Monday, September 28, 2009

Aftermath (Fig's birth, part 4)

See Part 1 Part 2 and Part 3

After Will was born, everything was a blur.

He was crying but he wasn’t a good color—more purple than pink. They let him stay on me for a few minutes, and then they took him over to the baby warmer to pink him up.

I had requested that the cord not be clamped until it stopped pulsating, but I honestly have no idea if they honored this request or not. After Will came out, they pressed on my stomach a lot, and it was nearly as painful as transition. My doula coached me to breathe through this part just as I had during contractions.

Something felt very, very wrong. I could barely speak. I felt weak and sick. I felt like I’d been drugged, which was cruelly ironic, because I had refused pain medication during labor specifically to avoid feeling this way.

Someone mentioned again how much I had been throwing up throughout labor and Dr. T said something like, “Oh yes, the antibiotics she had for the GBS cause nausea and vomiting.” I wanted to throw something at her. They gave me another bag of fluids and electrolytes to try to replenish the last 10+ hours of vomiting.

Rob called both of our parents, but I don’t think I talked to them; I don’t think I could. I had been so terrified of what might happen during the labor that I hadn’t wanted to tell them anything. I didn’t want them to be celebrating what I thought might end up a mangled mess. But beyond that, I’d had this overwhelming, primal mammalian desire to burrow in a dark hole and give birth unscrutinized.

At some point the young nurse told me that Dr. T recommended giving me pitocin now to slow down the bleeding. Pitocin? Are you @#$%^&* kidding me? is what I wanted to say, but couldn’t. Besides, wasn’t nursing the baby supposed to reduce hemorrhaging? Where was the baby anyway? Was it that thing over there crying? Why wasn’t I nursing it? My doula was there and she told me she thought it would be a good idea to consent to the pitocin. Maybe I was bleeding a lot or something, I don’t know. But if my doula thought it was okay, then that was all I needed to hear. It was just so ironic to accept piticon now, since I’d fought tooth and nail throughout the whole labor to avoid it. Somehow, I just didn’t care anymore.

They did bring the baby back to me to nurse at some point. I was laying down, unable to move, and when he latched on, it hurt terribly. Like burning sandpaper. I didn’t care. The nurses said that his latch looked good, that the pain was just something I would have to get used to. I let him suck and suck and suck.

They took blood from Will. Not just a heel prick, they took vials of it from his tiny arm because of the damn GBS. They had been so slow to start me on my IV of antibiotics that even though I’d been in the hospital almost 12 hours before he was born, they didn’t have time to give me the second dose. So it was protocol to take blood from him to see if he’d gotten any infection (which he had not). He didn’t cry when they took the blood. He only cried when they bathed him, scrubbing off the vernix and blood.

By now, Rob had been up with me for over 24 hours, and he had collapsed into a sleep next to me in a horrifically uncomfortable looking cot. I had to pee really bad, but I still couldn’t move. The young nurse was there, and she helped me out of bed. The next thing I knew I was on the bathroom floor and she was waving an alcohol swab under my nose to wake me up.

It turned out my blood pressure had spiked at the end of labor. I heard them talking about “pre-eclampsia” and “pregnancy induced hypertension” and I kept trying to tell them I didn’t have those things. In my whole life, my blood pressure had probably never been higher than 90 over 60, and now here it was, 160 over 80. Was that why I felt so terrible?

They told me that sometimes pregnancy induced hypertension (PIH) could happen after the birth. That didn’t make any sense to me. Even in my stupor, I knew that the “cure” for PIH or pre-eclampsia was to get the baby out, so I still don’t know why this happened.

At some point it became morning. They moved us to a different room and Rob ordered us pancakes for breakfast. I’d had a few bites of Fig’s birthday cake at some point after delivery, but the last time I’d eaten anything substantial was on Monday afternoon. It was now Wednesday. In retrospect, I realize that that was a big part of why I felt so terrible. Once I ate the pancakes (and toast and fruit and juice), things started to feel a little bit more clear.

Both of our families came to visit us and some of our friends visited or called as well. Nurses came in every hour to check my blood pressure, which remained freakishly high, but nobody knew anything about the results from the tests they had done. With so much going on, it was hard to get any sleep. I was exhausted but I didn’t even want to sleep because that would mean I’d have to stop looking at Will. I couldn’t believe that he was really here, that I’d really given birth, and that I had managed to do it without drugs.

I still felt so terrible—incredibly weak and sore all over from giving birth. My stomach felt like I had done a thousand sit-ups. I’m not sure if it was from labor or from vomiting for nearly 10 hours straight. Most infuriating to me was that I was still nauseated. As if 9 months of hyperemesis gravidarum wasn’t enough. It hadn’t gone away yet. My sister and even Dr. T had warned me that it would take a few days before the hormones left my system, but still, I’d been hoping that I wouldn’t feel so sick after the baby was born. No such luck.

At some point, I realized was time to get serious about nursing the baby. With some food in me and a few minutes of rest here and there, I struggled to think past the haze that had seemed to surround me since the moment my water had broken. It hurt so badly to nurse him that I knew something was wrong, and I had nurse after nurse come in and help me. They brought in a breastfeeding DVD for us to watch, and I realized that he was latching on wrong—that all of the nurses were continuing to help me latch him on wrong—but I couldn’t figure out how to get him to latch on properly.

At first I tried not to freak out about it, even though I knew that a bad latch could ruin breastfeeding from the get-go. I tried to keep calm by assuring myself that it would work out—this was, afterall, why I had been so hell bent on having an unmedicated, natural childbirth. Drugs and interventions used during labor can make breastfeeding really difficult, and that was the main reason why I had wanted to avoid all that.

Different nurses told us different things about how to feed him, how often to feed him, etc. When he was 24 hours old, they weighed him and I think they said he had lost 6% of his birth weight. Completely within the range of normal. But the nurse on duty then warned me that if he lost any more weight, the doctors on staff would tell me I had to feed him formula. She knew how dead-set against that I was, so she tried to help me avoid it. From then on, I fed him every 2 hours for 10 minutes on each side. It hurt like hell. One of the nurses suggested that I pump and we give him the pumped colostrum from a medicine dropper. So I pumped and pumped but nothing came out, and it hurt almost as bad as nursing him.

The baby was crying all the time. I still felt so terrible that I could barely even stand up, and Rob had to do everything. I couldn’t even get out of bed to change him. I started wearing down, fast. I cried every time I nursed the baby, and I cried in between nursing him because it still hurt so bad. I wasn’t sleeping at all. I hadn’t slept since Monday night and it became Thursday, then Friday.

I completely broke down about 3am on Friday—the morning of my 30th birthday. In addition to the lingering pain of giving birth, there was the unrelenting nausea and the burning, throbbing pain from nursing a baby with a bad latch and powerful suck. The night nurse, who was trying to be so helpful to me, asked if I wanted her to take the baby to the nursery so that I could sleep and she would give him “supplement” at his next feeding. I wouldn’t let her take him away. I hadn’t gone through an excruciating 23 hour labor with no drugs only to give up on breastfeeding because it hurt too bad.

At his weight check, Will was down 8% from his birth weight. Pretty low, but still within the range of normal. The nurse told me that the pediatrician would recommend giving him formula. She said that as a nurse, she had to tell me to follow doctors orders. But as a mother, she wouldn’t do it.

When the pediatrician came in, he was the rudest, most pompous jackass I had ever met. If you’re in Champaign-Urbana, email me and I’ll tell you who he is. He said I needed to give my baby formula because I was being discharged from the hospital on a Friday and would not be taking Will to the doctor until Monday. They didn’t want him to lose any more weight over the weekend. So because of the day of the week I gave birth, they were mandating that I give him formula. He told me that “the girls” (presumably the nurses?) would be in to show me what to do. He said there was very little chance that I would get into see the lactation consultant today because she was booked with other patients. At any rate, he assured us that she would say the same thing—that we should give him formula. I told him that if my baby’s weight loss was so severe that he needed formula, then this was an emergency and I needed to get in to see the lactation consultant right away. He rolled his eyes. I said fine, if I can’t get in to see the her, I will go to the free Carle Breastfeeding Clinic. He rolled his eyes again. Some women find that helpful, but they aren’t really going to show you how to breastfeed. They just use dolls.” Bullshit. I asked him if he had checked Will for tongue-tie—a fairly common condition that prevents babies from latching properly. He rolled his eyes again and told me that tongue-tie is rare and doesn’t cause problems latching. Bullshit. Seriously, if you live in the area, I will let you know who this jackass is so that you never ever ever take your children to see him.

After he left, I was a sobbing, hysterical, puddle on the floor. The nurse on duty tried to pull me back together by telling me kindly, “Honey, you don’t have to give your baby formula.” Thanks to her kindness and dedication, she got us an appointment with the lactation consultant for 1pm in the afternoon. It took forever to get discharged from the hospital, and during that time I couldn’t feed him because we were taking care of details and paperwork. We finally got out of the hospital and flew across town to our appointment. Will was screaming at the top of his lungs. It had been at least 4 hours since I’d been able to feed him, and nothing could calm him down. We sat in the waiting room with a bunch of sick people and our purple-faced-screaming, starving baby. I realized that this was the worst moment of my life. I asked the nurse at the reception if I could please go ahead and feed him even a little, but she told us we really needed to wait for the lactation consultant to work with us.

Finally, the lactation consultant saw us. She was amazing. She put him on me the right way and despite the fact that I was completely raw, it didn’t hurt at all. She said breastfeeding wasn't supposed to hurt and that anybody who told you otherwise was wrong. I was so overjoyed I couldn’t believe it. My milk was starting to come in, so he finally had more than just a few precious drops of colostrum to swallow. He sucked ravenously. They weighed him before and after the feeding and he gained 3 ounces. Contrary to what the pediatrician had assured me, the lactation consultant never once said I would have to give him formula.

We left to go home. Everything was in disarray—exactly as we had left it. My parents came and my mom stayed with us for a few days. Thank god for that, I don’t think I would have made it otherwise. She cooked and cleaned and cleaned and cleaned. The house had never been so clean. I will never be able to tell her how much this meant to me. Suddenly after becoming a mother myself, I needed my own mother more than I ever had before.

Nursing never really went well. He latched on great in the lactation consultant’s office, but I couldn’t do it the same way by myself at home. As the weekend progressed, he latched worse and worse, and it hurt just as bad as it had in the hospital.

As if all of this weren’t enough, Rob got sick. I had been afraid something like this would happen. Rob was carrying so much on his shoulders because I had basically been a hysterical mess ever since my water had broken. He’d had to be the calm one, to constantly reassure me, to constantly tell me everything would be okay and to constantly remain positive. I had been so afraid that he would crack under all this stress. During those difficult days, my mom took care of all three of us. I don’t know how she did it, but I’m so glad she did.

Aftermath of the aftermath

We saw the lactation consultant at least once or twice every week after Will was born. I was still in a lot of pain and still had trouble getting him to latch properly on my own. The lactation consultant gave me a nipple shield to use while I was still healing. In retrospect, this was a double-edged sword. It allowed me to nurse him without pain, which was miraculous. But it prevented him from properly draining out the milk. This led to my having repeated bouts of plugged ducts. My god that hurt. Plus, milk production is a supply and demand issue. If the baby doesn’t drain the breast—especially at the beginning—your body thinks you don’t need to produce so much milk. You end up with a low milk supply and a hungry baby. This is what happened to me. I don’t think it is completely a result of the nipple shields, but they definitely contributed to it.

For a while everybody tried to be supportive and convince me that Will wasn’t hungry—that he had gas or needed to poo or was bored or simply that babies just cry. These things might have been true for some of his crying bouts, but he was my baby, and I knew those endless purple-faced screams meant he was hungry. One week he only gained around half the amount of weight he was supposed to, and during the feeding at that appointment, he only drank one ounce (based on his pre-and post-feeding weight). That's when the lactation consultant said I had a low milk supply.

Dealing with this has been the most difficult thing I have ever faced in my entire life. I plan on writing an entry about all of the efforts we’ve gone to to increase my milk supply and keep Will growing, and I hope to write it in retrospective, with a happy ending. At the moment I’m still going through it though, and I’m not sure yet how it turns out.

Thanks for reading.

Friday, September 18, 2009

William Smiles

Someone's in a good mode

There is so much more to say about the aftermath of Will's birth and about everything that has happened in the days and weeks since then. But there's just not enough time for me to write about it. It's been hard, very hard. Labor was just the beginning.

He looked up at me and smiled last night, just in time to keep me from going off the deep end.

He's got the most beautiful eyes I've ever seen. Gray and blue and green and gold. Like Lake Nicaragua.

Wednesday, September 2, 2009

Waterlogged and tender (Fig's birth, part 3)

See Part 1 and Part 2

Now back to Fig's birth story:

My favorite song of all times is called “Driver Education” by Amy Ray. There’s a line in the song that goes, “We come into this life, waterlogged and tender,” and the whole time, that’s all I wanted for Fig. Fig was so sweet, so precious, and after I learned about the different drugs so frequently used during labor, I wanted no part of that. It had nothing to do with pride or trying to prove myself. I just wanted Fig to enter this life as gently as possible.

Now, having been stuck at 5cm for 4 hours (and my water having been broken for 12 hours longer than the hospital staff knew) it seemed like pitocin was inevitable. When my doula came back to the tub after her conversation with the young nurse, I knew she would try to break it to me lightly. But instead of telling me that they wanted to jack me up with pit, she asked me if I would consent to getting some intravenous fluids. I already had the hep-lock in place to get the GBS antibiotics, and my doula reminded me that I’d been throwing up every 3-5 minutes for the last several hours—probably causing some pretty severe dehydration. She said a dehydrated uterus couldn’t contract properly and that might be holding me back. I remembered reading the same thing in Ina May’s Guide to Childbirth, and an IV suddenly seemed like a great idea. The young nurse also said that Dr. T had suggested giving me some sugars in the IV, since I had not been able to eat in a good number of hours (and actually many more hours than they even knew about). If that is really what Dr. T suggested (and I’m not just misremembering things), then I’ve got to hand it to her for suggesting more gentle interventions before pit. I said yes, somehow thinking that if I got the fluids and sugar, maybe some of this excruciating pain would go away. It didn’t though.

At some point (my recollection of events may be out of sequence), my doula also suggested that I get out of the tub. She was beginning to suspect that all my time in the water was holding me back, and I would need to get out to get things moving. In retrospect, I realize how right she was about this, and also that if she would not have been there, it probably wouldn’t have occurred to me to get out of the tub. Without my doula, I definitely would have been headed straight for exactly the kind of birth I’d been wanting to avoid. When she told me to get out of the tub, it seemed like a hugely overwhelming task, but she and Rob somehow helped me rise to my feet and step out of the water. Just as I did so, I was hit with the worst pain I had ever felt in my life. I’m not sure I can adequately even describe it. It felt like my body was being split in two. I grabbed onto Rob, and if memory serves me correctly, let out a blood-curdling scream.

I don’t remember the exact sequence of how things panned out after this. I think that they had me get in bed—much against my will—once I got out of the tub. The young nurse said she needed to get a better tracing on the baby (as she hadn’t been able to monitor it very well while I was in the tub). She also said she would “check” me again, just on the off-chance that she’d been wrong about me being 5cm because she’d measured me at a strange angle in the tub. I did not want to get in bed and it seems I fought against it but eventually ended up there anyway. My doula told me to just hang on a little bit and then we’d move me to a side-lying position in the bed, so that hopefully it would be less painful and I might be able to get some rest. The young nurse quickly checked me again (it was incredibly painful) and pronounced that I was “6 to 7 cm.” My doula cheered; I could not react. I kept asking, “What does that mean?” and the young nurse responded, “You are 6 to 7 cm dilated.” But that wasn’t the answer I was looking for. I wanted to know, does that mean 6, or does that mean 7? And what does this mean for the pitocin and the epidural?

But nobody said anything about pitocin or an epidural. I felt like, if they’re going to insist that they put me on pit, I need to know. Don’t just spring it on me without giving me time to deal with it. And what did this mean for getting an epidural? Had I missed the epidural window? Somehow in my haze, I recalled that one of my favorite bloggers (@kristysf) had recently had a baby and had been very keen on getting an epidural. She had wanted to make certain not to miss the epidural window, and until I read her blog, I didn’t even know that such a thing as an epidural window existed. Because I’d had no intention of getting an epidural, I hadn’t looked into these things. Now I kind of wished I had, so that I would know.

The baby still looked marvelous, with great heart tones and whatever else it is (if anything) they monitor, so everyone was reassured by that. My doula then had me roll over (most ungracefully) to my left side. I thought, surely this will bring a modicum of relief. I remembered another of my favorite bloggers (Dooce), who wrote about being in this exact position for hours during her labor and getting through it by holding her husband’s hand. I held onto Rob, but the pain only seemed worse and worse. I think I was still throwing up during many of the contractions too. This position had worked for Dooce, but it was not doing the trick for me. Despite how unpleasant it was, I felt stuck there because I was exhausted and didn’t think I had the strength to move.

My doula said she thought we needed to get me on my feet and use gravity for a while. Oh God no, I thought, there is no way I can stand up through this. But somehow, Rob and my doula got me to stand at the edge of the bed, bent over and swaying back and forth. The contractions started to feel very different. I had thought they were intense while I was in the tub. Ha! That had been nothing compared to this. They came, practically on top of each other. There was no end to them. Even between contractions, there was still intense pain and unbelievable pressure. After a while, I couldn’t even tell when one contraction ended and another began. And it started to feel like all the organs of my body, from my brain on down, were trying to force themselves out through my perenium.

My doula was very in tune with what was happening to me, and she kept asking me, “Do you feel like pushing?” Pushing?? That would mean this ordeal was about to end, and it did not seem like the end was near at all. I couldn’t really speak to answer her, but I didn’t think that I felt like pushing. Pushing didn’t seem to be a violent enough word to describe what this felt like.

Eventually, I couldn’t stand up anymore, so Rob and my doula got me back onto the bed—this time sitting up cross-legged. This position made me feel that it was less likely that the contractions would force all of my internal organs out of my body. By this point, I was closing in on 20 hours and was completely exhausted. Rob and my doula each held onto me to keep me upright. I started to loudly hum or moan through contractions. Somehow it was the only way I could get through them. If I caught the contraction right at the beginning and took a slow, deep breath—then let it out in a loud, low hum, I managed to survive. My doula encouraged me to do this, and I remembered reading about this in Ina May’s Guide to Childbirth too. If I drifted off and let my concentration waver, then the contraction caught me off guard and it ended up being so intense that I had to scream through it. I thought of all of my friends who have had babies, especially those who have had more than one baby (meaning they’d lived through it once and actually wanted to do it again!) and wondered how they did it. I thought of my mother. I thought of one of my friends who had a difficult labor with her first son, but maintained that she enjoyed every minute of it. I thought of the all the hippies in Ina May’s book who described their contractions as rushes or waves and laughed or kissed their husbands all throughout the birth. None of this was like what I was feeling. Maybe it was my terror of the pit, of the GBS, of my water breaking so early, and the incessant vomiting. But this was not something I would ever look back on fondly.

At some point, I jumped up onto my knees during a contraction, unable to moan anymore but rather only shriek most ungracefully. I have no recollection of doing this, but thank god my doula was there because she knew that this meant business. She got the young nurse back into the room to check me. It was excruciating; I think I may have kicked her during the procedure. I dreaded hearing that I had made no progress, but instead, the young nurse said, “She’s complete.” Had I misheard her? It seemed like days had passed since I had gotten out of the tub, stuck at 5 cm. But it really had only been an hour and a half. From 5 to 10 in an hour and a half. Nobody had expected that. It was almost 1 in the morning and Dr. T was at home, probably asleep. While the young nurse rushed to go call Dr. T, my doula kept asking me if I felt like pushing. In retrospect, I realize that I was pushing and had been pushing for a while but it was completely involuntary and I didn’t even realize I was doing it. Some other nurses came into the room with trays of things and a bassinet for the baby. I still did not think that this was real. I felt like the nurse must have made a mistake; she would come back and tell me, “I’m sorry, you’re still at 5,” and there would be no end, ever, to the pain.

Everyone told me I had to wait to push until Dr. T got there. I became extraordinarily angry at Dr T (not for the first time throughout this) because it seemed that once she got there, this could be over, but since she wasn’t there, it would only be prolonged. Could I really be at 10? This was the most intense pain imaginable. They made me pant during contractions to try to stop me from pushing, but it was pretty much futile. You can’t stop yourself from pushing, it’s like a reflex. During each contraction, I grabbed onto somebody—Rob, my doula, maybe even the young nurse—and wailed in an attempt to pant like they instructed. I had thought that once you got to 10—to the pushing phase—the intensity of the contractions was supposed to subside. This was not the case for me. My doula constantly encouraged me, saying that these little, involuntary pushes I did during the contractions were beneficial and it was allowing the baby to gently stretch my perineum.

Finally the young nurse we could try a “practice push” to see what kind of “pusher” I would be and get an idea of how long this phase might take. When it came down to it, I had no idea how to actually push. The young nurse told me to take a deep breath at the beginning of a contraction and bear down as hard as I could while they counted to ten. I looked at my doula with panic, vaguely remembering that this standard hospital style of pushing was not a good way to get the baby out. Why? I couldn’t exactly remember… something about how holding your breath deprived the baby of oxygen and could make its heart rate decelerate. But for the life of me I couldn’t remember any alternative.

So I did it—feeling a ridiculously terrifying amount of pain—and before the young nurse had even uttered the number “3,” she was telling me to stop, stop, stop… the baby’s head was coming out and we had to wait for Dr. T. I was outraged. I just wanted the young nurse to catch the baby. Or my doula. Or Rob. Or anyone, really. They tried to distract me by telling me I could reach down and feel the baby’s head. So I did. It was kind of slimy.

Mercifully, Dr. T arrived, wearing black Capri pants and a white t-shirt. Everyone was trying to get me into a more reclined position on the bed, and I struggled against it, thinking that they were trying to make me lie down on my back. But they just wanted me sort of semi-sitting, which wasn’t as bad as I’d feared. My doula held one of my legs and Rob held the other. Dr. T took one look at me and said that in 2 pushes, this baby would be out. How could she lie to me, I raged, thinking it wasn’t possible that this could be happening so quickly. I was hit with a bone-crunching contraction and she told me to push, then realized that she hadn’t yet had time to put on gloves, and so I had to pant through it again.

Once Dr. T was properly gloved, another contraction started and everybody told me to push. I started pushing, feeling a searing, tearing fire, and hearing myself scream. My doula could tell that I stopped pushing, and she told me to just keep going—push through the pain, it was supposed to feel like this. In my mind I thought, there is no way I can push through this. It would kill me. I’d heard other people describe the pushing phase as a release… not as painful as dilation because you were finally working with your body. In fact, I’d even heard people say that at this point it actually felt good to push because you were doing what your body wanted you to do. For me, nothing could have been farther from the truth. If my doula hadn’t told me I had to keep pushing, there is no way I would have continued. But with her encouragement, I did. When the contraction was over, I felt a strange sensation. The pressure that had been there for hours, making me so certain my body would break in two, seemed to be strangely floating away. “The head’s out!” Dr. T announced. The head was out?! In one push? I couldn’t believe it. Before I had time to process this, another contraction came and they told me to push again.

I felt the baby leave my body. I saw it in Dr. T’s hands. She put it on my stomach. It was crying and covered in blood. I held onto it—it was wet and slippery. It smelled like blood and earth. I couldn’t speak. It felt like this was an out of body experience, like I was looking at myself from somewhere above. Wide-eyed, and still unable to speak, I looked at Rob.

Dr. T asked Rob if he wanted to announce the sex, but he couldn’t see from his angle—I was clutching the baby to my chest so tightly. And it hadn’t even occurred to me to wonder. It was Fig. It looked exactly like Fig.

Since Rob wasn’t in a position to see, Dr. T announced, “It’s a boy,” and then he peed on me.

I looked at Rob and said, “William.”

I had done it. No pit. No drugs. No c-section. William had come into this world just as I had wanted him to—waterlogged and tender.

Waterlogged and tender

William Miles Raguet-Schofield
August 12, 2009 at 1:19 am
6 pounds, 12 ounces, 19.5 inches long