Planning for Peanut - Peanut! part 1

Part 1

Week 40 - Worst Week Ever

Tuesday

Though I had no expectation little peanut would arrive on her due date, I chose to greet Tuesday, October 18th with a celebratory spirit. Though I could no longer wish for an early arrival, I took the date as a reminder that she would likely show up in the next couple weeks. And what's two weeks compared to nine months of waiting? Other than the frustration that comes with fielding the ever-increasing inquiry "Is she here yet?" I happened to feel perfectly fine.

Still, I anticipated my 40 week doctor's appointment with some trepidation. I knew that my obstetrician, Dr. B, was out of town and that I’d be meeting with his colleague, Dr. C, instead. All I knew of her was a particularly harsh online review I'd read when I was researching their practice (though I knew it wasn't fair to put too much stock in a single internet rant). And I also knew that this is when they would start with the twice-a-week ultrasounds and non-stress tests to monitor the baby's health. Though gestation is commonly anywhere from 38 - 42 weeks, as far as these doctors were concerned, 40 weeks is when you raise the red flag.

But again, I felt fine and other than testing positive for beta strep (a somewhat concerning condition that meant I’d be treated with antibiotics during labor - no biggie to me), I'd had absolutely no prenatal issues. So I was a little surprised when the triage nurse stated my blood pressure reading - "138 over 90".

140/90 is when you start to worry. I think my previous week's reading had been 110/70, so this was definitely abnormal. But since I felt fine, I wasn't too upset.

A woman wearing a loud plastic smock showed me to a room where I was hooked up to a non-stress test monitor. She was neat in appearance but quite sloppy in spirit; I immediately found her unnerving. In introducing herself, she mumbled something about "Dr. C", which led me to believe that she was the doctor (though she was dressed more like a nurse). Oh, boy I thought. This woman does not give me confidence. Dan thought I would be having just the ultrasound that day and asked her to check if the NST was really necessary. She nervously scurried away and returned a few minutes later, bearing a desperate, "Please don't scream at me!" expression.

"We have you scheduled for an NST and an ultrasound, but actually the ultrasound machine is broken so we may have to send you somewhere else to have that done or we may need you to come back tomorrow."

Ugh. I'm not a complainer and I certainly don't scream at anyone, so I decided to just suck it up and do what needed to be done. I just had to relax and get through the day. Hopefully little peanut would show up before my Friday appointment so I could avoid any further tests.

Relaxing in that atmosphere was no simple task. It seemed that all the staff I encountered were handling me with something I call "suicide watch kid gloves". That's when everyone seems to think you're about to lose your shit at any given moment, but you have no idea why. It would be like going to work on a day when everyone but you knows you're about to get fired. This was on top of the general atmosphere of mayhem that permeated the office that morning. With two physicians out and the ultrasound machine broken, I could tell they were all having a bad day. And then the NST monitor - which looked like it belonged in my elementary school's computer lab, circa 1985 - started chewing its paper printout, which could give the impression that little peanut's heart rate was plummeting. Dan alerted the lady in the loud smock, and she freaked out a bit more as she tried in vain to re-feed the dispenser. At some point, she reread my blood pressure - 138/80.

Finally, around 1pm, we were ushered to another room where I was to have my cervix checked. A few minutes later, a woman in a long white coat came in and introduced herself as Dr. C. Well that's a relief. (Later, I told Dan, "I thought that nurse said she was the doctor." He told me, "No, she introduced herself as Dr. C's nurse." Hmm.) "Your blood pressure has gone up. If you were past your due date, we would be really concerned about this. But since today is your due date, we'll let it go." Okay, that's completely arbitrary, but whatever. "We're going to send you down the road to get an ultrasound, just to check the baby's weight and fluid. That's at 3pm. And then you'll be coming back here on Friday. But I'm going to give you a list of symptoms and if you have any one of these, you need to call me immediately." I know now that she was looking for signs of preeclampsia - a headache that doesn't go away, increased swelling, upper abdominal pain, etc. I promised to call if any of those symptoms occurred. She checked my cervix and gave me one of those damned nervous smiles. "Still just one inch dilated," she said, as if this little ditty were playing in the background -

But I wasn't worried. Plenty of women go from one inch to fully dilated in a matter of hours. As Dr. B said on several occasions, "You really can't predict when labor will happen."

Since our one hour doctor's visit was turning into an all-day affair, Dan and I treated ourselves to a big lunch before heading to the other office for the ultrasound. Of course we'd hoped they would get us in right away so we could get that lousy day over with, but that just wasn't the case. As Dan pondered a Sudoku, I tried to build an interest in the General Hospital episode that was airing on the waiting room TV. Finally, a nurse approached us. "Excuse me. Are you the woman who is 40 weeks today?"

I smiled and affirmed. She laughed. "Wow, that's amazing that you're exactly 40 weeks and the baby isn't here yet. My daughter is 39 weeks and she is not happy." I made some vague pitying noises on behalf of her child. She continued, "I mean, I look at her and I look at you and I wonder, why don't you just get it over with?!" She laughed some more. Assuming she was about to take us to the ultrasound room, Dan set down his puzzle and stood up. But then she just walked away.

Friday

Since the ultrasound checked out fine and I hadn't experienced any of Dr. C's concerning symptoms, I had no worries about my Friday appointment. I dropped Dan off at work before heading to the office. Dr. B was still out of town, but I could tell that the workplace vibe was much calmer than it had been on Tuesday. But again, the blood pressure reading was higher than I'd hoped - 139/85.

The loud smock nurse was dressed in regular clothes and her hair was coifed with lots of gel. It was casual Friday. She attached me to the NST monitor again and I lazily read a magazine, knowing this could take much longer than the half hour that they generally claim. I didn't think much of it when she came back to check my blood pressure again (or the fact that it had barely changed since the first reading).

Moments later, Dr. C made an abrupt appearance. "Tara, your blood pressure is high. I'm diagnosing you with gestational hypertension and I'm going to recommend delivery."

I felt every muscle in my body stiffen. "When?"

"Tonight."

"You mean you want me to be induced?"

"Yes."

"Oh... I really don't feel comfortable with that."

"If we don't induce, your condition can develop into preeclampsia really fast and then your placenta could detach from your uterus and your baby could DIE."

And that was the first of many times I burst into tears during week 40 of pregnancy. NOTE: While I tend to have a pretty good memory, I admit I cannot remember most statements word-for-word. But I can tell you with absolute certainty that her sentence ended with the words "and your baby could die." I don't think that's something I could ever forget.

Dr. C was obviously surprised by my reaction. "I know you'd feel better if Dr. B were here for this."

Well, yes, but that's hardly the main reason I'm freaking the fuck out. "It's just that I really wanted to do this naturally. And I know I need to do what's best for the baby, but I didn't want it to be this way."

I can't remember how she reacted to that. I just know that a couple minutes later I was alone and the first thing I did was call Dan. He was in the middle of teaching his class, so I had to phone his department's office and ask the secretary to alert him. She was absolutely giddy when she realized it was me calling. She thought I was in labor. As I waited for Dan's return call, I imagined her excitement as she walked to the lecture hall. I thought of his students' reaction as she told him to call his wife, and how thrilled he would be to finally get that news. And it broke my fucking heart.

It was a terrible moment to be alone. I couldn't help remembering my wedding day, when I went to the salon to get my hair done. I'd been thinking of it as just a mundane task, not some sacred lady ritual that required the presence of an entourage. So I went by myself. And it wasn't that I suddenly wanted to make it into this special bonding moment with my non-existent bridal party. But as I sat and observed all the other brides on that June afternoon, I felt conspicuously out-of-place. The stylist was clearly confused by my being alone, and that I had no idea how I wanted my hair arranged. It would have been really nice to have a friend there, if only to say, "Hey, someone in this world thinks I'm normal for being this way."

The phone rang. My tearful greeting was a curt coda to Dan's happily anxious, "Hey, Tara!" When I told him what happened, he quickly reassured me that we were doing what was best for the baby. He asked if I had called our doula A. I hadn't, so he agreed to do so and promised to get there as soon as possible.

By the time he arrived, I was calmer but also more frustrated. Loud smock nurse had revisited my room several times and told me not to cry. "If you cry, you're going to make me cry!" she pouted, as if I cared. When he and I had a moment alone, he mentioned some of the things he and A had discussed. As a doula, A's job is to assist us in having the birth that we want. She doesn't give medical advice, but she's knowledgeable enough to express a variety of options. Sometimes, she just asks really good questions, like, "Were you diagnosed with gestational hypertension or were you diagnosed with preeclampsia?" or "If high blood pressure is the main concern, did you talk about alternatives to induction, like bed rest?" Hearing those questions made me realize that I had the right to slow down the process and at least ask for other options. It also reminded me that the ultimate decision was ours to make.

After the NST and ultrasound indicated a perfectly healthy baby, Dan and I spoke to Dr. C again. "Are there any alternatives to induction that we could consider?"

She sighed. I said, "Look, I know induction is pretty common here in Chattanooga, so it probably seems weird that I'm so upset about it - "

She became self-conscious and mumbled, "Yeah, it is really common."

"-but I really want to avoid having a C-section, and I know it's way more likely if I get induced."

In a slightly louder tone, she added, "Yeah, it's a 50% chance."

All I could say was, "Wow." I knew the rate was high, but I had no idea it was that high.

Suddenly, the doctor was open to alternatives. We agreed that I would have blood work done and that my blood pressure and the baby's stats would be monitored for six hours that afternoon. I would also complete a 24-hour urine sample (yep, that means collecting bits of urine in a big plastic jug over a 24-hour period). If there were any concerning symptoms, including a high level of protein in the urine, I would be induced asap. "And I want to go ahead and schedule induction for Sunday evening." This felt like a blessed reprieve, so I agreed. Dr. C sighed again. "If Dr. B finds out that I let you go, he's going to kill me!"

That's when we found ourselves in the odd position of comforting her. "Oh, he'll understand. We showed him our birth plan and he knows - "

"You have a birth plan? Ugh!" She actually groaned.

"It's just one page! We're very reasonable!" She whined a bit about parents with seven page birth plans, we demonstrated pity for the burden of her well-paid profession, and about a half hour later, we arrived at the hospital for my extended monitoring session.

After we got settled in the room, I told Dan that if peanut didn't arrive by Sunday night, I was willing to go along with the induction. I was a little surprised by his disappointment, but now I'm really grateful for it. If six hours of laying on a bed, hooked to a machine showed me anything, it's that being stuck in bed and hooked to a machine is miserable and a bit terrifying to me. I began to feel as if I were sick and weak, though I actually felt perfectly fine. And when I really considered why I was willing to go with induction, I had to admit that it came from a fear of confrontation more than concern for me or my baby. Frankly, I'm just really bad at sticking up for myself.

Just as I expected, the monitoring revealed no symptoms other than my higher-than-usual blood pressure. After reviewing the data, Dr. C decided I was fit to go home. By the time we left the hospital, I had decided that if my condition remained the same, there was no way I was going to let myself be induced on Sunday evening. And yet, I dreaded that inevitable confrontation with the dctor. It seemed that the best possible outcome would be giving birth before then. And that’s when I figured it would be a good time to experiment with castor oil.

The Weekend

Perhaps it seems odd to self-induce labor when an induction is exactly what I sought to avoid, but there are enormous differences between taking castor oil and being dosed with Pitocin. One of my main desires was to labor at home as long as possible before going to the hospital – not only because home is a more pleasant and comforting environment, but also because this is a smart way to avoid an unnecessary C-section. And unlike natural or even castor oil-induced contractions, Pitocin-induced contractions tend to be constant; you don’t get that rest in between that makes the experience more bearable (which is why induced women are way more likely to opt for an epidural).

Nevertheless, I jumped into the castor oil decision without doing much research, and I don’t think I'd be so eager if I knew then what I know now. I was wise enough to wait until I had completed my 24-hour urine sample before ingesting the oil on Saturday afternoon. In the meantime, Dan had enlisted our friend M in Wilmington, NC to drink some castor oil that same day, as a show of solidarity. M enjoys food challenges (especially those pertaining to hot sauce and spicy peppers), so he promptly agreed. We settled on Saturday afternoon as our “chug time”, though I was a bit delayed as I was waiting for Dan to get back from dropping off the urine sample at the hospital lab. M called me around 1:30pm. “Did you drink it yet?” When I told him I hadn’t, he warned, “You definitely want to mix it with something.”

“Yeah, I’m gonna put it in a smoothie. Why, does it taste gross?”

“No, that isn’t so bad. It tastes like wooden tongue depressors. But it’s just so slimy and viscous!”

Eww. When I poured the oil into my beverage, I saw exactly what he meant. That puddle of slightly yellow goo hung on top of my drink until I thoroughly stirred it in. Oh, well. Bottoms up!

The contractions started just a few minutes later. It was never too painful or intense, but they were consistent, coming every five to ten minutes. I got really excited, but within a couple hours they had all but ceased. I took my second dose of oil shortly thereafter. Not much happened at first, but within a couple hours I was having stronger contractions at eight to fifteen minute intervals.

Again, the pain associated with the contractions wasn’t bad. The real pain was from the diarrhea, which went from “Okay, this isn’t so bad” (at around 6:30pm) to “Oh my god, what have I done to myself!” (by about 9:30pm). At some point in between, M sent Dan what may be the best text message I’ve ever read –

“My anus is a hose. How’s Tara doing?”

Solidarity, indeed. This was a base, dirty pain, but at least I wasn’t feeling it alone.

The contractions lasted throughout the night and when I went to the bathroom at 3am, I noticed a small bit of the mucus plug (which can be a sign that true labor is imminent). I felt great joy at the pulsation in my belly and for being at home while it was happening. I knew at that moment there was no way I was going to let anyone take that experience from me.

But by 10:30am on Sunday morning, my resolve was all I had left from the castor oil experiment. Just as the diarrhea waned, so did the contractions. I made a quick decision and asked Dan to call the doctor’s office and tell them that I had been experiencing regular contractions every fifteen to twenty minutes - which was still true as of 10:45am - and that there would be no need to induce that evening. Technically, we weren’t lying (which is sadly important to my irrepressible inner Catholic) and even if I wasn’t really in labor, I’d be able to avoid the induction and another interaction with Dr. C.

Dan spoke to the on-call certified nurse midwife, who happily agreed to cancel the induction. She reminded us that it would be best to go to the hospital when contractions were every five minutes and lasting one minute in duration. If we didn’t get to that point by Monday morning, I was to schedule an appointment to see my regular physician, Dr. B. That’s when I cried tears of relief.

Ah, but that respite was short-lived! The CNM left a message for me a couple hours later to let me know that she’d spoken to Dr. C, who now happened to be concerned about my low platelet reading from Friday’s batch of blood work. Since this could be construed as a symptom of HELLP syndrome, she and the doctor were still recommending induction that evening. Just to clarify, I was not being diagnosed with HELLP syndrome – that would require the presence of other symptoms, such as high protein in my urine. When I called the CNM back, I asked if we could consider the 24-hour urine sample results before proceeding. She was silent for a moment. “Actually, there’s been a snafu and for some reason the lab didn’t process your sample. Dr. C told them to cancel it since she thought you were getting induced anyway.” Well, now I was just getting mad.

After a bit more haggling, the CNM consulted Dr. C and they asked that I go to another hospital to have my platelets and blood pressure checked again. If the platelets were still low, I would be induced. I was assured this visit would be brief, but of course I wound up being monitored for another 2 1/2 hours. Hello, uncomfortable bed and monitor cords! Haven’t seen you guys in a couple days.

At the end of that session, a young resident came to my room and essentially asked me, “What’s up?” I told him the whole story about my weekend (minus the castor oil experiment, but acknowledging that my contractions had all but ceased during the course of the day). Though I had answered all of his questions to so many people, so many times, he seemed unaware of the most basic details. “What’s your due date?”

“The eighteenth.”

“Of..?”

Sigh. “October. I’m 40 weeks and 5 days.”

He was clearly perplexed. “And you don’t want to be induced?”

I gritted my teeth. “Actually, despite the blood pressure readings, I feel just fine. And since I’d really like to avoid a C-section, and induction comes with a 50% chance that I’ll have one, then no, I don’t want to be induced.”

And as if I had spoken the magic words of the medically informed, he told me I was free to go.

My sister M was waiting for us when we got home. Our initial plan was that she would come to Chattanooga from Greensboro, NC when I went into labor. But it seemed silly to make her wait when that day seemed to be coming soon, one way or another. Her company was a balm to my increasingly angry mood, but at 2am, my rage was getting in the way of sleep.

“Why don’t you listen to the hypnobabies CD that A gave us?” Dan suggested. As he held my janky laptop on his belly, I listened to the dulcet tones through headphones. The woman on the CD cajoled me into a state of relaxation. “Breathe deeply. . . with every breath, let more tension go. . . Goooood. . . now give yourself an A+!”. It wasn’t exactly hypnotic, but I did get to sleep after that.

Monday

Having made it through the weekend without an induction, I was now eager to meet with my OB, Dr. B. We made an appointment for that afternoon. M drove me there, where Dan met us after he left work. Sitting in the waiting room, I wondered if Dr. B would push me for an induction, whether or not my blood pressure remained high. It seemed a strong possibility. But just knowing that he was aware of my intentions and that he was unlikely to say anything as brash or clumsy as, “your baby could die,” made me feel better about it. I happened to catch a glimpse of him when the door to the back swung open. That’s when little peanut gave me three strong kicks. She knew my sense of relief!

It was all uphill from that moment. Blood pressure reading – 132/80. NST and ultrasound – baby was doing absolutely fine. I certainly bristled when the ultrasound tech said, “I thought Dr. C was going to take her on Friday because of your blood pressure?” . . .“Take her”. . . language can be so revealing.

I sensed a mutual nervousness when Dr. B came to my room. First we discussed the contractions that had started and stopped. Then he noted that my blood pressure was back down and that the baby was checking out fine. Maybe because things seemed to be going our way, I felt emboldened to say, “It’s funny to me that when she first recommended induction, Dr. C said my baby could die. But then, when I started speaking to her in informed terms about why I wanted to avoid it, there were suddenly other options for us to consider.”

Of course, Dr. B was inclined to defend his colleague. And he did so rather convincingly, explaining that even though there may be only a 0.5% chance of the baby dying, no doctor wants to deliver that dead baby. And then he got a bit more defensive, which led to a long lecture about big babies and the perils of shoulder dystocia. Eventually, Dan found a break in the rant and asked, “Where do we go from here?”

And for the first time in week 40, we reached an agreement that I could comfortably honor – if peanut hadn’t arrived by Friday, I would return for another round of NST monitoring and an ultrasound. If she didn’t arrive over the weekend, I would go in for an induction on Sunday, October 30. Before meeting with Dr. B, I had spoken to a friend who had managed to labor on Pitocin without getting an epidural. I asked him if I would have the option of doing the same. He sort of rolled his eyes, sunk into his chair and said, “I mean, you can do whatever you want.”

Again, language is revealing. Granted, he said it in that kinda jerky, “Sure, you can jump off a bridge just because your friends are doing it, “ sort of way. But the point is that those words came out of his mouth. And though I already knew the statement to be objectively true, to finally hear it from a medical professional seemed a glorious turn of events. And as far as agreeing to the eventual induction was concerned, I truly felt okay with that choice. One way or another, I was almost done with the long doctor’s visits and the excess monitoring. I was grateful to have a few days to recover my good spirits and regain my mental and physical fortitude. If I were going to experience Pitocin without an epidural, I’d need it.

Dan made fried chicken and buttermilk biscuits for dinner that night, and I ate with a pregnant glee I hadn’t felt in days. Dan, M and I enjoyed a lovely meal, with lots of joking and fun story-telling. At the end of Week 40, I finally felt just fine, both physically and emotionally.

And in one week or less, I would finally be meeting my daughter!