Sunday, August 23, 2009

Tuesday's child? (Fig's birth, Part 1)

Warning: This does eventually have a very happy ending, but because it involves a fair amount of unpleasantness, I might suggest that my pregnant friends not read this before giving birth. Also, if it is going to upset or offend you that I go against medical advice, don’t read any of what follows.

So. I wrote several entries that I never actually posted because they were too anti-everything, but that means there is some pertinent background information that is missing. I’ll try to summarize it now.

At my 37-week prenatal appointment, I found out that I was GBS positive, meaning that I am carrier of a bacterium called Group B Strep. It’s no big deal; something like 30% of the population carries this in the microbiome. I don’t think GBS really does anything (it is not the bacterium that causes strep throat, for instance), because if you have it, (like me), you don’t even know. And just because you have it at one time, that doesn’t mean that you always have it. You could test positive at 37 weeks and end up not having it at all when you go into labor. Or vice versa—your test results could show up negative, but a few weeks later when you’re in labor you could have it and nobody would know. The problem is that if you are GBS positive, during birth, the baby might pick it up. I’m not sure what the transmission rates are—only that sometimes it happens. And sometimes, sometimes if the baby does acquire it, the baby could become really sick and possibly even die. Statistics for morbidity and mortality of infants who get GBS from their moms during birth vary depending on what source you are looking at. I’ve seen 1/4400, 1/2000, and 1/5000.

So what they do for this is give the mother antibiotics intravenously during labor in order to prevent the baby from getting GBS. I don’t know why it has to be intravenously (i.e., through an IV and not in the form of a pill or something); for some reason, I guess it just does. It’s not like this is something that has been done since the dawn of time though—they only started screening for GBS and giving antibiotics sometime during the 80’s. So… you’d think that this should have a positive impact on reducing neonatal mortality, right? Well, not exactly. There’s not been any good evidence to show that this protocol is really doing anything to lower the already extremely low rates of infants who acquire a GBS infection during birth. In fact, there was just a Cochran review (considered a gold standard in the medical community, from what I gather) published that indicates the use of antibiotics is probably not worth it. Here’s a direct quote from the summary of the article: “Very few of the women in labor who are GBS positive give birth to babies who are infected with GBS and antibiotics can have harmful effects such as severe maternal allergic reactions, increase in drug-resistant organisms and exposure of newborn infants to resistant bacteria, and postnatal maternal and neonatal yeast infections.” In fact, the article is pretty much summed up by this statement: “This review finds that giving antibiotics is not supported by conclusive evidence.” But still. Doctors give the antibiotics. Because.

Typically, they give you penicillin for this, but I am allergic, so they have to give you something else. You must be given 2 doses of this antibiotic, 8 hours apart. Which means, I would have to be in the hospital for at least 8 hours before giving birth. Plus, instead of releasing you 24 hours after birth, they keep you and the baby for 48 hours for observation. Being GBS+ also puts you on a different timeline for delivery. Because transmission of infection is more likely in longer labors, when the water has been broken for more than 18-24 hours prior to delivery, OBs are wont to speed things up. I specifically asked about this, and my particular OB/midwife team only gives you about 12 hours after the water breaks before they start pushing the pitocin and talking c-section. This news seemed like a death sentence to my dream of a natural, unmedicated childbirth. After getting the GBS results back, I lived in constant terror that my water would break and I’d be put on the countdown-to-“unnecesarean” timeline. It was not a happy way to spend the remainder of my pregnancy.

So that brings us to Monday, the 10th of August. I was 38 weeks pregnant, just at the cusp of what is considered “full term.” I went about my day as normal. I had a prenatal appointment in the morning and everything looked good. In the evening, I walked over to a La Leche League meeting, about 1 mile away. I had a really good time talking to the other mothers. Then I walked home. I felt good but was tired and strangely hungry and non-hungry at the same time. I got home about 8:30 or 9pm and checked my email. I had a message from SL, saying that he had made it most of the way through my dissertation and that he thought it was in good shape and I could anticipate defending it soon. A sigh of relief. I realized I had never really eaten dinner and was hungry, so I made a banana-soymilk-chocolate-peanut butter smoothie. After I ate it, Fig moved around like crazy. I’d never felt Fig move like this. I didn’t know whether to laugh or be a little bit worried.

Eventually I went to bed. Everything seemed fine. I woke up around 2:30 in the morning feeling intense pressure. I jumped out of bed a split second before water started trickling out of me and I ran in the bathroom. Has anyone ever hoped more fervently that she had just peed herself? No such luck. It was my water, breaking. I said something that I cannot repeat here on the blog. I was filled with a white-hot, ice-cold terror, more panicked than I ever had been before in my life. My water had broken and I was having no contractions. It was the worst case scenario I had feared my whole pregnancy, and even moreso since finding out I was GBS positive.

I didn’t know what to do. A huge part of me wanted to pretend that it hadn’t happened and just go back to bed. No part of me considered going into the hospital immediately, as I had been carefully instructed to do on account of the GBS.

The house was a mess. I did a load of laundry, scrubbed the floor. There, was that a contraction?? It was hardly noticeable, so how could it be? I stayed moving, constantly swaying, hoping that in the very least I could get the baby into a good position. I tried to reconcile myself to the fact that this baby would be born on August 11, a Tuesday, 10 days before it was due. It just didn’t seem real. I was exhausted. Finally I tried to go back to bed, in a state of terror and denial. I couldn’t sleep because it hurt. Contractions that were barely noticeable while I was standing, swaying, were much more evident when I was lying down. I tried to think of this as a good sign. Too panicked to sleep, I got back up and made Fig’s birthday cake. Throughout the whole pregnancy, one thing I wanted to be sure to do was make a cake for Fig’s birthday while I was in early labor. I thought maybe if I went ahead and made the cake, it would speed things along. I still didn’t have a plan of what to tell my doctor, the hospital, my doula.

The cake was done, then what? The same light contractions sometimes came every 5 minutes, sometimes spacing out to 8 or 10 minutes. The sun came up. It had been several hours already. I had to figure out what to do.

Rob didn’t go to work. We tried to watch TV but every time I sat down the contractions stopped. I knew I needed to rest, but I was scared of the contractions stopping. We walked around the neighborhood several times. I rocked on the birth ball. Every hour I took my temperature to make sure I hadn’t spiked a fever (which would be a sign of infection). I checked the baby’s heartbeat with a Doppler as an indicator of whether or not he/she was in distress. Everything kept checking out fine, but I knew that was no guarantee.

It’s just that at this point, I was going to have to lie to everyone about when my water broke, and that was incredibly stressful to me. As the day wore on I became positively frantic. I realized that my level of stress was probably holding me back from progressing. I tried to do some yoga breathing/relaxation to calm myself down, but that was easier said than done. Finally, about 12 hours after my water broke, I just couldn’t handle it anymore. I was a little scared about infection and GBS transmission, but I was really scared about even rarer complications, such as cord prolapse. I felt like this might go on forever with no progress if I continued doing what I was doing. I had been trying everything possible to get this going, and nothing had worked. I was getting really tired—having basically been on my feet and in constant motion for the past 12 hours. It was time to face the music.

Filled to the brim with dread and terror, I called my OB’s office, expecting to speak to my midwife and to have her tell me to come in and we’d decide if I needed to go to the hospital or not. But they patched me through to the OB instead. I did my best to convincingly state that I thought my water may have “just” broken, and she told me to go straight to the hospital. I called my doula and she said she would meet us there.

There was nothing left to do but go. I had visualized and meditated on the birth for my entire pregnancy and it had been nothing like this. I knew how important it was to go into this with no fear, no panic, but now, fear and panic was all I had. I sobbed all the way to the hospital. It felt like I was marching straight towards the operating room—never in my whole life had I felt such a strong sense of something going terribly, terribly wrong.

We rode the elevator with a woman in a wheelchair. “Oh, when are you having your baby?” the woman asked, her voice raspy like it was hard for her to breathe. “Today,” I said, but was crying so hard I could only manage a whisper. The woman smiled and congratulated me. “You know, they play a lullaby through the whole hospital every time a baby is born. I will be listening for the next lullaby they play… it will be for your baby!” I tried to smile and think of the lullaby they would play for Fig, and to push away my fears of pitocin, scalpels, operating rooms.

We stepped off the elevator onto the Labor and Delivery floor, and it felt like I was walking straight into doom. By telling them that my water had just broken, I had bought myself 12 hours. I only hoped it was enough.

(To be continued)


gutzville said...

Can we borrow it for a month or so?

Maria said...

Is there more to the story (other than Fig's health birth that is)? You left me on the edge of my seat.

Sending much love your way,

Melissa said...

J- i did have a doppler but it was borrowed and i gave it back. i have lots of red raspberry leaf tea and evening primrose oil you can have if you want it though.

M-- yes, there's more! i fixed the title so that it would make more sense! thx for the love.