In honor of Cesarean Awareness Month 2010, we will be filling the blogosphere with stories from real women (and their families) who know first-hand the consequences of a 32% cesarean rate. Each day we will post at least one birth story submitted by these women. Prepare to be moved (hint: grab a box of Kleenex)!
The day I went into labor with my daughter Ahleia, it began like just about every other day for the past few weeks – with intense, but intermittent Braxton-Hicks contractions early in the morning. It was hard to know at times if I was really heading into labor or was just “practicing” and as a result, I had a couple of false alarms where I’d thought for sure, “This is it!” only to end up with my contractions settling down by late morning or early afternoon. On the morning of April 8, which was Easter Sunday, I started having regular contractions from 5-7 a.m., coming at 15 minute intervals. They were not really painful, but consistent and uncomfortable enough to make sleep difficult.
At 7 a.m., I decided to get up to go to the bathroom. As I sat up at the side of the bed, I felt a small gush of fluids. My immediate thought was, “Uh oh!” I went into the bathroom and it looked like “bloody show.” Still, I had experienced something similar two weeks earlier, so I was unsure if I should get my hopes up. Not long afterward, I noticed the contractions were getting somewhat stronger, although they were still coming at the same rate. I sat up in bed, watching my husband sleep and debated about whether or not to wake him up. After about an hour, I gently shook him. He looked at me, and I said, “I don’t think we’ll be going to church today.” I was leaking small amounts of fluid but it wasn’t enough that I felt I wanted to go the hospital. Either they would tell me to go home because my labor wasn’t far enough along, or they’d want to augment it, which I didn’t want.
After breakfast, I called our doula, Sandi, to let her know what was happening. She gave me a pep talk and some advice about how to deal with the contractions and asked me to update her regularly. I admit I did not call her because my labor seemed to be progressing so slowly I didn’t want to demand a lot of her time and energy that early on in the process. She must have sensed that, because she called me several times during the day to see how I was doing. My contractions still remained at somewhere between 10 and 15 minutes at a time, although they did slowly become more intense as the day wore on. I felt like a slave to the clock.
Late in the afternoon, Sandi and I talked, and she decided to come over after we’d both had a chance to eat dinner. Seth and I decided to go to out for dinner. I figured I could handle the contractions at the restaurant, and I was in the mood for pasta, my comfort food. After we came back, I called Sandi and she recommended I call my doctor to see if they wanted me to come to Labor and Delivery, since I had been leaking fluids for the past 12 hours. I called and was told to come immediately. Once Sandi arrived, we packed up the truck and headed over to the hospital.
I was admitted into Labor and Delivery sometime after 10 p.m. and brought to a triage room for assessment. My OB was out of town. Talk about lousy timing! The attending OB wasn’t sure if I was actually leaking amniotic fluid, but I had dilated to 3 cm., and was around 70% effaced, so she felt it was better that I remain and labor there. She immediately recommended starting me on a Pitocin drip, but I managed to convince her to hold off. I wanted the chance to allow my body to progress naturally. Once Seth, Sandi and I got settled into the Labor & Delivery suite, I began walking the halls between rounds of intermittent fetal monitoring. The contractions would get very strong as I walked and I continued to breathe and just “be” through them. Often, I would stop and lean up against the wall or hold onto Seth. Usually either he or Sandi would rub my back and whisper encouragement in my ear. When the pain in my hips and pelvis got intense, they would each get on either side of my hips and use their hands to press in, which provided surprisingly substantial pain relief. The halls of the L&D section were quiet. Time was measured in steps, breaths and contractions. For a while, I preferred to be up and about, because as long as I was moving, I felt like I had some measure of control. Once I got back into the room, the nurses would want to hook me up to the monitor and it became about what they saw on the computer screen, not what I was experiencing in my body. It became about timetables, doctor’s schedules and hospital protocol.
I never actually saw the sun rise, but I saw the colors changing in the sky outside the window the morning of the day Ahleia was born. I spent a lot of time in the bathtub at that point because the warm water, scented with lavender and clary sage, offered more relief than the bed, rocking chair or fitness ball. Either Sandi or Seth would come in and pour warm water over my belly and sit by the side of the tub with me for a while. At that point, I had been in labor about 24 hours. I was very hungry, but the hospital would not allow me to eat anything. Sandi waited until the nurses were busy and gave me her yogurt to help keep my strength up. Then Seth went to the hospital cafeteria and snuck some chocolate pudding back for me to eat. I remember laying in the bathtub, watching Sandi and Seth take turns napping. I was physically exhausted but did not feel tired. I just existed from moment to moment, breath to breath, contraction to contraction as the hours passed.
At 7 AM, the OB examined me and I had dilated to about 5 cm, but I was only about 75% effaced. The decision was made then to start the Pitocin drip because my contractions were still somewhat irregular. I asked them to start very low and slowly build up the dosage, which they did. I was terrified that once the Pitocin started to work that the contractions would become unbearable and I would have to request an epidural. They did become more regular, but even at the highest dosage, I was still able to labor through, relying only on the constant support I received from Seth and Sandi. Unfortunately, once I was on the drip, I was not allowed as much freedom of movement – I couldn’t walk the halls or stay in the tub. Over time, the contractions in my hips and lower back/pelvis became very painful. I tried kneeling/crouching on all fours on the bed, sitting on the birthing ball and rocking in the chair in an attempt to get some relief and move things along, but the hours passed with little change. I had my laptop with me and we played music – John Coltrane, Miles Davis, Krishna Das, Rasa and Dave Stringer. We took turns reading Meister Eckhart. At nearly 18 hours in, we all needed distraction and encouragement.
At some point during early afternoon, the attending OB came in to see how I was progressing. There wasn’t much change, so the decision was made to break my water to see if that would move labor along. My waters had actually been leaking for the past 24 or so hours, but there was a “forebag” that she could feel when she checked the cervix, so she knew most of it was still intact. When the forebag was broken, I felt pressure, but no pain and was shocked by the amount of fluid that seemed to gush on out forever. The contractions got stronger, but the process was still slow-going. Seth left to get something to eat from the cafeteria and came back with this small plastic card, about the size of a playing card that had verses on it saying that he would always love me. He inscribed it with the date, April 9, 2007.
I was checked again late afternoon, and although I had progressed to 7 cm, my station was still high, meaning the baby hadn’t descended any further. It was then that the attending OB sat down with me and told me that if I didn’t progress any further in the next few hours, I would have to have a c-section because of the risk of infection to me and the baby since my waters had been broken for so many hours. It was difficult to hear that, because after over 30 hours in labor, working so hard to try to birth my baby the way I had planned and envisioned for months, I didn’t want it to end on the operating table. Time ticked on by and still no major change in my contractions. By now I was experiencing constant pain, like I was being gripped around my hips and low back by giant hands. I was exhausted and needed to rest a little, so I asked for something just to take the edge off. I forget what the nurses gave me, but it gave me relief without necessarily knocking me out or losing sensation. I could still feel the contractions and work with them, which is what I wanted.
Around 7:30 PM, the attending OB came in, checked me, noted that I had not progressed at all and said I had to have a c-section. I was devastated, although I knew when she walked in the room that she was going to tell me that. In fact, I knew somewhere during the late afternoon that I was running out of time and it was likely I would not have the natural labor I had hoped and planned for. The nurses went to get the consent forms and I sat there and cried. I actually apologized to my husband, who looked at me like I was crazy and said he was never so proud of anyone as he was of me. Sandi told me that watching me go through labor was one of the most inspirational things she’s witnessed as a doula, which meant a lot to me.
I signed the forms, and the nurses brought out our scrubs to change into. Both Seth and Sandi accompanied me into the operating room. The operating room was a shock after the cocoon I felt I had been in for the past day or so. It was cold, stark and so bright. The nurses led me to a narrow metal table and I perched on the edge while the anesthesiologist gave me the epidural. I had no problem with the insertion of the epidural but I hated the way it numbed me and depressed my breathing. My arms were strapped out at my sides in a t-shape, like I was being crucified. I felt the OBs working on my lower abdomen but couldn’t feel anything other than vague pressure and some rather rough shifting. Suddenly I heard the baby cry and they announced the time of birth, 8:09 PM. The OB held Ahleia up over the drape and Seth and I got to see her for the first time. She was nothing like and everything more than I had ever expected. The first thing that I thought was how much she looked like my Grandma Millie. The second thing I thought was, “How did she come out of ME?” The nurses took her to be cleaned up and weighed and it seemed forever before Seth was able to bring Ahleia over to me. She was this tiny bundle and her face was all scrunched up against the harsh light and we just looked at her in awe.
Before I was wheeled to recovery, I asked the OB who performed my c-section if I could see my placenta. She had kind of an odd look on her face, but brought the pan over to me. She explained that I had placenta accreta, which is where the placenta had adhered to my uterus and had to be surgically removed, which is why it was in pieces. There was concern that it had become infected and it was being sent off to Pathology for a work-up. She also told me that Ahleia was posterior and the cord had been wrapped around her neck. Finally she told me that my sacrum had protruded into my pelvic cavity, which was what made it difficult for Ahleia’s head to descend properly because of her position. All of it came as a shock to me.
I was wheeled to recovery (Ahleia went to the nursery) and was so relieved when the feeling started to come back in my body. I talked to some family and friends on the phone for a little while, and sat either with Seth or Sandi until they were able to bring me to my room. The room was a welcome respite. When I felt ready, Seth went to the nursery to get Ahleia. I felt very nervous waiting for him. The idea of a baby and the reality of a baby are two different things and I was so awed by her presence when I saw her for the first time that it scared me a little. It’s sad to say but I remember seeing her in the isolette, but don’t remember holding her for the first time. Exhaustion and medication altered my memory of the rest of that night. At some point I did nurse her, which I do sort of remember and she latched on pretty well, which was encouraging. She slept with me for at least part of the night – the only reason I know this is because there’s a picture of us cuddled up in the hospital bed, together at last.
This is where my memory gets fuzzy. I remember that early in the morning, the nurses came through to do their usual rounds. I was experiencing excruciating pain all the way up to my left collarbone from the air that inevitably gets trapped in your body as a result of abdominal surgery. It was very difficult to breathe because every inhalation made the pain worse. I either tried to sit up with the nurse’s help or she attempted to raise the bed and that’s I began to black out. My blood pressure had crashed and I was going into shock. I had difficulty breathing, could barely speak and the pain was worse than anything I’d ever experienced and I was fighting for dear life not to let the darkness take over. My years of meditation practice culminated into this ironic episode where I was forced to be painfully present in a situation where there was no relief, no escape – and I was teetering near death. Nurses and doctors flooded into the room. A recommendation was made to reverse the position of the bed in the Trendelenburg’s position, which is where the feet are raised so they are higher than the head to encourage blood flow to the heart.
My blood counts indicated I had suffered a massive hemorrhage. The night before, the nurses changed the blue pad on my bed a number of times. I knew that I was going to bleed after labor, but my instinct told me something didn’t seem right. I remember asking one of the nurses about it, and she shrugged it off. I had to trust that she had seen enough of this before to know I was normal. Instead, I bled out the entire night. I was eventually transfused with five pints of blood, but it still took 3 or 4 days before my blood levels were even somewhat relatively stable again. We eventually found out a routine hematocrit stat that was ordered after the c-section was never actually performed, which would have indicated significant blood loss. The OB who had performed my c-section told me that if they could not get the hemorrhage under control that she would have to go back in and do surgery. It didn’t dawn on me at the time that what she meant was, she would have to perform a life-saving hysterectomy.
My husband didn’t tell me until after I’d gone home a week later that there had been a crash cart parked outside my room the entire time. I’m sure he didn’t want to tell me because he didn’t want me to know just how serious my situation was. Normally when you’re in the hospital for any kind of surgical procedure, they want you walking around as soon as possible. It was not even possible for me to get out of bed for at least 5 days. I had IV lines in two places on my arm, an indwelling catheter, an oxygen tube in my nose and the techs routinely came to get blood to check my hematocrit stats. I developed fluid on my lungs from having IV after IV full of blood, antibiotics and who knows what else pumped into me for days. It was just one thing after another. Seth spent the bulk of his time caring for and holding Ahleia. We tried to keep her in the room with us as much as possible and she often slept curled up on his chest.
Miraculously, I did manage to nurse Ahleia although because of my condition, she had to be given formula as supplementation. Nursing was very difficult because I was so weak I could barely hold her, and my condition was not always stable enough for me to establish consistency. When my milk started to come in, I became engorged and feverish. I almost gave up altogether, but Seth was absolutely determined that I needed to give this my best shot. He dragged every lactation consultant he could find into my room to help me. One lactation consultant set me up with a pump so that I could at least give Ahleia breast milk instead of formula. That helped some but physically and emotionally, I was still struggling. Then, Seth found the lactation consultant who had actually taught the class I attended a few weeks earlier at the hospital came in to speak with me. I believe she was an angel in human form. She told me I was a survivor and that my experience was going to be a gift to Ahleia, because I would raise her to be a strong woman too. I wish I could remember everything she said the way she said it, because it had a very profound effect on me. My husband and I were in tears by that point, but a corner had been turned. I had what I needed to establish a successful nursing relationship with Ahleia. Nursing also helped my poor, battered uterus recover, a process that took a lot longer than normal.
About a week after my daughter was born, I was finally wheeled out of L&D like a prize fighter after a hard-won victory. Everyone on that floor knew my story and they all stopped what they were doing and watched me silently as I was wheeled down to the elevator. It still hadn’t sunk in how close to death I’d come until I went to see the OB who had performed the c-section on me for my initial post-partum exam and all of the office staff at the clinic gasped and ran up to see me as soon as I entered the waiting room. It was a very long recovery and a couple of small setbacks along the way, but I was extremely fortunate to have my family, friends and members of my church do what they could to support us during that time.