Wednesday, April 11, 2012

how it all went down: part 2

see part 1 for the first part if you missed it!

eyes on the prize . . .

4.5.12, morning
as we left off, i was being offered an epidural [hallelujah!!] and i accepted with gusto. for the record, my birth plan -- if you can call it one -- was

a) get epidural

b) get baby out safely

that was pretty much it. i did want to avoid systemic pain medications [just from my personal experience working in the delivery room, i'd seen some scary not-initially-breathing babies in situations where moms received stadol or fentanyl prior to a quick delivery] -- so that was why the initial offer of IV pain control was not to my liking.

anyway, i had heard horror stories about having to wait a really long time while the anesthesiologists made it to the room, but i was in the room and all hooked up by 8:30 am. the epidural insertion went smoothly although i have to admit i hesitated when i found out the MD putting it in was a second year resident [ie, he had not even finished a full year of anesthesia-specific training, and he had probably had NOT placed hundreds in his day quite yet].

his attending watched while he did it, and i have to say he did an excellent job. as in, i had amazing pain control without total paralysis/numbness of the legs. it didn't hurt much going in, or at least it was nothing compared to the contractions. it was pure, sweet, and total RELIEF. i spent the next several hours practically giddy with joy that i WASN'T feeling the pain anymore!

4.5.12, mid-morning
at this point, i was happily resting in bed while my uterus continued to contract like crazy -- only i could no longer feel it. the midwife [i was assigned one for the day, and she was fantastic!] made a comment that my strip looked like i was on pitocin -- even though i wasn't! josh and i were happy to hang out and talk and just chill waiting for dilation to happen. i attempted to nap, but mostly just listened to the baby's heartbeat on the monitor, excited for what was up ahead.

at some point, things seemed completely calm so josh headed down to the cafeteria to get something to eat. i was just chilling out in the bed, but then my ears perked up -- and not in a good way. i had been in enough deliveries to know what a baby's heart rate should sound like, and our baby's heart rate was not right. i knew it was too slow -- and too slow for too long. panicked, i buzzed my nurse and in about 0.5 seconds they were in the room, because they had already been on their way.

my room was suddenly full of about 5 people: the midwife, resident, and several nurses. they had me change positions, and an oxygen mask was thrown on my head. there was a tense minute or so [seemed so long to me!] where it didn't seem like things were improving, but with a move towards my side she finally recovered. i called josh, who dashed up from downstairs, probably breaking several speed records along the way.

apparently, this decel was concerning enough that the midwife started putting plans into place. i think at this point i was checked and was 5 cm or so, so making good progress but still with quite a ways to go before delivery. she also noted that my bag of water was definitely broken, and i informed her that i thought it may have been that way since monday. of note, there was never any "gush" -- just the same gradual leaking that did become heavier once the frequent contractions began.

for the time being, i was going to receive extra IV fluids to hopefully slow down my contractions and make our baby more comfortable. however, if it were to happen again, potential interventions would include an amnio infusion [instilling extra fluid into the uterus], fetal scalp monitoring [this idea made me sad!], and/or terbutaline [a drug which relaxes smooth muscle but can cause heart palpitations].

i think at this point josh decided he wasn't leaving until there was a baby in the room -- outside of my uterus.

4.5.12, mid-afternoon
things calmed down and were going just fine -- until once again, they weren't. the situation played out almost exactly as before -- i heard the beats slow down, freaked out, and found my room full of people within seconds [again, they were already on their way]. oxygen/fluids/repositioning happened, and this time it took a little longer for her to recover, but she eventually did. the midwife ordered more fluids and for a shot of terbutaline. if that didn't work, we would plan for the more invasive measures [amnio infusion/fetal scalp monitoring]. i was terrified and absolutely shaking [physical reaction to it all?] but game for ANYTHING that would keep our baby safe! by this point my cervix was at 8-9 cm, so we were getting closer to the finish line.

4.5.12, late afternoon
as it turns out, the terbutaline WORKED. my contractions were getting a bit farther apart, giving our baby girl a chance to recover better, and i didn't have any further decels.

unfortunately, after a few hours the trends were starting to go in the opposite direction -- too far. while terbutaline can increase maternal and fetal heart rates, ours were apparently remaining up too high for too long. meanwhile, my shaking started to morph into full-on rigors, and to my dismay my temperature was measured at 100.1. before i knew it, i was labeled as chorioamnionitis [possible infection within the uterine cavity], which i was higher risk for given that my membranes may have been ruptured for quite some time. my cervix was now at 9-10 cm with an 'anterior lip' -- meaning that there was a part that still needed to soften and dilate before pushing could begin.

i was dismayed with the chorio diagnosis because i knew what that would mean for the baby [more on that later] but again happy for anything that would keep her safe. antibiotics were started, as well as more fluid. i'm not sure how many boluses i received but i believe it was at least 3. still, i was getting closer to that magical 10 cm and starting to feel hopeful.

4.5.12, about 6 pm
the midwife re-entered the room and said she was getting worried about the amount of time baby and i had been spending with high heart rates and elevated temps, though things had improved somewhat with the antibiotics. she went to check my cervix again, and it was unchanged. the next step would be to try to 'labor down', which meant getting into a more upright position so that the baby's head could exert more pressure on the cervix.

i started inching upwards in the bed with the nurse's help, and felt something snap. i thought: oh god, could that be . . .

and it was. i was thisclose to the end and MY EPIDURAL HAD BROKEN!!

* * * * * * * * * * * * * * * * * * * * * * * * * * * *

to be continued in the final installment! annabel is starting to wake up

PS: she has a new nickname :)