Tuesday, August 10, 2010

Judah's Birth (or how I became a "VBAC candidate")

[written when 28 weeks pregnant with my second baby]

I don't really like talking about Judah's birth, because a lot of people don't understand my intense emotional reaction to it. Many people say "well, just be glad that you have a healthy baby". I am so glad! But it is so much more than that... Contrary to what many OBGYNs may think, C/S is not "just another way to have a baby". It left me deflated and disheartened. Judah's birth was by far the most difficult thing I've ever had to face.

Now that my abdomen is "blossoming" (the nicest way anyone has ever said that I'm huge in my midsection), several people have asked me if I'm planning a repeat c-section or if I'm allowed to try for a vaginal delivery with this baby girl. I tell them that I want to avoid another C/S like the plague!

Judah was born on August 5, 2008. Here is his birth story:
I had just graduated from nursing school, and I was a brand new registered nurse working in the newborn nursery. As part of my schooling, I had been witness to probably about 60 vaginal births and about 30 c-sections in the regional perinatal center where all the "high risk" mothers get sent to deliver. I had seen A LOT. I knew what could happen, what could go wrong. But I had also seen "perfect" births where everything went as it was supposed to. I was idealistic. The pregnancy had been amazing and I had no reason to believe I wouldn't have a pretty standard vaginal birth. I spent the last few weeks of my pregnancy (during the late night periods of insomnia) researching clinical journal articles on the best pushing techniques, the pros/cons to epidural use, how to avoid episiotomy... My plan was to labor at home as long as I could, and then hit the hospital for the delivery. (In this area, there is no birth center and only one midwife who attends home deliveries and I was unaware of her practice at the time.) I wanted as natural a birth as possible.

Well... that didn't happen. 4 days after my due date, I was sent to the hospital for routine "overdue" fetal testing. Judah seemed perfect-- except that they couldn't get a good read on my amniotic fluid levels. I hadn't had any leaking (when you're past your due date, you are on hyper-alert for ANY sign of impending labor! Trust me, I would have noticed!) and my levels were great only a few days prior. So, I wasn't worried. But they were. I was escorted immediately to labor and delivery to begin an induction. I wasn't even allowed to go home to shower or get my hospital bag. SO not cool. I was very disappointed that I'd have such a medicalized labor, and I knew how intense induced labors could be (I had witnessed dozens of them). I asked the nurse if I could just go home, and she told me that I would have to check out "AMA" and "you don't want to do anything that could hurt your baby! You'd never forgive yourself! It looks like today's the day!" I felt hopeless and helpless already.

I was admitted at 2pm Monday. I was considered "high risk" now because of low amniotic fluid levels (oligohydramnios) and therefore had to be on constant fetal monitoring. Let me tell you, that was a TOTAL DRAG. My belly skin was impossibly stretched and very sensitive. Those monitors were tight and itchy and uncomfortable. And... I couldn't move around very well. I didn't get my cervidil placed (to soften the cervix) until 9pm that night! (so... yeah... 6 hours of waiting). Then they told me to sleep. haha. Yeah right. The labor/delivery bed was incredibly uncomfortable, and I had a nurse come in every 20-30 minutes or so to reposition the fetal monitor.

The next morning came... and again I had to wait. I was supposed to get the pitocin drip started at 10, but it didn't start until after noon. But, oh man, I immediately began to have intense contractions. Isaac, my husband, applied counterpressure to my low back, and my mom read scripture verses to me. It was painful, but bearable.... I thought, if this is how bad it gets, I can totally do this. And I began to get really excited about Judah's arrival. In between contractions, we played "bananagrams." I wanted to stay as positive as possible and make the most out of an unfortunate situation.

Then, at 4:30, my water broke with a loud "POP" in the bathroom. The contraction immediately following was a thousand times more painful than anything I had ever experienced. I couldn't breathe. I was by myself in the bathroom, and I felt I couldn't stand, walk, or even call out for help. The contraction mercifully faded and I stumbled out of the bathroom, dragging my IV pole, as I huffed and puffed through shallow breaths to my husband that "water broke... call the nurse." Another MONSTER contraction hit and again, I felt totally helpless against the relentless pain that seemed to know no bounds. I felt the entirety of every contraction in the front, across my entire pregnant belly. It felt like it was on fire. It was this incredible tightness, like a boa constrictor was squeezing the life out of me. When the contraction passed, I whispered "epidural".

When it normally takes about 15 minutes to have the epidural catheter placed, mine took 45. It was originally placed in a "bad" spot which left me with ringing in my ears, heart palpatations, and a metallic taste in my mouth. Those things are never good. Sitting there on the bed, haunched over my squeezing abdomen, unable to move for 45 minutes was literally torture. But the end result-- let's just say I had a very good epidural!

Right before the epidural was put in, I was at 4cm. An hour later (and much needed rest), I was at 10! I couldn't believe it! I was completely elated and rejuvenated! I was so happy. Because of the epidural, though, I couldn't feel the urge to push. So I requested to let the baby passively descend before I tried.

Right before 8pm, my drill-sergeant for a nurse told me I had to start pushing. It was right after shift change, and they didn't feel like waiting any longer. I hated being that I felt so out of control and was being bossed around. I asked if I could push on my side, and she said "you can try for 15 minutes, but after that, if its not working, you're going to do things my way." Well, needless to say it wasn't working. I couldn't feel the contractions, so I didn't know when to push. I felt very ineffective. Apparently, Judah's head had come down, and Isaac told me later that he could see his little head with his dark shiny hair, but his head kept hitting my pubic bone and was getting stuck. The nurse had me lay flat on my back and pull on the end of a knotted bedsheet that went up over the birthing bar they had set up on the bed and was being held on the other end by a medical student (that poor student!). I was supposed to pull against the sheet in a tug of war each time I pushed. If anyone ever asks you to push in this position, SAY NO! It was awful. I had terrible heartburn from laying flat on my back and my shoulders and arms were tremendously sore for days afterward. Anyway, I pushed like this for another 2 1/2 hours. That's when the hospitalist midwife that was managing my labor said that I should be examined by the attending physician and that we might have to use a vacuum (did I mention that my own doctor never came?). The attending OB came in, did a quick exam, and announced that the baby was posterior (the back of the baby's head should be facing up, and the midwife told me all along that Judah was like this -"occiput anterior." But now, the back of his head was facing down... How the heck did he get so twisted during pushing? Laying flat on my back and not being able to move because of the epidural was probably the worst thing I could have done). The doctor tried to manually rotate his head during the next contraction, but when he did that, I gushed some meconium-tinged amniotic fluid (I had originally ruptured clear), and the monitor showed decels (the baby's heart rate was showing distress). So, the next thing I hear is "emergency c-section."

At this point, everything gets really hazy in my memory. I remember feeling so totally disappointed and helpless, then angry, and then really really numb. I got prepped quickly, and then I remember staring at the ceiling tiles, totally limp, wondering if Judah's birthday would be August 5th or 6th as they wheeled me to the OR. Is this really happening? It was now about 11:30pm.

When I was strapped down to the OR table, the anesthesiologist put an oxygen mask on my face, and clamped the nose piece so tight around my nose, that it was completely plugged. I felt like I couldn't breathe and began to hyperventilate. I also began to feel nauseous, and so the anesthesiologist (who in my opinion was a complete jerk with zero empathy... he played on his iPhone the entire surgery) tightly held an alcohol swab under my nose. I struggled to get away-- it was already hard to breathe without this guy holding my face down like that. I kept yelling "stop that!" and he just cooly responded with "I heard somewhere that this helps with nausea." Great. Thanks. At this point, too, I began to get "the shakes". I guess it's from all the adrenaline. My whole upper body began convulsing. It didn't stop until about an hour after the baby was born.

The doctor used his prickly tweezers to test the anesthesia. "Can you feel this?" "YES!" I said as I felt the sharp poke. Adjustments were made... "How about now?" "YES!" The anesthesiologist jerk said "No, you can't feel that!" And I screamed at him "YES I CAN!". More adjustments were made and I felt more and more numb.

Two of my friends from the nursery (the unit where I work) were suddenly at my side. Our evening shift ends at 11, and they saw that I was having a c-section, so they came to join me and support me. I'm telling you, they were lifesavers. Donna held my hand while Jen held that stupid O2 mask off my nose so that I could breathe. Isaac was there, too, praying for his poor wife who was just falling apart.

Everything was happening so fast. I heard someone say that they were going to push the baby back up (I guess all the pushing just lodged him in between my pelvic bones, but because of his positioning, I wasn't able to push him out). A bunch of shuffling... then some metal instruments clanging back against the tray. Then the doctor yelling to his assistant "NO, NO! Not YET!" which is something no person should ever hear during surgery.

Nothing can ever prepare you for the PRESSURE of a c-section. Contractions stop when they numb you, so after the incision is made, the surgeon and assistant put their body weight on top of your belly to push the baby down and out of the opening. Although I couldn't feel "pain", this pressure was enormous. I felt like an elephant was using me as a chair. Meanwhile, I'm nauseous, exhausted, have heartburn, am claustrophobic from that stupid O2 mask, and my upper body is still convulsing. This was definitely the worst experience of my life.

11:44pm: I didn't hear Judah cry. The first sound I heard when he was born was gasps from everyone in the room over his size! "Oh my gosh, Sigrid, you birthed a toddler!" That is another thing that no new mom should hear right after the crazy birth of her precious little baby. [Note to hospital staff: when a baby is first born, no matter what, you should comment on the baby's cuteness! Please, for the poor exhausted mother's sake!]

Because of the meconium, the neonatologist was there at the baby warmer. It was a few minutes yet until I heard his lusty cry. I couldn't see anything. The first visual evidence of my baby that I saw was his ENORMOUS foot print that someone brought over for me to see. At this point, exhausted and disheartened, I illogically began blaming the baby for everything that happened. My poor husband who was so scared and silent this whole time, excitedly brought the camera over to show me a picture: "Do you want to see the baby?" "NO!" I yelled. At that moment, I didn't want anything to do with him. I was so angry at him for everything he put me through. Those 10 minutes of irrational baby-rejection gave me so much guilt in the months following his birth. But at the time, everything was backward and crazy. I was no exception.

What seemed an eternity later, I was wheeled to the recovery room. I was exhausted... and still shaking. It was impossible for me to hold my baby. I dozed in the recovery room as my mom, dad, sister, mother-in-law, and husband passed the baby back and forth to each other. I groggily heard someone ask about me: "how's she doing?" "She's sleeping," my husband said. In reality, I was laying in bed, numb literally and emotionally, going over everything that had just happened in my mind. How did this happen? What did I do wrong?

My monitors kept alarming, but I was by myself in the room. Where was the nurse? I began hyperventilating, which caused the alarms to sound even louder. I felt so alone. So abandoned. Everyone wanted to see the baby. It wasn't about me. My bitterness toward the baby escalated.

Finally, the baby nurse (one of the nurses I work with) came in to the room and said that if I wanted to nurse the baby, now was the time. I almost started crying. After all this, I was supposed to feed him, too? The shaking in my arms had finally subsided, and Judah was handed to me. He was crying. This was the first time I got to hold him... he was almost 2 hours old. I remember thinking that his nose was too big for his face, but his eyes were incredibly beautiful. His mouth pulled back a little bit as he cried, and I could see that he had dimples. DIMPLES! He was so handsome. My bitterness slowly began to fade as I instinctively put him to my breast and he immediately latched on. I wept. Isaac was standing by my side.

Less than 10 minutes later, the nurse came in and said she had to take him to the nursery because his blood glucose was low. As a neonatal nurse, I totally expected that to be the case. Judah was 9 lb 6 oz afterall!

Then, I was alone again. I missed my baby. For the first time in 9 months, he wasn't with me. My nurse suddenly reappeared and gave me a quick sponge bath. I could finally wiggle my toes. The numbness had been, ironically, very painful. I felt completely paralyzed from the belly down for almost 3 hours after the surgery, and I remember that for two hours, I had just stared at my toes, willing them to move. They couldn't. It was such a weird experience. This had been the worst day of my life. I had lost control of everything-- even my toes.

I was wheeled to my postpartum room at about 4:30am. We stopped by the nursery first. Judah was still on the warmer. He was the biggest baby in the nursery. But he was my baby. He was beautiful. I loved him. It was so surreal.

The floor nurses hadn't mentioned to me anything about pain meds. I just assumed that they would be on a schedule at first and they would just give them to me when I was due. I didn't know that I had to request them. Consequently, the next 12 hours went by and I didn't have anything for pain. Once my epidural wore off, I tried to sit up in bed to nurse Judah and I literally screamed out in pain. Pain from my incision, but also tremendous pain in my shoulders from pulling that stupid sheet while pushing. My entire body ached; I felt like I had been hit by a car. A very apologetic nurse came in and gave me some medicine and told me that I had to request my pain control. I did just that... every 4 hours I rang the call light for my percocet. There was NO WAY I wanted to feel that again.

I got no sleep in the hospital. I was totally in love with my baby. I foolishly kept him in the room most of the time. He was a hungry baby, and my milk didn't come in until he was 4 days old. I nursed him every 2 hours around the clock. I was so exhausted. By day 3, I started to melt down. I called my mom and told her that I didn't want any visitors at all that day. I needed to just rest. By the time we were finally discharged Saturday evening at about 4:30 pm (I was admitted that Monday at 2pm), I was literally an emotional wreck. I cried almost the entire night. I called my pastor's wife and asked her to pray over me. I didn't know what else to do. I was so overwhelmed with emotional and physical hurt.

I struggled with that emotional pain for a solid three months after Judah's arrival. I would have dizzy spells and severe pain in my incision site off and on for 8 weeks. I could barely get out of bed by myself. I had nightmares.

One night, when Judah was two months old, I dreamed that I took a piece of glass and sliced open my own belly. I woke up completely terrified-- more afraid than I had ever felt in my life. I remember lying there in bed awake, but feeling unable to move or speak. I felt such an intense heaviness. I know that this was a demonic attack. After a few minutes of silently praying to myself, I was finally able to speak and I called out to Isaac. It was about 3am. He woke up, sensitive to the trembling in my voice, and knew that something was deeply wrong. I just said "pray for me!" and all of a sudden my husband started praying in tongues over me. I had never before heard him pray in tongues. Instead of being afraid or uncomfortable with it, it was the most beautiful sound I had ever heard. It gave me such peace and comfort. I just started weeping. I told Isaac about the dream and the incredible fear that had crippled me and he stayed up with me the rest of the night, praying over me. I finally had freedom from the nightmares after that night.

Another time, a few weeks later, I remember getting frustrated with my appearance when I was getting dressed in the morning. None of my clothes fit right and almost everything I owned had spit-up stains on it. I was a mess. I became so upset that I literally threw myself on the bathroom floor, started screaming, and banging the floor with my fists. Isaac just stared at me, unsure of what to do. I couldn't stop. I had no control over myself.

I know that what I experienced was way more than just "baby blues". I was never diagnosed with postpartum depression... but there was definitely something wrong with me for those first three months. I praise the Lord that he rescued me from that incredible depth, that darkness. It was so difficult.

Even now, I'm occasionally overcome with weeping when I reflect on Judah's birth. It was so difficult to completely lose control... To have my baby surgically cut from my body, when I was so close to delivering him on my own. To irrationally feel like a failure as a mother, a wife... as a woman.

I never want to experience that again.

So anyway... here we are, 28 weeks pregnant with baby girl. I finally met with an actual doctor at my OB practice (I had only seen nurse practitioners up until now) and she seemed almost annoyed when I even mentioned wanting to VBAC (have a vaginal birth after a cesarean). I felt like she was pushing me to just schedule a C/S (even though I know from nursing and medical journals that VBACs are considered safer than elective c-sections). She mentioned a bunch of scary statistics ("your risk of uterine rupture is 6%!" which is not true-- everywhere I've read in the medical literature, my risk of uterine rupture if I attempt VBAC is less than 1%. So I don't know where she got that info!) and said "well, your son was 2 lbs larger than an average baby which is hard for anyone to deliver... you'll have greater peace of mind and it will be less traumatizing if we just schedule a C-Section. But, if you want, we'll wait to officially schedule you until we scan you at 37 weeks and see how big this baby is... then we'll schedule your surgery for May 28th."

How does she know what will be less traumatizing? Every time I read about a successful VBAC, the woman exclaims that she felt so empowered and found emotional healing. I want that! I don't want another major surgery that will leave me unable to hold my two children for weeks. How can I take care of two kids by myself (Isaac can't take much time off of work... a couple days at most) if I can barely get out of bed? Even my friend that wound up with a second emergency C/S after trying to VBAC said that she has no regrets that she at least tried. Also, we're thinking of having more than two children. Once a woman has two or more C-Sections, it is much more difficult (almost impossible in this area) to find a doctor willing to let you have a trial of labor.

So... since I am not going to find true support through my current OB group, I decided to switch to the Nurse Midwifery Associates. I saw them for the first half of my pregnancy with Judah and just loved them. As a student, I attended many of their deliveries. I know that they will give me the flexibility, the patience, and the support that I need to have the best possible chance of a happy delivery! :)

And I know that whatever happens, God will never leave me or forsake me. He goes before me and beside me. He knows my pain and my hurt. And he is faithful to turn our mourning into gladness. I have the most amazing 19 month old boy. I love him with everything in me, more than I knew was physically possible. I am so blessed. And, yes, he was worth it all. Praise Jesus!

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