Thursday, June 16, 2016

Josephine Evelyn: A Birth Story

As I begin to write this Josie has been here for 9 days. I am currently writing from my hospital bed, and while I never thought I'd be back in the hospital nine days postpartum, I'm glad that I got the help I needed. 

Why take the time to write out a birth story? For me personally, it's part of the recovery process. It helps me heal, it helps me deal with any negative feelings I have left over from the whole event. It helps me to remember. And it helps me to know how strong I am.

So, if you're here for a neatly packaged story about how amazing and beautiful childbirth is, you might get that -- but you'll also get all the crazy stuff that goes along with it. It's raw, and intense, but so worth it for the prize.


On Thursday June, 2nd I was officially overdue at 40 + 2. Not super over due, but enough to make me a little crazy. For nine months all you hear about is second babies coming faster, earlier and easier and foolishly I believed that those things could be true for me! Both of my parents were in town, and while they had every right to treat me like a ticking time bomb, constantly hearing "any contractions? Are you feeling anything?" Got to me pretty fast. I also knew that if I went too far over, they wouldn't be able to be here for when she was born. That's the trouble with living a state away from my family, I knew we would need the help with Felix when she was born, so that made me even more anxious to get her out sooner.

I went into my appointment on Thursday ready to ask for the induction that I fought so hard my entire pregnancy to avoid. That was honestly the one thing I cared about! But I walked in and told my midwife "can you please put me out of my misery?"  

She checked me and made sure I was "favorable" for induction. She told me I was 2cm dilated, 50% effaced, -1 station and that my cervix was soft. This meant favorable. I asked her if there was anything else I could do that evening to try and go into labor. She gave me the same answers most people do: sex (NOT happening), nipple stimulation (tried that already), castor oil (tried that too), and long walks (tried that too and it gave me false labor). I left her office and waited a few hours for the call to be scheduled for my induction. They made sure to guilt me about it being "elective" which I knew of course, but the circumstances made sense for our family. Bottom line, I was favorable, baby was big enough, I had already had one successful induction with vaginal delivery, and the timing was right. We made sure our bags were packed and that our doula would meet us at the hospital at 7:30am.

 "It's a beautiful day to have a baby!" 

Driving the half hour to the hospital, we were both a ball of nerves. It's really kind of weird to schedule your babies birthday. I had wanted things to end so differently with this pregnancy, but I also had thought things would happen so much sooner!! Still though, we felt confident in our decision. Our doula, Brandy, encouraged me that we couldn't make s wrong decision, it just depended on which one was best for us in the moment.

We went up to labor and delivery and told the room wasn't quite ready yet. When we did get into the room we met our nurse, Sue, and got settled into the birthing room. We learned from the get go that Sue was going to be amazing. I wish she had worked a 24 hour shift so we could have had her the entire time! She was incredibly funny, warm, and made me feel at ease with everything that was about to happen.
  I switched into the sleep shirt/gown that I had purchased separately, and unpacked a few of the things I had brought with us. We knew generally what was going to happen soon, checking vitals, drawing blood, going over our birth plan, getting the IV started, and eventually getting started on the medicine to induce labor.

The morning dragged on, and 11am arrived before we knew it, and nothing had happened yet. I am a very hard stick, so getting the IV started is always an event in itself. Hot pads have to be placed, IV specialists are called, and even they had trouble finding a suitable vein. Finally, the specialist was able to place a good IV line on the second try. When she was finished, we finally got to meet the midwife on call who would be checking my cervix and getting things started.

The midwife gave me a bad taste in my mouth as soon as I met her. There is something about people who talk down to me that really bother me. Growing up around my mom meant that I understood a lot of medical lingo. I'm also a self proclaimed doctorate of Google, so I know my way around pregnancy terminology pretty well just by being a millennial who likes to be well informed about what's going on in my body. Anyways, she spoke to me like I was a kindergartner, slowly and like I knew nothing about being pregnant....yuck. I jokingly asked nurse Sue if I could fire the midwife, and while she looked at me in total agreeance of my reasoning, she said she was on call until 7:30 the following morning. Darn.

She then went ahead and "checked" me, which is just a nice and clean way of finding out what the state of my cervix is. Her assessment was that I was 20% effaced, -3 station, and 2cm. So somehow, I went backwards overnight. She walked away telling me that I was not in a good enough place to be induced and that she needed to speak to a doctor. Of course the tears started flowing right away. We had already gotten so far that morning: our doula was ready, the IV was placed, the bags were unpacked, and all of the pieces were supposed to now come together. Our nurse assured us that things would be fine and I struggled to believe her. Luckily, a few minutes later she came back and told me that because my blood pressure was slightly elevated, they would be able to induce me. Little did she know that SHE was probably the cause of my elevated blood pressure! 

They decided to start me on a drug called Cytotec to ripen my cervix, instead of starting straight on Pitocin. This was the same drug that I was induced with Felix with. I was instantly a little bit nervous, remembering how quickly the contractions came on with Felix and how they almost felt unmanageable. I was reassured though that once the Cytotec had run it's course, they would start Pitocin, which is able to be turned up, down, or completely off depending on how labor is progressing. I had my first dose around 11:45am, coincidentally it was almost the exact same time of day that I had the dose with Felix. It was hard not to compare the timing of both labors the rest of the day knowing that we had gotten started at the same time! 

Seth, Brandy and I spent the afternoon chatting and hanging out. We got to know each other and discussed the most random of topics. We shared a love for puns, warm cookies from the cafeteria, and while we were all so different we bonded in a really special way that afternoon. As slow as those first few hours of labor were, I'm so thankful we had the chance to bond with our doula and build a relationship with her.

This team of doctors and nurses was much more aggressive with getting labor started than my first induction. After the first dose of Cytotec, they decided that contractions were frequent enough, and that they would start Pitocin. They quickly turned up the Pitocin pretty regularly on an hourly basis. I went from 2 drips at a time, to 12 over the course of the next few hours. They decided to break my water around 8pm and that really turned up the intensity of labor. Up until that point contractions were very manageable. I have a way of handling contractions that I've almost trained myself to do. I close my eyes, freeze my body, and concentrate all of my energy into my uterus. It is a very private, quite, internal process but it helps me manage the pain. It also helps me to empty my mind and not focus on pain, but instead focus on the timing and remind myself that the contraction has a peak and an end, and that in between I can rest. Reminding myself of those things allows me to work through each contraction and not focus on the entire task at hand!

The internal handling of contractions worked well for a couple hours, we did a little bit of walking around the hall, sitting on the ball, and swaying from side to side trying to get the contractions to be strong and regular, all while they continued to up the dose of Pitocin. Since we all knew that a long night was coming and we should rest, we turned down the lights and all took our respective positions to nap. It was around midnight and I dreaded the next few hours. 

I didn't get a whole lot of napping in, but I managed to hold down the fort and handle contractions for a little while and "rest"! This labor was turning out to be much different than I expected. With Felix I had the ever dreaded back labor. He was sunny side up, with the back of his head running down the base of my back and every contractions was basically paralyzing my back with pain. This labor, from the start, was entirely in the front of my belly. I was simultaneously surprised, excited, and a little nervous -- I can't begin to describe how different these two labors were. I felt almost like a first timer. 


After our "rest" I decided to try sitting on the ball to help manage the contractions. Because I was induced with Pitocin, I required constant monitoring which is very limiting movement wise. I had to stay within reach of the monitors, they had to be attached to my belly, and they also had to be placed correctly in order to get a consistent reading of the babies heartbeat. The ball was in close enough range and had good positioning for me to labor on for a long time. 

Brandy decided to try a technique called the double hip squeeze to help ease the pressure of contractions. I never knew how essential the double hip squeeze could be! For the next 2 hours on the ball, Brandy was not allowed to leave my side. Poor thing, I felt her arms getting tired but she still wasn't allowed to move. Mamas who are anticipating labor any time soon, TRY the double hip squeeze, you will not regret the incredible pain relief it brings. It brought the pain level from a 9 to a 3, I kid you not. It was truly incredible. It is absolutely the most effective counter pressure technique I've ever felt. 

After a couple hours on the ball, I asked if I would be allowed to use the tub to labor in. Earlier in the day, I had asked our first nurse, Sue, and she said no because of the constant monitoring, but since there was a shift change at 7:30, I decided to ask our new nurse, Kelli, if I would be able to try the tub. She said "why not?!, the monitors are waterproof, you just need to keep your IV line out of the water!" -- this was music to my ears. She went to prepare the tub and I was so excited to have the opportunity to labor this way after feeling hopeless that I wouldn't have the option to! As it turns out, Kelli is an incredible nurse. A few mins later she came back and guided us to the room.
The contractions were very strong and intense at this point. I had to stop and work through them as we walked down the hall, but we made it. In this small room marked "Jacuzzi" was a huge tub, lined with candles, and a bubble bath all made up for me. As weird as it sounds taking a bath in front of your nurse and a doula you've only met a few times, I enjoyed every non-contracting second of that bath. Brandy and I had a wonderful conversation and the water was hot and comforting enough to take the edge off of the contractions. I think I was in the tub for around an hour before I felt like we needed to move on and try something different. 

I felt the contractions picking up in intensity and strength. I tried to keep my cool, not really letting anyone know how intense they were getting -- I think the more vocal I was about the pain, the more I psyched myself out that I couldn't go through the entire labor without an epidural. 

We got back from the tub and I attempted to labor on the ball again. They decided that was a good time to check my cervix. My nurse, who knew how uncomfortable the midwife made me, told me that instead of having the midwife check me, I could have her do it instead. I was so relieved and let her go ahead and check, she said I was at 5.5 centimeters. 

I tried really hard not to be discouraged, knowing how fast I could progress from there, so I remained calm and got back on the birth ball. The contractions quickly took a turn and got more intense. I knew it was getting real when the double hip squeeze stopped working! I decided to ask for Fentanyl, which was my first pain management plan that I had wanted to try before I asked for an epidural. This time we did not leave the epidural entirely off the table, but we did have a special phrase that I would use if we truly knew I was ready for it. Brandy asked if I was absolutely sure, and it took me a few minutes to reply, but it was a resounding "yes". I truly felt that I could not continue without it.
Because it is a strong narcotic, they had me get in the bed when they gave me the dose. Fentanyl acts pretty quickly, it takes the slightest edge off of contraction pain, but allows you to take your mind off of it, which is a valuable thing to have! It only lasts 30 minutes, and by the end of the first dose I was begging for the second dose. 

Kelli quickly brought the second dose, and at that point I knew I had to be getting close because the Fentanyl did absolutely nothing. I tried so hard to continue to internalize my contractions but I felt myself, I heard myself having more difficulty with each passing wave. By the end of the second dose it was 4am and I was almost screaming from the pain. I knew that was entirely the wrong way to deal with the pain but it was the only thing that my body could muster up. 

Remembering that laboring on hands and knees is sometimes helpful, I climbed onto the bed facing the back hoping to find relief, which turned out to be the most uncomfortable thing! The contractions were so strong at this point that I couldn't change position in between.

I knew in my head that this HAD to be "transition". I don't remember experiencing the textbook transition with Felix, we had learned that it was basically when all hell breaks lose. Mama becomes like a wild animal. Here's what I remember screaming:


I felt the baby coming down, I felt my body beginning to push, but I knew that the nurse had to give me the "ok" to do that. Kelli reminded me 3 or 4 times that she needed to check me before I mustered up the courage to turn on my side and let her. Her words were sweet relief,

"Your cervix is gone! Go ahead and push!" 

I went from 5.5cm to 10cm in less than an hour -- I can still hardly believe it! An hour previous I had felt like my labor was going to drag on for ages. I am so impressed by how quickly our bodies can progress at the end stages of labor. It took hours to get from 2-5.5, but less than 1 to get the rest of the way! Amazing.

At this point I was on my side, almost in the position of a peeing dog. It was a truly terrible position to be in, but as I mentioned, there was no time in between for me to move. 

By then, the ever so lovely midwife had shown up and was reminding me that I should turn onto my back to push. Which I knew, but her annoying existence didn't help by telling me that.

When I begin pushing with Felix, it was relief, when I began pushing with Josie, it was absolute agony. I guess that was a good indicator that what I was doing was effective. I felt e-v-e-r-y-t-h-i-n-g. Pushing her down and out was one of the hardest memories I have from this labor. It was the most intense pain I ever thought I would experience. 
I managed 3 pushes per contraction, and the 3rd push of each contraction was almost impossible. The first two were very effective, I could feel they were effective, but the last one always felt half-assed, even quarter-assed -- but at 4am with zero rest, it was the best I could do. Brandy was on my left (I think?), Seth was on my right, and I vaguely remember the nurse telling me that because my last dose of Fentanyl was less than an hour ago, they needed to call in the NICU team just in case Josie came out a little bit lethargic. 

My eyes were shut tight while I pushed. It was the only way I could block out the noise and focus. I tried to focus on Seth, Brandy, and Kelli telling me how good of a job I was doing. The midwife kept telling me I needed to work harder...... so there's that. If I didn't have a babies head stuck between my legs I would have kicked her.

 The closer I got, the more tired I got. I was trying so hard to focus on the end goal. The distractions in the room were hard. At one point I heard another man's voice in the room which totally through me off, aka, please stop staring at my vag DUDE. There was another woman who was just having a conversation in the middle of me pushing, I not-so-politely told her she needed to shut the heck up. Apparently the look on her face said that she was offended by my command, but if she had any sense in her, she would have never had an audible conversation while a woman was in the pushing stage of labor without an epidural. I'm still shouting in my head, "COME ON LADY!".  I had hoped for a serene environment when it was time to push, but instead I got a room FULL of people!

Seth recalls that I was crowning for at least 4 contractions. 
I remember shouting "IT BURNS!". And that, was the ring of fire we have all heard about! The hard part about the ring of fire, is that while you are seriously SO CLOSE, you are also so far if you can't muster up the energy to push the rest of the baby out in that contraction! I felt Josie's head come down, and go back up at the end of those few contractions, which was a really discouraging thing, though I knew I was still very close. 

A few more minutes and I had her head fully out, followed by her sweet little body. My words as she arrived were the same as Felix's arrival, and while I wish they were something more endearing they were just:

"Oh my God, Oh my God, Oh my God!"

I think there were a few "I can't believe I just did that", and "did that really just happen" in there too.

Josephine Evelyn was born at 4:49am after only 30 minutes of pushing.
 Her birth was sweet relief after a long evening and early morning! 

It would be really nice if the story got to end there. I was hoping to quickly deliver my placenta, usher the lovely midwife out of the room, and enjoy my new baby. I didn't get so lucky.

The quiet, concentrated presence at the end of the bed told me something wasn't right. After birth is never easy as it is, right after you deliver a team of nurses is usually surrounding you, pushing on your stomach trying to get it to contract and stop the bleeding so the placenta can come out. 

Well it was out, and being examined in a bowl because apparently it wasn't entirely out. 

This is the part of the story that I truly hate. 
I would rather push out three more babies than go through the pain of a manual d&c again. I joked with a different midwife the following day that I would likely have PTSD from going through this procedure, but it turns out I didn't need to joke because the PTSD is real. I am having flashbacks and random bouts of tears just thinking about it.

Ok, so a manual D&C is probably not the proper name, but it fits a lot better than, 

"the midwife had to put her entire arm into my uterus, up to her ELBOW, to get pieces of my placenta out."

and then... since the midwife couldn't get it all, they called a second, more forceful OBGYN to get the rest. Right before she did the procedure she told me something along the lines of, "I'm told I have small hands." -- which at that point was just confusing to hear. I had no idea what she was about to do, but obviously her having small hands was supposed to be comforting. 

You guys, I wouldn't wish this procedure on my worst enemy. I would rather they have wheeled me straight into the OR and put me under full anesthesia, then to have to go through that. I know they were probably not doing that for the sake of bonding with my baby, but like I said, it was worse than anything I can put words to. Brandy nearly passed out while trying to help me through it. At one point, I looked over and all the color had drained out of her face and she was asking Seth for something to drink. Apparently Seth looked at her and said, "right now?" -- but she was nearly collapsing while trying to hold my leg! She later explained that it wasn't the blood, or the birth itself, but seeing me in that much distress after just been through the pain of childbirth that made her so sick.  

While this was all happening, my body was hemorrhaging, just like I had with Felix. Thankfully, I only lost about half as much blood as I did with him, but coupled with the retained placenta, it was a scary incident. Having had two labors without epidurals, I honestly think it would be worth to get an epidural JUST for the afterbirth stitching and fixing. It is absolutely 100% worse than giving birth itself. And the large dose of Fentanyl they gave me during that procedure didn't even touch the pain, they might as well have given me Tylenol for how effective it was. 

I also had two 2nd degree tears, the same tears that opened with Felix's labor, opened with Josie's labor. They explained that the scars were just perfect enough to rip back open. Isn't that nice? :P 

After almost 2 hours of stitching, bitching (on my end), and begging for her to be done, I was able to enjoy my baby girl. They waited to weigh her and do all of the initial measurements for over an hour, which is really awesome. We were so surprised to hear she was 9 pounds. We had conversed about how she looked to be maybe in the high 7 pound range. I thought she definitely felt and looked smaller than Felix, so you can imagine our utter shock when the nurse said "9 pounds 1 ounce!".

We were transferred to the mother/baby unit shortly after 8am. Brandy left, which was sad. We had just been through such an event, and it was almost weird that she had to leave, though I know that after a long night helping me labor she needed some rest too! My parents came to visit and brought Felix along, and I had my first post-birth meal of Jamba juice, which strangely enough I wanted so badly after both labors. I desperately wanted to rest, but with this hospital becoming more "baby friendly", they do not have a nursery and do not take the babies away from their moms to rest anymore. I get why they do that, but it would have been so nice to have some time to sleep.

We spent the next day and a half in the hospital, enjoying our baby girl and recovering mentally and physically from the whole birth. I could tell right away how much she resembles Felix, but when she opens her eyes she looks like me! We had a few friends come and visit, and Felix and my parents came back periodically. Felix had a hard time with me being stuck in the bed, and kept asking me to get out. Now that we are home, he still freaks out if he sees me in bed!

It took me a while to gain my strength back, but when I was able to get up and look in the mirror I was surprised at what I saw. I first noticed that my shoulders were covered in broken blood vessels. I told Seth to look at them because of how strange they were, and he said "Babe, you should look at your face". It was so strange to see the face staring back at me, covered in spots! I did not expect that side effect from pushing, but recalling back on that part of my labor I know exactly why it happened! Over the next few hours Seth took notice of my right eye also having a broken blood vessel. It is called a Subconjunctival hemorrhage, and slowly got worse over the week. Now at 12 days post partum it is starting to look less scary and zombie like. I can feel people staring at it when we are out in public!

 I did a lot of reflecting that first night, going over the details in my head, and feeling so thankful that we had chosen to have a doula this time around. I think I've thanked Brandy 800 times and will probably remind her 800 more for the next few years how thankful we were to have her! I truly don't think I could have done it without her. And even though as rough as the whole thing was, I'm hoping Seth agrees to have another baby in a few years just so we can use her again ;)

I would love, again, if the story ended here. The drama of that birth was enough for me! But exactly a week later I landed back up at St. Vincent in the ER. 

Usually when you leave the hospital after you give birth, that is probably the worst pain you will experience. Every bump in the road, every trip to the bathroom, every movement involving your lower body probably aches. But my body got progressively worse over the course of the next few days. 

I noticed it first on Wednesday when we were doing our newborn photos. It felt like I had been repeatedly punched in the gut. When we left the hospital on Sunday they very clearly told me to take it easy. No laundry, dishes, lifting Felix, lifting the baby with the car seat -- it made sense but it was really hard to just sit and not do any of these things. But the pain continued, and on Saturday I found myself just crying and feeling like something wasn't right. I ached from my ribcage down, all over in my abdomen and back. I was sick to my stomach, had no interest in food, and I felt awful. 

I decided to call the midwife late in the evening and she advised me to go to the ER right away. Remembering how long it took us to pay off our last ER bill I was hesitant. I was actually kind of hoping that she wasn't concerned and that I should call on Monday when they would be back in the office. By Sunday morning I knew I had to go in, I woke up and was instantly in tears. It hurt to sit down, get up, roll over, breathe deeply, bend over -- here I am thinking things would be getting easier and they just kept getting worse. 

I packed Josie up in her car seat and started the 30 minute drive to the hospital. I started having flash backs of the manual d&c procedure which sent me into a panic. I knew that they would have to be looking "down there" to find out what was going on, but I was petrified that it had something to do with my placenta and that I would have to go through that pain again. 

Brandy met me at the hospital, something I didn't initially plan on, but the nurses told me that someone needed to be there to take care of the baby in case anything happened. It was such a sigh of relief to see her again. Just having her in the room allowed me to let go of all the emotions I had been holding in and tell her how much pain I really was in. She was surprised, we had had our post partum doula visit the day before and she remarked that I passed it off like I was not in that much pain. I just kept thinking that I had to be strong for my family and for my babies -- that's what motherhood teaches you to do! 

After a few hours in the ER (they never like to work quickly, do they?), I was sent up for an ultrasound to see if there were remaining pieces of my placenta causing the pain. 
The ultrasound tech was not allowed to say anything about what she saw, but it was obvious what I was looking at on the screen. As soon as she placed the wand on my belly, it lit up with white fragments, bleeding fragments, of placenta. I felt scared, but so relieved that the pain wasn't just in my head. It was no surprise when the OB came in and told me that there were indeed "retained products" left behind and that I would need a D&C procedure to get rid of the rest. 

A D&C can often be done in an outpatient setting. It is the same procedure done when a woman has a miscarriage, but doesn't pass the baby right away. But given my history of hemorrhaging, they decided to perform the procedure under full anesthesia in the hospital that day. The doctor reassured me that it was a routine procedure and that I would likely be able to go home the same day. 

I was prepped for surgery, and at 3:30 that afternoon I entered the OR. I have not had major surgery for about 16 years, so it was absolutely terrifying being wheeled into that room. Of course I knew that it was routine and that I would be totally fine, but there is always a lingering fear when any medical procedure has to take place! 

I woke up at 5pm in a strange recovery room with a nurse I didn't recognize. The doctor was by my side in a few minutes, and proceeded to tell me that I would need to stay overnight. I had hemorrhaged again

What the heck?! 

I still don't understand how I can have picture perfect pregnancies and births, and then manage to have an awful time recovering. It's a little scary thinking about the future going forward, and knowing how much my body struggles to clot. 

I was not able to keep Josie overnight in the hospital, and rather than leave Seth to manage with a newborn and our crazy toddler, Brandy offered to take her overnight. Brandy to the rescue, again!!
 At first it sounds strange to let someone we don't know extremely well take her overnight, but it was clear to us that we needed to say yes. She took Josie that evening so I could get the rest I desperately needed, and promptly dropped her off with us in the hospital the next morning. Brandy, if you're reading this, which I can bet that you are...your help means more to us than we can explain. Having no family in Oregon means that we have been pretty much on our own since moving here, but you have treated us like family and we are forever grateful. I hope you know how much you mean to our family. <3 
Here are her sons snuggling our sweet girl.

We keep recanting how glad we were that I decided to come in that morning and get checked out. If I had continued to be quiet about my pain and ignoring it, the outcome could have been so much worse. I honestly cant stress enough how important it is to trust your gut and listen to your body. I consulted mommy groups, wikipedia, and my doctor Mama and had gotten mixed reviews on whether the pain was just after-birth pains or something worse, but deep down I knew something wasn't right all along.

Just a few hours after the surgery I was amazed at how much better I felt. It was the first time I wasn't experiencing abdominal pain since Josie was born. And now, finishing this extremely long blog post 4 days later, I am amazed at how quickly my body has recovered. I feel like I have done a 180 and the pain is almost 100% gone. Hallelujah! God knew I needed my strength back in order to deal with the extreme task of having two children at home! 

We made it to the end of the story. 
Sorry for all the gruesome details. I did warn you though. 

Josie is 12 days old today. We are totally in love with her. 
I would do it all over again just to have her in my arms. And now I'm crying again, because I know those words ring true for every mama out there. 

And I bet in a few months when I've forgotten the craziness of child birth, I'll look over to Seth and say, 
"Let's have another!" 

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