Tuesday, November 13, 2012

The Longest Six Hours (Ever)

As one L&D nurse put it, Matthew did not make a graceful entry into the world.

My water broke at home last Monday morning (although it may have actually started on Sunday afternoon), but it was just a teensy trickle, enough to make me question whether it was really amniotic fluid or some random gross fluid that emerges late in pregnancy. I'd been having erratic contractions for days, and they didn't really pick up the pace or become semi-regular until Monday evening. We put Jackson to bed, watched our TiVo'd episode of Homeland (I wasn't about to be a whole week behind!) and called our neighbor to come stay at the house while we trudged over to triage to see if we were staying the night to have a baby, or coming back home. At L&D triage, sure enough I tested positive for amniotic fluid (and glory be, the internal exams, even with speculum, didn't hurt like hell as they did before...). I measured 3cm dilated and about 50% effaced, but contractions remained irregular and mild so augmentation with pitocin was required. Since I wasn't sure when the slow trickle of fluid had begun, it was assumed that we were on the clock and that I would need multiple rounds of antibiotics (I tested positive for group B strep again). Fair enough. I braced myself for a long night.

So off to our room, Lucky Number 13 (I should have seen that as a sign). The OB resident broke my water (the sac was still intact) and there was meconium. Strike one. Nobody panicked, though, and I measured at 5cm, so we figured things were progressing nicely and the baby would be out soon. I requested an epidural and the next hour was spent in agony as the anesthesia resident poked me no less than 5 times trying to get one started. Every time, he hit bone and/or fireworks shot down my right leg, so he would start over. His staff doctor came in and ordered him to stop and give me a rest, and I spent the 20 min break freaking out over the possibility of a fast, augmented labor with no pain relief. Around this time, the back labor started. Hoo boy. So they returned and the resident was told to take a seat, and his boss got the needle in on her first try. Ladies first, y'all. The flood of warm fuzzies down my spine into my legs was the most welcome relief I've had in ages. (Besides finally having my first postpartum poo at 6 days after birth. Whew.) Then of course, the itch began, and I spent the next hour rubbing the itch all over like a crackhead. But the pain relief, good sweet fancy Moses.

So the OB resident returned to check me a while later and I was stuck at 5cm. I don't know what time it was at this point, but hours had gone by and the pitocin dose had increased and there was no progress. I nearly cried. Then we all put 2 and 2 together and realized that my back pain prior to getting the epidural surely meant the baby was turned posterior, and we starting repositioning me every half hour or so to encourage him to turn so he could start to descend. Somewhere during that time, the resident and nurse waltzed in calmly to tell me he was having fetal tachycardia and that I would need to wear an oxygen mask and internal monitors and that we would need to get more aggressive about repositioning, considering moving to all fours if needed (it never was) to get him to turn faster so we could deliver him sooner. So, fetal distress. Strike two. I'm not sure how much time passed after that, only that I wrestled with the closest thing I've ever had to a panic attack inside my head as I focused on every single contraction, willing it to help the baby turn and move. Then around 3:30am (?) the pressure began. I felt him move very fast with each increasingly painful contraction (what epidural?) into the birth canal, and with every contraction the urge to push was stronger. I called for the resident to check me and I was only at 6cm. I gave up the pretense of "nearly" and just cried. Into my oxygen mask. With the urge to push getting unbearable, and only dilated to 6cm, I was full-on freaking out. About 3-4 contractions later I told the nurse I absolutely could not hold back from pushing anymore and I needed to be checked again, NOW. Within less than 10 minutes I was already at 9cm and "stretchy." Now tears of relief. My OB came in (he had popped his head in periodically to check on us) and I told him I really, really, was going to push now and couldn't stop it and he calmly replied, "Okay, let's see what you can do." Well. What I could do was push and scream like a crazy person because this was happening unbelievably fast, like nothing I could have been prepared for, and was unbelievably painful, in considerable contrast to Jackson's second stage labor during which I had felt no pain and was joking around with a med student in between pushes. The second stage contractions this time remained like transitional labor contractions, long and intense and little break in between. So I kept pushing while the OB and resident set up their tray of goodies, and after just a few pushes delivered the baby's head. That's when my OB called for an assist with "a shoulder."

Shoulder dystocia. Strike three. His shoulder was completely stuck behind bone, and 2-person maneuvers were required to free it, quickly. My internal panic bubbled over and came full circle, as I realized I had to pay attention and do whatever they said exactly as it was said, to deliver this baby in the next couple of pushes. Pain be damned. While they applied pressure in places I didn't know were capable of such pain, I pushed through it as hard as I could until I felt him emerge on the final push. No one even bothered to wipe him off, they just handed him to me, sludge and all, so I could hold him. And immediately he cried and rooted. No greater relief has been felt by anyone, anywhere, ever. His APGARs were 9 and 9, but his left arm was obviously injured as he wasn't moving it much at all. I just held on to the relief that he was here, he was (mostly) okay, and labor was over.

Oh. And he nursed right away, like a champ. Rooted for a breast and latched on like he was a pro. This gave me a fleeting moment of joy and additional relief. Until they checked his blood sugar, and it was super low. Even after nursing. So, hypoglycemia. In the game of birthing, strike four.

It turned out that all the maneuvers to free his shoulder failed, and so my OB had to (in a last ditch effort to beat the clock) reach in and essentially yank his shoulder to free it. Rather than taking my baby to my mother/baby room with me, we had to drop him off in the NICU for an x-ray and for formula feedings to stabilize his blood sugar. I spent the rest of the early morning and day alone in my room, getting updates from the nurses in the NICU and traveling by wheelchair to visit him when I could. I wasn't able to hold him until orthopedics had evaluated his arm. But I got to see the x-ray, which was heartbreaking. A complete and displaced fracture of the humerus shaft. Poor baby. After ortho came around and decided that they would not splint the arm, just pin his sleeve to hold it in position, I was allowed to hold him for bottle feedings but advised not to try to breastfeed just yet, since it requires a lot of repositioning that might cause him pain. I was encouraged to pump, but I honestly just felt so beat up and depressed about this whole turn of events, and have such a hate-hate relationship with the pump, that I told them to continue formula feeding and that I would work on breastfeeding him once we had a better shot at it (eg, when I could move him around a bit more and when milk came in). I felt surprisingly okay with this decision, but a few nurses and even the pediatrician on call gave me shit for it; although I'm sure they viewed it as "advice," it pissed me off considerably. I followed my gut (and guess what? Today I have milk in, with a vengeance, and he's nursing!) and didn't need to be questioned. Anyway, this ain't my first rodeo. I did my best to ignore them.

So now we're home, he's nursing and taking occasional bottles, I'm battling engorgement (bless his heart, he's still nursing even with that obstacle) and swollen feet and constipation and exhaustion, and his arm is healing. Our follow-up with ortho and an x-ray is next Tuesday and the surgeon expects to see a healed fracture. Babies are miraculous.

I've had a few pretty hard cries over how all of this happened, how traumatic it felt at the time, how alternately scared and determined I felt through the process. But he's okay, I'm okay, Jackson loves "his baby" to pieces, and we're figuring out this parents-of-two-children thing one day at a time.

Oh, and today was the scheduled induction day.



hope4joy said...

I was beyond nervous for you while reading this birth story. What a tough little guy he has proven to be already. You did an amazing job and got him here safely despite the obstacles and you should feel great about that. Glad everyone is home and doing well.

Mina said...

You do have to go over the top in everything you do, don't you? :-) Seriously though, you are one very tough lady, to have gone through all that and keep it still together and be able to make the right decisions... My respects, dear!
Very happy to hear that most of the bad stiff is behind you. Hoping you get the best of news from the next medical visits. Poor baby, how he must have hurt. And poor mama, how she must have hurt to see her baby hurting. Traumatic, but finally over (lame try to see the good side here, no need to tell me).

bunny said...

Oh, the idea of you having to be separated from him sure makes me cry. What a hard time you had with this gorgeous little one, you brave mama.

I'm really glad you're all okayish, but so SORRY this rough pregnancy had to end with such a rough BANG. But it did end, and now the good part. Give him a big kiss for us.

Pundelina said...

Congratulations on Matthew's arrival Jen! He's scrumptious xx

Reading your L&D story was not scrummy though, I remembered feeling similar things when tLG was born, it was truly terrifying and in the end even though I got a live baby, he wasn't ok and neither was I.


jenicini said...

You are freakin' awesome. I'm so glad you and M are doing okay. :) Hope his arm heals quickly! xxxx

kdactyl said...

OH my word Jen...how scary for you. So glad Matthew is doing so well. I attended the birth of my girlfriend's son who had shoulder distotia (sp?_)....they had nurses on top of her pressing on the pubic bone and one applying fundal pressure and they actually broke baby's colar bone during delivery. It was really scary...but amazingly happened really fast. He, of course, was fine after...but while reading your story...I could totally relate to the situation. So glad nursing is going well and your whole family is enjoying the new addition.

ASP said...

Man, I had tears in my eyes reading this. What a story. I'm happy the little guy and you are okay though, minus the shoulder dystocia (is that what you said?!). He's a doll, that's for sure. Take care of everyone, including yourself! XXXX

BB said...

Oh boy! I am just glad things are falling in to place slowly. Best wishes with this new journey!

Rhianna said...

I pretty much knew the course of your labor and Matthew's birth, and I was STILL holding my breath reading this, Jen. Intense is the only word I have right now to describe it.

I can totally relate to that concentrated feeling of determination amidst the tears though, especially with the posterior baby stuff. Back labor is not for the faint, man. I can't even imagine what should distocia must feel like. It makes my vag quake in fear. You are amazing. Really.

I'm so excited he's here, relieved that he's a healthy chap (all considered), and darn envious that he has such a badass mama.

I can't believe he's THREE WEEKS OLD now.