Friday, March 06, 2009

Birth Story Part Three: Epidural, Schmepidural

Disclaimer: This is the part of the story in which the shit hits the fan. If you are at all squeamish about bodily fluids or talk of a screaming woman, you probably shouldn't read this particular post and just maybe wait to read the next installment, where baby is born. If that stuff doesn't bother you, read on...

So, my water broke at 7:05am and I wasn't even sure that is what happened at first, so I decided to call the nurse to see if she could help me out of bed to go to the bathroom. My new nurse, Cheryl, came in, and as I walked to the bathroom I left a trail of clear fluid behind me, and Cheryl said, "Yup, you're definitely ruptured." My heart soared, because this was my first tangible evidence that labor was underway. I also noticed as I walked that I was feeling A LOT more pressure on my bottom, and I considered this a good sign as well. In fact, the pressure was so strong that I had to stop and take several breaks on the way from the bathroom back to my bed to collect myself. Cheryl commented that I was definitely committed to having that baby today now that my water had broken, and I silently laughed at the nurse from the night before who suggested I might be going home to wait it out.

My contractions were also starting to pick up quite a bit. I was expecting this--when I went through my induction with Gracie, the one thing that managed to rocket me into labor was my water breaking, so I was prepared for labor to take off with a bang once that happened this time as well. I made Aaron take this opportunity to go down to the cafeteria to grab something to eat, since I wasn't sure that he would have that chance over the lunch hour. And, although my contractions were coming more frequently, they still weren't at the point where I felt I needed Aaron to coach me through them. I also called my parents to let them know what was happening, and I told them to go ahead and take Grace to school since I wasn't sure the baby would arrive before the end of her school day anyway.

Dr. Fab came in at 8:00am as promised, and she was pleased to hear about my progress. She informed me that another dose of Cytotech would definitely not be necessary at this point. She also brought up something neither of us had considered...the fact that I had had cryotherapy on my cervix a couple of years ago (about a year after I delivered Gracie--I had some precancerous cells on my cervix and they were removed). Dr. Fab mentioned that she thought of this after my 4:00am check and told me that because of the cryotherapy, there was scar tissue on my cervix and that was making it difficult for my cervix to dilate at the same rate a normal cervix would. At this point she checked me again, and sure enough, I was still only dilated 1 cm. Crap.

Cheryl, my wonderful nurse, told me that in cases like this when there is cervical scarring, the cervix tends to "pop" open after several hours of labor and then dilation occurs very rapidly. She also asked me what I had been thinking of in terms of pain medication, and I told her that although I hadn't ruled out having an epidural completely, that I would like to try other methods of pain control before going that route. Cheryl then brought me the consent form that I would need to sign should I decide to have an epidural and told me that I could sign it then and then if I decided that I didn't want the epidural, we could just tear the form up. She also warned me that with circumstances being what they were with my cervix, things could go very quickly and that if I was feeling the need for the epidural, I should ask for it right away so they could start pushing the fluids I would need immediately. The nice thing was that there was no pressure involved in what she was was purely informational and non-judgemental.

Before Dr. Fab left to head into the office, she decided to place a pressure catheter in my uterus to measure the strength of my contractions since she didn't feel that the external monitor was doing a good enough job of tracking them. Having her place that was very painful, especially when I would have a contraction, and I whimpered a bit as it was placed. She also attempted to place a scalp monitor on Tater's head to better monitor his heartrate (since again, they had such trouble tracking it via the external monitor), but she was not able to do so because I had not dilated enough. Dr. Fab said that she was going to head into the office for the morning but that she would be back at noon to check on things. She told me to feel free to relieve her of her morning appointments before then if I wanted to, and I laughed.

As the morning progressed, my contractions became strong enough that I needed Aaron to coach me through them and help me breathe through them. I was even getting to the point where it was helpful to moan through the contractions, and Aaron encouraged me to let it out and do what I needed to do to feel better. In fact, the contractions were strong enough and frequent enough that I asked for a dose of Nubain (I LOVE Nubain) mid-morning, and that took the edge off of the contractions for a while and actually relaxed me so much that I fell fast asleep between contractions. The only bad thing was that even though my contractions were strong and frequent and I had established an active labor pattern, they were still spaced out and they were not becoming more frequent--they had been coming every two to four minutes all morning. At this point, Cheryl suggested a "whiff" of Pitocin, just to pick things up a bit. I agreed, and Cheryl paged Dr. Fab to see what she thought, but Dr. Fab said that she wanted to wait until she came in at noon to see what kind of progress I was making before going that route.

Noon came, and so did Dr. Fab. She noticed that my contractions were getting much stronger (both from the readings from the pressure catheter and from my moaning and yelling through contractions) and so she did another cervical check--2 cm. I couldn't believe it. I was so disgusted. From what I remembered from my labor with Grace, I was having these types of contractions when I was heading into transition, and I was terrified that if I was feeling this way at 2 cm, I would feel much, much worse as my labor progressed. I expressed my frustration at the situation, and Dr. Fab gave me my options. I could wait things out to see if labor picked up even more on its own (which could take hours) or we could go ahead and try the Pitocin to see if we could speed things up. I didn't even hesitate...I wanted the Pitocin, and before I got the Pitocin, I wanted the epidural. I was exhausted, I was in tons of pain, and I wanted things to be over with. I handed my signed consent form to Cheryl and she immediately pushed IV fluids to get me ready. I was very excited that relief would surely be on the way soon.

The one thing that no one mentioned to me was that if cervical dilation occurs very quickly, sometimes an epidural doesn't have time to catch up and it offers only very slight, if any, relief. I suppose in hindsight I would have still gone ahead with the epidural had I known this, but part of me wishes I would have known because I would have had the proper expectations. I was fully expecting to feel tons of relief once the epidural was administered and I thought I would be able to maybe catch a quick nap while I finished dilating.

I was wrong. At 12:45pm, the anesthesiologist came in to administer the epidural which was an excrutiating process in and of itself. For one thing, my contractions were stronger than ever and we had to keep pausing so I could holler my way through another one before they could continue. And, because of my terrible back pain, I couldn't sit well at the angle that the anesthesiologist needed me to in order to thread the catheter into my spine, so she ended up having to do the procedure twice. Again, I didn't care so much about that because compared with the contractions, the epidural felt like a bee sting, and I was so sure that I would feel so much better afterwards, I would be willing to do anything. Once the epidural was finally in place, the Pitocin was started.

But for some reason, relief was no where in sight. The first couple of contractions I had after the epidual was placed were a little more manageable--I had to control my breathing through them and I felt a lot of pressure, but the pain wasn't as acute as it had been in the hour or so before. However, after two or three manageable contractions, the pain kicked back in with a vengance and soon I was yelling through my contractions again. Cheryl asked me if I was feeling pressure or pain and I screamed, "BOTH!!" I told her that I didn't think the epidural was doing anything anymore. I felt so angry and desperate and nothing was helping me with the pain anymore. Cheryl went to get Dr. Fab (who had brought her lunch to the hospital with her because she had a feeling things would progress quickly once the Pitocin was started) and another cervical check was done. Suddenly, I was at 4 cm. It was 1:45pm.

Things started to happen very quickly after that. The room started filling up with equipment. Nurses and Dr. Fab were rushing around, putting on scrubs, warming up the incubator, and checking on baby's heartrate. I continued to feel each and every contraction, except now that they were bolstered by the Pitocin, they were much, much closer together and much more intense than they were before. I did the best I could to follow Aaron's lead and breathe effectively through each contraction, but as they peaked, I abandoned any attempt to control myself and just let myself holler as loud as I could until they were over. Cheryl tried to get me to breathe and relax as well, but as any woman who has ever been through labor knows, any attempts at logic or gaining control once you hit transition are futile. All that I could do was hold on to Aaron as tightly as I could and stare at his face as intently as I could to try to keep myself tethered.

At 2:15pm, Dr. Fab checked me again because I was starting to feel A LOT of pressure on my bottom and I was at 6 cm. Then, less than 20 minutes later, I had dilated to almost 10 cm and I was getting ready to push.

Cheryl was absolutely right. My cervix had popped.


Carrie said...

Oh, man. This sounds really rough. I hope I never have to go through an induction -- of course if ones life and baby are in danger like yours were it's the right thing to do, but it seems like every step of the way was such a struggle. Ouch.