Thank you to you, my faithful dozen or so readers….One of my resolutions this year is to blog more often and more regularly. I am not doing well at keeping that resolution, but I have a great excuse! Dee finally had her baby!
Pregnancy always seems long to the mama, and it does not help when others continually ask her if she has “had that baby yet?” Thankfully pregnancies don’t last forever, and Sweetpea made her debut this past week.
The two weeks leading up to her birth were stressful. Sweetpea’s projected arrival date was December 23, but Dee desperately did NOT want to go then. She wanted to get through Christmas so she could enjoy all the family events. Sweetpea obliged.
When Dee went in for her 40 week check-up, I accompanied her. One of the reasons I had encouraged her to seek care where she did was because I had had such wonderful experiences with the practice. Of course, they had always been the role of support and back-up for me since my last three babies had been born at home. The doctor I loved so much had, unbeknownst to me, stopped seeing OB clinic patients and was focusing almost exclusively on the other aspects of the practice. They had a new OB doctor, whom Dee had met exactly once. The midwife that had been present for the birth of our other granddaughter and had been used by a dear friend for all four of her births saw Dee the first few times before informing us that she was moving. So they had a new midwife, K, whom Dee had not ever met. That left her in the care of the nurse practitioner, a woman who had the personality of Attila the Hun. Lindy had accompanied Dee several times and had nothing nice to say about Attila. I had to concur. When Dee objected to having her cervix checked yet AGAIN, Attila tried to coerce her by saying it was necessary for the health of her baby. When I asked why this was, Attila could give me no good reason. In fact, in the end, she had to admit that there was no real reason other than to record it in the chart. To say I was unimpressed would be an understatement.
The next week, at 40 weeks and 6 days, Dee saw the midwife, K, for the first time. She was very friendly and was open to Dee’s birth plan. It was a simple birth plan. She wanted to go without drugs if possible, she wanted intermittent monitoring so she could move around. She wanted to hold the baby as soon as she was born. She wanted to nurse the baby immediately. She wanted a quiet room. She wanted to eat during labor. The midwife was open to all of it, but because Dee was almost 41 weeks, the OB, Dr. D, was insistent that Dee have a non-stress test. Now, in most non-stress test situations I have witnessed, the mother is placed in a comfortable recliner, monitors are attached to track baby’s heart rate, and mom is asked to record when baby moves. Dee was asked to lay on a very uncomfortable exam table and she was not asked to record baby movements. The baby’s heart rate was not extremely variable, but it did go as low as 119 and as high as 145, neither extreme for long periods of time, but certainly variable. They were not satisfied. The NST was considered a failure. Next, they shuffled Dee off to get an ultrasound to check for fluid. Keep in mind that they never once laid hands on Dee’s abdomen to feel the baby…
The sonographer was unable to detect any measurable pockets of amniotic fluid. The doctor came in and started telling Dee that it was her responsibility to have an induction right away. She talked extensively about HER liability and how she could not guarantee the health of the baby. She said that Dee could NOT labor at home because the liability was too great; the cord would be compressed and the baby could have “losses”. Dee agreed to an induction the next day, but as we both left, neither of us felt it was the right thing to do. We knew that the baby was in the wrong position, for one thing. She was too high and Dee’s cervix was completely closed. Dee agreed to let the midwife strip her membranes, but it was not very effective due to the closed cervix. What they wanted to do was use Cytotec (misoprostol) to soften the cervix and then induce using pitocin.
The whole situation was problematic. True oligohydramnios (low fluid) can often be detected without ultrasound. Often the baby will not be able to move, and the outline of the baby will be visible. When we suggested that perhaps Dee could simply go home and drink a lot of fluid, we were told that this was ineffective. It is ineffective if the placenta is not working well, but for the majority of women, this is the BEST way to boost amniotic fluid. I already did not believe the doctor had Dee’s best interest at heart…her entire discourse about her liability had been a huge clue for us. The fact that they wanted to use Cytotec with its known risk factors of uterine rupture and the inability to actually monitor dosing was also a huge red flag. And finally, while we are not experts in reading ultrasounds or NST tapes, it was obvious that the baby was not in distress. In fact, when I asked if the baby was in distress, the midwife had to back-pedal a bit. She said that distress was a strong word and that they really had no idea how the baby was faring that late into the pregnancy with that “old placenta” and low fluid.
The next morning, supposedly the morning of the scheduled induction, I took Dee to Gainesville to see a chiropractor instead. We knew that the baby was not able to get around to the right side for some reason…and we thought a specialized adjustment would be helpful. We saw a wonderful chiropractor that day. She was gentle. Dee’s SI joint was sorely in need of adjustment, and once she had that aligned, she worked on Dee’s uterine ligaments. She wanted to see us that afternoon to make sure the adjustment was holding, so Dee and I went to eat some spicy Mexican food. We also picked up an oil diffuser and some peppermint and lavender essential oils. When we returned to the chiropractor, the adjustment had held and she worked again on the uterine ligaments. We made an appointment for New Year’s eve, which was the next day. We attended that appointment, and Dee was moving much more freely, and her uterine ligaments were feeling much looser as well. We made another appointment for the following Monday.
We celebrated New Years eve…all my children except the boys were with friends…and New Year’s Day we had fifteen up for lunch–all the children, my parents and some of Lindy’s friends.
The next conundrum was that Dee was scheduled for a follow up NST with the OB on Friday, but neither she nor I felt that she was going to get unbiased information at that visit. Meanwhile, I had contacted my home birth midwife. She had retired after attending the birth of Curious George, but she was still in contact with her old partner, and she got back to me with a recommendation of a practice in Atlanta where we could get a reasonably priced ultrasound. When I called, we were able to get an appointment that afternoon for an ultrasound and a consultation with a very well known perinatologist. The cost was under $200, and I grabbed the appointment.
Dee and I picked up Star Child and set off for Atlanta. It was a cold, rainy Friday afternoon. The girls and I made our way to the eleventh floor after parking in the parking garage. (I rediscovered the joy of having to pay for parking.) We did the paper work necessary and then they called Dee back. Star Child and I accompanied her. The sonographer was a very personable young woman who obviously knew what she was doing. She put warmed (!) gel on Dee’s belly and did the basic measurements. Her estimate was that Sweetpea weighed 7 lbs 14 ounces. (For the record, I never believe the ultrasounds for weight…I have never known one to get it right.) She estimated that there was about 8 cubic cm of amniotic fluid. In other words, plenty. Then she called Dr. B in to double check. He came in and did the measurements again, finding between 8 and 9 cubic cm of amniotic fluid.
Dr. B was amazing. A tall, thin, distinguished man of dark complexion, he exudes calm and reasonableness. He explained to Dee that her amniotic fluid levels were just fine, that if she had measured below 5, he would have recommended that she go home and drink a gallon of water and come back the next day to remeasure. He said that even in cases where the fluid drops below 4, he would not recommend induction unless the placenta was clearly compromised. He then looked at the placenta, and upon seeing some calcification, he remarked that it was perfectly normal for almost 41 weeks, and that calcification does not indicate a non-working placenta. He then looked at the cord, explaining that they could clearly see that the vessels in the cord were pumping blood regularly and without any pauses, which could indicate a problem. He recommended that Dee undergo a non-stress test and then we would meet with him for consultation.
Dee was placed in a very comfortable recliner and the monitors were attached. She was having some mild contractions, but nothing serious, and they barely registered on the monitor. The baby was quite active, and Dee recorded almost 20 movements in the short time she was being monitored. We were in a suite with several curtain partitions, and there were a few other mamas also being monitored in the room; we could hear the babies, if we could not see them. After about 20 minutes, the sweet nurse came and got Dee. and we waited just a few minutes before Dr. B came and ushered us into his office.
Dr. B was so reassuring. As I brought up every reason Dr. D had given for the need for induction, Dr. B countered. He said that Dr. D’s behavior rightfully made me angry because she was not willing to have what he called a “reasonable conversation.” When I told him that she did not think fluid intake would increase the amniotic fluid, he said that this was true if the placenta was not functioning properly, but that in a healthy pregnancy, with a functioning placenta, fluid intake would radically change amniotic fluid levels. He then went over the baby’s NST results. He said that her heart rate went up and down as it should. He showed it to us and said that we were perfectly capable of looking at the monitor and seeing if the heart rate showed variability. He also said that if the other practice insisted on another ultrasound, that we should look for the dark pockets and make our own judgement.
Dr. B’s motto is Bring Back Birth. He has a chart in his waiting room comparing statistics for home births and hospital births. He backs up home birth midwives from all over the state. You can tell that he believes in a woman’s innate understanding of her body and he trusts women to be able to birth their babies. He explained what the umbilical cord looks like and why it is unlikely to get compressed during contractions. He told Dee that there was no reason to force the issue. He then looked at me and said, “Don’t let them bully her into an induction! That is a perfectly healthy baby and perfectly healthy mother. She will come when she is ready.” He recommended another NST the following Friday if Dee had not given birth by then. His whole purpose was about helping Dee have an empowering birth experience. He was nothing short of amazing.
We drove home in heavy traffic and rain, causing Star Child to be a few minutes late for work. As Dee and I talked, she decided that she really did not want to give birth with the practice that had so shamefully tried to force her into an unnecessary induction. To be honest, I was feeling quite a bit of trepidation, too. I called Dr. B’s practice back, and found out that we could actually change providers. The catch was that the insurance would cover any hospital fees and any delivery attendant fees, but it was too late to get insurance coverage for any office visits we might need. We did find out, though, that we could pay out of pocket $300 for one visit, but no more than $600 for several visits, including any diagnostic testing such as the NST. It seemed like a bargain for peace of mind. The office manager said she would email us a records transfer form, and that she would fax it to the other practice first thing Monday morning. If Dee were to go into labor over the weekend, we were stuck, but if she could hold out until Monday afternoon, then the records could be transferred and we would be good to go to Atlanta for the birth.
Sunday I was under the weather and stayed home to try to get better. Dee was feeling tired and also stayed home, so the Handy Man took Star Child, Gladys Mae, Little Princess and the boys to church. She came in and told me at one point that she felt she had lost some of her mucus plug. I told Sweetpea that she had to hold on for another 24 hours.
Monday morning at 4:30 AM, I felt Dee enter our bedroom. (Don’t ask me how that happens, but often when one of the children tip toes into our bedroom, I will jolt awake.) I sat up and asked if she was okay. She said she had been having contractions since 2 AM, that they had not gone away with a change in activity, and that they were about four minutes apart. I got up and went to sit a few minutes with her in the living room, double checking her times, etc. I gathered up a few things I still needed to pack…I checked email and notified the ones who needed to be notified…I finally went back to lie down for a few more minutes, figuring that first labors are usually pretty long and that we had time.
Twenty minutes later, I could hear Dee groaning. It was now almost 6 AM, and it was obvious that the contractions had gotten more intense. I got up again, this time for good. I was now having to talk Dee through the contractions. (“Breathe, relax, let your body melt into the couch, breathe, relax your jaw, relax your forehead, breathe, let your belly sag, breathe….)
We had a dilemma. Theoretically, if we could light the right fires under the right behinds, we could get the records transferred and Dee could go to Atlanta. I called Dr. B’s practice and explained our situation to the answering service. A midwife promptly called me back. She said she did not think we would have enough time, but that she would call Dr. B and have him call us. I went to take my shower, and Dr. B called a few minutes later. It was almost 8 AM. He said that the good news was that Dee had not been induced, and he said that my job at this point was to give her a protected space where she could feel safe and to help her have an empowering birth.
At 8:30, Dee’s contractions were 3 minutes apart and were now lasting 2 minutes in duration. I knew it was time to get moving. Gladys Mae packed the cooler for us and placed a towel on the passenger seat as per Dee’s thoughtful request, we grabbed all the gear, and we set off for the hospital. Now, one thing I remember well from having Dee, Star Child, and Gladys Mae, is that every bump in the road can be AGONY when you are having a contraction. Poor Dee had to deal with our driveway and dirt road….I tried to make the bumps gentle, but it was a fruitless enterprise. Dee told me at one point that I could speed. I assured her that she would not be having the baby in the car and that I wanted to arrive to the hospital safely.
We arrived at the hospital at about 9:00. The practice had not done any of the initial paperwork to get Dee’s chart started, so while the nursing staff took Dee back to triage, I started the chart with the admitting clerk. Meanwhile, Lindy had arrived, but she was not being allowed back to triage. (Lindy was there in the “husband” support role, while I was there in the “doula/advocate” role.) I asked the clerk who was on call, and to my immense surprise and relief, it was Dr. F, the doctor I had loved so much who was no longer seeing OB patients. (God’s favor, no doubt!)
They took me back to triage to be with Dee, and the nurse said she was measuring 4-5 cm dilated. They had the monitors on, but had not gotten what they considered a reactive tape on the baby. I asked Dr. F about intermittent monitoring, and he balked a little. He then said that he recommended against it, but that if Dee was willing to sign a waiver, he would let her do as she wished. He quickly wrote a waiver up, she willingly signed it, and then she looked at me and said, “I can’t do this, Mama! I need an epidural!” The nurse assured her that once she was in the room and had been given a bag of fluid, they would be happy to administer an epidural. Dee signed the consent forms.
The other issue was that Dee had tested positive for Group B strep, which can cause a very serious infection if the baby were to get it. This is treated with IV antibiotics while the mother is in labor. Dee was finally assigned a room. They inserted Dee’s IV and started running fluid and antibiotics.Meanwhile, I shut the door, we dimmed the lights, I plugged in the oil diffuser, Lindy came in, and Dee continued the hard work of labor. The room was calm, it was fairly distraction-less, and Dee was in the zone, eyes closed, working hard to relax and cooperate with her body.
I continued to coach her through each contraction. She was fabulous! At one point Lindy reached forward to grab Dee’s hand. I looked at her and said, “I wouldn’t do that if I were you. She probably does not want to be touched.” Lindy replied, ” But she said she wanted me to hold her hand!” Dee pulled her hand away and said, “Don’t!” I explained to Lindy that Dee had to concentrate to relax, and that holding her hand was distracting. I also told her that a woman in labor is a contrary creature and can change her mind as often as she wants!
At about 11:30, Dee said she felt some pressure. She had not yet gone through the first bag of fluid, and was still completely unmedicated. She was sure her water had broken, and then she felt even more pressure. The nurse checked her dilation and was shocked to discover that the cervix was GONE. They quickly dispatched a message to Dr. F, and the nurse told Dee she could start pushing. She also said that the bag of water was still intact. Dee was mildly embarrassed later that she had evidently peed herself, but I assured her it was quite normal.
Dee was given permission to push. The nurse held one leg while I held the other…they broke down the bed, and Dr. F walked in. He quickly donned his gown and shoe covers, and assured Dee that she was making good progress. The amniotic sac had not broken at that point, so he snipped it as it was bulging. He was mildly alarmed that there was meconium in the amniotic fluid. (This is not uncommon, happening in as many as 25% of births. Meconium aspiration can be a problem, but it usually is not problematic.) Dee continued to push. Sweetpea seemed to be in quite a hurry! The doctor grabbed the vacuum extractor, although he later admitted that he probably did not need it as he barely used it to just help the baby’s head clear Dee’s pubic bone. And then Sweetpea’s head was out, followed quickly by the rest of her! The doctor placed Sweetpea on Dee’s abdomen, and Dee rapturously met her first born…it was an emotionally intense and exhilarating moment!
They took Sweetpea to the warming bed to suction out the meconium, while Dee was quickly cleaned up a little bit. She had extensive tearing and the doctor started the repairs. Sweetpea was brought back to Dee and Dee started to nurse her. Sweetpea was ready to nurse! She latched on immediately and had no issues at all. The doctor spent the next hour stitching Dee–mostly on the inside as she had torn internally in two long places. He said that normally with tearing like that, he would take the mama to the OR to make the repair, but since Dee was doing so well and not jumping around, he would do it there. Thankfully those internal tears were not so painful to repair…the other tearing was another story. Dee was a trooper, contentedly nursing her baby and waiting for the doctor to finish. Dr. F is very meticulous, and while he takes a long a time, he does a good job.
Sweetpea weighed 7 pounds and 5 ounces at birth. She was 21″ long. I stayed with Dee overnight, and the next day, right after Sweetpea’s 24 hour PKU, Dee and Sweetpea were released, and I brought them home. We went to the pediatrician the next day, and Sweetpea was showing a little jaundice, which is perfectly normal in breast-fed infants. The pediatrician wanted Dee to take Sweetpea to the hospital the next day (at three days old) for another heel stick test to collect blood to test for bilirubin. That day was rough day for us…it was a frigidly cold day, with temperatures never getting above freezing, and I spent over 4 hours on the road dropping kids off at class, and then going to get Star Child’s car for new tires (so she would not get a ticket after already receiving a warning because they were so bald.) Dee and I decided we would go the next day for the bilirubin test, which we did. Sweetpea passed. No special lights for us!
Sweetpea has been a wonderful infant. She sleeps longer stretches at night, giving Dee as many as 3-5 hours at a time. Dee is trying to rest when Sweetpea does, and with all the willing baby holders in our home, this is made easier. We are all in love with Sweetpea!
Home at last, and the dogs had to meet the baby…Mischief was very attentive to Sweetpea!