* * *
After a wait that feels like forever (contractions continue to rock me the whole time), our nurse comes back and lets us know that there is finally a room open. Greg (the best sherpa around) bundles up all of our bags and pillows, and we go to see our new room. As we enter, I immediately realize that this is not the same glorious room that we had in the morning. There is only one small window that is hidden behind a huge column when viewed from the patient's bed, and I couldn't even guess what the view was because I never saw it. But it is a room. It is our room, where we will be delivering our daughter, and I really don't care what I can or can't see from that window. That's not why we're here anyway. It's amazing what 16 hours of labor will do to your priorities!
Now it's time to really focus, though. I'm only dilated to 3 cm. I have a long way to go before reaching the needed 10 cm for birth, and I'm in pretty deep pain already. As Greg settles the room, and the nurse starts to hook up the fetal heart monitor and contraction monitor, I try to decide the next plan of action. I had originally thought I would go through this relying on my breathing and active movements to get me through, at least for as long as I could stand it, before getting an epidural, but I hadn't expected it to take 10 hours to dilate the last 1 cm. I don't know how much longer I'll be able to do this - mentally and physically - before I'm exhausted, but I also understand that Hoag policy requires the mother to be at 4 cm to get an epidural. Does that mean I could be going through this intense pain for 10 more hours? I start to build myself up mentally for this possibility as I sway back and forth, death gripping the sink in the room and breathing through another contraction.
Just as I'm hunkering down for the long haul, a new nurse, Sarah, comes in and introduces herself. She explains that we've come just as the shift is changing, and she'll be my nurse through delivery. Ironically, this is exactly what had happened in the morning when we came to the hospital, and the nurses who had been with me then were just now coming back on their shifts. It's funny to think about what they had done in those 12 hours compared to what I had been doing.
Sarah quickly assesses the situation (my white knuckles, primal moans, hypnotic swaying), and immediately asks me (God love her!), "Have you considered a pain management plan?" I sheepishly look at her and admit that I hadn't. I had actually thought I would just do this and bear it until I could get an epidural...and in this idealism, I had never realistically considered the alternative...a pain management PLAN! I feel somewhat silly at this moment, but I'm all ears to hear her suggestions, since I hadn't expected to be in labor for 18 hours and still have 7 cm separating me from my daughter.
Sarah explains that the best approach to pain is to nip it in the bud early and then maintain a level of comfort from there. This would be much easier for my body than trying to go through the delivery process AND handle the pain, especially since the process is taking so long. This makes a lot of sense. She then explains that there is an opiate she could give me through an IV that would not numb me like an epidural but would reduce the sensation of pain, hopefully long enough for me to dilate to 4 cm, when I could get the epidural. The side effects on me are primarily drowsiness, and the effects on the baby are minimal, although she could also have some drowsiness that may last after the delivery, depending on how long it takes. I would be able to have two rounds of this pain medication before we would have to reassess.
I consider my goals for lasting as long as possible without drugs, and I concede that 18 hours is legitimately a long time. I also think about the need to give my body the chance to put energy entirely into progressing and the fact that I will also need energy for pushing when that time comes, and I decide that I am ready to take the opiate. I tell Sarah that we're a "Go," and she tells me that the next step will be to hook me up to the IV, then we can get things rolling. OK...we have a PLAN!
Sarah tells me to try to lie down in the bed while she goes to get the supplies for the IV, and while she's gone, the two nurses who had originally been with me in the morning come in to say hello and see how I'm doing. I'm pretty blown away by how supportive and encouraging they are, taking time out of their shift to wish me well, and I'm thankful yet again that I'm doing this at Hoag. The staff really cares, and from my interaction with these two nurses and with Sarah so far, I feel like I can trust that they are looking out for our best interests. This is reassuring because I had doubts about whether or not to take the pain medication, and I've heard plenty of stories about hospital staffs trying to push approaches that are not in the best interest of the mother or the baby, but I realize very quickly that these nurses really are here for me, and I feel confident that I'm in good hands. From that moment on, everything starts to really click...for the most part.
Sarah returns, and she starts preparing me for the IV. Now, remember, I'm still having intense contractions every 3-4 minutes this entire time, but this is a routine thing, getting an IV, and I've had blood drawn about 50 times throughout my pregnancy (it seems), so this should be no big deal, right? Well....
(Warning: if you don't like shots or needles, this part is graphic!)
Sarah tells me that she's read my Birth Preferences (again reaffirming my confidence), and she knows I want the IV in the arm instead of the hand so my movement is not restricted as much. We pick a big vein just above my left wrist, wait for a contraction to end so I can be still, and she goes for it. Everything seems good until blood starts spraying out of my arm when she tries to insert the line for the IV. Sarah pulls everything out immediately, and we apply pressure to stop the bleeding. Apparently I have rolling veins, and they're giving her fits to start this IV!
Sarah takes a look at my other arm to see if I have a good vein over there, not wanting to inflict too much pain on the same arm. The IV needle is not a small bore needle like the blood draw needles, so the idea of getting stuck again is not appealing, but we have to make this happen. I have another contraction, and we wait. She finds a good vein on my other wrist, and she goes for it again. This time the needle goes completely through the vein! My wrist starts blowing up with fluid, and she immediately pulls everything out as I go into another contraction. At this point, I'm ready to tell her to forget it, if it weren't for the pain medication that's at the end of this crazy procedure.
Sarah, being very smart, calls it. She tells me she's actually very good at doing this, but she never sticks a patient more than twice unsuccessfully before calling for another nurse to help. I can understand and appreciate that. She's smart enough to call in backup, so I don't worry about her two misses and move on. And who do you think comes in to help? One of my nurses from the morning! We laugh at her insistence on being involved in my delivery, and we get on with it (after waiting for a contraction, of course). This nurse comes prepared with Lidocaine to numb the area in the arm we stuck the first time, and then she inserts the IV needle. Perfect! The IV is hooked up, and mercifully, Sarah administers the first dose of pain medication immediately.
It takes approximately two minutes before I start feeling good. And not just good, but really, really good. We know it's working when I have a total drunk moment and start slurring my words. The opiate makes me feel sleepy and thick, and the pain from the contractions is reduced to a completely manageable level. I barely feel pain, in fact, although I still feel the contractions, but I don't have to breathe through them, and for the first time in many, many hours, I am able to relax and rest. We are now on cruise control to a certain extent, as my body does what it needs to prepare for birth, with an immediate goal of reaching 4 cm dilation so I can get an epidural.
As the opiates take effect, Sarah comes in to check on me, and she tells me that everything looks good, but now my contractions have slowed down. She tells me that this is always a possibility with pain medication, but she wants to do a cervical exam to see if there has been any progress in my dilation. By now, it's been around 3 hours since I got to the hospital and was at 3 cm, so I'm really hoping we'll see some movement, but as she's checking she tells me I am still at 3 cm, and I am instantly disappointed, especially since my contractions are now 6-7 minutes apart. I know where this is headed if something doesn't change soon, and I do not like the alternative...having a c-section. Having read my Birth Preferences, Sarah knows I do not want a c-section, and she makes a suggestion about how to proceed.
She basically lays out a path of choices that makes me decide what my priorities are. If I do not dilate any more after two rounds of opiates, and my contractions are still slow, I will most likely not get the epidural for a vaginal birth because there is a good chance I would eventually be headed for a c-section as a result of how long I've been in labor already. If, however, I do dilate at least a little more or my contractions pick up, we can go ahead with the epidural, but even then we may be headed for a c-section if there is not substantial dilation within a reasonable amount of time. Another option is to finish the two rounds of opiate, get the epidural, and start using Pitocin to make my contractions stronger and hopefully accelerate dilation. Sarah acknowledges that this approach goes against my preferences of not using Pitocin for induction, but in this scenario, we may need it to get me dilated enough to have a vaginal birth. She also suggests that before we even get to the epidural, we rupture the membrane containing the amniotic fluid around the baby as a more natural way to stimulate delivery, an approach that can also accelerate the process. My concern about this is putting the baby in distress because of a lack of the protective padding the amniotic fluid provides, but Sarah points out that this is more of a concern if we are in labor for a very long time after the amniotic sac is ruptured. If the timing is right, my body will still be producing plenty of amniotic fluid, and there will be enough to provide the padding our little girl needs through her delivery.
It's a trade off. I don't like the idea of introducing a drug to control how my body contracts, nor am I thrilled about the idea of rupturing my membrane, but having a vaginal birth is even more important to me. I also want to avoid the possibility of any situation involving fetal distress due to the length of my labor, although I know this isn't guaranteed because it could still happen because of the Pitocin and the increased strength of the contractions or because of the lack of amniotic fluid providing protection, but I feel like the sooner we can get to 10 cm dilation, the less chance we'll have for distress, so I agree to have the amniotic sac ruptured, and if I get to the epidural stage and I'm still not dilated, we'll start Pitocin and then see where we go from there. That being decided, there's not much to do but wait to see what my body does.
By now, Greg, who has been holding my hand through all the IV attempts and helping me make all of these decisions along the way, is exhausted, and I'm pretty far gone as well. It's around 10:00 pm, and we've been in the hospital 4 hours already! Our families have been in the waiting area the entire time, including family that drove up from Encinitas, but it looks like we will not be delivering soon, so we tell them to go home and get some rest. We are going to sleep, but we'll let everyone know if anything changes. As I drift off to the sound of the fetal heart monitor, the contraction monitor, and the white noise machine we brought cranking out the sound of crickets, I hope and prey there is change.
* * * *
If you've ever been in a hospital overnight, you know that it's impossible to sleep for too long. Throughout the next couple hours, we have visits from Sarah every so often, checking my contractions like a hovering hen. At around midnight, the first round of opiate wears off enough that I have to breathe through my contractions again. While the pain never gets as bad as it had been before the drugs, it gets to a point where I am certainly appreciative for pain medication. Sarah comes in and gives me the second round, and we take a look at my contraction chart to find that they have gotten closer together again. This is a good sign, and we decide to let this go for awhile longer so I can get some rest before we do a cervical exam to see if there is any progression.
Time is a blurry thing when you're on an opiate, and it seems like I sleep for hours before Sarah is back to check on me. This is probably a good thing because I feel rested, and when she comes in to do the next cervical exam, I'm relaxed, although slightly anxious about the results. My contractions have sped up to a respectable 4-5 minutes apart, and they are strong - all good signs. Now for the exam....
Still 3 cm! My God, would I EVER dilate?! It's been at least 6 hours since I was readmitted and at 3 cm, and it seems like nothing is changing. Sarah, Greg and I are all disappointed. She tells me that despite my contractions getting closer together, we should go ahead with rupturing the amniotic membrane. Greg and I agree, and she calls the doctor on duty to perform the procedure. I'm not excited about this, primarily because I worry that we're crossing lines now that are irreversible, and I really don't want anything to go wrong that would put the baby in distress, but I know this helps stimulate dilation, and that is what needs to happen...now.
The procedure of rupturing the membrane is pretty straight forward. Sarah preps everything for the doctor on duty, and we go yet again into the cervical exam routine, except this time, the doctor inserts what looks like a long, hooked crocheting needle, and in one swift movement, a torrent a fluid releases with a surprising gush as the membrane is ruptured. I feel like a dam breaks somewhere in there, and a small amount of pressure seems to be released, but for the most part, I don't feel a big difference.
Baby is now on a one way track that has to end with her coming out soon. Without the amniotic fluid to float in, she has 24 hours before she has to leave her comfy nest. This would be the equivalent of my water breaking, which surprisingly, despite what the movies would have us all believe, only happens in 10% of pregnancies. If you come to the hospital with your water broken, though, they give you 24 hours max before getting that baby out, primarily because of the chance of infection that can happen since part of the function of the amniotic sack is to provide a sterile environment for baby to grow in, and with the sack ruptured, anything can get in. So, it makes a lot of sense to get baby out before infections can happen. That's also why there often ends up being a need for Pitocin at this stage. If the contractions don't make dilation happen within that 24 hour window, a c-section becomes inevitable. These are all of the factors rolling through my mind as we wait to see how rupturing the membrane affects my contractions and dilation, and I drift off to sleep again.
Of course, not for long. Sarah is back to check on me, and it's time to see if we have any progress again. By now, we're all a little jaded, and when she tells us that I'm still at 3 cm, the reaction is not so drastic. But we do talk about what is best, and we decide we'll go ahead with the epidural and the Pitocin when the opiate starts wearing off. Sarah throws the 4 cm rule out the window for the relief I will need as the Pitocin starts to work, since it looks like I am not going to dilate without it. I feel like I did when I was finally admitted to the hospital - relieved, as if I have passed another stage and am making progress, although I know that we are still not entirely where we need to be, and I'm worried about that.
I get another hour of sleep, and by the end of that hour, I'm in pain again and breathing pretty heavily through contractions. In some ways it's reassuring to feel how strong they are and to know they're coming quickly, but I'm ready for the epidural, and I'm happy when Sarah comes in to tell me she'll call for the anesthesiologist. After 45 minutes, the anesthesiologist arrives, a big burly man with hands the size of Montana and a quiet, steady approach - appropriate for someone who will be inserting a thin tube into the minute space between my spinal column lining and the dura tissue just outside this lining. The room for error is zero on this procedure, and it makes me nervous just thinking about it, but I know it's what I want, so I try to relax, which, of course, is the moment I get the shakes.
It happens to me any time I'm getting any significant medical procedure, like surgery or apparently an epidural, and I can't ever seem to stop the uncontrollable tremors that take over my body. So now, when I'm getting a procedure that requires an exact approach, here I go with the tremors! I try to relax as the anesthesiologist gives me the shots to numb the area where he will inject the epidural catheter, but no matter how hard I grip Greg's hand (as he watches the entire procedure happening behind my back with fascination), I can't stop. With deep breaths, I try to at least keep my shaking somewhat under control, and when the anesthesiologist tells me it's really important to stay still as he inserts the epidural, it takes everything I've got, primarily out of a fear of being paralyzed, to stay still, but our steady handed doctor finishes up with no problem, and within 5 minutes, I can't feel much below my waist due to the epidural drugs.
Interestingly, Hoag uses a type of epidural that doesn't numb you completely, and you can still somewhat control your movements, although I can't hold my legs up to save my life, and Greg has to move them for me whenever I roll over. I can barely feel where he touches me, literally like a body part that's fallen asleep. It's pretty trippy, but even stranger is that I can't feel my contractions at all. Even on the opiate, I still had the sensation of pressure without the pain, but now there is nothing, and in a weird way, I miss them. The contractions become so personal. They are your indicator that something is happening, and they require so much from you physically, emotionally and mentally, and when they're gone, you are released in many ways from this constant, intense interaction with your body and the process. I wasn't exactly sad, and I certainly didn't want to feel all of the pain I had been feeling earlier, but I did feel a degree of loss that surprised me.
I'm also now relying on the contraction monitor to tell me how often my contractions are coming, and I suddenly get the sense that I really can rest now because I don't even feel the pressure of the contractions, and there truly is nothing I can do beyond wait for my body to do what needs to happen. Sarah goes ahead and gives me the Pitocin to hopefully stimulate dilation, but I can't even feel that, and now I really fall asleep. Of course, it's not long before she's back, and it's time to do another cervical exam to see how far I've dilated. Would it be surprising to find out that I'm not so excited about this procedure anymore?
But this time, we actually have a change...4 cm! I know, not a huge difference, but after so long with nothing changing, 1 cm is exciting. We're hoping this will continue. It's a good sign. Contractions have increased in strength, according to the monitor, and they're now 2-3 minutes apart. The only problem is that I actually should have dilated more since Sarah administered the Pitocin. She asks if she can increase the dosage slightly to see if that will help get us further along, and I tell her to go ahead, and then she leaves me to go back to sleep.
At the next check, however, our small victory seems to have been empty. No more dilation. It's now been around 30 hours since I started labor, and I'm only 4 cm dilated. This is the moment. It's 3 am on the second day of labor with the clock ticking. It feels like a make or break situation, and Sarah looks me in the eye and says, "Let me crank it."
I know what she wants to do, and I just look at her and say, "Do it."
"We need to get you dilated," she says.
"I know. Let's do it," I tell her.
As she cranks up the Pitocin amount in what feels like a last ditch effort, I drift back to sleep with serious hopes that it works this time.
* * * *
