Sunday, April 17, 2011

Veronica's Birth Story - Part 2

I am writing this as quickly as possible so that A'Dell can read it before she goes through HER second labour.

Part 1

Once I finally wrapped my head around the fact I was in labour -- and I' m usually not that dense, I swear! -- we settled in to the L&D room. I was delivering at a different hospital than the one at which I delivered Teddy, as the midwives had gained privileges at more hospitals around the city. The L&D rooms at Montfort, the primarily francophone hospital where I had Teddy - were very nice, but the ones at the Civic Hospital were not bad either. The Civic has a Level 2 NICU and is used to seeing sicker infants. As such, the staff don't panic when there are complications. We will ultimately discover how important this tendency is.

I once again had a cheering section and I attribute my ability to have two pain-med free deliveries to this support. In the room this time were Dave, midwife Jackie, primary doula Zoia, second midwife Amanda, and doula student Mary. Most pregnant friends express surprise at the number of people in the room, wondering if I was embarrassed. I have no problem telling them that by this point, you don't care who sees you, especially if it's people you trust. And having that many people to give you ice, to smooth back your hair, to cheer you on through the rough parts...I am tearing up just thinking about the amazing support I have received both times.

When I delivered Teddy, I had some crazy bleeding near the end. It was likely due to my anterior placenta and my totally exhausted uterus -- I ended up having to push Teddy out AFTER my tired uterus had stopped contracting. I needed to have pitocin to deliver the placenta, and I had to get an IV placed while Teddy was crowning. NOT fun, let me tell you. This time, we decided that I'd probably need pitocin again to help with the placenta. We got the IV placed while I was between contractions.

With the IV in place, I lamented to fact that I couldn't labour in the tub. When Jackie overheard me, she quickly set me straight - I could totally use the tub and we'd just work around the IV. She made me promise that I'd have to get out of the tub if my water broke and/or I had the urge to push. And once again, the tub was amazing. I was only in it for about 15 minutes, but it just like last time it made that last bit of transition a bit easier to bear. But I kept getting the urge to push, so back to the bed I went. It was just after 8 a.m.

I started to push, but the fact that my water hadn't broken combined with an anterior cervical lip (again) made progress painful. This stage was just awful. With Teddy, pushing was great - I was finally able to DO something with the pain from the contractions. But this time, I couldn't stop shaking, I was overheating, I thought I would throw up - it was just wretched. It came on so quickly this time. I had a minute or so of "I can't do this!!" moaning and groaning, but the cheering section kept cool clothes on my head and neck and kept encouraging me. My water hadn't yet broken, though, and it was impeding my pushing. Finally and with my permission, Jackie used an amnio hook broke my water and started a bit of pitocin for the eventual delivery of placenta. And that's when things started going a bit pear-shaped.

There was meconium in the amniotic fluid, which the midwives told us immediately. That meant that I'd need to have continuous monitoring from the bed for the remainder of the delivery rather than the intermittent doppler monitoring I'd had up to that point. It also meant that once she was born, an on-call pediatrician and crew would have to take her over to the warming table and clear her airway to prevent meconium aspiration. Jackie put the call in to the team, and I was dimly aware of a few people coming in to the room.

I pushed through the anterior lip with Jackie's help - she had to hold it down, just like Ann did the last time - and harnessed the contractions to push, push, push the baby down the birth canal. It was painful, but I knew that the sooner I got her out, the sooner we'd be able to deal with the meconium issue.

I pushed for 10 or 15 minutes, and this time I could feel how close she was to being delivered. And then, she was crowning. Jackie coached me through, pushing and panting at appropriate points. And then her head was out. I could hear her making some noise, but the midwives couldn't encourage it because they were worried about her aspirating the meconium.

But just like last time, things stalled. Amanda had been monitoring the baby's position the entire time. She'd come in to my pelvis on the left, but had down a corkscrew through my pelvis and came out on the right. In doing the corkscrew, she'd opened up her shoulders and come untucked. And she was stuck. Shoulder dystocia one again; I must have some pelvic craziness. And the crazy corkscrewing took its toll. Poor Veronica's entire face was bruised, and all of the blood vessels in her eyes burst. The whites of her eyes were red for three weeks.

Once the baby's head is out, you have 4 minutes to get the body out before you have to do an emergency c-section; sometimes they'll break the baby's arm to prevent this. They call in an OB team in this sort of potential emergency situation. With Teddy, we got him out after just over a minute. With Veronica, it was closer to 2.5. I pushed, Amanda pressed down into my abdomen to force the baby's shoulder to tuck, and Jackie reached in was finally able to haul her out, all 8 lbs and 15 oz of her. It was 8:46 a.m.

Poor Dave had a front row seat to all of this, but the worst part was that she had an APGAR of 3. She came out totally gray; Dave was petrified that she wouldn't make it. She was immediately whisked away to the cart to be in the care of the pediatrician and his team. They had to intubate her 3 times and do chest compressions in order to get her breathing steadily. But her second Apgar was 7, so she rebounded right away. And to their immense credit, the midwives and doulas reassured him right away that everything was going to be fine.

The pitocin really worked, because I delivered the placenta less than 2 minutes later. That's right - LESS THAN SIX HOURS from first contraction to delivery of placenta.

A lot of this time was a blur, as it happened so fast. But a few moments stand out. These include:

- the fact that everyone was so focused on the baby's breathing that the didn't pay attention to sex. The team kept saying "he'll be fine. He's fine." Finally, I called out "HE?!?". But the doulas and Dave assured me that it was, in fact, a girl.

- Jackie's astonished tone of voice when she pronounced "Your perineum is intact!" Frankly, with such a big baby and so much yanking down there, it's a minor miracle.

- Jackie and Amanda saying in a kind but serious way: "Sarah, promise us that you'll never attempt a home birth!"

After her 2nd APGAR, they brought her over to me. Her breathing had a bit of a hitch to it, and she wasn't terribly interested in nursing, but I snuggled with her while they cleaned me up.

More on the aftermath - my blood pressure spike, her initial nursing trouble - in the next installment.


  1. Ack! I can't believe the shoulder dystocia happened again. Why am I not remembering ANY OF THIS from last summer?

    I've never heard of that 4-minute rule...Is that because of the meconium or something to do with her arms/shoulders being out of alignment for that long?

    Either way... What a freaking ROCKSTAR you are.

  2. @A'Dell - it's a 4 minute rule any time there's shoulder dystocia. Once the head is out, there umbilical cord gets really compressed and the fetal oxygen level drops. Anything longer than 4-5 minutes can lead to Cerebral Palsy or even fetal death. YIKES, eh?

    But thanks for the compliment! My midwives have said that in a future pregnancy, I'd likely have to have shared care with an OBGYN and maybe a C-section as my kids keep getting bigger and bigger. I am not sure they'd be able to haul out a baby bigger than V. I will gab more about this in the next installment.

  3. I'm scared and you rock. (=
    Bigger kids? YIKES! I'm hoping for a small, wee, little baby. HA. You have seen papa bear. lol