Saturday, November 23, 2013

The Story Of My "Failed" HBAC

October 30th and 31st
                At 41 weeks 4 days, I decided to try to do a sweep to get things moving. A visit to MariAnne’s office showed that I was not dilated enough to do so. I was a fingertip dilated and 50% effaced, baby at station -1. I was not too surprised; tons of people have no signs of progression before labor starts! The next day, 41 weeks 5 days, was Halloween – I had been so worried I wouldn’t be able to go with Nolan and yet here I was, still pregnant! During the work day I’d been having contractions, some painful, most mild, off and on all day. Things picked up as the evening progressed and I had regular contractions, about every 6-9 minutes, all night.
November 1st
                I slept pretty well, hoping to wake up to some major contractions in the wee hours of the morning. Friday morning they were still present, but had not increased in frequency, so I thought that going for the NST/BPP to be on the safe side, just in case this wasn’t ‘real’. As soon as I walked into the hospital, my contractions stopped. The contractions that had been going for a whole day, stopped just from walking into the hospital – it is amazing how the mind works!
                We spent most of the day at the hospital. The NST was perfect, but the BPP showed low fluid. The staff was extremely harsh and pushy. They wanted to induce and they wanted to do it NOW. I couldn’t do it, I knew my body was getting things started and it just needed a little more time. So, I signed out AMA and went home. A call to MariAnne and she assured me that hydration would help and to relax and let the adrenaline from the visit go, she was sure it was stopping my contractions. By that evening they started coming back. They were roughly 10 minutes apart and needing me to focus on them at times. They continued through the night, disrupting my sleep a bit, but not in a major way.
November 2nd
                Things got real at about 5 a.m. I woke up to a pretty harsh contraction and they continued. I lost massive amounts of my plug during those first few hours. They ranged about 6ish minutes apart, lasting 30-40 seconds. Within 2 hours, they were 3 minutes apart, last 45-50 seconds, and I was moaning through most of them. MariAnne called at about 8:30 to check in and I gave her an update. Even with them being 3 minutes apart, the short frequency had me convinced there was no rush in her coming out. She said she would head my way at about 1:30, unless something picked up before then. I spent most of the day contracting by myself, hubs had running around to do and I was handling them by myself pretty well.
                By the time MariAnne got there they were pretty intense and having counter pressure felt fantastic. They stayed 2-3 minutes apart and lasting about a minute each for the remainder of the day. MariAnne arrived about 2:30 and I was 4/5cm dilated, 70% effaced, and Oakley was at 0 station. The contractions continued and there was not a position that I was comfortable in. I found the strongest contractions were present while sitting on the toilet. I tried to spend as many contractions there as I could handle. We rotated positions on the toilet, birthing ball, on all fours, etc. Nolan tried to comfort me during contractions; he would come up rub my belly and tell me – ‘it’ll be ok mommy’ over and over again, while rubbing my belly, during contractions.
                Around 5p.m. another check put me at 6cm and 90% effaced, Oakley still at 0 station. A problem presented itself when my blood pressure was hovering at 160/100. We talked with MariAnne and she suggested that getting in the tub might help bring down my blood pressure. They started filling the tub, which took some time. At about 6:00 I hopped in the tub, it felt amazing and best of all – my blood pressure came down! I continued to labor in the tub with contractions much easier to manage and they only slowed slightly to 4ish minutes apart on occasion. The decrease in blood pressure was only temporary and by 7:30 it was back up again. Another check within 30 minutes and it was still the same - 160/110.
                At that point MariAnne sat and talked with me about transferring. Oakley sounded good, but my high blood pressure readings had her worried. We talked for a bit and decided a transfer would be best. I got out of the tub and got ready to go while everyone else put bags together, cleaned up the tub, etc. At 8:45 my water broke, a relatively small gush, but noticeable none the less. It looked meconium stained, but initially we assumed it was more of my plug. The contractions got really intense after my water broke and were coming every 2 minutes. The hour+ ride to the hospital was much of a blur, I was in so much pain and unable to change positions made things even worse. I was crying through the contractions.
                We arrived at the hospital and walked to triage. Upon admittance my blood pressure was still elevated and they took urine and blood to check for pre-eclampsia. All was clear as I knew it would be. They did a quick check to ensure that Oakley was head down and sent me to L&D. I was still 6cm and 90% effaced at this point. I hung out on the birthing ball while everyone got settled in and MariAnne stayed and talked with me for a while. I had some more gushes of water that undeniably showed meconium in the water. My blood pressure stayed elevated, but since I obviously wasn’t pre-eclamptic they didn’t bother me too much about it. The doctor on call was not exactly VBAC supportive and kept claiming that Oakley wasn’t handling contractions well and that we should start considering a RCS. Granted he did have decels during contractions his recovery from them was within normal range. They pumped me full of fluids and his decels and my blood pressure both got better. I am guessing a bit of dehydration may have been a viable culprit. MariAnne left at about midnight and said she would check in the next day.
                The doctor, quite literally, harassed me all night. If she wasn’t coming in to see if I wanted a RCS, she was doing cervical checks with no regards to my contractions. My contractions slowed during the night, can’t even tell you the frequency because all I wanted to do was sleep and no one was letting me. She kept talking about my contractions slowing down and when I asked her if Pitocin was an option to pick them back up should they continue to peter out she told me that she would ‘never allow’ me to receive any induction medication, but if I wanted an epidural and RCS she would be happy to call the anesthesiologist. She was a peach, no doubt. Luckily the nurse I had, had two natural births of her own and was very encouraging. She came in as often as she could to help me through contractions while my husband tried to get some shut eye.
November 3rd
                Thankfully shift change came somewhere around 5-6. Our new doctor, Rankin, came in to tell me that I was the hot topic of the morning. He was quite encouraging and said that he was not ready to throw in the towel. I had managed to progress an additional cm during the night and was solidly 7cm and 90% effaced with Oakley still at 0 station. I talked with Rankin for a bit about my previous pregnancy/section and the reason for transfer and what course of action I wanted to take. I told him that I would prefer to avoid Pitocin and wanted to give my body a bit to see if the contractions picked up on their own. He was supportive, agreed, and left saying he would check back in.
                About 7:30 my contractions were still wildy inconsistent and sometimes, nonexistent. So we started Pitocin at about 8. Within minutes I started feeling contractions, some were mild, some were intense, and as they continued to increase the dosage the contractions got even more intense, longer, and closer together. By 11ish they were back to back longer and stronger than any of the contractions I had had previously. Oakley was handling the contractions ok, but it was important for me to stay on the monitors, his decels were starting to lag. A couple of cervical checks revealed no progress in dilation, effacement, or station. I was growing weary from the contractions, but was staying as optimistic as possible.
The contractions stayed 2minutes apart lasting a minute each from 11ish on. Most of those hours are a blur. At about 3-4 and showing no progress we regrouped and decided to try an epidural to see if relaxing would help things progress. The anesthesiologist was in surgery and unable to get there right away. She came in sometime around 5(?) to administer the epidural. She made my husband and mom leave the room while she did it which was quite upsetting for me. It took three tries for her to get the epidural in correctly. Once it was place I was able to feel contractions, but only that they were present, not the pain associated with them. I positioned myself in an upright position with my legs position Indian style to open my pelvis as wide as possible now that I was immobile.
The contractions continued and intensified, Oakley heart rate deceled, and the lags between it coming back up continued. A check about 2-2.5hours later showed no progress, no change in station. I had progressed 1cm in 24 hours. My water had been broken, with meconium in it for nearly 24hours, and my temperature was creeping up (though not high enough to call fever at that point). We had another chat with Rankin at that point and he left us to discuss our options. My husband, always supportive of my choices, even then, only said that he felt like we were – ‘just waiting for something to go wrong’. He was right. Independently these items were not significant, together, they were and that brought me to tears. I cried for a while and called for Rankin to tell him that we were going with the section.
I am not much of a negotiator, but I made demands as it was important this experience was different than Nolan’s. Due to the meconium they had a NICU team on standby for when he came out. They were to get him first and make sure that he hadn’t aspirated any meconium. I talked with the NICU team to ensure that my husband would be able to stay close and even to cut the cord, assuming all was well. I talked with the anesthesiologist to request that after baby was born that my hands be unstrapped so that I could hold my son. I talked with the nurses to ensure that he was not to leave our side, at all. Rankin, the surgeon, and I talked about being sure to use the same scar and to do another double stitch. They were wonderful and agreeable and didn’t fight me on anything.
On November 3rd, after roughly 36 hours of active labor, Oakley was born weighing 9lbs 9oz and 22.5inches long via RCS. He had the same markings his brother did at birth. An impressive cone head (sans hematoma thankfully) and bruises on either side of his head giving me the assumption that he was posterior as well. He was wedged in my pelvis and invoked some wiggling to get out. He received Apgar’s of 9 and 9 and did not aspirate any meconium. My placenta showed no signs of calcification and everything looked healthy. No one can ever say that he was in any danger by me going postdate, Rankin said so himself ;)
I, unfortunately, was far too shaky from the epidural to hold him. I still had them release my hands so that I could touch him while William snuggled him close by. Sewing me back up took longer than originally anticipated. Apparently from the previous section my bladder had adhered to my uterus, so they had a lot of scar tissue and adhesions to reconcile with. They even pumped my bladder full of sterile milk to be sure it was fully functioning - first time I've ever heard someone ask for milk in the OR - even some of the nurses were confused LOL 
William took Oakley to recovery so that they could check his blood sugar and wipe him down; he still had quite a bit of meconium on him. I was able to close my eyes for a bit, I could barely hold them open, likely due to the major blood pressure drop that I experienced from the epidural. Everything went as I requested, except for one issue. The bladder adhesion meant I only receive a single closure this time since they were worried about nicking my bladder while sewing me up. I don’t know what the future impact of that will be or if it will even matter since I have no idea if I will have more children.
I arrived in recovery about 30 minutes after they had taken Oakley back. Apparently his blood sugar was a little low (by a few points) and one of the nurses had tried to give him a bottle. Thankfully Oakley fought the nurse on taking it and my mom stopped her. A little less than an hour after birth we had our first nursing session, he latched on and nursed like an absolute champ. He was so alert! ((Also chewed out the nurse a bit, but that’s another topic altogether)) His blood sugar came right back up within minutes after we nursed. We stayed in recovery for an hour and almost got stuck there since apparently no one wanted to take me being that my blood pressure and pulse were still elevated. Eventually a number of calls to different doctors to confirm that my blood pressure and pulse had been elevated since admittance and was not a product of the surgery they allowed us into a regular room. 
The end result was this gorgeous little man that I would do it over and over and over again for. He is perfect and amazing. It will be a long time before I can reading someone else's birth story without crying. It'll be some time before I am not bitter about my utter inability to birth him the way nature intended and the sting of others who can does not pierce me so deeply. These are my petty, shameful truths, and I am working on owning them the best I can.


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