Thursday, March 22, 2007

Jack's Birth Story

Pregnancy had its ups and downs for us- from the anxiety of the amniocentesis and 2nd trimester gastro (and the orf!), to the fascinating and even fun changes of later pregnancy, punctuated by the odd unexpected blip (the episodic high blood pressure,or the famous-head-over-dog agility flip, aka the Billy-Belly-Flop). Overall, I think I really enjoyed it- feeling J move and hiccup and respond to me.















Late pregnancy had become a bit harder, the awful reflux returned, the pelvic pains increased in frequency and intensity, and I had trouble coping with the 40+ temperatures in early March (especially with no air-conditioning). I was happy with the planned induction at 40wks for my blood pressure, but hoped I might go early- baby had been well down for a while, and I'd been getting increasing "period pains". Despite all the "tricks of the trade", it didn't happen. On Thursday 6th, I spent a morning out shopping, and the Braxton Hicks tightenings started to get regular and painful- I hoped this was "it", and even called Richard at the Woolorama to let him know... but it all petered out to nothing (luckily- because Fred made the Saturday Open final).

So on Wednesday evening we headed off to King Edward, up to Labour Ward, where examination showed I was still only 1cm or so dilated, and the planned Foley catheter was inserted. Richard went home to sleep, and after half an hour at most of increasingly painful "period" sensations, the Foley fell out! So I was able to sleep overnight, and early Thursday, when not much progress was evident, Dr H broke my waters (straight up her arm, making a fair mess).

A syntocinon drip went up shortly afterwards (my veins vanishing at the sight of local!), and the contractions started to kick in. Turns out they were intense versions of the "period pains" I'd been getting for the last couple of weeks, and were pretty bearable at first, if I could keep moving. The synto was only at 12mL/hr, but I was contracting 5 in 10min straight away, so they left it at that. Using the telemetry CTG monitoring, I could take quick walks around the ward, which felt fantastic. Back in my room, it was all about pelvic rocking and squats, with Richard rubbing my back. Tennis ball massage felt amazing- highly recommended. I just could not lie down, especially on my left side- it caused excruciating back pain with each contraction (expected, because he was OP). Unfortunately my movement made the monitoring difficult, with my heart beat picked up instead of baby's. Despite one of my wonderful mid students holding the probe on full-time, I was restricted in how much I could move, or rendered the monitoring useless.

I was reexamined at half past one, and hoped to have made good progress to inspire me to continue, but I was only 3-4cm at most, so I decided to go for an epidural, which would allow me to stay still enough for effective monitoring. Polly came down and did a CSE, which was quick, painless and amazing relief! I was the most comfortable I'd been for weeks, could walk to the toilet without problem, and laid back, chatted and napped while the synto was gradually cranked up. After a few hours, the spinal started to wear off, and I began to feel contractions again, so started using the labour PCEA. Everything for the next few hours is a bit of a blur, but I remember Allison (antenatal class MW) visiting, some fascinating discussion of the new natural/active caesareans, and then gradual onset of some strong right sided back pain, despite PCEA boluses, and requiring some rescue top-ups. The pethidine bolus worked really well.

Monitoring was also becoming increasingly difficult, presumably because bubs was moving further down/around in my pelvis, so I'd been lying mostly slanted to my left, and ended up with a dead left leg, while my right back pain persisted. The foetal trace was showing intermittent decelerations, occasionally causing concern (especially to me), but not anything regular or definite. So we decided to change to a scalp clip for monitoring, which worked well, and relieved all the anxiety I'd suffered every time baby's heart beat dropped off the monitor.

Unfortunately the dead leg didn't resolve, and I wasn't able to walk to the loo, so agreed to a urinary catheter. While Melissa (my mid student) was catheterising, I was lying on my back, tilted, and suddenly the baby's heart rate started to drop. I could hear it slow, saw the monitored rate head to 80, and obviously Melissa called for help, because the reinforcements arrived, and I was being turned one way, the other, and back again, Dr H arrived, and I was suddenly terrified, dissolved into tears, and clutched Richard's hand. J's heart rate came back up spontaneously, the synto was turned down to 36mL/hr, and I got it together somewhat, but we started to watch the monitor with more concern.

Reexamination showed slow but steady progress during the evening, with only "variable" decelerations, and despite the increasingly problematic right back pain, I started to hope we might be getting somewhere. But by Dr H's next review, at 1.30am, J's trace was showing regular late decelerations, and I was still only 9cm, with a big lip. So we agreed that a c-section was the safest option. I was lucky enough to get the next theatre spot, and was prepped and sent up fairly promptly.

Its all a bit of a blur from here on in- but I remember being totally and inexplicably terrified. I knew exactly what was involved, I trusted everyone concerned to look after me and Baby J, but somehow a caesar had never seriously entered my plans or expectations. Intellectually, I knew it was possible, but I'd never even read the chapters in the books or the pages on the websites that covered it. I'd hardly discussed it with Richard.

What I was frightened of I'm not sure- I'd never had any surgery before, so the concept of being operated on was a bit different, but I think my main fear was that the epidural would be inadequate, and I'd end up needing a GA. As it turned out, the lignocaine top-ups worked brilliantly, and although my initial block was a bit uneven (higher on the left), after Joel (called in from home, poor guy) gave a few extra doses I had a fabulous block. I was still glad I hadn't eaten all afternoon though.

It was so weird to be on "the other side"- looking up at Sue and Joel as they hooked up the monitoring, fluids and phenylephrine, and experiencing the uncontrollable shaking I've seen so many times in other people. Being slid over onto the table, the familiar faces from such a weird perspective, Richard suddenly appearing next to me in scrubs... all too weird.

It all seemed to happen so fast- I don't even remember them starting, no real sensation of touch, and I always seemed to be a couple of minutes behind the action- noting that the drapes were up, so maybe they'd started? Hearing the suction of amniotic fluid and not registering that they must be well into the operation- and then I was totally unprepared to hear Dr H announce "No wonder he wasn't coming out! Where were you hiding this boy?", just before they dropped the drapes, lifted my head up, and I could see a blue tinged "drowned monkey", with screwed up face and extended limbs, held above a surgical scene. I don't remember if I said anything, someone commented that he'd be a rugby player, and then Richard was over with the paediatricians, camera in hand, and I heard suction and beeping, and eventually a rather feeble cry. I remember a few things being injected into my IV, the antibiotics stung, and I think there were a couple of doses of synto. Suddenly there was a paediatric resident standing next to me, offering a tightly wrapped wrinkle faced baby, Richard was next to me, and I was holding J. They offered me skin to skin contact with him, but I think I was too shaky and declined.

I don't remember much after this except J- how absolutely beautiful he was, so quiet, so alert, his huge dark blue eyes, bow shaped mouth... I was just lost in him. Somewhere there Joel took some photos of us, somewhere the drapes vanished and I was being cleaned up and transferred onto the bed. Dr H was telling me that I'd bled a bit (1200mL, big floppy uterus from all that labour) and the cord blood collection had been done, somewhere I was trying to thank everyone, and asking to be sat up, and holding Baby J as we were wheeled down the corridor to recovery.

And then I was in Recovery, with Sylvia, some of the other theatre regulars, and our midwife from Labour Ward, and I was feeding Jack. He latched straight on, looking up at me, and I was just blown away.

So that's how it was- a bit unexpected, but a fantastic experience. I was so glad I had the team I did, a fabulous obstetrician I trusted, the wonderful anaesthetists and theatre team, and the stellar Labour ward staff. I have some strange feelings of inadequacy about "failing" at vaginal delivery, I guess I never thought that would be a problem for me and my big hips, and I certainly never thought I would care. But at least I know I had a good try at labour, experienced a few hours of decent labour without analgesia, and got most of the way! And by far the most important thing is that we have Jack, and he's healthy and perfect. I'm totally in love, its like being on some truly amazing drugs, and I can (and do) spend all day just looking at him, his angelic features, his soft skin and hair, his huge dark blue baby eyes, his array of expressions. I think Richard thinks I'm half-crazy, but even without the mother-hormones, he's as doting a dad as any man could be. How lucky are we?





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