I had planned the birth of my dreams and watched it completely unravel one intervention at a time, as so many other women also have. It began with unbearable back labor and the hunch that Baby Girl had found a comfortable spot on a violently painful nerve. There were no breaks from pain even when there were breaks from contractions. It vibrated so intensely through me that I felt like I would explode into a cloud of atoms long before the baby came, or I would have a stroke trying to contain it within the inadequacy of my body. A vessel too small.
I begged for the epidural I had turned my nose up to for 42 weeks of pregnancy, pleaded for someone to help me escape my body. Hours would lapse before the night shift anesthesiologist, whose pants were too short and arrogance too obvious, could be summoned to slide the wire-thin catheter into my spine, piping relief to my lower half. Within minutes of receiving it, though, I felt like I was surfacing.
I labored throughout the night mostly without event. Once the baby's heart rate dipped, and the night team rushed in to make suggestions for interventions. I tried to hold on to the remaining tenets of our birth plan, but before I could clearly refuse an internal fetal heart rate monitor for the first time, the midwife-in-training had already broken my water in order to attach it to the scalp of my tiny girl. Luckily her heart rate stabilized, and I didn't think too much of the water being broken. In fact, I was relieved when the amniotic fluid turned out to be clear since the midwives kept foreshadowing a meconium doomsday as 42 weeks continued to approach without a baby.
By mid-morning on Monday, the morning shift (doubled by shadowing students) had decided that I needed a Pitocin augmentation because I wasn't progressing "fast enough". Basically on cue, the baby's heart rate showed distress. This time an OB resident came in to advise the second insertion of an internal fetal heart rate monitor, only she was much more pushy than the midwife the night before. I told her, "no." We waited a few minutes, adjusted the dosing of Pitocin, and the baby's heart rate again leveled without having to have that spiral needle screwed into her head to tell us she was ok.
In the afternoon I was checked for what felt like the 30th or 40th time by the 30th or 40th person, and I was told that I was ready to push. So I pushed, and they said that I pushed well, but my tiny girl wasn't coming, and the midwives and nurses and midwives-in-training and nurses and OB residents gave up on a normal, vaginal birth. There was mention of a vacuum extractor and forceps to help us along, only the vacuum extractor, which for whatever reason seemed more humane to me, wasn't the suggested intervention tool. They wanted to use forceps. Despite the fact that we had been shown a pair of the 2-foot long chrome jaws of life in a birth class several weeks before, I didn't really think they were still used. They're so cold and archaic and barbaric, but I was told that the OB who would be using them was "the best" - as though they carry with them a respected art.
I burst into tears as the neonatal team and all of their trainees, the anesthetist, every nurse, midwife, OB, and medical student crammed into my room. My heels were planted firmly in stirrups, the overhead spotlight was turned on, and I turned to my husband and begged him to talk to me. I was reminded of the first time my mother had made me look away from a shot. I thought that if he could distract me from the onlookers, from the scraping and prying I could feel in my bones as the device was inserted and jostled in place, from the spectacle that was being made of me and my baby who had turned her head or neck just so she couldn't descend properly, that maybe I could find some essence of calm among this chaos. But he wanted to talk about the baby. I didn't want him to talk about the baby. I wanted him to talk about a day or a moment or a subject one million miles separated from the humiliation and disappointment and heartbreak and discomfort of a pair of metal tongs gripping my tiny girl's face, prying apart my pelvis. The prying was hard to detach myself from even as he tried to change the topic. I asked about the sensations, the breaking, the strength of hardware against my bones, but the OB looked up over her mask and told me, "you're fine."
But the forceps didn't work. I spiked a fever, no thanks, I'm sure, to the broken waters the night before and the numerous cervical exams that I had tried to temper without success. I couldn't push the baby out, she couldn't be pried out either, so they said, "c-section", and I cried harder. The OB told me not to worry, she'd make a little "bikini cut". An insult. As though vanity was my top concern.
The onlookers spread like ants to prepare for the section. Getting from my birthing room to the OR was a blur of motion and an elevator and sobbing. I kept begging for my husband, who I was assured would be able to join me soon. But "soon" seemed like an endless wait.
They put me on a cross-shaped table. They gave me drugs that made me tremble so violently that I thought my teeth would shake loose from my jaws. They curtained off the carnage to keep me from coming undone as they sliced me open and pushed and pried against my body until they could wrangle the little baby from my womb.
It felt like hours as they worked to get her out - silently. My husband was finally allowed to come in and sit with me as they surgically removed our daughter. I kept asking if she was ok. He said she was, but he was crying. He would tell me later that it was a hard lie to tell. She was flopped onto my belly, a lifeless purple heap, a one minute APGAR score of 3. My teeth were chattering, chattering. Then she let out a hoarse little cry, and my husband said, "that's your daughter."
Her five minute APGAR recovered to a 9, and she ended up being fine. She spent the two hours following my surgery bonding with her dad while I took a Morphine trip to God-knows-where, emerging thoroughly concerned only with drinking orange juice and scratching a drug-induced full body itch. It had been a nightmare. I had missed my chance to enter motherhood the way it was intended. I was no witness to her birth. I missed the natural hormonal response (i.e., initial bonding), that instinctual flood of love. I had no interest in my newborn. She didn't even feel like my daughter.
Wednesday, October 3, 2012
Friday, September 14, 2012
Considering the Bishop Score
On Tuesday my husband and I were invited to attend a mini lecture on the risks of induction. This was the day after skipping my first induction appointment that was unsolicited and unwanted - at 41 0/7 weeks. Beyond my strong convictions to have this baby girl au natural, there actually are medical complications to consider. Complications that may be so commonly occurring, in fact, that they have been adopted as normal to the process of labor and delivery.
One of the most discussed scenarios in the natural birthing camp goes something like this: induction > increased labor pain, increased intensity in contractions > fetal distress > C-section.
This is in no way to say that there isn't a time and place for induction or c-section. It's just that when we heard about the Bishop Score at this mini lecture, I think our jaws dropped. The Bishop Score is used...or was used, as it seems...to determine whether or not a woman is a good candidate for induction. And it is based on the physiological conditions of the cervix and the baby, not a calendar date. Common sense can be such a beautiful thing.
At 41 weeks, by choice, I hadn't had a single pelvic exam because there was no reason. I could have walked around for weeks several centimeters dilated, and I didn't want to get my hopes up. I'm not a patient person. Likewise, I could go from 0-10cm in a very short time frame, but I didn't want to get discouraged in my wait for soon-to-be-baby girl if there wasn't a glimmer of progress being made. And certainly, no one made mention of a Bishop Score and how a cervical exam might shed some light on the discussion of induction. The only factors presented by the hospital staff were some skewed data used to make fearful cases for expediting our baby's exit. First it was meconium aspiration, then it was a reference to nonspecific "risks" and a misquoted ACOG standard for induction, and most recently the deterioration of placenta as well as the explanation that if I haven't made progress beyond 1 cm by 2:20pm today (41 4/7 weeks), as a first time mother, I would not be capable of having this baby without the aid of an induction. Did that last one just blow your mind? It did mine.
So when we went in for yesterday's non stress test to check on our perfectly healthy unborn babe, we asked for an exam. The findings put us at a 3. The Bishop system suggests between 8 and 13 as favorable scores for successful inductions. This lack of consideration again blew my mind. Here I am being harassed on nearly a daily basis to have my body pumped full of cervical ripeners and artificial hormones when it isn't even primed to have a baby, who in my opinion hasn't come because she isn't ready.
So you can imagine how appalling it was last night at 11pm when Labor and Delivery called to ask me to come in right then instead of the Friday morning appointment forced upon me, the second made after politely declining induction altogether. But the icing on the cake was definitely the provider who called back at 11:15pm to explain the likely failure of my body and it's equally likely need for drugs to produce a baby regardless of the fact that its signs all point to "not ready".
We have chosen to wait until Monday (42 0/7 weeks) and reassess soon-to-be-baby-girl's place in the world, since it is true that several risks do go up slightly at that point in gestation (meconium aspiration, fetal macrosomia, dysmaturity syndrome, and stillbirth and neonatal mortality risks double from 0.003% to 0.007% after 42 weeks). But we're keeping in mind that making a baby is also a very individual process. Some just cook longer than others - period.
She is not estimated to be large, thus making the risk of fetal macrosomia, a baby born weighing 8 pounds 13 ounces or more (mayoclinic.com), and dysmaturity syndrome, "characteristics resembling chronic intrauterine growth restriction from uteroplacental insufficiency" (ACOG: Clinical Management Guidelines for Obstetrician-Gynecologists Number 55, Sept. 2004) pretty much a non-concern of ours. Her amniotic fluid is good, her heart rate is good, her movement is well within 10 kicks per 2 hours, and all of my vitals are healthy as well. There appear to be two real causes of friction between the hospital staff and my family: noncompliance with scheduling at a facility with very high birth volume and exaggerated worst case, yet pretty unlikely, scenarios.
Today we are scheduled to see yet another midwife, who I suspect will insert an inflated version of her postdate risk of choice even though we haven't reached "postdate" yet. The plan is to get my membranes stripped to naturally coerce labor to begin if for no other reason than to get out of the loop of stressful confrontations with these people. We absolutely want what is best for our tiny, stubborn offspring, which is why we're waiting a few more days for her to decide that maybe it's time to become a part of this big, wide world.
One of the most discussed scenarios in the natural birthing camp goes something like this: induction > increased labor pain, increased intensity in contractions > fetal distress > C-section.
This is in no way to say that there isn't a time and place for induction or c-section. It's just that when we heard about the Bishop Score at this mini lecture, I think our jaws dropped. The Bishop Score is used...or was used, as it seems...to determine whether or not a woman is a good candidate for induction. And it is based on the physiological conditions of the cervix and the baby, not a calendar date. Common sense can be such a beautiful thing.
 |
| thanks to BabyMed.com for the borrowed chart |
At 41 weeks, by choice, I hadn't had a single pelvic exam because there was no reason. I could have walked around for weeks several centimeters dilated, and I didn't want to get my hopes up. I'm not a patient person. Likewise, I could go from 0-10cm in a very short time frame, but I didn't want to get discouraged in my wait for soon-to-be-baby girl if there wasn't a glimmer of progress being made. And certainly, no one made mention of a Bishop Score and how a cervical exam might shed some light on the discussion of induction. The only factors presented by the hospital staff were some skewed data used to make fearful cases for expediting our baby's exit. First it was meconium aspiration, then it was a reference to nonspecific "risks" and a misquoted ACOG standard for induction, and most recently the deterioration of placenta as well as the explanation that if I haven't made progress beyond 1 cm by 2:20pm today (41 4/7 weeks), as a first time mother, I would not be capable of having this baby without the aid of an induction. Did that last one just blow your mind? It did mine.
So when we went in for yesterday's non stress test to check on our perfectly healthy unborn babe, we asked for an exam. The findings put us at a 3. The Bishop system suggests between 8 and 13 as favorable scores for successful inductions. This lack of consideration again blew my mind. Here I am being harassed on nearly a daily basis to have my body pumped full of cervical ripeners and artificial hormones when it isn't even primed to have a baby, who in my opinion hasn't come because she isn't ready.
So you can imagine how appalling it was last night at 11pm when Labor and Delivery called to ask me to come in right then instead of the Friday morning appointment forced upon me, the second made after politely declining induction altogether. But the icing on the cake was definitely the provider who called back at 11:15pm to explain the likely failure of my body and it's equally likely need for drugs to produce a baby regardless of the fact that its signs all point to "not ready".
We have chosen to wait until Monday (42 0/7 weeks) and reassess soon-to-be-baby-girl's place in the world, since it is true that several risks do go up slightly at that point in gestation (meconium aspiration, fetal macrosomia, dysmaturity syndrome, and stillbirth and neonatal mortality risks double from 0.003% to 0.007% after 42 weeks). But we're keeping in mind that making a baby is also a very individual process. Some just cook longer than others - period.
She is not estimated to be large, thus making the risk of fetal macrosomia, a baby born weighing 8 pounds 13 ounces or more (mayoclinic.com), and dysmaturity syndrome, "characteristics resembling chronic intrauterine growth restriction from uteroplacental insufficiency" (ACOG: Clinical Management Guidelines for Obstetrician-Gynecologists Number 55, Sept. 2004) pretty much a non-concern of ours. Her amniotic fluid is good, her heart rate is good, her movement is well within 10 kicks per 2 hours, and all of my vitals are healthy as well. There appear to be two real causes of friction between the hospital staff and my family: noncompliance with scheduling at a facility with very high birth volume and exaggerated worst case, yet pretty unlikely, scenarios.
Today we are scheduled to see yet another midwife, who I suspect will insert an inflated version of her postdate risk of choice even though we haven't reached "postdate" yet. The plan is to get my membranes stripped to naturally coerce labor to begin if for no other reason than to get out of the loop of stressful confrontations with these people. We absolutely want what is best for our tiny, stubborn offspring, which is why we're waiting a few more days for her to decide that maybe it's time to become a part of this big, wide world.
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