the birth of the Duke, part 2

Our caravan arrived safely at Sutter sometime around 11:00 p.m. I breathed and moaned through three contractions on my way in before we got into our room. Once there, they hooked me up to an external fetal monitor to measure the frequency of my contractions and the baby's heart rate. At that point it looked like my contractions were coming about every five minutes. The nurse then checked me for dilation and effacement and I was incredibly disappointed to hear that I was most of the way effaced, but only about three centimeters dilated. At this point it had been about 30 hours since I first started timing contractions, and getting close to the 24 hour mark since I'd really slept, and that had only been for three hours. Although everyone tried to encourage me by saying that the first three centimeters take the longest and that the next seven tend to go much faster, I was exhausted and incredibly discouraged.

Our doula suggested we spend some time in the jacuzzi, which sounded great. She filled the tub and Troy and I spent a good amount of time in there. It was really relaxing and did help with the pain of contractions. I believe it was after we got out that I had my first real melt-

down and started talking about needing some help. Troy and our doula encouraged me to continue on, just putting one foot in front of the other. The doula suggested that some activity might help get things moving, so we walked a bit and did some "step aerobics" with a little step that was in the room. Sure enough, the contractions picked up a bit. I think it was also during this time, though, that the baby's heart rate started to drop a little after each contraction. The nurse gave me an oxygen mask to hold over my nose and mouth when I was able to, and that seemed to resolve the problem immediately.

Some time during these wee hours of the morning (it's all a bit of a blur now, so I'm probably telling some of this out of order), the nurse decided to check me again. Minimal progress. I was maybe at 3 1/2 centimeters now. This was when I really decided I was going to need some help to get through this labor, and our nurse and doula, while still encouraging me to continue on, discussed our options with us. These included breaking my water, giving me morphine to temporarily help with the pain and allow me to get some sleep then continue on "naturally," and giving me an epidural to help with the pain for the rest of labor and allow me to sleep. We would be able to try the epidural with or without pitocin, but our doula warned that pitocin would probably be necessary in this case to help move things along. For some reason I was more afraid of the morphine than the epidural, I think because I had learned a lot about epidurals through my reading and childbirth classes and was more familiar with potential side effects. I also didn't like the idea of this labor continuing on for potentially days longer, so I pretty quickly made up my mind that I wanted the epidural and pitocin. Troy and our doula handled this decision wonderfully, encouraging me to labor a little bit longer while I really thought it through, discussing with me the risks and benefits of this course of action, and really just making sure that I was making a well-informed, well-thought-out decision. Our doula was a little more aggressive about encouraging the natural route and tried using the analogy of a strenuous hike I had been on, during which I didn't think I could make it but continued pressing on and eventually did. I wasn't having any of it at that point, though. I said something along the lines of, "Yeah, I hear you, but this is different. I want the drugs." I told her that with our original doula I had discussed my preference for a natural birth, but that I had my limits, one of which was a very long labor. I also shared with her my concern about having the energy to push this baby out. I did need a moment, though, to have another good cry and talk to Troy about my fear that I was disappointing him. He had also wanted a natural birth and had such confidence in my ability to do it. I am so glad we got this moment together because he took the opportunity to tell me how much he loved and respected me and how I had made a "valiant effort" to have the birth we wanted, and that of course he respected my decision to go the intervention route. It was so important for me to hear that and know that he was right there with me.

Even after we made the decision to get the epidural and pitocin, it was several hours before it actually happened. We passed the time in much the same manner as we had previously, including another session in the tub. At a more respectable hour of the morning, the backup doctor came in and again discussed with me my options, one of which was returning home to labor more. My response: a slightly more polite version of "HELL NO!" We did decide, however, to break my water, just to see if that would help things progress a bit. She did, and it pushed me up to four centimeters. The doctor spotted a small amount of meconium in the amniotic fluid, but it was so little that she wasn’t really concerned. We also found out that our original doctor would be arriving back in town shortly and would be available after noon or so. It looked like she would be delivering our baby after all!

Later in the morning, the nurse hooked me up to an IV to get the fluids I needed before getting the epidural. From this point on, I pretty much had to stay in bed. In some ways it was difficult to get through contractions without being able to move around, but at the same time I was so exhausted I welcomed the excuse to stay lying down. I think it was close to noon by the time the anesthesiologist came in to get me set up with the epidural. He had a little trouble getting it in and there was some question as to whether it would actually take, but it did. Although the numbness was a strange sensation, it was really nice to see the contractions showing up on the monitor and to not really feel them at all. The nurse then started the pitocin drip on the lowest setting and put in a catheter. Our doula continued to make sure we were well informed about everything the doctors and nurses were doing, and then she encouraged the entire birth team to try to nap. We encouraged her to do the same. Troy and I slept in our room, while the others rested and napped on the couches in the waiting area.

We got at least a solid hour of sleep in before the nurse came in and noticed that the baby’s heart rate was dropping following each contraction. She called the same on-call doctor in (ours was still not yet available) and she became concerned when she saw the monitor. She and the nurse were both in and out of the room a couple times before the doctor spoke with us. She said that the baby’s heart rate dropping could be a sign of distress, and that if this pattern continued, they would be unable to up the pitocin as much as they suspected they would need to to get me fully dilated. She, a family practice doctor like our own, said they wanted to try changing my position first, but also said she had consulted with the OB on call regarding the possibility of a cesarean delivery. I burst into tears, sobbed for a minute, then pulled myself together and took charge. I told the doctor and nurse that the baby’s heart rate had been dropping the night before, before I had even had the epidural and pitocin, and that the nurse on call at the time had just given me a little oxygen, to which the baby responded very well and stabilized immediately. I asked whether we could try this before we even started discussing the possibility of a cesarean. The doctor and nurse looked at each other and then told me that, sure, we could try that. I also remembered reading that a slight drop in a baby’s heart rate following contractions was normal, and that reassured me. Sure enough, the combination of them turning me on my side and giving me oxygen fixed the situation immediately. Baby held up incredibly well from that point on. Later, Troy told me that he felt that this was the point in the labor at which I really decided who was in charge.

Over the next couple hours, the nurse gradually upped the pitocin. Sometime during this stretch of time, our doula encouraged our naturally nervous moms to get out for a glass of wine and some food. They left for the Crow’s Nest. However, it wasn’t much later when I started to feel a lot of pressure down south. I mentioned it to the nurse and asked when they would check me again for dilation. She casually said something like, “Mmm, I don’t know, in a little while.” Maybe a half hour later I was feeling yet more pressure and mentioned it again. “Well, I can check you,” she said. I was happy to have her do so. She sounded very surprised to discover that I was at nine centimeters. That would explain the pressure. I asked when they would call our doctor and I got another casual, vague response. Troy, our doula, and I debated about whether to call our moms, as they hadn’t been gone long. We joked that if we called them and told them to finish their drinks and then come back, that they would chug them and race over. Sure enough, that’s exactly what happened, except that they stopped for a minute to announce to the entire restaurant that they had to leave because they were having a baby. They were back at Sutter in no time, very excited and perhaps a little tipsy, too.