Friday, October 21st
Over-packed for an Induction Odyssey
We started the day knowing we might have to go in for induction, but hoping otherwise. It was one day before 37 weeks and we knew the OB would be much more likely to recommend induction at this point in the pregnancy. Fern’s last 24 urine test results were in and we learned that her proteinuria had quadrupled in two weeks and was up to about 1,500mg (normal level is under 150). A nurse took her blood pressure twice and it was high too – around 150/90. Even though the nurse was using a poor technique to take the bp and didn’t let her relax much between readings, we knew Fern’s borderline high bp levels from the weeks before were, in fact, becoming regular high. When the OB came in she didn’t waste much time telling us that she wanted us to head right to the hospital. Our midwife, Rose, was with us at the appointment and she had come with packed bags. We had been prepared (by Rose) that we might be sent to the hospital from that appointment, but it still felt like a big shock and we both admitted we hadn’t really believed it would happen. It was so definite and final.
Rose left to pick up some food and meet us at the hospital and we headed home. After an hour or so scrambling around at home, packing last minute items (including: a copper pot to give to Cactus so she could cook the placenta and Christmas lights for ambiance, a rolling pin for massage and many other things we did not use at all – the kitchen sink is a fair analogy), we took final photos together as a family of two in which we look remarkably rested and upbeat even though I remember feeling somewhat exhausted and stressed. We headed to the suburban hospital with our supplies and food for labor, birth and beyond (so much food). I have a habit of packing twice as much underwear as I think I’ll need and in this case it really paid off. I ran out on the last day. Rose met us in the lobby and we headed upstairs to labor and delivery around noon (I only brought up a fraction of our stuff at first in order to save some face. I eased the rest of it up over the next several hours).
We were taken straight to a nice room and we waited. Kim, the charge nurse, came in to say that everyone was held up in a delivery but she took some vitals from Fern, inserted an IV line (which later clotted and had to be reinserted) and put her on the blood pressure cuff (which took her bp every 10 min) and fetal monitor. She took our birth plan (the short version that Rose made us write after we showed her our rather wordy first draft), read it and put it in our file. I remember thinking the labor and delivery floor seemed weirdly quiet and empty and it was hard to believe there were women laboring away. In fact, during our whole stay we only ever heard one woman in active labor. We saw a few walking the halls; their presence made Fern increasingly bitter after a day or so with no progress on her induction.
It was a while before we met the doctor on call, Dr. Groovy, and our nurse for the day, Sue, and developed a plan for induction. We liked this doctor a lot. He was very reasonable, conservative and level-headed (Sue told us he was great and her favorite – one of the few doctors at the hospital open to catching babies with mothers in non-back-lying positions). Sue was a British midwife-turned US nurse and very open to natural childbirth herself. Basically, we were as close to a roomful of hippies as we could get in that situation.
The Plan
It’s common in most hospitals across the US to induce a completely non-started labor like Fern’s using Misoprostol (brand name Cytotec), a cervical ripener. But that drug scared us and Rose had warned us against it because it can start labor too fast and lead to very fast contractions and even uterine rupture. Basically, Cytotec acts quickly and when it works well, it works beautifully, often ending up being the only drug needed to start a fast and productive labor. This is why it’s favored in the hospital – it can have fast, easy results. But when it goes wrong, there’s no reversal, no way to take it back (like with pitocin, for example, they can just turn down the drip). Using Cytotec to start labor is actually an off-label use – it’s an ulcer medication and has never been approved by the FDA for this purpose. So we felt like using Cytotec could be dangerous and would also be more likely to create the need for a c-section. We wanted to use Dinoprostone (brand name Cervidil), a drug actually meant for the purpose but one that works much more slowly. Cervidil is inserted like a tampon and takes about 12 hours before you might see results. The benefits are that it’s time-tested and approved for labor induction. It can also be removed if the body reacts poorly to it.
We were amazed and happy to learn that Dr. Groovy had a lot of the same reservations about using Cytotec that we did and actually preferred starting with Cervidil. He said he didn’t like how fast things can go wrong with Cytotec and that he’d once tried to remove the pill from a woman having a horrible reaction but found that it’s absorbed into the body almost immediately and removing it does nothing. To put this in perspective, Dr. Groovy’s view is pretty much unheard of these days and we lucked out big time that the doctor on call was not only willing to go along with our plan but actually agreed with us. Rose had told us stories of patients requesting alternatives to Cytotec and none being available in the hospital or having to bring their own upon arrival. We were so happy to have avoided the fight we had been certain we’d be having.
We think getting Dr. Groovy on admission set the tone for the labor and helped allow it to go as slowly and naturally as it did. Oh, and Dr. Groovy also said that Fern could eat until she was in active labor – a gift much bigger then we knew at the time. The nurses had already told us that she wouldn’t be allowed to have food – little did we know that if we had had a different doctor on admission Fern would have been fasting until Monday afternoon (3 days). Or, more likely, she would have opted for a c-section out of starvation.
We decided to start with one dose of Cervidil and they finally administered that around 4pm. When Dr. Groovy did a pelvic exam, Fern was 1cm dilated and about 50% effaced. The baby was at -3 station. We were excited about this because it felt like her body had already done some work and might be easy to induce (haha!). Fern had done a few days of evening primrose oil at home and a couple of acupuncture sessions, but hadn’t had time for much else. Inserting the Cervidil was very uncomfortable for Fern because it had to be placed right on the cervix with a gloved hand and no lubrication. I repeat, no lubrication. That was the first of several very uncomfortable pelvic exams and they were pretty terrible to watch.
We talked about magnesium sulfate (anti-seizure medication for the pre-eclampsia) with Dr. Groovy. He wanted to avoid it, but thought it might be necessary if Fern’s bp stayed up and her proteinuria climbed as well. This is another drug we feared since it can make you really uncomfortable and loopy during labor and you have to stay on it for 24 hours after delivery. But we also knew that it might be necessary if the pre-e was getting worse. Obviously, we didn’t want Fern to have a seizure during labor. We appreciated the wait and see approach.
Three Cheers for Midwives
We loved Sue from the beginning. She was a practicing midwife in England before coming here with her husband a few years ago and she’s the one they give to the natural-minded patients. She had a great, natural approach to labor, even for someone like Fern who had to be induced. Even though we had other nurses we liked, Sue was one of the few who really related to us both. She took some time to sit down and chat about being pregnant and getting pregnant. It turns out she also went through three years of infertility before conceiving her daughter and even went to the same RE that we had seen. She was very sweet and honest and engaged with us both. She proved to be our advocate.
Our other constant support was Rose who was with us from the OB appointment that morning through every minute at the hospital. We feel so lucky to have had her by our side because she helped us make every decision and she advocated for us fiercely. Most midwives wouldn’t have come until active labor but Rose wanted to be there because she knew a lot of the important decisions about drugs and protocol would be made before labor began. Her support was invaluable as we talked to various doctors and she was very proactive in the room (grabbing the nurse when we needed her, putting Fern on her side and in a better sized blood pressure cuff to get the bp to stop reading so high, asking questions we couldn’t think to ask). Rose slept three nights on the waiting room couch, ate all of her meals with us in the room and barely left the floor. She didn’t know how long induction was going to take either (and on the last day she admitted to only packing 1 pair of underwear because she hadn’t imagined how long it was going to take – she should have followed my rule) but she never appeared impatient or like she had anywhere else she needed to be.
Cervidil Round One: Riding the Local into Labor
Since Cervidil can take up to 12 hours to do anything, we all went “to bed” Friday night – me to the couch in the room and Rose to couch in the waiting room with a stack of blankets. I think Rose was the only one who got much sleep.
After 12 hours, the Cervidil caused some very minor cramping but not much else. No contractions registered on the monitor. Though Fern’s BP had been high for the first half hour after being admitted, it was nice and low (one teens over eighties) while she was in bed, so they changed the cuff to read less frequently (once every half hour then once an hour) so she could get some rest over night.
The nurses change shifts at 7am and 7pm and the doctors at 8am and 5pm. Our new nurse for the night was Shauna. Shauna was very sweet and talked about her dogs and did everything she could to make Fern comfortable. But it was a very uncomfortable night and neither of us (most especially Fern) slept much at all. Fern even took two Ambien to try to knock out but they didn’t work at all against the nerves and discomfort of the situation. Every time Fern would roll over or move Shauna would have to come back in to find the baby’s heartbeat again on the monitor. This happened several times an hour. Furthermore, since Fern was still really pregnant, she was getting up to pee frequently. Each time she got up she had to take off the bp cuff and unplug the fetal monitor then walk to the bathroom with the cords draped around her neck. When she’d get back to bed, Shauna would come and very apologetically arrange the monitor again.
The room was oddly huge which was good during the day, but I felt very far away on my couch. I was at least 10 feet away from Fern and it was hard to feel connected to what was happening through my grogginess. I felt a little guilty that night because Fern was getting up so much and I was over on my own bed. Since I was so far away it was easy to feel like I was just watching the whole thing and not really participating.
Saturday, October 22nd
Even though the new doctor on call had been there since 5pm on Friday, she didn’t come and introduce herself until midnight. I mean, I guess we were awake since we didn’t sleep much that night, but it still seemed kind of rude. I got out of bed and went over to Fern’s side but trying to figure out if I have any questions while wrapped in a sheet, pillow creases on my face and sans bra is not easy (after that I wore a bra to sleep – call me old-fashioned). The hospital is a strange place at night.
That was Dr. Probably-A-Lesbian – she was barely a blip on our radar.
Cervildil Round Two: Second Verse Same as the First
Around 6am Fern received a second dose of Cervidil – another incredibly uncomfortable insertion. Rose and I held Fern’s hands while she cried and we told her it would be over soon even though it felt like it took forever. Over the course of our stay Fern developed an intense fear of the pelvic exams and would start to panic in anticipation of one, unfortunately, probably making them even worse. It was hard to see her in so much pain – strangely, harder than seeing her in labor pain – and the whole thing felt so inexact and crude. Different doctors and nurses would guess differently at centimeters with their different sized-hands, or try clumsily to place small pills that would stick to their gloves.
Our day nurse was Kristi. Kristi was nice enough but not very memorable. We got a new doctor – Dr. NiceEnough – later that morning. Dr. NiceEnough is the only doctor I never even met. I went down to the depressing Subway restaurant in the lobby for some “lunch” (somehow this Subway was even worse than most Subways) and missed her intro. It didn’t matter too much because we didn’t make any decisions with Dr. NiceEnough.
Fern spent Saturday on the fetal monitor and blood pressure cuff. We broke up the day by watching some Northern Exposure and the last couple of episodes of Project Runway online and by napping. For everything that was about to happen, the lead up was pretty boring. I jog regularly (or did before Goldie came) but I’ve never craved running so much in my life – not a jog, not something that involves changing into spandex, but running with all my energy. We had some very sedentary days. Fern ordered room service, which was pretty decent, and we chatted with Rose and our parents on the phone. Not much happened on Saturday. At some point I walked around on the hospital grounds outside and took pictures of the orange leaves for the photo challenge (because I’m an over-achiever) and wondered if it was going to be our baby’s birthday. Labor remained elusive.
Round Three: Let’s Get Mechanical
Shauna returned Saturday night, as did Dr. Groovy who was surprised (or at least pretended to be) that we were basically as he left us (except our stuff was a lot more spread out over the room). Dr. Groovy decided (and we agreed) that the Cervidil was not working and we opted to try a balloon catheter overnight. A balloon catheter is basically what it sounds like – a balloon that they insert empty into the uterus then fill with saline. The idea is to mechanically open the cervix which can sometimes trigger labor.
After getting that in place we got great news – no fetal or blood pressure monitoring overnight. Fern’s bp had been very stable and the baby hadn’t registered any distress since we checked in so Dr. Groovy said it was safe to sleep off the machines (have I mentioned how groovy Dr. Groovy was?). We got what feels like a luxurious amount of sleep that night – no ambien necessary for Fern and an unnecessary bra for me (the nurse and doctor mostly left us alone). I’m glad we slept so well that night because Sunday was harder.
Sunday, October 23rd
A Gathering Storm
Guess what? The catheter didn’t do anything at all. Our new nurse was Elizabeth and our new doctor was Dr. Not-Having-It. He had long fingers; this will be important later. It was immediately clear that Dr. Not-Having-It was not loving the meandering, hippie approach to this labor induction and, though he was extremely kind and funny, his tone was decidedly less patient. In contrast to boring, plan-executing Saturday, Sunday felt like the dark clouds were rolling in and we worried a lot more. We were running out of options and Sunday is the day we started to feel pretty sure that the baby was going to be born via C-section. Probably because Dr. NHI said as much. We were scared and overwhelmed and felt backed into a corner.
The catheter was in until about noon or so even though it was supposed to come out after twelve hours. We were hoping that the extra time would trigger something. Dr. Not-Having-It removed the catheter and performed what was the most comfortable of the pelvic exams which showed no progress. This is where those long fingers came in handy. Then we had a chat with him and it started to feel scarier. Basically Dr. NHI wanted to start Cytotec or do a cesarean. He was coming from a place of concern over Fern’s pre-eclampsia which is understandable – he was concerned that if we didn’t get things going soon then Fern could get really sick. He ordered some blood work to try to get a handle on the pre-e and we decided to start the Pitocin drip to see if that would be the ticket. Welcome back fetal monitor and bp cuff and so long food. I’m pretty sure Dr. Not-Having-It was mentally scrubbing into our c-section and that’s why he wanted to get Fern off of solids. Even though he wasn’t telling us what we wanted to hear, Fern just told me that Dr. NHI was actually her favorite doctor after Dr. Groovy because she appreciated his humor and concern for her health.
Round Four: The Drip to Nowhere and a Deal with the Devil
The nurse came in every 30 minutes or so and upped the Pitocin until we hit the maximum dosage. Nothing happened. No cramps, no twinges and definitely no labor. Sunday afternoon I had a sinking feeling in my stomach. It felt like I was being forced to stare at something I really didn’t want to look at. I can’t remember if we cried but we felt the inevitability of a c-section and it was scary and frustrating after all that time. We were nearly out of drugs to try, short of Cytotec (can you see where this is going?).
I struggled with finding the balance between Brave Face and This Sucks and I’m not sure how well I did. I remember going downstairs at one point and feeling such intense dread and fear but really wanting to avoid bringing that back up to the room. Fern was scared enough on her own and it felt like I needed to be supportive rather than freak out. Not that we didn’t freak out together, we did. But I was trying to remain hopeful too. This is when I should have called someone to talk but I felt like I didn’t have the time (strangely). I did get to talk to L&H that night on my way to pick up some dinner, and that was really helpful.
The blood work came back and was actually pretty favorable – no dramatic increase in proteinuria (and I can’t remember what else they were monitoring but it was all good) and so I think Dr. M. backed off a little and that’s when we struck a deal. We wouldn’t do a c-section that night but would instead try Cytotec. Basically, Fern’s poor response to the Cervidil told us that she did not have a lot of receptors open and her body was not ready for labor. She was not at all sensitive to any induction tactics and experienced almost zero change during the entire 2.5 days. So our decision to start Cytotec on Sunday night was different than it would have been on Friday. Frankly, we were skeptical it would do anything at all so we weren’t too worried about an over-reaction.
The beauty of having an HMO and an incredibly long induction is that no matter what one doctor says you just need to sit tight until shift change and you’ll get a fresh perspective. The doctors we saw were all Kaiser doctors who worked most of the time at their regular OB practices and then did periodic shifts at the hospital. They do not linger at quitting time and no one ever promises you that you will have one, consistent voice for your stay. I used to think this was a negative but it really worked to our advantage during induction. If the doctors had longer shifts or if they came back day after day they might have gotten tired of us and our turtley ways and refused to indulge our ‘just one more’ attitude. Just when we felt stuck with no where to go, Dr. NHI went home and never came back – 10 points for the HMO.
Sunday Rose and I really got into chatting and talked about family histories, her sister’s death while she was pregnant with her daughter, baby names and middles names, her excellent analysis of my mother (both of them are New York Jews of a similar generation and Rose had some major insights!), and her relationship with her daughter. I also tried to teach her how to use Facebook, which was very cute (her lack of ability to comprehend it). Fern was involved in some of these conversations, but mostly it was just me and Rose, sitting on the couch together with our laptops and talking. It was truly a highlight of the long induction, getting to know her better.
You’ve Been Reading for Hours and Something is Finally About to Happen
Sunday night we had another great nurse, Karen. She was doing her first ever night shift and was extra friendly and helpful. She took our long format birth plan and read it through – that felt like a really nice gesture since the last shift had written us off to the operating room. She brought Rose extra blankets to her waiting room couch and just generally tried to make everyone comfortable.
Dr. Tiny was the doctor that night – another one that we barely interacted with except that she put in the Cytotec before bed that night. She was very petite and had small hands. Not good. The pill stuck to her glove and she attempted to insert it several times before it worked. Before bed I snuck Fern some yogurt because I was worried about how long it had been since she had eaten. We were watching TV and I held the spoon as if I was eating it and quickly fed her bites every couple of minutes. I’m a nervous rule breaker so this was big for me.
Fern was back on all the monitors that night and got almost no sleep because, in addition to the monitor shuffle, she started having cramps which Karen verified were mild contractions. Around 3 or 4am they became regular. I guiltily slept off and on through this. I knew that Fern was starting to hurt but I think she didn’t want me to be up all night, so she didn’t express just how uncomfortable she was feeling. In retrospect, Fern says that the pain was pretty minor, but at the time it felt intense. Karen was really supportive and attentive all night.
Oh man, I’m exhausted for y’all reading this. What marathoners you are!
This first half sounds like my labor (cervidil + pitocin = nothing). I’m glad to know in advance that your story ends differently than mine did.
Eeeeek even though I know how it ends I still can’t wait to read the second half. The first half sounds so exhausting! You all are so strong and determined… I admire you!
Looking forward to part 2!!!!
Yay! This is awesome! I’m loving the details and so happy to finally get to read this. And simply amazed to know that the end of the story was a vaginal birth with no epi. That is just such a feat given the pre-labor situation.
xo
I am on tenterhooks even though i know the ending
You went through so much… You guys rock. I am so glad you got this all down. Hugs!
It’s long but so interesting. I love how you named all of the doctors. Looking forward to part 2.
i love the detail. dr groovy sounds awesome. glad you caught a break there, even though fern ended up needing cytotec after all.
I am so ready for part 2! I enjoy all the details, it where I glean insight, so keep it coming.
I’m a detail person, too (though I can never remember them all, then get frustrated by my own story!) so I am LOVING the details. Agonizing how long it took, though!
Totally understand the need for details and my memory is shot which is why I had to type mine up right away!
What an adventure you guys were on. I’m so sorry it had to go this route, ESP when it just seems that Goldie just wasnt ready yet
oh boy! so sorry that your induction dragged on and on like mine
I remember going in that first night thinking our baby was coming that night or at the latest the next day 
love the detail… i never came even close to capturing any of it.
xxoo mulberry
Oh I can’t wait to read more! I’m so glad you started off with such advocates of natural birth, and even though you did eventually have to go with the cytotec, it sounds like this was one of those difficult decisions that really was necessary under the circumstances.
By the way, I am very fond of detailed birth stories (ours was something like three installments), so keep the specifics coming, and don’t worry about editing!
Wow, what a ride! I’m excited to read the rest. I love all the detail, personally, and I know you’ll be glad to have it in the future to share with Goldie and just for your own memory.
Please tell me part 2 is written already.
Even though I know the ending, I’m on the edge of my seat! You gals are troopers, that’s for sure. Can’t wait to hear how the rest of the story unfolds!
Love this. (and I love the details…)
Wow. Looking forward to part 2!
Whew, I’m just glad after all that, a vaginal birth was managed. This long, difficult labor story is bringing back memories, sigh.