on delivery: the birth!

author's note: this may be graphic at times - discussing bodily functions. (remember: i am a nurse. we talk about topics over lunch that would make even those with steel stomaches squeamish.) read at your own peril. :)


we were ushered into the ob triage area - an off-shoot of the ER. once settled the midwife stationed there checked how far along i was. this was the moment. if i wasn't as far along as i hoped, i would go home to labor further. it was nerve-wracking because, meanwhile, mentally, if i wasn't as far along as i wanted to be, it would be a major let-down and, again, make me worry that i wouldn't be able to meet my goal for a natural childbirth.

so the midwife checked and i was 5.5 cm and 100% effaced. i looked to my doula who said, "that is excellent."  i was hoping i'd would be further along honestly, but i was happy i had made so much progress at home. and i felt more confident knowing we were exactly where my doula wanted us to be.

we were then transfered up to the labor and delivery unit. the first point of order was for the nurses to place an IV. i had tested positive at 36 weeks for GBS. GBS (group beta strep) is a type of bacteria that can exist in the perineal area. adults that test positive are considered to be colonized; in fact, 25% of all healthy, pregnant women will test positive for the bacteria (American Pregnancy Organization) and reportedly, it is more common among healthcare workers. however, there is an increased risk for infants born to moms who test positive for GBS; they can contract pneumonia, sepsis, and meningitis. but not every baby born to a mom who is GBS+ will contract GBS. as a precaution, however, it is routine practice to administer IV penicillin to those who are GBS+ upon admission to the hospital and every 4 hours thereafter. the medical team wants to get in at least 2 doses.

unfortunately, because of my body's response to the pain of labor, the fact that i hadn't eaten or drank much since the afternoon and had also been vomiting, my veins were pretty small and flat, which ultimately makes them hard to access. we had 2 nurses working with us as one was in orientation and each tried once and was unable to obtain IV access. they then called in the anesthesiologist. stereotypically speaking, anesthesiologists are not people-people. they are weak when it comes to bedside manner as most of the time, other than in pre-op, their patients are unconscious. we experience this as well at the children's hospital where i worked. we call on the anesthesiologists when no one else is able to obtain IV access, but it is a last resort. they are often not very nice to the nurses nor the children. once i worked with an anesthesiologist who supported the child extremely well through the IV access and was extremely pleasant to work with, but unfortunately, in my experience, this is the exception. but i digress.

the anesthesiologist seemed nice enough, but was unsympathetic to the fact that i was in labor. when she first came in, i politely asked her to wait before poking me for my contraction to subside. she was none to pleased, acting as if this were an extreme demand on her all-too-precious time, but did comply with my request. sadly, it took her 4 pokes to gain IV access. all the while, she made sure to point out how horrible my veins were and to make it clear that it were my fault, not her's, that she was unable to gain access. meanwhile, after each poke, she would leave the catheter in my arm - not the most pleasant experience. i understand the practicality of it - if you leave it in and are still using a tourniquet on the same arm, you won't have blood squirting out of the holes. it is a common anesthesiologist practice, though i don't know any nurses (even those in flight-for-life) who practice similarly. even when she switched to my other arm, i had to ask the nurses to remove them as she hadn't.

finally, on the 6th poke and probably an hour later the anesthesiologist was successful. Dave and our doula were fuming. i was irritated at how long it was taking, but i didn't quite have the same anger they did. i joke now that it was like a nice distraction from the contractions themselves - like a weird version of acupuncture. honestly, much less painful than i feared but certainly it was all relative.

as a part of our birth plan, we had wanted to use the bath tub/whirlpool. i was worried as there was only one for the unit and it was a first-come first-serve kinda thing, but fortunately it was available when we were admitted. (this could be in part because it was the middle of the night and because i didn't have an epidural which precludes you from using it.) 

on the way there, i was walking faster than the nursing staff preferred. because of the difficulty in obtaining my IV they were VERY concerned about losing it. they kept telling me to slow down and be careful. it is funny to me as a nurse that i couldn't be more helpful in a sense. obviously my plate was full but i remember thinking - i am not going to pull out my IV, it is fine! of course when we got to the tub room i realized i had to go to the bathroom and poop. both my doula and the medical team were concerned that i was feeling like i had to push, a sign of 2nd stage labor, which can often be confused with and mimic the feeling of needing to have a bowel movement. i assured them that no, in fact, i just needed to go to the bathroom. :) and i did.

once i finally made it into the tub, it was heavenly. again, in the water was the only time that i felt any kind of relief between contractions. while they didn't disappear completely, they subsided enough that i could socialize with my birth team. we got a sort of rhythm down. when the contractions would start, i would prop myself slightly raised out of the water as i would get tremendously hot. Dave would put counter-pressure on my quads, which hurt quite a bit with the contractions. and Sheila would hold the battery-operated fan in my face. it worked. i continued to make progress. after some time had elapsed in the tub, (time was evading me - i couldn't tell how long had passed as i really was focused only contraction to contraction), the midwife checked me again. i hadn't been checked since we arrived in the ER. i was 8.5 cm. we were thrilled. i am recalling that it had been maybe 2 1/2 hours so i was making excellent progress. at one point later there was some discussion as to whether or not my water had broke. i was passing lots of clots, which is normal at this stage, but one of the nurses thought she saw a push of liquid during one of the contractions.

we continued on in the tub in this rhythm for a bit longer. soon enough, however, i began to feel the urge to bear down and push with the contractions. the midwife came back and told me i could stay a little longer in the tub and NOT push or we could go back to the room and she could check me there, but at that point, going back to the tub wouldn't be an option. (this hospital does not perform water births and is adamant about making sure no one *accidentally* gives birth in the tub.) i decided to ride it out a little longer because i knew i would not feel as comfortable outside the tub. (at this point, comfortable was truly a relative term. intermittently throughout my labor, and certainly at this point, i would exclaim, "i can't do this." dave would assure me, "yes you can" and our doula cleverly would say "you ARE doing this!" there came a point when i would say i couldn't just so i couldn't have the positive recognition and encouragement from my team. they really helped propel me through.)

finally the urge to push overrode my desire to stay submerged. on the walk back to the room, in an effort to be a helpful patient, i turned to the CNA who was walking along side me pushing the IV pole and said, "we are going to walk fast." she smiled and said, "no problem!" and we were able to hustle back to the room. the midwife checked me and i was at 10cm - fully dilated! we were ready to push but, in fact, my bag of waters hadn't broke yet. she had mentioned to me earlier that the only time she would consider breaking waters is if i was fully dilated. she had seen in her experience that it could slow things down in the final stage of labor. so she asked, "is it ok if i break your water?" momentarily i didn't know how to answer. everything we had read about and learned in our natural birthing class said that letting the bags rupture spontaneously and not artificially was the best way. but at this point, i also didn't want to slow down the process. it is *REALLY* hard to make a decision like this (like any!) when you are in labor. but i agreed. i do think it was the right decision at this stage. i wouldn't have wanted them ruptured early but it seemed like it made sense at this point. it did make me realize  some things about the medicalization of labor. even as informed as we were, we hadn't ever come across anything about bag rupturing once pushing. and we had really prepared. it is easy to understand how other laboring women could be railroaded in a more medicalized experience. not that natural childbirth is for everyone, but it is overwhelming once in the process and easy to veer off course if you are ill-prepared and don't have a supportive team. in the end, i did agree to have my bag broken at that time, with no regrets. it was an odd feeling for sure.

then the pushing began. at some point around this period i was hooked up to a fetal heartbeat monitor and contraction monitor. our little one was showing some heartbeat decelerations, which can sometimes be indicative of fetal distress. in our case, they suspected some cord compression where his head was pushing on the cord in turn decreasing blood supply to him. as a result, they wanted me on my left side to increase blood flow. we had prepared for me to be in squatting position when in the pushing phase, but instead i was lying on my side with my legs in a clamshell, officially called the left-lateral position.  the pushing was very slow-going, so it seemed to me, and painful. i had learned that for a lot of mothers, the 2nd stage (pushing) of labor was easier in a way than the 1st stage because it was active and you were able to DO something. however, the pain overrode any excitement of action. it was really painful. at some point, because of the decels they wanted to put oxygen on me. the nurses asked, "is it ok if we put oxygen on you?" i remember thinking - seriously? of course, i understood that it was considered best treatment for the decels again to ensure what blood was getting through to the baby was oxygen-rich. but again, i was in NO position to make an informed decision. pain should be one of those factors that is considered to make it impossible to obtain informed consent. i clearly remember my response being, "sure, whatever."

additionally, figuring out how to push more effectively was not straight forward. i could tell when i was doing it right based on the feeling as well as the cheer of my team, but it was exhausting. it was hard to maintain such pressure with each push. it also was confusing to the body somehow that to push increased pain in a sense but it was also the way to get rid of the pain. i knew some pushes were better than others and had to just kept trying for consistency and efficacy.

after awhile, my midwife suggested we change positions. she said i could try squatting or lying on my right side. i looked right at her and asked, "which is going to make the baby come faster?" "squatting" she replied. needless to say, i chose squatting.

the nurses obtained a squatting bar and rolled it to the foot of the bed. the plan was for me to sit back and relax in the bed in a sitting position between contractions, but when a contraction came that i was to pull myself up with the squatting bar (and the aid of my birth team) and squat and push. we did this successfully for the first contraction in this position. as soon as i went to sit back i felt an excruciating pain and pressure against my tailbone. just like it is instinct to pull your hand out of the fire, my instincts kicked in and i stood up straight on the bed. my doula and midwife were none-too-pleased. i am pretty sure they wanted to kill me. "you have to sit down," they implored. "no," i said. "it hurts too much." they pushed and i politely refused. we finally came to an agreement that before i stood up, i would let them know so that they could spot me. and so we proceeded...

we continued for awhile at this. it felt like an eternity. finally the midwife saw i was tiring out. she suggested i lie on my right side back in the clamshell position. what i liked about this position was that it was restful. our doula and dave would put counter-pressure on my feet, giving me a semi-solid surface against which to push when the contractions came. after some time, i started to finally make real progress. the baby was crowning. i was able to reach down on feel the top of his head. prior to labor beginning, i had indicated that i wanted to watch this stage of labor with a mirror. however, once we got to the pushing phase i was exhausted to say the least. with each contraction, i went into this deeply internal part of me to get through the pain and do what i had to do to keep it progressing. (amazingly i didn't yell at anyone. dave and i were both prepared for me to cuss him out during the labor. but in spite of it all, it just wasn't where i went. i didn't find it necessary.) for the most part my eyes were closed. we had learned in our bradley class that in this phase in between contraction, the laboring woman should be in a sleep-like trance. this seemed to come naturally to me. i would have loved to watch but i was too exhausted and too internal to do this. but touching the head was confirmation of how far we had come. he was almost here!

shortly thereafter our midwife gowned up. i must have looked seriously defeated because she looked at me and said, "i don't put this gown on for nothing. we are almost there." she had started rubbing mineral oil into my perineum to aid in the stretching. it is the general practice to use surgilube, but our doula had brought the mineral oil, which even the midwife said worked MUCH better. she would then put two fingers on each side of his head to aid in the stretching of my vagina with the goal of preventing a tear. it hurt. it burned. it was not comfortable. so i let her know. "nicole, i do not like that." she responded, "i know but it is going to help." "nicole, i do not like that." "that's not me, that's your baby." in my head i was thinking, "give me a friggin' break," but i actually was able to reason that i knew it would help. (incidentally, i didn't tear really at all. i had what the professionals call "skid marks", essentially vaginal abrasions - but no stitches required!) as his head emerged further she was having a hard time telling its orientation. "stop pushing" she said. so i did. i thought maybe the cord was wrapped around his neck. in fact, the baby had his left hand crossing over to cuddle his right cheek, palm facing in. this meant he was coming out slightly cock-eyed and the midwife needed to get his hand into a safer, less twisted place. this explained a few things - the slow progressing of the 2nd phase (given that he had in fact widened the diameter that needed to pass through my vagina), the pain against my tailbone, and the hematoma we would find on his head after birth. once she got him better situated, the head started to emerge further. after one big push, i felt immediate release. the pain was gone. i turned towards dave and asked, "is the head out?" he nodded. "one more push!" the midwife exclaimed. i pushed and, whoosh, out he came. 

the midwife immediately flopped him on my belly. he was beautiful. i started crying and he started screaming. (i guess it is traumatic being born - the only thing more traumatic than giving birth, they say!) i remember gazing down and kissing him all over. he had blue hands and feet, but i knew that was normal and that they should pink up in a few minutes. 

dave is a softie and is in touch with his emotional side. i had asked him not to cry during the labor. i was going to be looking to him as my pillar to get through this. if he started crying, what would that mean for me? so he didn't cry. until this moment - he looked at me, eyes brimming, and said, "can i cry now?" i think i laughed and nodded. sheila and my mom were quickly by my side to gaze on the wonder that is our son. 

someone noted out the window, "look the sun is rising." and it was - beautiful rays of gold, orange, pink, and yellow were streaming in. it was the most beautiful morning i had ever witnessed and i've witnessed a few. welcome to the world, charley stephen drake-lovelace. born june 1, 2012 at 5:06am. i suspect our lives will never be the same.