Isabel Evangeline

born February 23, 2012 at Tampa General, story told by Courtney

Wednesday Feb 22, 2012 (GA 38w1d) started as a “normal” day, with the exception that I had only gotten 3 hours of sleep the night prior. I had gone on maternity leave early, about a week prior, due to the back pain I had been suffering from for months, and my routine was still adjusting to not having to go to work. I got up, got Allison ready for daycare and had an appointment with her teacher to review her progress. Then I went home and met with my doula to finalize our contract and go over our birth preferences. During our meeting I had a couple of Braxton-Hicks contractions but nothing that was different from the last couple weeks. I took an hour nap and decided to try assembling some of the furniture for our still completely empty nursery.

I got as far as unpacking the pieces for the dresser before I had to go to my chiropractor appointment (for lower back/pelvic pain) and grocery shopping for dinner. Watching TV with Fred that night I commented that the Braxton-Hicks contractions seemed more frequent and joked that maybe I should start timing them, instead we went to bed. Around 11pm the contractions seemed to “change”, but they were not painful and I was so tired I tried to go back to sleep. Around 2:30am I started timing them, and found they were averaging 3-4 minutes apart and 45 sec to 1 min long. I nudged Fred around 3am and told him he might be missing work today and texted my doula (good thing I had just signed that contract!).

I could have lay in bed but I was unable to sleep through or even between contractions so I got up to make biscuits (I was seriously craving a bacon egg and cheese biscuit, but unfortunately I over cooked them!) After about an hour the contractions were far more painful, and I found myself concentrating and breathing through them, so I got my water bottle and ipod with our “relaxation mix” and got into our bathtub. At 4:45am Fred got up to go to the gym – his normal routine – and after watching me through one contractions, he decided to not leave me home alone with Allison in the chance that she might wake up while he was gone. I labored in and out of the bathtub until close to 6am (bowels started clearing and mucous plug was leaking out), at which time we decided to start making phone calls. I called my doula (who hadn’t gotten my text and was surprised I was already in labor), my mother and mother-in-law. We started packing our hospital bags and I labored around the house, on and off the birth ball and with Fred trying to rub my back and keep me relaxed. Contractions were 2-3 min apart, getting more intense and much more painful.

Allison woke up and tried to “help mommy” with her “owie”, very cute, but then Fred had to try to keep her occupied. His mom showed up around 7:30am (with breakfast sandwiches!) to take care of Allison, and my doula around 8:30am. By now I was well into active labor, but we talked about laboring at home a little longer to avoid downtown traffic and because my big fear was getting to the hospital and only being 1-2 cm dilated. We also called ahead to see if any of the labor tubs were available (both were in use). Contractions were intense to say the least, lasting about a minute, but just as they peaked this horrible cramping would start in my hips and continue another 30-45 secs longer, so it seemed almost continuous. I also started shaking terribly right before them (which was at least a good warning) and feeling very nauseous. I remembered that these were signs of transition, but didn’t think I was there yet (I wasn’t- apparently some people get the shakes all throughout labor).

I tried walking around outside, but standing through a contraction was virtually unbearable, even supported by my husband and doula. Around 10am we decided to go to the hospital, and took our time gathering our things and decided it would be best for me to have the whole back seat of the Durango to labor freely in. Fred got the car all packed up but he forgot to take out Allison’s carseat, and neither he nor my in-laws could get it out! So after what seemed like forever contracting in the back seat of the car, I got fed up and yanked the damn thing over the seat in between contractions – problem solved! We finally left around 11:15am.

The drive there was awful, and of course we ended up behind a highway patrol for most of the 30 min journey…we pull up to the hospital and Fred forgot where to go! So I direct him to the ER valet and get out but had to immediately sit on the bench outside for another contraction – some employees jumped all up in my face and kept asking me questions, like if I wanted a wheelchair or something…did they seriously expect me to answer during one of these??? I think I told them to shut up!

We got checked in and my doula took me up to triage around noon and they put me on the fetal monitor, attached the pulse ox and got IV access (all required). Thousands of questions and forms to fill out! They even asked me what form of birth control I was planning on using after delivery. Really? That’s topping the list right now? I asked again about the labor tub and was told even if it was available I wasn’t allowed to use it since I was a VBAC. Just the week prior my midwife told me it would be a great idea to labor in the tub since we figured my back pain would make my labor more painful. The nurses did however ask me for my birth plan. Then they checked me…only 4 cm, 0 station. I admit, I was disappointed that the strength and frequency of the contractions didn’t have me further along.

Finally got a room in L&D and after a while Dr. Wykoff (whom I hadn’t met previously) came in. He said he was going to be in surgery most of the day but that he read my birth plan and he knew that the VBAC had been discussed with me previously…then during a bad contraction he says “well remember, you chose this”. Oh that irritated me.

For the next 3-4 hours I labored terribly, shaking and vomiting and unable to find a position to cope with the pain, with contractions almost continuous. Definitely not like some of the peaceful birth videos we had seen! At some point my blood pressure spiked a little so they checked my urine for protein and started monitoring my BP more often, which meant more wires to tether me down. It had been awhile so I asked to be checked again, 5cm. I felt trapped and imprisoned by the wires and the hip and back cramping sending the contraction pain over the top- I couldn’t imagine there would be a stage worse than this and fear took over. I could not get into the mindset of “one contraction at a time” and I could only think of the hundreds of contractions to still come. My doula, husband, and mother (not sure when she arrived) tried to coach me through them, but I was done. I asked for the epidural.

It took the anesthesiologist awhile to show up and they had to run a liter of fluid first. The resident had to be talked through the procedure and had to replace the cannula twice, so it took over a half an hour (during which everyone else had to wait outside, leaving me to deal with the contractions alone). Finally I got some relief. One area on my right side did not take and would still spasm with the contractions; this was the same ligament that my chiropractor had been working on loosening over the last week to try to help with my back pain. It was tolerable though, and helped me know when a contraction was coming. I had asked that the epidural be kept as low as possible since I knew it could cause its own complications. After the epidural, Dr. Wykoff came back and said I was 6 cm, 80%, -1 station but with a bulging bag of waters. He said he wouldn’t intervene (thank you!) and that another doctor was coming on duty soon. Since the epidural slowed the contractions down, my doula gave me some recommendations to help progress – moving side to side, foot and palm massage, and other methods to release oxytocin that I won’t go into.

There was no sleeping during this epidural! And it worked- by 7pm I was at 9cm, and 0/+1 station. By now Dr. Cox was on service and she said she would give me another hour to labor but then suggested AROM as it would likely put me complete. She went ahead and broke the waters at 8:10pm, and there was concern due to presence of thick meconium. Since baby was okay on the monitor we labored down another hour. By then I only had a lip of cervix left, and Dr. Cox stayed and the nurses prepped for delivery.

I had been scared of pushing, thinking it would be very hard and exhausting, but it wasn’t that difficult at all; I had them set up a mirror ahead of time and I think that help motivate me. I did have to push in a side lying position though, every time I pushed on my back I would vomit, and the epidural limited the position options. She decelled slightly during pushing, so they gave me oxygen in between contractions. I pushed for about 45 min and she came out with the cord lightly wrapped around her neck, but still screaming. They had to take her over to the NICU team immediately because of the meconium so we didn’t get to have the delayed cord clamping or the immediate skin-to-skin contact, but Fred got to cut the cord (Dr. Cox didn’t give him a choice!). Her APGARS were 9 & 9 – longest 5 minutes ever! – and I finally got to hold her.

She was very alert and latched on to my breast within 10 minutes. Isabel Evangeline was born at 10:03pm and was 7 lbs, 7 oz & 20 inches long. We had on our relaxation music and the song playing when she arrived was titled “Delicacy and Strength”. I had a second degree perineal tear and superficial periurethral tears, not surprising with her head circumference >98 percentile!. They also let me keep the placenta for encapsulation.

isabel2Recovery was so much easier than with the C-section, some very minor soreness from the labor and even the tears were nothing in comparison. Looking back I don’t regret the epidural, I think it helped me relax enough to allow my body to progress, but I do wonder if it could have been avoided if they had let me labor untethered or in a birth tub. I also wonder how much baby’s position contributed to the back pain- if the spasms were “back labor” or if it was the sprained sacroiliac joint I had been dealing with all along. Regardless, I could not have gotten to where I did without my doula’s help, my husband’s support, and the Bradley training!