The Elijah Cannon: Part 2, Labor & Delivery

From this point on, I might start inventing details, but I'll try to keep them interesting.  Hopefully my doula, Kim will be able to provide me some details to fill this in. So much has happened since the L&D event, and during most of my labor, I think my mind escaped to another dimension.

So, there I stood at 10 p.m. Wednesday night, in the bathroom, leaking and bewildered. I got on the phone with Kim to give her a heads up.  I told her I'd call Dr. Tate, per my instructions. Brian, well, I can't recall what it was he found necessary to do - perhaps dash upstairs to alert my parents - but he asked me to put my drippy self back in bed with the boys and try to get them to sleep. I'm not so sure he was thinking straight, but I gave it a go.

My parents had driven up the day after I originally thought I was in labor.  After a couple uneventful days, we had been really hoping they'd get to see a baby while they were up.  Just in case, we promised them a visit if they missed out. I wasn't thrilled about the time of day this was taking place, but at least we were for sure on the road to a baby now!

I called Dr. Tate, and his response slightly disappointed me, but looking back, I should not have been surprised. I had envisioned staying home and trying to get some sleep, or a hot shower and waiting until labor really kicked in. At the moment I wasn't feeling much contraction activity. Doc T wanted me to go in and have the baby checked to make sure there was no risk of cord prolapse, etc. It's good that he wanted to play it safe. By his reputation, you'd think he was a big radical risk-taker, but that's just from those who haven't studied the facts. He has a fantastic record with Vaginal Births After (Mulitple) Cesarean (VBAC, VBAMC, VBA2C etc), breech babies, multiples and other non-standard births.  What's unique about him these days, is he knows how to handle anything that comes up, with solutions other than C-Sections.  He can turn babies, use forceps or vacuum, dive into emergency surgery, or whatever is needed. He believes in labor and birth and in a mother's body's ability to do what it was made to do. His approach this night wasn't like I've heard before from other doctors, though.  Typically they would barrage me with all the scary possibilities and risks - I would feel like I was being scared or manipulated into a course of action.  All of my encounters with Doc T during the labor process were full of sweetness, confidence and compassion with a tone of reasonable caution. He never led me to feel manipulated, and told me outright he believes in informed consent, such that he gives the facts and his opinion, but it is my decision. I always felt valued and respected.

After my talk with Doc T., I called Kim back to let her know the plan.  We were going to keep her posted on the triage results and call her in when needed. She reassured me that we could take this step by step and make decisions for ourselves based on what felt right, such as whether to officially check in, or leave to do some walking after triage.

Mom was up by now, and we chatted a bit.  She remarked at the similarities to her third labor - a pasta dinner, followed by some stretching exercises, followed by water breaking. The similarities unfortunately did not end there, as we would find out later.

Brian had the car loaded up and we hit the road. We hadn't gone far before the contractions picked up to a regular pattern.  I think we picked up some breakfast, but I can't recall for sure. By the time we'd stopped at a gas station to pick up illicit snacks and drinks for the labor room, I was getting very uncomfortable and contractions were 3 minutes apart.  By the time we were within 10 or 15 minutes of the hospital, I knew I would want Kim with us soon, so I texted her, asking her to come in.

We got checked in and set up in a triage room. My water break was confirmed and I had a sterile speculum exam. At some point we were moved to our labor and delivery room. I paced around the room for a while, stopping occasionally to lean on a chair or the bed.  Eventually the nurse was nervous enough that she got me pinned down to strap on the monitors. Elijah's heart rate was doing well. My contractions were regular and getting stronger. At this point I loose almost all sense of time.  For a little while, at least, I was able to participate in conversations and watch some Super Bowl commercial candidates that CareerBuilder.com had out for voting. Shortly after, I checked out.

I lived the next 8 or more hours two or three minutes at a time.  The pain became unbelievable. I'd always had really bad menstrual cramps that would have me curled up in bed groaning, if I had the luxury. I was anticipating that labor would be largely like that or slightly worse, followed by some more intense or even excruciating pain right before and during delivery. I figured I'd want to work the circuit of defiantly shedding my monitors to sway in a hot shower, or pace the floor. I assumed I'd work up a big appetite and want to graze on my hidden snacks and drinks. Whoa mama, was I wrong!

The pain rocketed to about a 15 on a scale of 10 and I felt pretty much paralyzed.  I didn't want to move, even a little.  It seemed like any time I changed positions, it triggered an even worse contraction. I tried standing and swaying with Brian and hated it - I felt like I was being suffocated on top of having my uterus twisted into knots.  Of course, he's almost a foot taller than me, so that's not particularly comfortable in any state. I tried leaning on the bed, which was so-so, but the contractions made me want to squat, and against better judgement, I hadn't trained for that. I spent a good deal of time on the ball, leaning on the bed.  That worked out fairly well because Brian sat on the other side of the bed and holding my hands and saying calming things to me between contractions and Kim sat behind me, coaching me through contractions and squeezing my back. I could effortlessly make minor position adjustments and stretch my back. Much of the time, though, I had planted myself somewhat Indian-style on the bed, grappling at my own back and, for some reason, often supporting much of my weight on my fists.  I knew I should try to relax my entire body, but something about that felt good.  I tried to focus on keeping my face and lower body relaxed.

At first, Kim's coaching seemed a little esoteric, as she was encouraging me to "go deep", but soon it completely clicked and became a tangible and effective pain-coping ritual. I could tell when I was losing control of the pain, as my voice would get higher and I'd feel more panicky. When in control, I prepared for the contraction by relaxing my body and clearing my mind, and as the surge came on, I began to groan in a low voice, and as it built, I would groan harder and deeper, while visualizing all the energy being directed down and out and being put to work preparing the way for baby and moving him towards birth.  I was thoroughly shocked and stupefied by the intensity of the pain - and the completely bizarre and feral noises I was making.

A well-meaning nurse kept popping in and would comment about hearing me out in the hall and ask if I wanted pain medicine.  That was a bad thing for me.  I already would struggle pretty severely with self-doubt at the apex of contractions, wondering how I could possibly endure another.  Having pain relief dangled in front of me really weakened my resolve. I never let go of my goal, though.  I wanted to birth a completely unaffected/unmedicated baby, and I held onto that, even with my weakest grip. I wasn't sure if time had slowed or completely vanished. I felt locked in a loop of torture and relief that seemed to have no end or beginning, and almost all other reality had vaporized. As each contraction would wind down, I would hear voices fading in reminding me to let go and relax and I would take a deep breath and try to blow away the residual pain and all I could gasp was, "ICE!" Brian would calmly hand me the cup of ice chips - those wonderful, delicious, delicate pellets of hospital ice - and I would crunch down on a few and feel my mouth rehydrate and the cool trickle of moisture down my throat, and then fade back out to await the next test.

Finally, when I was feeling entirely wild-eyed and beat-down, someone came in to check me.  I was so nervous to hear the answer.  If it wasn't a significant amount of progress, I didn't know how I would go on. It seems like she dug around for an eternity, which had me bracing for utter discouragement. But when she stood straight and said I was a 7, I rejoiced.  I was in transition!  About that time I first noticed the sunlight. Brian and Kim cheered me on - I was almost there! For a while, Kim would occasionally ask me to describe location of the pain. For the longest time, I was not sure if the pain was becoming more "cervical" or not. Near this time, I felt like I had to pee really bad, but was in a bit of a panic because I didn't think I could get out of bed through the contractions.  Brian found a pan and I managed to get out of the bed, and am pretty sure I missed the pan anyway, with the little that I could squeeze out. Oh well, one loses concern for these things. I think I finished the job later when I started pushing.

Soon after, my mind began to chant, "Where's Tate? When's he coming?" Every time the door would open I looked hopefully in its direction, hoping to see my doctor walk in. The pain had begun to include definite sensations of bottom pressure, and my contractions were ending in a much different, almost relieving sensation, accompanied by a wild roar of a vocalization. The seemingly omniscient "Doc T" strode in with his entourage some time after 9 a.m. In my mind, I leapt up with joy to see him and threw my arms around him with relief. In reality, I belted out a wolfpack battle cry.  He sat on my bedside and place my foot on his chest, ready to check my cervix. I felt a slight panic when I realized he was waiting for a contraction. As he examined me, I reflexively pushed at him with my foot. He instructed me to pull my knees up instead of pushing them out, which required a complete rewiring of my brain.  Whatever he was doing amplified my pain about ten times, which I didn't think was possible.  He stood up and announced I was a 9 and was already pushing and couldn't help it and that I'd be ready to push in about 15 minutes. This was around 9:30 a.m. People milled around as the minutes passed and I thought I was going to pass too.

I was lucid enough to answer that I did want a mirror. I amused myself realizing that I paused to marvel at how perfectly the mirror was placed. I crumbled into another contraction. Doc T tucked away his tie and checked me again. I realized then what he meant by pushing.  I realized the sensation I'd been feeling at the end of my contractions was my body pushing. Doc T suited up in his protective gear and started digging at my birth canal again.  That made me push like mad, but I had to be coached that I was fighting myself by making noise and not pulling on my legs hard enough.  I was afraid to hold my breath, like I'd burst a blood vessel or something. I thought I was pulling hard, but found I could go further.

Pushing felt great. It's hard for me to say that and segue to saying it felt EXACTLY like pooping (like I read it would feel), but I guess there's something at least slightly rewarding about relieving myself of feces too. However, to continue with the TMI streak, large poops hurt.  This didn't register as pain. Tate was dumping oil down the pipe and massaging and stretching some part of my birth canal.  While he was doing that, it made me have to push.  They kept telling me not to push when I wasn't having a contraction, but I couldn't tell anymore when I was having a contraction. Doc T stepped away for a moment (I think to ready some forceps due to a brief decel), and I sat there marveling at the mirror, seeing a tiny circle of Elijah's head, wondering impatiently when I was supposed to push again. It felt like 10 minutes later (but clearly wasn't), that I decided to push, thinking maybe I was feeling the urge again. This time I held my breath and I wrenched my knees up. In the mirror I saw Elijah's head lurch out and Doc T lurch forward. There was commotion and I wasn't sure who was saying what to whom, but I couldn't stop. A moment later, the rest of Elijah sprang forth. Brian jokes that Elijah came out like a fighter pilot ditching his craft and the cord stretched taut like a rubber band springing Elijah back. So, on January 14 at 10:09 a.m. I pooped out my 8lb 13oz, 20", APGAR 8/9 son in 13 minutes!

Doc T offered an ever so slight reprimand and started mumbling about the damage. I wasn't physically aware of what he was talking about. I didn't have a chance to feel that "ring of fire" or the 4th degree tear or any of that. I was on a high with my sloppy new baby on my chest and it was amazing. I felt powerful and alive. Elijah and I stared at each other as I squeezed him and smelled him and babbled about how beautiful he was and "Hi, I'm Mom," and who knows what else.  There were after-birth things going on below, but I paid no mind. I started wiping him down, and noticed some of the "stuff" wasn't wiping off.  Knowing that babies are frequently born with all sorts of spots and rashes, I casually asked, "What are all these spots?" It quickly became apparent that he was covered from head to toe in red and blue blisters. Nobody had a clue what it was. I was about to see if he'd try to nurse, but he sounded really gunky, so they tugged him away to suction him.

They were taking some time with him, and in my daze, I wasn't aware that there was any significant concern with him, so there I lay, splayed out on the table, with nothing but a dislodged nursing bra, a cell phone and a very bright light in a formerly private place. I passed the time texting since-forgotten messages to since-forgotten recipients, as Doc T tried to put Humpty Dumpty back together again. After a bit, Brian told me he was going to accompany Elijah to the nursery for observation. There we go again, having our new baby whisked away. But, he came into the world the right way and I got to spend some time with him, so...okay. The stitching seemed to take forever and I seemed to have lost my gladiator toughness, because I kept yelping at the needle pokes, and Doc T tried to keep up with the numbing medicine.

Once I was all stitched up and the crew was packing up, I found myself bewildered again. This was supposed to be hugs and pictures time. There was supposed to be a milky-mouthed baby in my arms, and cheesy grins, hugs, high-fives and thank-yous all around. I lay there with no covers, no baby, no husband, completely tongue-tied, while everyone busily cleaned and charted.  I hope I at least thanked Doctor Tate. He provided me a priceless gift. Brian and Kim were fantastic too. I can't imagine how I could have plowed through that labor without them. Without Kim, I would have been an out-of -control mess and that would have put Brian in a very challenging and disconcerting position, trying to figure out how to meet my needs and help me cope with the agony. I very well might have crumbled into strategies that might have lead down a very different and unfortunate path.

A kind nurse finished cleaning me up and got me situated with a very welcome ice pack. Kim stayed with me while we waited for me to be moved to my recovery room and the next leg of my unwelcome adventure.

The Elijah Cannon: Part 1, Early Labor

Today's probably not the best day to be writing this.  I think I'm fighting the blues, but I'm not sure what else to do at the moment.  Throughout the weekend of the 9th, I was getting lots of Braxton Hicks (BH) activity, which was really exciting.  I'd gotten some during my first two pregnancies, but I don't recall having them with this frequency.  All day Saturday, with fair regularity, I was getting a mix of BH and mild contractions.  It felt so good to see my body at work, doing what it was supposed to do.  Sunday seemed like a "break" day, with only the occasional BH.  That felt a little disappointing, even though it was still only my 39th week.  I was excited to get this thing going.

Sunday night I went to bed with mild, regular contractions.  Monday morning, about the time Brian gets up for work, I was having more painful contractions that had been keeping me up for a couple hours.  I told Brian they seemed very regular and close, so I got in a warm bath and we started timing, as he got ready for work.  They were right around 3 or 4 minutes apart, sometimes two minutes.  I sent Brian to work, knowing that if this was the 'real deal' it could very well go on for hours or days.  I finished out a full hour of timing to be sure.  The contractions required a fair degree of focus, but I could still talk through them. As per my instructions, I called Dr. Tate to inform him.  To my dismay,  he wanted me to go into the hospital to get checked out, and make sure the baby was doing well.  I called my doula, Kim, and told her I'd let her know what the hospital said. She set my mind at ease about the visit, reminding me that after triage, it was still my choice whether to check in or go home.  I also gave my parents the heads-up that something might be happening.  Since we had to get the boys together, packs some bags just in case, and arrange for a sitter, Brian turned around and headed back home.

I was glad Brian was there, because it would have taken me forever to get everything together, stopping every 3 minutes to crumple over in pain.  Brian called our friend, Emily, who answered the phone with, "Is it baby time?"  We got the boys up and took them over to Emily's so they could play with their friend Luke, and headed to the hospital, making sure to eat on the way.  We arrived at Emory University Hospital Midtown around noon.  Dr. Tate has an outstanding reputation and record with VBACs (Vaginal Birth After Cesarean) and difficult deliveries, and although EUHM has to stick to its policies, many of the nurses respect him and seem to give his patients as much slack as they feel permitted.  I was not real keen on the internal exam this time because I'd come to the notion that it really didn't tell me anything.  My body wasn't telling me I was anywhere close to the finish line, so I knew that it would be just a number.  If I was 2 cm, I could be that way for days or minutes.  Regardless, I made my official prediction of 2cm, 80% effaced.  That seems to be my magic number.  It's where my body was with the last two pregnancies when it seemed to be the beginning of the end. To our nurse's amusement, I was spot-on. I kept my own clothes on after the exam. It helped to mentally bolster my feelings that I was in control of my body and that I wasn't going to be tied down there yet.  The nurse ( I wish I'd remembered her name - she was so awesome), hooked me up to the monitors. I noticed that as soon as I was on my back in bed, the contractions began to fizzle.  It's just like taking your car to the mechanic and it fails to show the problem when you get there.  The nurse started talking about the baby looking sleepy and she wanted to get him to look better so I'd have a better shot at being able to walk around.  I sat up a bit and asked for a drink.  She made me promise not to need an emergency c-section and slipped me a few cups of apple juice.  I chugged those and got out of bed, and the baby responded positively.  She thought the readings looked great and called Tate to let him know.  She reminded us of EUHM's policy for VBAC patients, and practically told us it would be wise to leave, since I would have to be on continuous monitoring and would be stuck in or beside the bed, possibly end up needing augmentation with Pitocin, and on down that track to another C-Section.  We high-tailed it out of there as soon as we could and headed over to IKEA to do some walking.

IKEA turned out to be an ideal place to do the labor walk - chairs, bathrooms and drink fountains around every corner. It was getting late in the day, and I was feeling like this time could be better spent playing with the boys, so when I could walk no more, we decided to head back to Emily's house to pick up the boys. By the time we got there, my contractions seemed to be fizzling down to 10 minutes, then 15 minutes, then I quit counting. Emily has some magic perfume or something that puts children under a spell.  Her house is about the only place I can show up and have my kids tell me to "Go away. I want to stay with Luke." We lingered there for a while, delaying the war that would erupt when we ripped them out of their place of contentment to head home.

The evening ended in an entirely unexpected and confusing way - with nothing.  I never realized early labor could behave that that with such regularity and intensity and not progress with continuity to more labor and a baby.  I reasoned it out that I was in a pattern of contraction day, rest day, worse contraction day, and figured the next day would be a rest day, hopefully followed by a real nasty real-deal baby-pushing day. Tuesday was in fact, a far more comfortable day than I cared to have. When someone asked me how I was feeling, my response was "unfortunately great." Wednesday came and to my dismay, it was also far too painless.  I was tired.  So tired. We curled up in bed and plodded on through "just one more story" with the boys. The last book was about to be snapped shut when  I said, "Uh oh, I think I'm leaking. Yep. Definitely leaking. Brian, my water just broke."