Friday, November 25, 2011

Planning for Peanut: Peanut! part 2

In part 1, I recapped the events of pregnancy week 40, during which I was under a lot or pressure to induce labor. I managed to avoid an induction, but made a deal with my obstetrician that I would be induced on Sunday, October 30th if little Peanut hadn't arrived by then.

Week 41
On Tuesday, October 25th, I awoke relieved. I didn't have to go to a hospital or doctor's office that day, or the next day, or the next day. I could finally enjoy my sister M's visit and work in some sight-seeing before the baby's arrival. The lower half of my body was recovering from the previous weekend's ill-conceived castor oil experiment. I was ready to enjoy my last several days of pregnancy.

Of course, I told myself the same thing I'd been telling myself for weeks - all that could change if little Peanut decided to emerge from the womb. But having been aware of that possibility for a whole month and having been through the medical interventionist wringer that was week 40, I couldn't help wondering if that was ever really going to happen. Maybe she just wanted to stay in her cozy, uterine clubhouse. With all the nonsense she'd be apt to encounter every day, I could hardly blame her.

After Dan left for work and before M got out of bed, I called my best friend S and recounted the events of the previous days. S is the father of twin toddlers and his knowledge of certain terms I used - like preeclampsia, for instance - made me realize that I was joining a special club called parenthood. I didn't know what "preeclampsia" meant a week ago. And I bet that two years ago, S didn't know what it meant either. But if you or your spouse has given birth, you just know this stuff. He knew about the castor oil trick, too. He laughed and groaned simultaneously when I told him of my effort. "I think if you want to avoid induction, it's probably best to avoid self-inducing, too."

"Yeah, yeah, yeah. But hey, it gave me a preview of coming attractions. That's something, right?" He laughed at me some more. I added, "For what it's worth, I'm having contractions right now. Who knows? Maybe today will be the big day."

If this were a movie, my water would have broken two minutes later. M would rush me to the hospital just in time to avoid an automobile birth at the junction of I-24 and I-75. But the mundane truth of the matter was that I'd been feeling contractions for days, even before the castor oil debacle. I didn't know at the time that what I was sensing was more than just a strong Peanut kick until I was hooked up to a non-stress test monitor. But there it was, registering a neat, little bell curve on the pink graph paper printout. Contractions are no big thing until they start coming hard and frequent, and even then they can stagnate. I met a woman who told me she'd had contractions six minutes apart for ten days before she gave birth. Now that's a bummer.

After I hung up with S, I drank coffee and nibbled some food with M. Though I was in a good mood and happy to have some mellow time at home, my appetite remained elusive. I can't eat when I get nervous or anxious, but what was there for me to sweat? Sure, those contractions were more intense than any I'd felt before; the castor oil contractions made my uterus feel like a balloon that's being inflated, but now I felt grinding cramps rising from the cervix. But these were still too infrequent to be taken seriously. I decided to think about other things. M and I made sight-seeing plans for that afternoon and eventually rose from the sofa to get ready.

When my obstetrician Dr. B described contractions to me around week 37, he said, "It's enough to stop you mid-sentence, if not to stop you in your tracks." I was walking Dulce when I felt the first one of those. I remember standing in the middle of the street, staring at my neighbor's yard, thinking, Oh, that's what he meant. Several minutes later, when I was gathering my purse and cell phone, I felt another one. By the time we had buckled our seat belts in M's car, I told her, "I've been feeling pretty regular contractions for a little while now. I'm going to start timing them." That was at 2:30pm.

We drove up Lookout Mountain to Point Park, a Civil War memorial that boasts the best view of the city. I reminded myself of the number one bit of advice given to women in early labor - just go about your business as usual. Buy your annual Point Park pass because the old one expired. Show M the beautiful view of the city. Go to the bathroom. Nothing to see here, move along! But I couldn't help leaning against a rock or sitting on a bench every time I felt that grinding cramp, and the clock sure wasn't lying. Seven minutes. Eight minutes. Ten minutes. Back to eight minutes. I knew I was a long way from the finish line, but it seemed like this might really be happening.

By 3:30pm, I gave up any pretense of continuing our sight-seeing tour, but I definitely had to eat. Doing that would only get harder as labor progressed. We headed to The Terminal, my favorite restaurant/brewpub in Chattanooga. Thinking with respect for my stomach and the work ahead of me, I eschewed the root beer and bison burger I really wanted and ordered a water and salad instead. We sat at a high table in front of the bar. The stools looked more inviting than low chairs or wooden booth benches, though I still had to stand up and stretch as each contraction rolled across my belly. I think I caught our waiter smiling excitedly as he passed our table. If this were a movie, they'd lay me on the bar while the brewmaster shouted at his minions to fetch the hot water and towels. What's with the hot water, anyway? Is it really going to stay hot throughout the entire labor?

I'd called Dan at the start of our meal, just to let him know that something might be happening. Like me, he was cautiously excited. "Oh. Okay... why don't you call me back in a little while and let me know how it's going?" Before we left the restaurant, I did just that, telling him he should meet me at home as soon as possible.

I found the remainder of my early labor hours very difficult. Trying to go about business as usual when you know you're about to give birth seems like trying to do your income taxes while tripping on acid. How does one focus on everyday stuff when your whole world is suddenly bathed in a fresh, strange light? I tried watching "Pootie Tang" with M. I tried tackling simple household chores. But by 7:30pm, I was sitting in bed, attempting to eat crackers and apple slices with my eyes closed, bracing myself for those ever-increasing contractions. I'd phoned our doula A earlier to let her know I was in labor. She said that she would come whenever I felt I needed her there, allowing one hour of travel time. The natural birth books say that you move to the next stage of labor when you find yourself getting "very serious". Was I there yet? I mean, I felt a little uneasy but I was still able to mock Alex Trebek as Dan and M watched Jeopardy in the other room. If I could still joke around, did I really need A to come over quite yet?

I held out until around 10:00pm. By then, my contractions were three to five minutes apart and I was starting to get a little freaked out. It wasn't the pain that worried me as much as the feeling that this was all suddenly moving way faster than I could handle. A arrived at 11:00pm, along with her young apprentice E. NOTE: When I hired A in August, she knew she'd be busy in October and asked if we'd mind her bringing in E, a doula-in-training. If another client's birth prevented A from getting to us in time (unlikely, but not impossible), E could step in. Otherwise, we would have two doulas instead of one. The latter scenario came to fruition, which is greater proof that I am the luckiest of bastards.

The first thing I said to A and E was, "I think it's getting serious, but it's so hard for me to tell because I make a joke out of everything!" A nodded in her sympathetic but not exactly agreeing way, and I suddenly felt calmer. She was carrying a Pilates stability ball and suggested I use it to make myself comfortable. I got on the floor, my knees resting on a pillow and laid my chest upon the ball. I rolled gently, back and forth, as I awaited the next contraction. A encouraged me to breathe deeply as she and E rubbed my back with silken fingers. After the contraction passed, I turned to them and said, "Thank you very much. That felt really nice."

I now realize that would be like taking one bite at the start of an exquisite twelve course meal and saying to the chef, "Thank you very much. That tasted good." Between A, E, M and Dan, I had people massaging and comforting me until we left for the hospital around 7am. Sometimes I had all four of them at my side. Other times they would work in shifts, taking turns to eat, go to the bathroom and nap. I spent most of those eight hours leaning over the stability ball, my eyes shut. But sometimes I would stroll around the house, pressing my hands against a wall as I slowly breathed my way through the steadily longer, harsher contractions. I took a bath at one point. I threw up a couple times, too.

I used to think that vomiting was the worst physical malady, but labor pains gave me a new perspective on that. Puking was just a big relief. Contractions are such a different beast. I kept in mind what I'd read in the natural birth books, that each contraction brings you one step closer to meeting your baby. The best thing to do is to not fight it, but just let it happen. Early in the night, A advised me to make low, deep grunting noises as the contractions occurred. I felt a little silly at first, and then I got scared. I whimpered and nearly cried, but A cut me off. "Tara, no. Breathe deeply. Low, deep grunting sounds." That shook me from my panic and honestly - no shit - I never lost my cool after that point. Making those noises gave me a focus. When I felt the pain rising within me, I knew exactly how I had to approach it. I just had to be like the dude from Crash Test Dummies.

Throughout the night, I kept thinking, If this were a movie, I'd be screaming and saying mean things to my husband. According to my witnesses, I was actually very quiet and polite. The movies make you think that the experience of childbirth turns every woman (regardless of her usual temperament) into a raging shrew, which is okay because she's giving birth. And really, if that happens it is okay, but it didn't happen to me. And I take some satisfaction in knowing that even in those most trying moments, I was absolutely myself.

Having an attentive entourage sure as hell helped. But it wasn't until 2:00 or 3:00 in the morning that I noticed the littlest helper of all. After a contraction passed, I lifted myself from the stability ball to take a sip of water and saw my cat Zenobia laying at the edge of the bed. She stared at me, with her front left paw outstretched, as if she were ready to rub my back. E said, "She's been at your side all night." And she followed me the rest of the night, too. Since then, Dan has referred to her as a Certified Nurse Midcat*.

Zenobia - Queen of Palmyra/ Therapy Cat

Around 6:00 or 6:30am, I thought my water broke. I now know that it was actually more of the show that I'd seen on Saturday night (a lot more), but that's when we decided it was time to go to the hospital. I'd told A earlier that I was afraid of the ten mile car ride. I imagined every railroad track, bump and abrupt curve, and how the contractions would magnify those seemingly minor discomforts. She smiled serenely and said, "But in the grand scheme, it's not such a big deal, is it?" It wasn't. Again, I was calm. We left at 7:00am. The earliest glimpses of dawn and the cool, dewy October air was just the refreshment I needed as we slowly made our way to the car. Believing that my water had broken, I was slightly alarmed when I didn't feel any contractions on the way to the hospital. Shit, am I almost to the pushing stage?

Alas, I still had several hours of work ahead of me. The contractions resumed after I got to my room. The nurse verified that my cervix was 6 centimeters dilated and my water bag was intact. And as the long hours passed, I knew I'd stay in a holding pattern until that water broke.

Around 11:00am, I was sitting with my chest against the inclined back of the hospital bed, my arms dangling over the edge, waiting for the next grueling contraction. If I were to fulfill most people's expectations, this would be the moment I'd be begging for an epidural. Most women get to some point in their labor when they start to think, "I can't do this." It's usually when they're really close to the pushing stage (which is generally easier and more satisfying than the stage I was in). I wasn't doubting my ability to handle the situation, but I was starting to believe it would last forever. There was no way I'd ask for an epidural; after all my fussing for a natural, un-induced childbirth during week 40, my pride just wouldn't allow that. And I didn't think it would help anyway. I considered asking the doctor to break my water bag, but my experience thus far was that every intervention seemed to involve more difficulty. Every simple test involved marathon monitoring. Every quick IV injection of antibiotics led to an hour of being hooked to a machine. No, I was determined that little Peanut and I were going to do this together. Yes, I'd have to endure more contractions. So what? You've already been through a whole day of this. Pain is just a thing and you can put it aside. Why fear it?

Eventually, A convinced me that resting on the toilet would be the best way to get my cervix to open up. I was sitting there, leaning into Dan's arms, and I could feel Peanut pushing against the water bag. By this point I was no longer just letting the contractions happen. I was actively working with that pain to push baby Bernadette toward her destiny. I buried my face in Dan's belly, grunted and pushed, and then I heard the second happiest sound of my life. Splash!

A, E and M cheered. I exhaled and laughed. The nurse barked, "Okay, that was the water. Get up! I'm not having any toilet babies today." I begged for a moment to rest, but she wasn't having any of that. As I stumbled toward the bed, she called Dr. B and I readied myself for that glorious, much-touted pushing stage.

If this were my everyday life, I would be so embarrassed right now. Forget the fact that I'm not a particularly touchy-feely person and I shy away from massages. Forget that I tend to avoid being nude around anyone who isn't Dan. I'd been walking around half-naked, falling into other people's comforting arms for hours. But now I was expelling all sorts of liquids from the space between my legs. I didn't care. The nurse was of a much different opinion. "It's going to take me hours to clean this up!" she muttered. And though I usually take pains to avoid being a bother to anyone (especially workers), I didn't care about that, either.

When Dr. B arrived, I could tell he was uncomfortable with two doulas in the room, though I'd told him on several occasions to expect them. He seemed to have completely forgotten about my birth plan, too. "No stirrups - what?!" He just couldn't handle all of this previously discussed information, so he behaved like a douchey buffoon. Out of nowhere, this trusted professional started talking to me in this weirdly bombastic, too-loud tone. Occasionally he'd take a time-out to flirt with the nurse. How did my high school gym teacher get in the room? Is this guy actually going to deliver my baby? At one point, he looked at A's DONA shirt and asked, "What's a donna?"

"Um, it's DONA. It stands for Doulas of North America."

A blank stare and "Huh," was all he could muster. He turned to me. "Okay, Tara. Now you're getting ready to push. This is the one situation where I think it's better for a woman to not have an epidural". Translation: it's the moment when it's more convenient for him that I didn't have an epidural. "I need you to take all your energy and push where you feel pressure, right here," he said, reaching into my vagina. "Push like it's a bowel movement. Okay... now! Push!"

I took a deep breath and exhaled as I pushed, but the results did not please him. "No!" he said. "C'mon, like a bowel movement!"

I was beyond unembarrassed. I felt like taking a dump right then and there. Bowel movement? Here's your stinkin' bowel movement! Thankfully, A chimed in with other advice. "Don't let your breath out. Use it to help you push. When you feel the urge, you'll probably push a few times. Just make sure to get a deep breath between each one. And take a break whenever you need to. "

Oh, how I relished those breaks! This stage is supposed to be so great because you get to take control and really make that baby move. But it requires a lot of energy and I was oh so spent. I'd been awake for 30 hours, I'd thrown up everything I ate in that time, and here I was at the end of the most physically exhausting trial of my life, trying to push a baby through my vagina. Yet, when I felt that urge to bear down, I had no choice but to give it my all.

Dr. B saw some progress. When I got some good pushes in, he encouraged me to stick with the same technique. And then he started saying, "Push through the Bern!" Well, that's a weird way to refer to my baby. How does he remember her name is Bernadette when he can't remember that I have a birth plan? Then I realized he was really saying, "Push through the burn!"

That was actually helpful. Push through the pain. Don't hold back. Each time I did, my audience would coo with delight. "Oh my god, we can totally see her. She has hair!" they told me. I'd spurned the birth mirror - I had enough on my plate without having to look at the mess between my thighs - so I only had their reaction to track the baby's progress.

Even Dr. B got excited. "Yes! We can see her head. It's about the size of a dime."

WHAT?! This much pain and all they could see was a dime-sized bit of baby head? But my body was too busy for me to stew. I pushed some more. I pushed through the burn. As everyone got more excited, I was more eager to be done. And when I heard Dr. B say, "Here she comes," I took a deep breath, pushed into the most excruciating pain I've ever known and screamed in agony. And then I heard another scream. And that's the best sound I ever heard in my life.

At 2:10pm, I cried, "She's here! She's finally here!" And there was my little Peanut, Bernadette, dangling in Dr. B's hands. By that point, there seemed to be about 20 other people in the room. Though I had wanted to hold her immediately, they took her away for a cleaning since there was meconium in the fluid (apparently, Bernadette wasn't shy about pooping either). Since all I ever wanted was for this baby to be strong and healthy, I honestly didn't mind waiting for them to get her ready. But it felt like forever before the nurse laid her across my belly, where she immediately latched to my breast and began feeding. "Well, hello there!" I said. "You're just beautiful." And then I fell into her twinkly eyes. That's how I met my daughter.

So, yeah, giving birth naturally is definitely the coolest thing I've done in my life. It gave me a new perspective on pain and a new measure of my endurance. I felt enormous pride when A leaned over the bed and said, "You are a strong woman." I certainly don't think that anyone who chooses to use drugs during birth is wrong for doing so. Rather, I wish all women felt comfortable, sufficiently informed and empowered to make whatever decision suits them best. I'm just so happy that I got to do this how I wanted, especially since my moments-old baby looked like this -

Healthy and strong, just as I'd wished.

*Contrary to our fears, Zenobia has been an absolute sweetheart to Bernadette. She seems to regard the baby with a certain maternal awe, gingerly leaning in to sniff her head before shyly backing away. Z also continues to comfort me. For instance, there was a night during the first week when B screamed for hours. Dan offered to walk her around the house while I tried to get a few minutes of sleep. I was laying in the middle of the bed with the blanket pulled over my head when I felt Z crawl under the sheets. She used her front left paw to press my hand against the mattress. Then she retracted the claw in her right paw and used that to caress me. I had no idea she was so coordinated, or so sensitive! Well that just melted my heart into grateful, sleepy tears.

Friday, November 11, 2011

Planning for Peanut - Peanut! part 1

Part 1
Week 40 - Worst Week Ever
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.
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?"
"You mean you want me to be induced?"
"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.”
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.
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!