There was great news and bad news with the shift change, but we only knew the good at first:  Sue was back!  Seeing her that morning was a definite boost.   She was obviously very happy to see us too, though sympathetic and shocked that we were still there.   I kind of felt bad for our night nurse when I asked who was coming on in the morning and then enthused quite a bit when I heard Sue’s name.  Dr. Asshole was our doctor for the day and the one who would deliver Goldie.  She was the worst doctor in the lot.  The goodness and helpfulness of Sue ultimately outweighed the negatives of Dr. Asshole, but I’m disappointed we landed with that doctor.

Dr. Tiny was still on in the early morning and ordered another Pitocin drip around 6am.  Another painful cervix check showed 3cm dilation and about the same effacement/station (possibly one station lower).

Then labor started like gangbusters – so fast that we didn’t even realize what was happening.  Since Fern was on a liquid only diet she could only eat broth, jello and similar things (the room service menu had a whole liquid section which was nice of them but kind of depressing to select from).  She ate some broth around 7am and threw it up around 8.  This was transition to active labor but it was hard to believe that’s what was really happening.  It seemed impossibly early.  As Fern threw up into a tiny kidney shaped tray (they really could give you bigger puke buckets), I thought about a conversation we had had with h & l at a Dairy Queen by h’s mom’s house only three weeks before.  H told us that she got really excited when l threw up in labor because she knew that was a sign of transition.  Then I thought about how weird it is to get excited about vomit and debated with myself about whether this could be transition.  I cautiously hoped it was.  Then I thought about how impossible it was that we had just eaten that ice cream and talked about labor with our friends and now we were in labor and everything was about to change.  And I wished that h&l were there with us.

When I got up sometime around 5:30 or 6 I made my biggest mistake of the day – I didn’t eat breakfast.  I talked to Lyn a lot before induction since she had a similar home-birth-turned-induction and was a great support as we switched to the hospital.  Lyn had impressed upon me the importance of eating throughout labor.  So I was thinking of it, but I couldn’t manage anything much at that moment.  We had been ordering a guest tray for me when we ordered Fern’s breakfast but Rose warned me not to eat food in front of Fern once she was on her liquid diet (a really kind suggestion) and even though Fern said she didn’t mind, a breakfast tray just felt a little leisurely during this labor that was starting to really progress.  I did eat a protein bar and some peanut butter crackers at some point that morning, but after the adrenaline of labor and birth wore off I almost collapsed from hunger.  If labor had lasted much longer, I would have been useless, I’m pretty sure.

After Fern threw up her broth the contractions started to get serious.  We put Bach’s Lute Suites on the ipod and tried to make a nice mellow atmosphere but Fern was hurting and I’m sure she didn’t feel very mellow.

Sue, wonderful, amazing Sue, asked if anyone had put Fern on the telemetry (cordless) fetal monitor over the weekend and was rightfully outraged that they hadn’t.  Getting on the telemetry monitor I think is a major contributing factor to Fern’s vaginal birth.  That monitor and Sue saved us which sounds dramatic but I don’t think is an exaggeration.

Since Fern’s bp had been so stable and low the entire weekend, Sue allowed for periodic bp monitoring instead of constant (another majorly helpful move) and basically treated Fern (cautiously) like she did not have pre-e.  While this might sound dangerous now, it really was a very forgiving and level-headed move.  Sue still checked Fern’s bp regularly, but Fern now had the freedom to sit on the birthing ball, walk down the hall and sit in different positions.

Fern and I took one walk to the end of the hall, pulling the Pitocin drip along, and looked out at the beautiful views.  That was the farthest Fern had ventured since we arrived and for me it was kind of surreal to leave the intensity and staleness of the room and watch cars along the highway full of people having a normal Monday, heading to work without any knowledge about what was happening up here.

One hall walk was enough for Fern.  Her bp stayed low but she found walking incredibly uncomfortable.  I hugged her during her contraction in the hall and she leaned on me but mostly she wanted the stability of the room, so we headed back.  I was glad to be back too.  Being in the hall by ourselves felt scary and I didn’t feel ready to handle what might happen (I’m not sure what exactly I thought might happen, but I liked the extra people).

Fern got through a number of contractions sitting in bed with me or Rose pressing on her back.  She did some standing with one leg on a suitcase, leaning on me.  Rose told me to push on her back and press her hips together to ease the contractions.  Generally back pushing was what helped most for Fern.  She didn’t love the exercise ball and didn’t try squatting.

Rose tried to get Fern to pull her belly up during a contraction (apparently this helps move the baby down into position) but that was very painful for her so she didn’t do too many that way.  It really looked like Fern was going to kill someone during those and it’s amazing to me that she was in such intense pain and persisted.  She was so strong.

Around 10am Fern was laboring seated on the edge of the bed and her water broke.  It was everywhere and it was so thrilling.  I think we were both having trouble realizing that labor was going to keep progressing.  When you’re pumped full of all those drugs it doesn’t feel like the body is really in control.  To witness Fern’s body suddenly taking over for all the pills, drips and tricks was amazing.  Sometime around now Sue did another cervical check (which I thought they weren’t supposed to do after the water had broken, but Rose didn’t object so we just went ahead – if I were doing it again I would have at least asked if it was a good choice/optional).  Fern was 4cm dilated – beautiful progress!

Speeding Towards the Finish Line
Even though I think that pelvic exam was unnecessary, I’m glad we knew the dilation because things were about to get crazy!  Sue told us that the telemetry monitor was waterproof and that we should draw a bath for Fern.  The bathroom was small and they didn’t have fancy, jetted tubs like the other hospital we looked at, but it sounded good to Fern and she went in around 11:15.  This was a dream because we had been planning a home water birth and Fern was looking forward to it so much, but when the pre-e crept up we were sure that she wouldn’t be able to labor in water at all.

Fern was in the tub for about 90 minutes and, though the pain was intense, she felt a lot of relief in there.  I sat next to the tub and every time a contraction came, I sprayed water on her back and belly.  Rose dimmed the lights and put Bach on in the room and it was pretty peaceful.  Fern was in a kind of trance-like state and didn’t say much.  She rested between contractions and even fell asleep sitting in the tub.  It felt long and short at the same time.  Sue came in a few times to check bp, get the baby back on the monitor (the belt slipped a lot in the tub) and to make sure everything was ok, but mostly it was just me and Fern.  Even Rose, who had been playing a very active role before, stayed back in the room.  Unlike in the hall, it felt good to be just the two of us.  We haven’t been alone together since.

Sue had told us that Fern needed to get out of the tub when she felt the urge to push.  A little after 12:30 Fern started to feel like she had to poop and, though it felt way to early for that to be the urge to push, Sue hurried her out of the tub and back to the bed.  Fern and I both felt like Sue was perhaps overreacting a bit.  But Sue did a cervical check around 12:40 and said Fern was nine and a half.  Fern was out of it and cutely asked, “nine and a half what?”  I understand her confusion because her dilation happened fast but it was clear to the rest of us what was happening and all of a sudden things started moving.  The doctor was paged (urgently) and Sue started transforming the bed for pushing.  They have a big bar (perhaps called a labor bar?) that fits over the bed and then later the bottom half of the bed is removed all together.  At some point a cart full of instruments appeared and someone yelled at me to move the suitcase Fern had been using earlier.

Sue said that there was still a tiny bit of cervix so Fern shouldn’t start pushing just yet, but Rose whispered to Fern that she could push if she needed to.  Rose told Fern to make a grunting noise with each contraction and she excelled at the vocalization!  Fern started secretly pushing with each contraction.

Lots of people showed up in the room and Sue and Rose helped Fern get on her side.  Though she did have to push in bed, it really was the best possible version of that.  Fern was on her left side and put her right foot up on the bar.  She pushed off against one of the nurses, Rose or me with her lower foot.

The whole room was abuzz – a very sharp contrast to the last few days and at least those of us not in labor where getting excited.  Then the doctor came in (cue foreboding music).  Dr. Asshole picked up a copy of our birth plan (I made about 400 copies to have on hand) and said it was fine except that we couldn’t do both skin to skin immediately and let the cord stop pulsing before cutting, we had to pick.  She had this theory that putting the baby on Fern’s chest right away would cause the baby’s blood to flow out of her body and back to the placenta.  What????  I’ve never heard this theory before and I barely knew what to say.  Rose politely but firmly questioned the doctor and told her that she always safely allows both the cord to pulse and immediate skin to skin and I think this challenge pissed off Dr. Asshole and she dug in even more.  To me Dr. Asshole seemed insecure.  She was relatively young and it felt like she was compensating by standing arbitrary ground but it was clear she wasn’t going to relent.  There was an awkward moment, Dr. Asshole on one side of the bed, me and Rose on the other, at a stalemate while poor Fern labored between us.  I looked over at Rose and she gave me an encouraging nod which gave me the courage to ask the doctor if there was any room to move on this.  That was a big step for me because I am not great at standing up to authority figures (especially under stress) and it felt so impossible that we were having this disagreement while Fern was fully dilated and pushing.

Once I asked, Dr. Asshole agreed to go off to consult another doctor.  She came back and said she and her colleague had just looked up some articles and she still didn’t feel comfortable doing it our way.  She then asked Sue her opinion, basically forcing Sue to step into a very uncomfortable disagreement.  There was no way Sue could really side with us because she had to work with this doctor, so she said something vague while looking incredibly uncomfortable.  I was so mad that the doctor was using Sue this way.  So Rose suggested we compromise and have baby be skin to skin with me until the cord stopped pulsing.  The doctor agreed and they got me a gown (everyone seemed worried about my clothes).  I was annoyed at the Doctor’s stubbornness and missing Dr. Groovy but was glad to have the conflict behind us.

Fern actually started pushing at 12:45 but officially started at 12:55 when the doctor gave her permission.  During each push we held Fern’s feet or held them to the bar.  The doctor was telling Fern to hold her knees apart (presumably so she could see better) and Rose was annoyed because she didn’t think that was a helpful position so she told Fern she should do what was comfortable.

The monitoring got more frustrating during pushing because the sensor would come off with each contraction and the nurses were instructed to re-find the heart beat each time.  They had to roll Fern around a little to find the baby and that was frustrating for her.

But pushing was really productive and fast, though it felt just the opposite to Fern.  Especially when it took more than one contraction to feel a change.  As Fern pushed I held her hand and supported her.  I said what seemed supportive but I can’t remember what words I used.  I had taken off my shirt and bra when they put the gown on and was annoyed that the gown wouldn’t stay on better.  I had to hold it up and fix it a lot and I was irritated that I was spending my time that way.  Not that anyone noticed or cared, but I was flashing them quite a bit.

Goldie’s head started showing soon and Fern reached down and felt it (once was enough for her – she didn’t like touching it).  As it was part way out they suddenly couldn’t find the heart beat.  The doctor and everyone else started to panic except Rose who looked me in the eyes and told me it was fine and not a big deal.  I believed her and felt for the thousandth time so grateful that she was there.  They couldn’t find the heart beat because the baby’s heart was practically out of Fern’s body and was moving, but the doctor treated this as a Very Big Deal.  Without really asking (or maybe she did ask, but rather quickly), Dr. Asshole starting drilling the internal monitor into the top of the baby’s head.  It didn’t work and so she had to redrill it.  That one also didn’t work.  There were about 3 nurses trying to find the heartbeat and as she failed with the internal monitor, the doctor said she was going to have to vacuum the baby out.  Fern was getting a little hopeless and she later said that she was on the verge of asking for the vacuum just to get it over with.

Then wonderful Sue had Fern roll onto her back and they found the beat instantly with the regular monitor.  All this was completely unnecessary panic and I am so glad we had Rose there telling us that there was nothing wrong.  I think if we had had a more experienced doctor, we wouldn’t have gone through all that.  Every time the doctor drilled into the baby’s head, Fern could feel her recoil and squirm.  Goldie had a scab on her head for about 8 weeks and it made us so angry each time we saw it.  It wasn’t until Fern’s 6 week postpartum visit that Rose told us the doctor had been massaging the baby’s head with KY jelly the whole time (as a misdirected way to prevent tearing, we assume) and so that’s why the internal monitor didn’t go in.  Amazing.

Fern was doing wonderfully but she was exhausted.  She asked a couple of times when it was going to be over and felt like we were lying when we said the baby was almost here and getting closer with each push.  At some point Rose said, “You’re doing this, Fern” and Fern said, “I’d better fucking do this.”  To be honest, at some points I did feel like we were lying to Fern a little.  I had absolutely no idea what progress was – I couldn’t measure the head’s progress from where I was standing – and I was relying heavily on Rose for cues.  I had read lots of stories of stalled labors and stuck babies, so that didn’t help my confidence.  Even though the labor ended up being relatively short, we didn’t know this was going to be the case and so every stage felt potentially permanent when we were in it.  I was still really afraid of a c-section and with all the people standing over the bed looking for problems, it felt like someone could declare the need for one at any moment.

Born
The final push was a total shock to Fern and to me as well.  She said it felt similar to the water breaking – suddenly something moved where nothing had moved before.  To look down and see a baby come out was surreal and beautiful, indescribably so.  I had been looking at the top of her head for so long that she seemed huge when she finally came out.

Goldie was born at 1:39pm and they quickly moved me to the base of the bed and I took off the gown.  The doctor said “she’s slippery, don’t drop her” (a brief annoying moment since my patience was already low with her) as she handed Goldie to me.  I held her to my chest, our baby girl only seconds old, and it was absolutely amazing.  Cliche as it sounds, it really was the best moment of my life.  From the pictures I looked somewhat tentative but I just remember holding her tiny body and wanting to keep her close and take in every inch of her.  I sobbed with joy and maybe a little with shock.  After so many days I could barely believe I was holding our daughter.  After so many years I could barely believe I was holding our daughter.  Rose told me to look up so she could take a picture and I have the weirdest expression on my face in those shots.  I remember thinking, I have no idea what to do with my face.  Smiling seemed wrong, sobbing seemed wrong.  There are a bunch of pictures (I think Rose was trying to get a salvageable shot) and I look pretty dopey in most of them, but in love.  At some point Goldie pooped meconium all over my pants but I didn’t notice until later.

After probably not quite long enough, the doctor cut the cord (I was going to do it before I got the skin to skin role).  I thought it seemed a little quick and Rose agreed that the doctor could have let the cord pulse longer, but at least we got to let it pulse for a few minutes (I just checked my photos and Goldie’s first picture with Fern was 1:43, so it was pretty fast).  I brought the baby to Fern and put Goldie on her chest.  Goldie frogged up right away and we took pictures and Fern kept exclaiming something that neither of us can remember, but I think it was, baby.  At that point, Fern couldn’t feel much down there and definitely didn’t feel the need to push, but she tried and the placenta came right out.

Fern had a second degree tear which the doctor started stitching up while Rose tried to get Goldie and Fern breastfeeding in the side-lying position but Goldie wasn’t ready to latch on.  At some point the doctor showed me and Rose the placenta (Fern wasn’t interested in seeing it even though she later ate it in a tomato juice smoothie and a bunch of pills!).  Dr. Asshole said it was fully intact and looked great.  She then pointed out one part and told me that there was basically a latent time bomb in the placenta.  It had a name which I blocked out.  If you think you know what it’s called, please don’t tell me.  We’re happy not to know.  Basically if the placenta had been in a different position the baby would have died in utero.  She said we where very lucky.  Ugh.

Shortly after this terrifying tour of the placenta they weighed Goldie – 5 pounds, 7 ounces – and gave her back to Fern to try nursing some more.  But Fern started to feel a lot of pain and was having trouble lying with the baby.  Sue gave her some ibuprofen.  Fern’s pain increased and she opted to have Goldie get her vitamin K shot, heal prick and temp because she was in too much pain to hold her.  I went across the room with Goldie and cried while they poked at her.  We found that Goldie had low glucose and since she wasn’t breastfeeding yet (and maybe even if she had been) they declared she needed supplementation.  This is another time I was so glad we were at that hospital.  Since Suburban Hospital is a Baby Friendly hospital, they don’t give formula but instead have a store of donated breast milk on hand.  As I got set up to feed Goldie, some nurses quickly and suddenly started pushing on Fern’s uterus to get her to pass some clots.

The Scary Part
They tried to give me a bottle for the breast milk which I was about to accept when Rose (thank you, Rose) stepped in and objected so that Goldie wouldn’t have nipple confusion.  I felt terrible that I hadn’t thought to ask for something else, but I really didn’t realize there would be other options.  I got set up in a chair with our tiny, 5.5 pound baby, an SNS (supplemental nursing system) and a syringe full of breast milk (two entire ounces which was an insane amount for her tiny stomach – she barely takes that much in one feeding now, at 13 weeks).  I was terrified feeding the baby.  I didn’t know how to hold her and it was really awkward to hold the syringe, baby and feeding tube.  As I sat there, trying not to choke the baby, I watched in horror as a nurse pushed incredibly hard on Fern’s uterus causing her to scream so loud (louder and more urgent sounding than in labor).  Fern grabbed the nurse and tried to shove her off.  It was horrible to watch.  I know some people have trouble watching their partner in pain during labor, but I didn’t feel that way too much because it felt productive the whole time.  Watching her in this struggle with the nurse was awful for me and as I held the tube into our daughter’s mouth, I just cried and shook.  I was so alone in my corner because I was sitting pretty far back and almost everyone was rushing to Fern’s side.  I was so thankful for Rose who remained calm and comforted Fern.  If I couldn’t be there with her, Rose is absolutely who I wanted with Fern.

The uterus pushing nurse persisted in spite of Fern’s resistance and Fern passed a truly enormous blood clot.  The room filled with people and light again and the doctor came in to make sure there were no more clots.  I don’t know how big the clot was exactly, but let’s just say that they put it on the scale and weighed it like a baby.  Fern lost a lot of blood and her hematocrit level went down to 25 which is the cutoff for needing a blood transfusion (her level went back up quickly enough that she didn’t need one).  The good news is that Fern felt instant relief from the pain after passing the clot.  The ironic part is that the treatment for the clot is four Cytotec to help shed any remaining clots, placed anally (yup).  So more Cytotec for Fern.  I soon finished giving Goldie her milk and was able to give her back to Fern.

We don’t know why Fern hemorrhaged, but we think the long induction could be to blame.  There have been studies since the 1970s showing a link between Pitocin and postpartum hemorrhage.

The Dust Settles
Things calmed down and cleared out and except for a scare when Fern got up to go to the bathroom and almost passed out (luckily, Sue was with her), Fern felt ok, though incredibly fatigued from losing all that blood and, oh, laboring and giving birth to our baby.

Goldie had a very long sleep starting around now and we made some phone calls to announce her arrival while holding our tiny, amazing bundle.

Even though we were in the hospital for a record-setting amount of time (no nurse we talked to could remember anyone being there longer for an induction and labor), Fern’s labor was remarkably short – about 7 hours of active labor.  The other remarkable thing was that she showed no signs of pre-eclampsia during active labor and so was able to skip the Magnesium.  They had been planning to put her on it after birth for 24 hours as a precaution since the risk of seizures is still there.  But ironically? fortuitously? the hemorrhaging incident meant that she couldn’t take the Mag because Mag causes/exacerbates bleeding and the blood loss also caused her blood pressure to go down.  So, thanks, blood clot?  Definitely a mix of good and bad there.

Rose left pretty quickly after things settled back down.  She had been with us longer then she’d ever been with a client for labor and she was a little desperate to get home.  We can’t blame her.  To her credit, the first glimpse of her drive to get the hell out of there didn’t show before her exit when she practically threw her things in a bag and bolted for the door. She earned that escape.

After Goldie’s birth they were in a hurry to transfer us to the recovery wing.  I was pretty overwhelmed with all that had just gone down, my incredible hunger as well as a terrible stomach ache that had started up.  At one point as I was trying to find something to eat, get Fern something and pack, I just burst into tears.  I couldn’t focus and I hated that I had to do anything other than look at my baby.  All my nerves were raw.  As hungry as I was I could barley eat the food we ordered.  My stomach was in knots and I was completely overwhelmed with trying to load up our bags (it was no longer as neatly packed as it had been when we arrived).  I think the intensity of the day’s events was hitting me and I was taxed.  I felt pretty sorry for myself that I had to do all these housekeeping tasks.  Eventually I got it together and we moved out to the recovery side (Fern and Goldie were wheeled over and, meanwhile, I had to take 3 trips with the luggage cart).  We left an incredible mess behind us – blood was absolutely everywhere.  I felt bad for the people who had to clean up after that labor.

Unexpected Challenges
Life on the recovery side was surprisingly difficult.  We wanted nothing more than to love and hold our baby but an incredible number of people with an array of opinions (many of them contradictory) came into our room on a near constant rotation.  I can’t remember who they all were and what they wanted anymore – there was the pediatrician, the charge nurse, the regular nurse, the night nurse, the supervising nurse who wanted our feedback on all the other nurses, the lactation consultants, but then so many more.  They kept pricking Goldie’s heal and they took her out for hearing tests and rotated her hips and looked at her eyes.  They gave advice on breastfeeding and swaddling and everything else.  Fern was in a lot of pain from the tearing, the blood loss and everything else her body had been through and she and Goldie were experiencing many of the typical frustrations of learning to breast feed.  There were constantly people checking Goldie’s latch, analyzing input and output (we had to keep a log), instructing Fern to pump and monitoring Goldie’s weight.  On top of this we both questioned all of our actions and decisions and agonized over everything.  I think this is natural for first time parents, but it was extra stressful in that environment.

By the time we started the labor induction process, we had mourned the loss of our home birth and had, more or less, come to terms with the hospital birth.  We were so happy with the hospital we picked during the labor side of things, but what we didn’t prepare for (and probably couldn’t have prepared for) the postpartum stay.  That is when we really felt the loss of the home birth all over again.  We felt so harassed and exhausted and it just seemed impossible that they couldn’t leave us alone.  We didn’t like the nurses on that side either.  It felt so much harder to get to know Goldie with all those people around and sleeping apart in separate beds (well, one bed, one chair that pulled out into a “bed”).  After a day I became completely desperate to leave.  The experience was especially hard as a dyed-in-the wool introvert – it never felt like we were alone.

They kept us two days to monitor Fern’s recovery and Goldie’s weight and I felt like I was willing to sell my soul to get out of there by the end.  When they told us we’d be able to go on the second day, we demanded an expedited release (you have to get checked out by various departments, doctors, nurses, etc. and apparently some people don’t care when or how fast that happens) and we ran out of there.  In all, we were in the hospital for 5 days and then after one day home, we returned for another two because of Goldie’s jaundice – another terrible stay.

Best Laid Plans
Despite the induction circus and taking almost every induction drug available, I still think Fern gave birth naturally.  But I’m not going to get into an analysis about what constitutes natural birth right now.  Obviously, this was a very medically assisted labor.  But given the circumstances, Fern achieved her modified goals and that’s what matters.  She set out to give birth vaginally without an epidural and she achieved that.  She considered asking for an epidural many times during the earlier part of labor but made it through and I’m proud of her and what she accomplished.  Who knows what she would have decided if active labor had been longer, but I feel certain that she would have made the right decisions for her body and for Goldie, even if it meant a departure from the plan.  Remarkably, through luck and perseverance and shift change fortune, we didn’t stray too far from the birth plan that we wrote and rewrote a million times before labor and we feel lucky that we were allowed to chip away at induction and feel comfortable with all the drug decisions.  I still mourn our missed home birth and postpartum period but I am very happy with the experience we created and feel so proud of Fern and proud of me for bringing Goldie joyfully into the world.

Before you settle in to read you should know that I have a detail problem.  I have this in real life story telling too.  I get it from my mom.  Somehow I feel like I’ll lose the details if I don’t record them or say them and I have a hard time letting any of them go.  I made an effort to edit this down, but this isn’t the time for me to try to be someone I’m not.  And I want to record everything we can remember so we’ll have it in years to come.  So this is the story of Goldie’s birth, as best I can remember.  I’m breaking it into two posts so it doesn’t crash your computer.

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.