Tuesday, 30 September 2014

Story of a birth

As so many people have asked me, I've decided to write about my experience giving birth.

Before I went through it myself, I read about it, took an NCT course with my Mr., and asked friends about their experiences. All of which was helpful, and did help prepare me, but on the day so much went differently and the reality looked and felt unlike anything I'd imagined - especially my fears, which loomed very large on the evening before: they came true (I was induced by drip) yet the fear turned out to have been worse than the reality.

Our brand new daughter
20 hours old
This post will be long, and it will be honest. If you wish, stick with me; if you just want the gist of it, here goes: I was induced at 38 weeks and 5 days, after unsuccessful membrane sweep and prostaglandin gel the method was the syntocinon drip. From the start of established labour (3 hours after drip start) to birth was less than four hours, and I used gas & air (entonox) as pain relief. My daughter and I are both well and healthy; the experience was amazing. And hard. But amazing.

For those of you who want the full story, warts and all, the reality of how it was... here goes.

I had a membrane sweep on Wednesday. It didn't set off labour, but it did help get things started. Membrane sweeps aren't pleasant but with years of debilitating period pain behind me I wouldn't have called it all that painful either. Bit of deep breathing and it was done in five minutes. I was given a Bishop Score of 3 out of 13; from 5 they consider the cervix to be favourable to induction.

On Thursday night I began to wonder if my waters were going - draining ever so slowly. I couldn't make up my mind, put a pad in and figured it'd become clear soon enough. The same continued through all of Friday. On Saturday I thought best to get checked, even though I wondered if I was being overly cautious as this slow leak (if there was one) was so, so slow... in fact after examining me the midwife who checked was so unsure about it herself that she asked a doctor, who decided that for safety's sake they would consider it broken waters. Since it had been over 24 hours they kept me in to start the induction process.

With broken waters induction doesn't involve a 24 hour prostaglandin pessary but a 6 hour gel which was put in at 4pm on Saturday. They then transferred me to the ward to wait for it to work, and the Mr. was able to join me then, having taken the hound to his doggy hotel for the time being.

We had the tiniest room but it was a single room and we shared the single bed somehow, waiting and hoping for contractions which didn't come. Meanwhile the delivery suite downstairs was extremely busy and we were advised to get as much sleep as possible (I don't think either of us managed to really sleep).

An amniotic hook - like an oversized crochet
hook, this is what they use to break the waters.
At about 6.30am it was our turn to go downstairs. The room where I would labour and give birth was huge! After talking to the midwife and explaining the waters situation she agreed to break the waters which she could still feel over baby's head and give us another two hours to see if that kicked things off, before going the drip route which I was so afraid of.

Breaking waters - once that was done they were definitely going, at last! Not even as unpleasant as the sweep, because it was much quicker. It still caused no real contractions though. Very gentle intermittent belly hardening was all. So the drip it was!

At 9 am the midwife started me off on the drip, very slowly, increasing the dose at regular intervals as she saw my body's reaction to it. I should say that because I was induced, the midwife stayed in the room with us the entire time from start to finish. She was obviously very experienced and calibrated the dose carefully. I could feel gentle contractions at first, the Mr. and I played scrabble for a while until contractions became too distracting.

As contractions became harder and harder to cope with, my main fear was from what mums who had been induced had told me: that the breaks between contractions would go away and it'd soon be one on top of another, without relief. By that time, contraction pain was immense and I was living for those breaks. I couldn't have coped without them. About 90 minutes into established labour I asked for an epidural (having been told it would be wise to get it in early so that I wouldn't have to wait once the pain was truly unbearable).

The midwife put on a very unimpressed face and said I should really try gas & air (entonox) first. Reluctantly I agreed. (She later told us how impressed she was that I had asked for an epidural only once and then just got on with it!)

I should say the initial drip was started at about 9am with no real action for a few hours. Established labour was from about noon, when I was examined at 4cm. At that time, the midwife said the next progress check would be about 4 hours later: they don't want to check too often with waters having broken over 24 hours earlier, because of infection risk. I'd made it about 90 minutes when I asked for the epidural & got the gas & air. Until then, the birth skills I had learned from this book and at the NCT course - especially vocals & breathing and stress balls - got me through, and Mr. talking me through each and every contraction as if it was a wave to paddle board into: get to the top, sweet relief on the way down, then a total break from pain. 

With gas & air that pattern continued. By then I felt incredibly tired though! I have never felt so leaden tired in my whole life, so barely capable even of speech. All I could repeat, in between contractions, was how tired I was. I could not have had what they call an 'active' labour: as soon as it was established I was so physically tired I could barely move at all. I went to the toilet a few times on very shaky legs but that was all I could do. I was mostly on my side, changing positions was barely possible.

A gas & air mouthpiece.
The gas & air gave me an extremely dry throat and it didn't take the pain away but it did somehow make things more bearable. I still felt everything. The trick with gas & air is to start breathing it just before contraction takeoff, not to wait, and I could stop on the descent and pant. I found because I felt so, so tired that holding the mouthpiece was major effort and breathing slow & steady was as well, so it was wonderful to just drop it on the way down, pant, and enjoy the pain free moments. Then I would flop competently on the bed, mouth hanging open, not caring - not a muscle in my body wasn't like lead.

Responding to anything at all was major, major effort, even though I was fully aware of everything going on around me. Mr. never stopped talking me through contractions, wiping my skin with a cold wet flannel, offering water with a straw. He was my rock, offering me his constant reassuring strength.

To my incredible relief, I never lost the breaks between contractions, the midwife so skilfully calibrated the drip. For a while she wasn't happy that I had too many contractions that were too short each - only about 30-40 secs long - but things still progressed. She was rather surprised that before the 4 hours of established labour were over, I was ready to push (I was surprised I had the energy to do that, and to make the noises that came out of my throat). After a quick exam showed I was nearly 10cm dilated, she got a second midwife to come in and said I should just do what my body told me.

Remember, I was fully aware but I must have looked almost comatose... somehow I made it onto my knees on the bed, leaning on the raised head part, but did not have the strength to lift myself up on my knees. So I hung there, crouched, and there wasn't space between me and the bed for baby to come out! I had a few pushes there though and I could tell baby was moving down.

The midwife eventually got me to turn a bit so that the baby could get out, and I ended up kind of hanging on my left side, propped almost upright by the head rest - she said this looked really uncomfortable but I had no strength to change positions and it did work for me. Several pushes... then I could feel the head with my hand. It kept slipping back a bit but I was happy with that to avoid tearing. I could feel tearing coming if I didn't give it some time; the pain down there was acute. I would push, pant, whatever I felt like in the moment.

At one point baby's head was stuck half out when the contraction ended and she kicked me hard on the inside - I actually screamed with pain. That was the most painful point! But with the next push her head was out, another two or so and she was there, put straight on my chest by my midwife.

I was so tired I didn't have time to open my eyes, focus and turn my head towards her before they took her off me again in a hurry, cut the cord and took her to the resuscitation station in the room - Mr. said she was very dark blue and floppy and they were obviously worried enough to go to emergency procedure. But even as they took her across the room though she revived and they gave her back to me quickly, almost too quick for me to react to what had happened. Obviously she was just a bit shocked by the quick exit!

I'd never made it to four hours of established labour. It started at about noon and at 4.07pm she was out! She fed beautifully by 5pm, I had a managed third stage meanwhile because with the drip they worry about excessive bleeding. I shook like a leaf for a good half hour after delivery, I think from sheer exhaustion - my actual blood loss was minimal according to my hospital notes.

Now that was a long, long story but I did promise not to hold back. Physically, no question, this was the hardest thing I've ever done. I've cared for my dying mother at age 15, especially at night, and went to school in the day (where I'd often fall asleep in the middle of lessons) but it's safe to say I have never, ever felt so completely and utterly disabled by tiredness. Yet the actual duration of it all was very short and it was an amazing experience, in hindsight.

The fear was worse than the reality.

Saturday, 13 September 2014

An uncomplicated pregnancy except...

All the worry I'm facing at the moment about gestational diabetes, all the complications associated with that, have really taken up most of my thinking lately. I've been reading about it voraciously, too. And what I've been finding has been extremely helpful in bringing me back from the brink of panic, where I was last week.

I'm grateful I had the glucose tolerance test that discovered my gestational diabetes. Because of it, I've been very careful about my diet in the weeks since. Gestational diabetes can cause complications because:

  • the baby can grow too large
  • sugar spikes in the mother can 'age' the placenta prematurely, causing it to deteriorate in function towards the end of pregnancy
  • the baby can be born with too much insulin (as he/she was having to compensate for mother's sugar highs)

Well, in my case -

  • I know baby's perfectly sized because of weekly ultrasounds
  • Baby's amniotic fluid is perfectly adequate too, not too much or too little
  • At the moment, with weekly checks, placenta function and blood flow in the cord are perfect
  • I have no sugar spikes because I control my sugars well through diet.

Which leads me to question whether any of the risks above are things I should really worry about. Unlike a mother with pre-existing diabetes, my risks are already lower; and the only large study I have been able to find that compared mothers with well-controlled GD to mothers without GD found that 4 in 10,000 women without GD had stillbirths, versus 5 in 10,000 with GD. That's one more, which does matter, but even if my baby was stillborn it would only be 20% likely be caused by GD!

How I feel. Backed into a corner
filled with fear.
Am I willing to risk my baby's life because I don't want to be induced? No, absolutely not.

But unless the doctor I'm seeing next week can give me a good reason why I am actually at risk, I will ask them a few questions...

  • Placental failure, which was thrown at me at the last appointment: how quickly does it happen, if it happens? Is it like kidney failure, or heart failure, which doesn't mean function stops - only that it deteriorates, which can be picked up in good time? 
  • Can we agree that from Week 38, I can be monitored regularly - daily if necessary? 
  • If we reach 40 weeks and baby still hasn't made their appearance, I understand risks actually do rise and I would agree to an induction then.

So that's my battle plan for next week. My preference, however - if you're the praying sort, please pray this for me - is that baby will just decide to come naturally. Before Week 38 if possible, so I don't have to go through all the above. It's nerve-wracking to negotiate with medics as a non-medic who has no way of knowing what risks are truly worrying and where the medics are just trying to cover their backs against litigation. I feel very, very out of my depth. All I want is for baby to be well...

By the way, full term (37 weeks) is this Tuesday. Baby would be very welcome to show up right then.

Monday, 8 September 2014

Fear, trust, and loving someone I haven't met yet

As I sit here writing this, my belly is moving on its own. I'm getting kicked in the ribs. At 36 weeks, this bump has acquired a distinct life of its own.

And like the life inside, I have changed and matured a lot in the last 36 weeks.

I've never wanted to be a mother. When we got married, I agreed to be open to the possibility; and when I became pregnant, I knew how much I would need my heart to change over the months it would take to grow this baby. And yes, it's happened - is still happening!

So am I ready to be someone's mother for the rest of my life? Uh, that's way, way too big a question to contemplate! What I know is that I am a mother already. I haven't met my child, but he/she is real and alive and I am his/her mother. And yes, I do love this child!

Which is why I am terrified, utterly terrified to the point of crying every time I think of it, that he or she could possibly not be OK. I have gestational diabetes, which I control with a strict diet and with some success - a high reading every 2-3 days - and last week at my antenatal appointment they told me that there was a risk that the placenta could just stop working in late pregnancy, which results in stillbirth. No one told me how high that risk is, and honestly, I don't need to know: it's there, and the stakes are the highest they can be. It clamps my insides shut to think of coming home from hospital without this child, who's so active and alive within me right now.

I'm not sure I have ever known real, trembling fear until now.

Perhaps to some degree that is what being a mother is all about - someone once told me that having children was like giving birth to your own heart and having it run around in the world, outside of you. You can't always protect it and it's gut-wrenching, scary. Kids take risks; kids get hurt; they have their own lives to live and pains to feel. Perhaps you always fear for them, and perhaps the fear I'm living with now is just a foretaste. It's all I can do to pray that this child lives so I can continue to fear for them...

Bump view. And Fred.
And that is where trust comes in. I have to somehow find a way to come up for air from this fear and find trust - trust in doctors, who know what they are doing and are looking to induce at 38 weeks to get baby out and into safety; trust in my own body to sustain this life until that happens; but trust in God? Let me be very honest - I'm not at that place right now.

God as I see him is the one I look to for strength, whatever happens - even in the ultimate disaster. I don't think he has ever promised me that I would have a child, nor did I ask him for one, and he definitely hasn't made any specific promises about this child. I don't know what his plan is. That's the scariest part. As CS Lewis says, God is not safe: but he is good. Only his idea of good comes from a bigger perspective than mine, which is why I can't presume that I know what he's going to do. All I can do is throw myself at his mercy, and bring my fear and pain to him to deal with.