hula hoop motions while sitting on an exercise ball. If nothing else, I knew that the physical exercises would at least help this baby stay in an optimal birthing position. No surprise breech babies allowed this time around!

Mmmmm...Eggplant Parmesan...tasty, but didn't induce my labor
I knew that if my body had not gone into labor on its own within a week of my due date, I would be willing to consider some more – shall we say – drastic measures. Even so, I continued to hope and pray that Baby #2 would come when he or she was ready.

My midwife, Pam, and doula, Alison, both recommend acupuncture and acupressure as a means for readying the mother’s body for labor. Alison credits acupuncture for getting labor started for her second child. I’d never done acupuncture before, and was a little apprehensive about having a bunch of needles stuck in me. However, an acupuncturist/doula/massage therapist friend of mine, Maria, privately messaged me on my due date to offer her services if I was interested in using them. She shared that she has had a lot of success with acupuncture for VBACs in particular. The idea of meeting with someone I knew put acupuncture in the “maybe I could do that” category. I told Maria that I would let her know.

41 weeks pregnant, passing the time with another trip to the playground!
One week later, at 41 weeks pregnant, and with no signs of imminent labor, I finally decided to give acupuncture a try. It was a new experience for me, having needles stuck into particular points on my body for uterine and cervical stimulation. I can’t remember what all these points were for, but I know that I had needles in my lower back, ear, hand, ankle, and on the outside corner of my pinky toe (that one really stings going in!). I learned a little about the practice of acupuncture from Maria, and enjoyed the chance to relax, but really didn’t know if it was doing anything. Two days later, a Friday, I went back for another session, this time at the recommendation of my husband, Jon. We hoped it would give my body the push it needed to take off on its own, hopefully over the weekend.

Saturday arrived, with no signs of labor. Alison texted me that morning to ask if I wanted her to make me a castor oil smoothie.

Castor oil…the powerful laxative that not only empties the bowels, but irritates the uterus, often resulting in the routine tightening of the uterine muscles called contractions. I had read several birth stories where castor oil successfully jump-started labor. However, castor oil also makes many women sick. Vomiting or diarrhea while laboring? No thanks!

Yet, theoretically, I knew that I was willing to try it. The 42-week mark was only four days away. On that day, Pam would be legally required to consult with Dr. W about the condition of my pregnancy. Most doctors would not allow a pregnancy to last that long in the first place. That day, I could lose a lot of freedom and decision making power over how and where I would give birth. I knew I was willing to try castor oil before then, but when?

I decided to text Pam about trying castor oil. She said that it was completely up to me if I wanted to try it, but that she would definitely want advanced notice before I take it. She also mentioned that she has a specific protocol to follow for best results, if I chose to go that route. First, she said that castor oil plain or in a smoothie would be best taken earlier in the day so that I wouldn’t be up all night on the toilet, which would probably leave me exhausted at the delivery. Second, she told me that nothing less than four ounces of castor oil is worth the drink. Any less could potentially not be enough to produce the desired result of contractions. Third, Pam reported that castor oil works best when coupled with some time on a breast pump, as nipple stimulation also can produce contractions. Finally, she said that it’s most important to stay hydrated before and after taking the castor oil.

I spent the rest of the night debating whether or not I should take the smoothie. I stayed up late, reading dozens of online forums where women reported their experiences with castor oil. The most common story went something like this: “I made myself a smoothie…a couple hours later I had diarrhea…a couple hours after that I had a baby.” However, some women reported getting really sick, even having diarrhea during labor (ugh!). Even more reported that the castor oil had no effect on them at all. Of course, some of these women were attempting to induce themselves at 38 weeks pregnant, or less. And I had no idea how much their dosage was.

Sunday morning, I privately messaged Maria to ask if she had any advice concerning castor oil. She informed me that her sister used castor oil to coax her fourth baby out, but that it made her feel pretty sick during labor. She reassured me that it has no negative effects on the baby whatsoever. Then, she volunteered herself to help me in my labor in any way that she could be of use. "Please don't hesitate to call!" she wrote. "I am just passionate about babies being born healthy!" I was so touched by her sincerity, and told her that I just might take her up on the offer if I felt like I needed her.

Sunday night, I found myself in Alison’s back yard, celebrating her husband’s birthday with food from his new birthday grill. We enjoyed the beautiful weather, watched our kids play in a water table, and talked about my midwife’s castor oil recommendations. Together, we decided that I should make a castor oil smoothie the next morning after having a good breakfast. Alison would come up to my apartment with her kids around midday, hopefully while I was starting to see the effects of the castor oil. If labor really got started, she’d be there to watch Jadon, call Pam, and assist me while we waited for the rest of the birth team to arrive.

Monday morning, Memorial Day, I woke up full of anticipation. What if today’s the day? Will it be a boy or a girl!? I couldn’t wait to meet my baby.

Jon was sitting out in the living room with Jadon when I emerged from the bedroom. I set myself to making breakfast. We finished eating shortly after 9:00. As Pam recommended, I waited over an hour to allow my food to digest before I took the castor oil smoothie.

At 10:40, despite still feeling pretty full from breakfast, I did my best to finish the smoothie in one quick sitting. Then I waited. In one hour’s time, I was supposed to use an electric breast pump to get some contractions going, switching sides every five minutes for a full hour. I sat on the exercise ball, watching some Curious George with Jadon. I over-analyzed every little feeling in my body. Was that my stomach churning, or the baby? I felt like a ticking time bomb.

Alison arrived with her two kids while I waited for the hour to pass. It was nice to be distracted from what was going on in my body while we talked.

Around 11:45, I started the breast pump. My insides still churned while I spent my first five minutes on the right side. A few seconds into the left side, my mouth started watering like crazy. “I’m going to throw up,” I announced to Jon and Alison. Luckily, I made it to a garbage bin in time. With every heave of my stomach, the awful churning feeling went away. On the one hand, I felt relief, since the castor oil was out of my system. On the other hand, I felt defeated because “operation castor oil” no longer seemed feasible.

I texted Pam to see what she’d have to say. She suggested that I still complete the hour on the pump since we weren’t sure how much castor oil my body had taken in. Even if I hadn’t been able to digest much, some women successfully jump-start labors with a breast pump alone.

Sure enough, within ten more minutes of using the breast pump, I started experiencing mild contractions. They were extremely easy to handle, but definitely had a peak in strength before they resolved. They soon fell into a regular pattern of three minute intervals, usually lasting about a minute. My hopes revived as the pattern continued for the entire hour, and seemed to maintain itself even when I went off the pump for a break.

My dresser, standing ready with my home birth kit and lots of clean towels...for weeks!
Thirty minutes off the pump, the contractions slowed to four or five minutes apart, but quickly resumed their three minute intervals when I started my second hour on the pump. All the while, they required no concentration or effort on my part.

At the end of the second hour, Alison and I decided to take a walk, hopefully to ramp up the contractions. With rain clouds looming overhead, we thought it best to simply do laps around the dead-end street where my apartment is located. Contractions continued as steady as ever, but with no increase in intensity. Some of our neighbors were sitting in their open garage while we walked. After our third loop around the street, it was clear that we had become a topic of conversation. 

As we passed them a fourth time, I called out, “You must be wondering why we’re walking in circles!”

“Oh, we know why…you want that baby out!” yelled one of the guys, as they all laughed.

“But I have to ask,” chimed one lady, “How far along are you?”

“Twelve days late,” I replied with a smile.

“Twelve days late!” several of the neighbors repeated, in disbelief.

“Wow, you look great for being twelve days late!” the lady remarked. “Good luck!”

When it finally started to rain, Alison and I returned to the apartment. I called Pam as we headed inside. Pam thought it best for me to take a break. If things really were going to get started on their own, I would need energy for labor. If the contractions tapered off and stopped, then it just wasn’t meant to be. She encouraged me to eat a good dinner and to get a good night’s rest either way.

I thought this was good advice, even though I really was hoping for labor to take off at any moment. After all, this day was the perfect day for my baby to be born. Jadon would be going to bed soon, and he could just sleep through the birth and meet his baby brother or sister in the morning. Alison and her family were already at our apartment; they were planning to leave for vacation late the next day. How could I have this baby without my doula and close friend? I also really wanted to avoid the non-stress test at the doctor’s office we had scheduled for the next morning. I knew that my pregnancy was healthy and normal; what if the test didn’t satisfy Dr. W and his staff and they’d want to keep me there for further monitoring or something?

My bedroom, rearranged to fit the birth tub. Also a constant reminder that my baby still wasn't here! 
I decided to take a cool shower and lay down for a bit while Alison prepared dinner for both of our families (seriously, what would I do without this woman?!). As my body settled into rest, the contractions spaced out to nine or ten minutes apart. I joined everyone at the table and realized at the end of the meal that the contractions had stopped completely. I was disappointed, but I tried not to show it.

Alison and I went for another quick walk after dinner, just to see if contractions would start up again. They didn’t.

By the time we returned the apartment, I was holding back tears. The unacknowledged emotions that had been building since my due date seemed to surface all at once. Today was twelve days past the due date! Don’t second babies normally come sooner than firsts? Jadon was born on day twelve; why hadn’t labor started on its own? I thought I wouldn’t be seeing Dr. W and his staff again; what if he’s not okay with allowing my pregnancy to go pass 42 weeks? Jon took off of work last week, and he can’t take off that many more days; who’s going to help me out if he has unavoidable commitments? If only I had been able to keep that castor oil down, then maybe I’d have a baby in my arms right now! What if I’m trying to force something my body, and baby, simply aren’t ready for? Why does 42 weeks have to be this magical cut off date? I just need more time!

The tears finally streamed down my face as Alison and her family packed up to go home. She reassured me that the hours of contractions that day certainly were priming my body for labor. Labor could even start on its own that night when I was sleeping. She told me that her phone was charged and ready for my call, and she’d be back as soon as things got going. She even mentioned that she was considering changing travel plans if need be, especially if there were sure signs that labor had begun.

After they left, Jon and I discussed our plans for the next day. He made a few phone calls and was able to reschedule his jobs for the next day so that he could come with me to the non-stress test. I went to bed thankful that Jon would be able to come with me, but still nervous about what Dr. W and his staff might ask of me, considering that I was so “late,” and a VBAC. 

With Jadon tucked into bed, we prayed for peace, patience, and trust in God’s plan and perfect timing. Then, emotionally and physically drained, I went to bed.

Part II coming soon!