Lessons Learned

This is actually a follow-up post to The Epic Birth Story.  It is an Epic Follow-Up. John pointed out that I didn’t actually talk about what we learned from that whole experience and that was one of the most important aspects of the birth.  So here are two of the most important things we learned.  

Advocacy

I’m a nurse.  I’ve worked in hospitals.  My family has had our fair share of hospitalizations, illnesses, and injuries.  I consider myself a well-informed, knowledgeable, educated advocate in my own health care. However, looking back at the birth, we realized there were a lot of times we should have been stronger advocates with what was going on.  

One of the biggest problems was that I was never in a position to advocate for myself.  By the time I got to the hospital, I was feeling o.k., but all of my focus was going into the labor.  This was our first experience with this so we didn’t know what to expect.  John was in no place to be able to determine what should or should not be happening.  We were so thrown by the first midwife’s lack of attention that we didn’t think to ask for more.  

For John, that lack of attention is something he feels strongly about. In the future, if the midwife is too busy to spend time with us, we need a different care provider, even if it is an MD.  This is something that I know at the time I would not have wanted, but looking back, it would have been helpful.  Our midwife had multiple complicated cases going on and when prioritizing, we were low on the list.  I was a woman who had an uncomplicated pregnancy, with perfect fetus positioning, and came into the hospital laboring well and fairly far along. Therefore it seemed like we didn’t need much attention.  Honestly we didn’t, but we did need someone to listen to me and notice when he flipped his head and was now OP, causing excruciating back labor.  

For me, there was so much psychological damage done by the point the other midwife got there I was at a point of no return.  Also, the second midwife assumed certain basic assessments (such as where his head was) had been done by the first midwife, as I’d been there for many, many hours.  The second midwife did those assessments, but not right away because there wasn’t a need.  UNLESS THE FIRST MIDWIFE HADN’T DONE THEM.  

Medication

This is a topic I feel I could write a thesis on. Going into this birth, I was very pro natural childbirth. I think home births are a wonderful idea, but we decided based on our proximity to our hospital of choice and the fact it was our first child we would forgo that option this time around. I saw medication as a very black and white issue and I think this is often how it is presented. You either had a medicated birth, or you had a natural childbirth. And while everyone says either is o.k. and the midwives were supportive of either route, I have always felt there was a stigma to medicated births.  I know I definitely had one. When I envisioned my labor, medication was to be used basically if I failed. If I just couldn’t do it. 

Honestly, pretty much that is what happened when I chose the epidural.  I had failed.  I physically and mentally could not continue laboring. It wasn’t an emergency, the baby was not in distress, I just couldn’t do it. At that point we did not know about his presentation, but that doesn’t matter. The fact is I broke down and begged for an epidural. At the time, both the midwife and Angel Nurse sat down with me and had me focus on them and expressed their belief it was the right decision and in no way a failure. I remember agreeing but inside thinking, yeah, right, this is what you tell everyone. It wasn’t until Angel Nurse sat down with me a second time and impressed upon me that I wasn’t a failure, it wasn’t a wussy decision, it was a necessary one. She pointed out that I was in a hospital and they had drugs and they were there for a reason . Yes, some people chose to use them the whole time, but that in other circumstances, they are used because they have to be. Everybody wants to get the baby out and have mom and baby be o.k. That requires medication sometimes. 

Why was I so hesitant to go to the drugs?  Why was everyone so hesitant to give them to me? What was I worried about?  Did it make me less of a woman?  A mother?  Would my birth story be exciting until the moment until I say I had an epidural?  Oh, one of those women, people would say.  While it was nice to find out I wasn’t crazy and his presentation had changed and that the epidural turned out to be absolutely necessary, I think it is important for me to explain to people that I made the choice for the epidural before I knew about his presentation. I made it when the only reason to have it was because I couldn’t relax, was beyond exhausted, could not tolerate the pain any longer, and it was not an absolute medical necessity.  I wanted it.  

And I loved it.  I can’t believe I didn’t get it sooner. It was wonderful for all the obvious pain relief reasons, but there was one other reason.  That reason was that I was able to experience and enjoy the entrance of my son into the world.  It was still incredibly hard work, don’t get me wrong.  And in a lot of ways an epidural makes it harder because your ability to push is kind of limited when you can’t really feel below your waist.  But I could enjoy it.  I was able to be present and be an active participant in everything going on for his actual birth.  There is a lot of labor that is a blur, but from the moment the epidural went in I remember everything incredibly clearly.  I remember when the midwives first felt his head and then when they saw it and then when everyone else saw it and then when John got to deliver him and by that point, I had enough feeling back (without the pain) that I got to feel his delivery.  Minus the subsequent explosion. I would not trade that for anything.  And if a woman wants to be able to have that clarity and enjoyment for all of her labor, I no longer have any deep down judgements for her.  

My mom (who had two completely natural, unmedicated births) and I were discussing this the other day and she made the observation that we’d think someone had lost their mind if they said well, I need my appendix out, but I’m not going to have any pain medication, I’m going to do it naturally.  So why is it we harbor such negative feelings for women who choose to have pain medication for one of the most painful experiences a person can go through?  I know not everyone has such feelings, but I think many people do, whether they realize it or not.

I am absolutely still pro natural childbirth, but I now look at pain medication during childbirth as a continuum.  There are varying levels of pain medication and varying times it can be given. Will I automatically get an epidural at the moment I go into labor if I have any more children? No, I really don’t think I will.  Will I get one later on during the labor?  Absolutely, depending on how the labor is progressing.  I might not need it, but if I feel I do, I will get it way sooner than I did this time.  

I’m not sure why we feel we must be stoic. Martyrs for the childbirth cause.  There is way too much to worry about and to be stoic about once the baby is here.  The real work and exhaustion doesn’t begin until then anyway.  

The Vagina Monologue

Sunday, October 12
We went to visit friends of ours who just bought a house on 25 acres about 30 minutes from us. We took the dogs and did LOTS of walking. Each time they asked me if it was too much, I emphasized that I was walking this baby out of me. This was also the last night of sleeping in more than two hour chunks. I sometimes wonder how I could have enjoyed it more if I had known that fact.

~10:00pm
We call the doula and tell her to come on over. She gets there and I continue to labor well at home. It was painful, but nothing that was too much for me to handle. With the doula and John I felt like we were doing great.

October 14
~12:00am

John and the doula decide they should call the midwife again as I am becoming less responsive to them when I’m in a contraction. It was as if we’d never called the first time. Who was I? When was I due? What was my pain on a scale of 1-10? I threw the phone at John. We packed up and headed towards the hospital.We get to the hospital, the ER nurse times my contractions which are now about three minutes apart and has me upstairs practically before the paperwork is complete. We get to the room and there is a hospital gown on the bed. Not a big deal, but for me it was HUGE. This was a MIDWIFE DELIVERY. I WAS ALLOWED TO WEAR WHATEVER I WANTED. WHY WAS THERE A HOSPITAL GOWN ON THE BED??? A few deep breaths later and the nurse said it was fine to wear my own shirt. She was a pleasant nurse, nothing special, but nice. The midwife comes in. Checks me, I’m 6cm, 90%effaced. Pretty awesome for a first time mom! But no, that’s not her response. She informs me that I will dilate approximately 1cm every three hours. Thanks! And she leaves.

I was crestfallen. At that rate it would be 12 more hours. My doula was horrified that the midwife had said that. She immediately jumped in and said no, no. If I wanted that baby out sooner, we would get him out. Every woman was different and I had done great already. I tried to bolster myself back up and get my head back in the game.We walked, I spent a lot of time in the shower because it felt awesome, we did all the laboring things you’re supposed to do.

She comes back in to check me, I’m at 7cm. Pain is starting to increase. But she has a complicated delivery coming in so she’s going to be gone for awhile dealing with that. If I need anything, the nurse will be right there to help. BUT I’M HAVING A MIDWIFE DELIVERY. MIDWIVES STAY WITH ME AND ARE THERE ALMOST THE WHOLE TIME.

She comes back to check me. The pain has entered a new stratosphere. No longer is it that nice rhythmic abdominal slicing. It is now indescribable white hot agony in my back crippling me with every contraction. I can barely walk. I can only be in the shower or on my hands and knees. Any other position is unbearable. Unfortunately I am exhausted by this point. I literally fell asleep in the shower while standing up. So I have to go back to the bed at times, which is excruciating. Apparently Bogey had been sharpening my ribs and was now using them to cut his way out through my back. The nurse mentions that she thinks he may have turned and be causing back labor, but the midwife brushes her off.

She comes back to check me. 8cm. Oh you’re in transition! It will go quickly now! It is comments like those that are the reason laboring women are not allowed near any objects that could be used as a weapon. If the pain is really that bad she can give me Stadol. Or artificially rupture my membranes. That would hurt more, but speed it up if that’s my problem. But she has a C-Section to go to so just let the nurse know what I want to do. BUT I’M HAVING A MIDWIFE DELIVERY. NO DRUGS CASUALLY THROWN AT ME. NO ARTIFICIAL MEMBRANE RUPTURING. And she’s gone. I do not take the Stadol. Or rupturing.

Five hours later. Shift change. She comes back in to tell me who the next midwife is and is on her way. Good luck!  We saw that first midwife a total of three, maybe four times that night.

New midwife arrives. One I’ve seen and really liked. And a new nurse. Angel Nurse. Most perfect nurse ever to walk the earth. The midwife comes in and immediately sits down on the bed, takes my hand, and TALKS WITH ME. Where are we (oh gosh, 8cm. five hours later. hmmm. FIVE HOURS IN TRANSITION), how am I, what’s our plan of attack, what do I need, who is everybody (John, doula). Everything I’d been waiting for a midwife to say and do. She also notices on her check that there is a lip to my cervix. Problematic because it means a part of it isn’t dilating. She has John and the doula put me in a crazy position to try and get Bogey’s face to push down on the lip and open it up. This resulted on taking my already unthinkable pain to a level there are no words for. It was the most physically nauseating pain I have ever experienced. Like a gun being shoved up inside of me and going off with every contraction, obliterating my insides. I have two contractions that last 10 minutes each, with two minutes in between. The doula says enough and she and John stop forcing me into that position. I go to the shower, hoping that maybe, just maybe, when you add water to this pain you will actually melt into a puddle and disappear down the drain, leaving a baby in place of your wrecked body. Three hours later I am sobbing in the shower BEGGING for pain medication. No one will give it. I’m sure at this point if you look at my back you can see the shreds of flesh that someone has been systematically burning and gouging off. It was during this time I ask for another check.

8cm. 8 hours in transition. Which will go by so quickly, right?! The midwife sits down with me. It is time for a pow wow. Things are not progressing. I’m not relaxing, I’m actually fighting against the contractions. The problem however was that my cervix was beginning to swell. And if we didn’t figure out a way to reverse that, it would swell to the point that he could not get out and they’d have to c-section him out. After a lot of discussion an epidural is decided on. I could not get on board with that fast enough. If I could have snorted it I would have. But having it shoved into your spine is a pretty good delivery method. It was magical.The epidural was the best feeling I have ever had in my life. Or I guess really the absence of the pain was the best feeling. Never have I ever felt anything so glorious. If recreational drugs give you a feeling anywhere close to as good as the epidural, I now understand the addiction. The anesthesiologist was the most amazing person I’ve met in my life. I now see why they are paid as much as they are.

Post Epidural
Reed gets in. The midwife says we’re shutting things down for a couple of hours so that all of us can get some rest. She comes back two hours later I’m 9 1/2 cm dilated, 100% effaced. The lip is pretty much gone, but still just a little bit there. But I don’t care. Put me in whatever position you’d like, I can’t feel anything below my waist. Tie my legs together and hang them from the ceiling. The midwife and Angel Nurse are excited to see I have other emotions besides screaming.

It also turns out that when they do an exam to feel for the sutures in his head (something the other midwife NEVER DID) they find that gosh, he has turned his head and is now facing in the OP position, which causes back labor.  Had I not had the epidural, there was no way he was coming out of there without being cut out so the midwife said she was super glad we made that choice. 

Soon I am 10cm 100% effaced, no lip, and he has dropped down, ready for action. This was the most midwifey part of the labor. They are down there saying how fabulous my perineum is (sorry squeamish folks that never wanted to know that level of detail about me, you should probably stop reading now). How he is being so kind by gently stretching it. Oh, there will be no tearing you lucky girl! Angel Nurse goes to the kitchen to get some oil to rub on there, they apply warm compresses. If you listened closely, you could hear Kumbaya being sung. 1 hour and 45 minutes of pushing later, Bogey makes his entrance. And because it was a wonderful hands on midwife, John delivered Bogey into this world.

I have a baby. There is a baby sitting on my chest. It was the most shocking life altering moment. I grab him and bring him up to me, his eyes open briefly to give me a look of “what the…” and then I notice, as I hear Angel Nurse say it, his nose is flaring and he is grunting. A quick way to get yourself shipped out of the delivery room. He is pink, so no one freaks out quite yet, but he keeps doing it. We get him for about three minutes during which Reed takes a ton of amazing photos, but then Angel Nurse takes him and John, per our birth plan (it came in handy for something) to the newborn nursery. They take him to the nursery instead of the NICU so that John could go with and if something goes wrong NICU would come to him. And they’re gone.

It was at this point I notice the midwife busily still working. My first thought is oh my god, I’m hemorrhaging. But she says no, no, nothing like that. When I finally ask what’s going on, she says well, um… There was some tearing. We need to do some reconstruction. Now let me tell you, if you ever had to pick a word you would not like to hear in regards to your Vajayjay, reconstruction is that word. Reconstruction implies REBUILDING something. Something that is not rebuildable.

To this day, no one, including the midwife knows exactly what happened. There are hypotheses. One is that because he went right from above the cervix to out of me, he didn’t have any molding so he came out with a perfectly rounded head. He looked like a c-section baby when he was born. Another is that with this perfectly round head, as he came out, he flipped his head. John’s personal theory is that Bogey built a cherry bomb while gestating and exploded it on his way out. We’ll never know. The end result however, was that my Vajayjay was obliterated. Torn to shreds. Not the perineum, no, remember it was perfect! But pretty much every other part was torn. Words such as filleted open, extra flaps of skin, etc. were casually being tossed around. Over an hour of reconstruction later, I was repaired. Angel Nurse, who was supposed to have stopped the epidural a long time before had kept it going as anesthesia for the reconstruction. Because no one, she said, should have to go through that unmedicated.

John calls us from the nursery, each of us apparently having a bit of news we didn’t really want to share. I told John about my sparkly, newly redesigned ‘08 model Vajayjay. 

He told me that Bogey had gotten to the newborn nursery, and promptly stopped breathing. His O2 sats went down to 70, he turned blue, NICU mobilized and came to the nursery. He started back up on his own, but it meant I wouldn’t get him for awhile.

That night we got him back and he’s been with us ever since. The hospital had its ups and downs. I only had one stubborn postpartum hormonal Lily moment in which I refused to let one of the nurses give him a shot because I didn’t like her and had been fighting with her all night. I opted instead for the next shift to do it. I literally took my consent form back from her. John realized that was definitely a battle not worth fighting for and let me have my moment of crazy.

And that’s how Bogey, now Cameron, made his way into the world. He is doing great. He only pulled his no breathing thing once more in the hospital, as we were leaving and it totally freaked me out. He occasionally will gag himself and stop breathing for a little, but a few good slaps and he straightens out.

I’m a little worse for the wear. We are almost a month postpartum and despite the best repair and reconstruction job around (everyone who has seen it has been mucho impressed with my midwife’s skill) I still have awhile before I’m back to normal. The midwives have started cauterizing the area in hopes of decreasing some of the pain. Let me tell you how awesome THAT feels.

John is amazing and pretty much spent the first three weeks of Cameron’s life being the sole caretaker with help from my mom and sister. I’m able to get up and around more and feel like only now am I actually starting to enjoy this little person we created. It has been a long, long road with some more miles to go, but hopefully I’m in the homestretch and will soon be able to completely focus on being a mom.

And no, to all of those asking who think they’re so hilarious by asking, there will not be any more kids for awhile. I will be tripling up on birth control. Assuming I ever have sex again.

Coming out of the fog

One question I’ve had is whether or not this blog will continue now that Bogey has arrived.  The answer is yes.  It will just transform from a blog about the pregnancy of Bogey to a blog about the baby Cameron and how he has completely taken over the lives of his parents.  So for those of you who could care less about too many pictures and too much inane detail about something that just sleeps (sometimes), eats (all the time), and poops (with such force he could propel himself into space) feel free to retire from the blog.  For the rest of you, welcome to the next chapter of  our lives.  The blog will retain its name because after all, it is still about our life plus one.

A little bit more

O.k. o.k.  so all the important stuff was left out of the last post. John was helping me get the word out that Bogey had arrived.  Promise we are calling him Cameron, with the occasional Bogey slip-up. Here are the vitals:

John Cameron

Born 10/14/08 at 4:43pm

Weight: 7lbs 2oz 

Length:  20 inches

Lots more to share, but I am exhausted and just happy to find time for this post.  One of the characteristics most commented on so far is his serious expression and furrowed brow.  This comes directly from his mother, something that drives John nuts.  This is serious Cameron:

But there is also reflexively smiling Cameron:

He is pretty darn cute, so we’ve decided to keep him.

36 hours of thrills

Hi, this is John, I am posting for Lily.  She apologizes for the lack of posts but she has a good excuse, she birthed a child.  The fetus that was Bogey in now the baby named John Cameron.  Lily and child are happy, healthy, and home.  The delivery wiped Lily out, hence me writing this post, so she has not made any calls since the birth.  Pictures will be posted soon, amazingly Cameron has Lily’s ears.