Wednesday, February 27, 2008

Birth Story: Premature Rupture of Membranes at 31 weeks. Beautiful, NATURAL birth 1 month later

The strength, wisdom, and determination of this mother despite all that was thrown in her path amaze me. That she could handle all of this, within the hospital setting, after 2 previous gentle homebirths is awe-inspiring. She told her birth story on the Mothering.com listserv.

Ember Lotus Halcyon
29 January 2008
1:45 p.m.
5 lbs. 1 oz.
17.5 inches
34w6d gestation

Ember's entry into the world started 4 weeks before her birthday. I was rolling over in bed and felt a gush of warm fluid.
"Uh-oh", I said. "That can't be good." I had experienced SROM before my first daughter, so I was familiar with the sensation. I did NOT however anticipate it occurring at 31 weeks gestation. I was NOT happy. I knew the possibilities of pre-term labor. I knew the dangers of a 31 week preemie. I also knew that my hopes for my third home birth were quickly coming to a screeching halt.
I decided that at 11 pm at night was NOT when and how I wanted to handle this situation, so I let my husband, Mark, know what had happened, what that meant, and what I planned to do about it. I cleaned up, put on a pad and went to bed. "If I don't wake up in labor, I want a good nights rest under my belt."

The next morning I did a little more research on pPROM and made an appointment with my midwives to confirm that I had, in fact, had a pPROM. I packed some pads, my laptop and little else, and headed into town. I knew I'd probably be headed to the hospital, but out of wishful thinking and simplicities sake, I did not spend the time trying to figure out what to take with me. "If I need it, Mark will bring it." Was the thought I had.

The midwives confirmed it was indeed a PROM, as amniotic fluid poured down my legs. We discussed my disappointment and with their well wishes and hugs, I headed off to my sister, a CNM, who no longer worked with, but knew many of the staff at the hospital I had chosen. Knowing my lifestyle choices as she does (very natural approach/non medical intervention) and as educated as she is (pros/cons/terminology/procedural) I chose her to be my advocate. She would then drive me to the hospital L&D. It was the last time I would feel the sun on my face for an entire month.

My visit started immediately by refusing a catheter catch urinalysis to check for infection and a vaginal exam.

Mark came after work with a few things I would be needing: toothbrush, change of clothes, hairbrush, etc. I spent the night in observation. A cascade of choices and refusals followed. I was suddenly thrust into a game of deciding which medical interventions and treatments I would agree to, which ones I would argue, and which ones I would absolutely refuse. This "game" was not a fun one. Before now, I had never in my life spent a night in the hospital, and CERTAINLY had no intention of spending any time there due to pregnancy and childbirth. It was NOT my way, nor my desire.
NO, I will not agree to that.
Yes, you can do that thing to me I swore I'd never do.
Yes, you can give me steroid shots, so that if I go into labor in the next 4 days, like 96% of pPROM cases do, my baby will have a better jump start on lung development.
Yes, I will agree to IV antibiotics.
Yes, I will submit to an ultrasound so that we can guess the weight of my baby...
Yes, we will go ahead and find out the sex of our baby, since we are here... oh my, she's a she. I guess we should pick a name.
No, you cannot do a trans-vaginal ultrasound, because nothing, and I mean NOTHING is going near my vagina.

I did not sleep that first night, because I was terrified my baby would come too soon and spend the next month or two in NICU.
Day 2 came and went. I called for my notebook and pillows. Day 3 came and went and I called for other personal care items. Day 4 was like a giant milestone. Once I made it past day 4, I had been told that "all bets are off" and I suddenly thought "I'm going to be here awhile." I began asking for my fuzzy blanket, crayons, my tea, my bunny slippers, more clothes, different clothes, hair ties, blow dryer, some symbolic stones I had been given during pregnancy. By the weekend, I had many things to keep me busy, preoccupied and comfortable. Now begins the wait for baby. Would it be one more day? Would it be several more weeks? No one knew.

I made healthy food choices and stuffed myself silly in hopes that I would grow a quickly chubby and healthy baby. I stayed in bed as to lose as little water as possible. I drank Red Raspberry Leaf Tea. I drank water. I drank TONS of water. I changed my pad each time I went to pee, whether it needed it or not. I was obsessively clean. I took tons of vitamin C. I asked for prenatal vitamins WITHOUT iron. I asked for pro-biotics. I wrote out my birth plan. I wrote TWO birthplans: one for if it was very soon and baby needed extra help, and one for later on, and she wasn't in immediate danger, in case we made it that far. I refused sleeping pills. I refused stool softeners. I submitted to vitals check and fetal heart tones every 4 hours around the clock. I submitted to Non-stress tests daily (for awhile). I stayed in bed. I chatted online. I was refused tylenol. I explained and re-explained my thoughts and ideas for the pregnancy and birth. I defended my ideas to residents. I felt relieved after visits from perinatolgists. I was refused a heating pad. I had blood drawn to check for infection. I gave away my pee to check for infection. I never once came down with an infection.

I had a few bad days. I had a few sad days. I laughed about the situation. I cried about the situation. I hardly ever saw my 10 year old. I saw my 19 year old twice. I saw my husband on most days. I talked to my mother every day. I answered, "no, i'm not having any bleeding or contractions" four times a day for 28 days. I missed my cat. I missed my bed. I missed sunshine. I missed the sound of birds. I missed cooking. I missed my life. I looked forward to the future. I feared the future. I couldn't wait to hold my baby. I started to refuse the non-stress tests because I found them to be VERY stressful and NOT helpful to the situation at hand. My baby obviously did not like "performing for the machine", but I had no fear for her at that point. That machine was unreliable and a pain. I started getting irritable. I refused to be induced when I reached 34 weeks. I was told the dangers. I was told my baby's cord would get compressed. I was told my placenta was surely sheer off. I was told that infection was imminent. I reminded myself and thought only of the benefits of waiting until SHE was ready. Each day I counted one ounce of weight gain and two less days in the NICU for my baby.

I stayed at the hospital for mine and my baby's safety, however, I began to hope for my home birth again. If I made it to 36 weeks, I would go home to have a home birth. Maybe everything would turn out the way I wanted. Maybe we would be able to actually catch our own baby afterall. Maybe I really could have another perfect birth. I was getting impatient but had to wait on my baby. SHE was the one that would decide how this went. Not me, not the doctors, it was she who would decide.

The day I turned 34 weeks, I awoke to streaks of blood tinged mucus. I said to Mark, "how do you feel about becoming a daddy today?" I knew for sure that this would be the day. This was the first day that I could be attended by the midwives instead of the o.b.'s. I gave thanks that this day had come. "Well, if I have to be in the hospital for this, at LEAST I can have a midwife." I was just a tiny bit closer to a less invasive birth.

The day came and went; as did the next day, and the next. In fact, three more days passed before I ever had anything resembling a contraction larger than a braxton-hicks, although I imagined SOMETHING was happening, albeit on a very slow schedule. I was uncomfortable, but certainly not in active labor. I was becoming ever burdened with the sensations lasting days. The contractions, the blood streaks, the "feeling" like "this is it" for DAYS.

On Sunday night, I was awakened at midnight with uncomfortable contractions. I began to pace the floor. I began to have to breathe through them. I called Mark and finally told the nurse. I went to L&D and spent the entire night awake and uncomfortable. False alarm, I went back to my room.

Monday was uncomfortable as well, but the contractions were irregular and didn't feel very effective. I said nothing to the nurse. I was up all night again with painful contractions. I moved, I squatted, I changed positions. I paced. I tried to rest. I rocked my body. I breathed thru them.

Early Tuesday morning I went to the bathroom and there was a gush of blood. Ok, so now this really IS it, and I hope that's not what I think it is... After a quick check by the doctor, it was, in her opinion, exactly what I thought it might be, but was crushed to hear her voice the words: the beginning of placental abruption.
I nearly cried when I heard this, as I was so terrified of medical intervention, so terrified of medications and pitocin and epidurals, so terrified of a c-section, so terrified to come all this way, fight so hard, and lose my baby, so disappointed and sad to have lived the last month of my life in a hospital, away from my family, away from MY life. So upset to have spent so much time defending myself and my baby, just to have it end like this. I was very upset, albeit not surprised that with two perfect homebirths behind me, this baby would come in such an awful, medical way. It seemed so ironic, it seemed so mean. All I could do was surrender and do what had to be done.

I was surprised when the o.b.'s told me, "it's not entirely out of the question that you still have a vaginal birth you know... you are still the perfect candidate for one. It's just that your placenta and the birth of your baby are now in a race. Your cervix is 2 cm. You may want to re-think pitocin."
I was moved to L&D and met the midwife that would be attending me. I sat on the birth ball. My mother showed up. My daughters both showed up. My sister showed up. I breathed through the contractions. They were deep and low and painful. They did not feel effective, as painful as they were. As surprised at my body as I was for a month without going into labor, I was now just as disappointed that I knew, just KNEW this was going to be a long, painful, ending in c-section and/or death for-one-or-both-of-us nightmare. I was sad.
I asked for fentanyl to ease my pain. Not my physical pain, but the emotional pain. "If it's going to be like this, I just want to be numb." It didn't help. I kept saying to my family, "I should just take the whole medical tour, now that I'm in this predicament." I began to question whether to ask for a c-section just to "save" my baby. Labor didn't scare me, a RACE between birth and my placenta did. A birth in THIS place terrified me.
My youngest daughter and mother fed me ice chips. My oldest daughter and husband pressed on my lower back. Two hours after arriving in L&D I was checked and was STILL 2cm. I was told, "I think it's time for a kick start, Julie. How do you feel about starting some pitocin?" I looked at the doctor with defeat, "I feel absolutely awful about it. I don't know how else I'm going to do it. Go ahead and start it." I was scared to death of pitocin, hearing that the contractions were horrendous and laboring without pain relief nearly impossible to do with it. I feared my uterus would clamp down and we would all die as a result of my attempt to bring my baby "sooner than later", again, in a race with my placenta.

At 11 am I was put on a pitocin drip at the lowest dose. The very next contraction told me that it was, in effect, working. I worked through maybe three or four contractions and yes, they hurt like hell, but suddenly I felt like I was in actual labor. Labor that was DOING SOMETHING and told the midwife, "can we please turn it off?" "Yes, of course we can, but I don't think those contractions are from the pitocin, it hasn't really been going in that long."
"It feels really strong, I noticed a distinct change in the contractions. I want to see how it feels to NOT be on the pitocin. We can always re-start it, right?"
"Yes, of course we can."
They turned off the pitocin, only about 10 minutes into it. The labor continued on. I spent the rest of my labor reminding myself that they had turned off the pitocin. Mark even checked for me that the pitocin had been turned off. I couldn't believe it. The contractions were so intense and so close together, there is no way there was no pitocin. My sister laughed and said, "I can't believe that you felt that... it was so little... maybe you only needed a little whiff of it to get things moving."
I began to have contractions every 3 minutes or so. I doubted my body even more, the pain so intense. So much more intense than my other labors. I wondered if it was because of the wires and IV's. It was so awkward to try to labor with all these monitors and blood pressure cuff and oxygen monitor. I wondered if being in the hospital made it hurt more. I felt like a caged animal, unable to labor as I wanted, move as I needed, arrange myself for the best possible working of each contraction. I did the best I could, changing positions, standing, rocking swaying, sitting on the birth ball, laying on my side... that hurt the most. Swaying on all fours.

I suppose some would think I was not restricted at all, however, I am not used to such interventions and accessories to birth. I felt trapped. I felt tied down. I felt very encumbered. It was so unnatural to be doing this very sacred thing in such a medical and institutionalized place of business. I wondered if there was something wrong. Nothing told their machines that anything was wrong, I had doubted the machines all month, and my body all day. I was still convinced I'd end up with my worst fears realized, and really unsure of how long this torture would last, I asked for an epidural. I wanted to see my baby born. I had been up for two days. I was afraid a spinal wouldn't last long enough until the c-section. I asked for an epidural. I felt defeated and cheated by my body. My 19 year old told the midwife, "she doesn't really want an epidural! MOM! You don't REALLY want an epidural! You don't want them drilling a big needle into your spine!" "Oh Bayleigh, If I have to be here, if I have to do this, if I have to do it this way, I might as well get the entire tour." I said. "If I am less than 8cm, I want the epidural." My mom said, "you don't have to be a hero, Julie." "I know mom." The midwife checked me and I was 6cm. "Give me the epidural." The midwife asked me, "Julie, do you want me to talk you out of this?" "NO." Was my answer, hard and firm as it sounded, I was very sad inside. I didn't want it. I wanted to rest. I had not slept for two days and had no idea how long this would last. I was not at home and I used to tell people, "in the hospital, at some point, EVERYBODY asks for the epidural."

It was true. I never asked for one at home. It was the farthest thing from my mind. I felt defeated. I wanted this to end. I wanted to be numb and I wanted my baby. They called for the anesthesiologist. I continued to labor hard and fast. Minutes later, the anesthesiologist arrived and told everyone they had to leave, except for one family member. Everyone left the room, except for my husband. She scrubbed my back down. The contractions were one on top of the other, no breaks in between. She kept telling me to hold still. I began to make otherworldly noises. Mark thought the anesthesiologist was hurting me. I knew it was the sounds of childbirth. She began to put in the little numbing shots. I continued to moan and squirm. Thinking the entire time, "oh my god, I can't believe I am submitting to this. I can't believe I'm going to NOT feel my baby be born." I said out loud, "I am getting pushy. I want to push." The anesthesiologist said, "ok." she grabbed the plastic off my back, gathered her things and left, just that quickly. The nurse said, "Let me check you!" I lay on my side on the bed. The nurse checked me. She said, "Julie, there is no cervix there. You are fully dialated." I could have told her that. I had gone from 6cm to fully dialated and pushy in less than 20 minutes. She left the room to fetch the midwife and family. Out the door we could hear her, "Baby on the way! Baby is coming!"

It was at this point, Mark and I were in the room. No doctors, no nurses, no midwives, no machines, no drugs, no family, no hospital, no place, no time. Nothing existed but me, him and this amazing force called childbirth. I reached down and felt the top of my baby's furry little head. I felt my perineum stretch. I panted until the next push came, holding my hand on the top of her head. I stopped panting and pushed. I felt her crown; my perineum stretching enough to let her soft little head out to about her cheeks, maybe to her little neck. So precious and tiny and I could FEEL her as she entered the world, her head fitting perfectly in the palm of my hand. I panted. With the next push, a long and hard one, I guided her out and felt her move past the shoulders, and with great expulsion, as her body became longer, my reach became shorter. As I became WE, I looked up to see Mark reaching for her, and I knew she'd be ok. I knew I could let go. I knew her papa would hold her and make sure nothing happened to her. I was able to let her go. Just the two of us, and now the three of us, I collapsed onto the bed, fully relaxing for the first time in a month. We had delivered our own baby, unassisted, in a HOSPITAL.
The midwife was soon behind Mark, helping him wrap her in a blanket and hand her up to me. Time stood still as I gazed into this tiny, beautiful work of art. She gazed back. She was perfect, absolutely perfect. She was finally here.

The room filled with people. Doctors, nurses, family members. All in disbelief at what had just transpired. My 19 year old was pissed she missed it. My 10 year old kept repeating, "oh, she's SO CUTE!" Mark kept saying, "good job." The midwife said, "I don't even know why I came to work today!" The doctors said, "We might have known that after all of this, you would end up delivering your own baby. We just thought you would bar the door to do it!" Our little Ember Lotus Halcyon came into the world in less than 3 hours after the whiff of pitocin, 6 days after the first tinge of blood, 3 days of prodromal hell, ONE MONTH of hospital bedrest, at ALMOST 35 weeks gestation. Some would say too early. We think she was right on time. Many say "unbelievable".

Never one minute in NICU, never an issue with breathing, she stayed warm on the bare chest of mama and papa. We all left the hospital together: Papa now a father for the first time and filled with love and so many feelings he never knew existed; me after one long and harrowing month, the last week being by far the most difficult; a placental abruption, a retained placenta, a hemmorage amounting to two liters of blood, a manual removal of the same placenta... and her... with a mouth so tiny that breast-feeding will take weeks to establish fully; a yawn so dainty and adorable, you wonder how something so teeny could possibly be functional, and little puppy noises that melt the heart; In a tiny pink outfit labeled "preemie" that I ordered the first week I checked into the hospital that is still too large for her, at 4lbs.9oz. we left the hospital.

She is my lesson in surrender. She is an exercise in determination and grace. She showed Mark and I how to work together again in ways that were instinctually natural. To come together in ways that we have not been, in entirely too long. A friend said it was magic the way that by surrendering some things, standing firm on others and in facing one of my absolute worst fears and turning myself over to it, we were given the gift of a perfect birth. At the very last moment, to be the ones she came to, just the two of us. Into our hands she was born. Had I not asked for the epidural, we would not have found ourselves alone at the perfect moment. Had one more minute passed, I might have actually had the epidural and never felt my baby be born. Mark calls her birth story serendipitous. I say it was kismet. She is just content to lay on my chest as I type this and sleep a deep halcyon sleep. She doesn't have to say anything. She is perfection in miniature.

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