Tuesday, July 14, 2015

Loch one, Loch two, Loch Lomond

Surprise!  We're having a baby today(ish).
 On the morning of Wednesday, June 17th, I was standing in the kitchen minding my own business when my water broke.  I was 33 weeks pregnant, so this wasn't great.  All my babies have come early, but this was the earliest yet.  I'd been seeing a high-risk OB, but I'd just had an appointment on Monday and he declared that I was not showing signs of going into labor imminently, and I should go ahead and start planning my home birth for approximately four weeks hence.  With my last labor, exactly 90 minutes elapsed between my water breaking and holding a baby in my arms, so it appeared there wasn't a lot of time.  Aaron was working in Ballard and the boys were with me, so I called my brother-in-law who happened to be working nearby and asked if he could drive me to the hospital.  I hadn't had a single contraction yet, but I didn't want to risk delivering on the side of 405 while driving.  I hastily stuffed some clothes and a toothbrush into a bag, grabbed a snack and a stack of towels to sit on and got in the car.

At the hospital, an ultrasound confirmed that my water had broken and the baby was very much head-down.  Aaron and my cousin Shannon arrived soon afterward with snacks, and we settled in for whatever was in store.  I was still in the triage area at this point, and soon I had a few contractions.  When I told the nurse my labor history, she quickly got me into a room and got an IV going.  I was given a large dose of magnesium to stop the contractions, and a shot of steroids to help mature the baby's lungs.  I'd never had a magnesium drip before, and although the nurse tried to prepare me for how it would feel, words can't really do it justice.  Magnesium has a relaxing effect on smooth muscle tissue, including blood vessels.  In high doses, it causes rapid and intense flushing.  What it actually feels like is something I can only imagine is similar to being set on fire from the inside.  The nurse had filled a basin with icy water and washcloths prior to administering the magnesium, and I tried to lie very still and not panic while I directed Aaron to place cold washcloths on the parts of my body that felt most incendiary: "My feet, my feet!  Okay, now drape a couple across my calves.  Now my Adam's apple, wtf?!" It was a fun game for everyone.  Luckily, the most unpleasant sensations only lasted 25 minutes or so, then the dose tapered down to one third of the initial bolus.  My contractions stopped, I sent Shannon home until further notice, and gave Aaron a list of things to go buy(diapers, a car seat...).

I proceeded to have contractions slowly and sporadically, sometimes three hours apart, never closer together than 20 minutes.  They were mild, like bad period cramps, but came just often enough to keep me from sleeping at all that night.  I was also hooked up to a fetal heart rate monitor which kept slipping out of place every time I moved, so the alarm would start beeping and then my nurse would have to come in and try to re-position the monitor until it could read the baby again.  Magnesium slows the baby's heart rate and I was high-risk anyway, so taking off the super uncomfortable monitor wasn't an option.

The next morning, my OB's partner came in and checked me.  I'd had some bloody show, so it appeared that labor was still progressing albeit slower than my usual pace.  I was 4 cm dilated, so the doctor decided to keep the magnesium drip going in an effort to get a second dose of steroids into me(given twice, 24 hours apart).  Meanwhile, a neonatologist came down from the NICU to prep us for what we might expect once our as-yet-unnamed baby was born.  He told us that babies born at 33 weeks have very good survival rates with generally few complications, but they usually need to be in the hospital until they reach 38 weeks.  He went over the various forms of oxygen supplementation our son might need, and explained that some premies find touching too stimulating, so there was  chance we might not be able to hold him.  Upon his birth, there would be an immediate assessment and if he seemed stable enough, I could hold him for 20 minutes or so before he'd go upstairs to the NICU.  I told Aaron that if there was the slightest sign of trouble, I wanted him to baptize our son and made sure the doctors knew about this plan.  Then we waited.

And waited.

I made a labor playlist, and we discussed names.  I tried unsuccessfully to sleep, so instead I talked to the baby.  "Baby, mama needs a favor.  I know you're little, but I need you to be a fighter.  Daddy and I want you to be strong and healthy, and we want to take you home as soon as possible.  So I know you're not even supposed to be born yet and it's a lot to ask, but please, be our little warrior."

Around 9 p.m., I was still only have 2-3 contractions per hour, and I could still talk through them.  They felt slightly more intense than they had the day before, but didn't yet come all the way up to the top of my uterus.  However, I was beginning to feel surges of adrenaline in my legs, a feeling I recognized as transition.  I hit the call button and asked the nurse to check me.  She said they generally try to avoid stirring things up in women whose labors they are trying to stall.

"I know, and I appreciate that, but I have two concerns: one is that I'm still 4 cm and contracting just often enough to prevent sleep, and I'm coming up on 40 hours without sleep.  If I'm still 4 cm, I want an epidural so I can actually rest before having to birth a baby.  My other concern, the one I suspect is more likely the case, is that my lame contractions are, in fact, accomplishing something and I'm further along than anyone suspects."

She agreed to check me.  I was 7-8 cm.  Sneaky uterus.  The on-call OB came in and said "You don't want an epidural; you're going to deliver this baby within the next four hours, and your recovery will be so much better without one." (spoiler alert: he was right)
 My doctor arrived around 11 p.m., and we talked birth plan.  He wasn't on call that night and had already worked a full day at another hospital, but he'd promised me that he would come to my birth no matter what.  I love him.
Chatting, like you do.
 After a while, I felt the urge to push but my contractions were still so-so.  When I did push, I could feel the baby ramming into my pubic bone.  After a few pushes I declared that I felt like I was being hoisted by my own petard; the harder I worked, the worse it felt.  It was 11:45 p.m., and we all wondered if this baby was coming on the 18th or the 19th.  Then my contractions stopped.  Just disappeared.

"I need a chair," I said.

"For what?" my nurse asked.

"For lunges," I replied.  "I'm going to do lunges and get this baby under my pubic bone."
I actually said the words "Pants-off Dance-off!"
 The comparison was too obvious.  "Got a little captain in you?" I said.  I did, in fact, have a little captain in me, and I wanted him out.  The fact that I had not yet lost my sense of humor was an indication to me that labor was not yet fully underway.  So I did lunges for a while, then tried getting on all fours on the bed, then asked for and was brought a birthing stool(which, inexplicably, was bright purple and had actual glitter in it).  After a while I decided to just lie down again.  My doctor offered Pitocin, which I declined at first but after realizing that the magnesium was hamstringing my uterus I agreed.
 And then s*** got real.  Not as real as my other labors, but real enough to make a little progress.  I told my doctor that my contractions still felt pretty ineffective, so he asked if he could put his hand on my stomach for the next one.  The next day, he told me that he'd seen women have stronger Braxton Hicks than the contractions he felt in me.  I pushed, but I wasn't in a good place mentally.  I actively felt ambivalent about getting this baby out, knowing that my body was the safest place for him and that if I did succeed in getting him out, he was going to be taken from me.  Labor wasn't painful enough for me to want it to be over, and my contractions weren't really helping.  I decided to just get it over with, and started pushing hard.

That was a mistake.

I should've waited for the Pitocin to kick in more, because once I got the baby's head approximately halfway out, I ran out of steam and didn't have contractions to help me.  So the baby just paused there, head halfway out, not moving.

And that's when the screaming started.

With Jack, I remember grunting a lot during the pushing phase.

With Matteas, I was quiet and focused and barely made any noise at all.

With this baby, I felt like I was going to lose my mind if I didn't getsome relief from the terrible burning that felt like my entire body was being ripped open with a dull butter knife.

"Don't push," my doctor said.

"Then cut me open and get him the f*** out!!" I screamed.  "I can't not push, I need him OUT!"
 And then he was.  Pink and screaming, with the cord wrapped once around his neck, he arrived at 1:26 a.m. on June 19th.  He weighed in at 5 lbs. 1 oz., and his apgar scores were 8 and 9.  I don't remember Aaron cutting the cord, I just remember being so happy that he was screaming(functioning lungs!) and out of me.

World's Best Doctor.  Seriously.  He was so calm even when I swore at him, and went above and beyond so I could have continuity of care during a very stressful pregnancy.

Other than needing a few weeks to figure out how to eat, our baby didn't have any issues.  He never needed any oxygen support or meds, maintained his temperature consistently and gained weight well.  Every doctor who looked at him declared him mature for his age.  After 18 days in the NICU, we brought him home.

We named him Lochlan Rafael.  Lochlan means "warrior," and Rafael means "God has healed."