birth of Joshua Alexander - and post birth issue ...
On Friday at 5.40pm, my waters broke ... contractions started pretty quickly, but there was still only the pretty occasional actual contraction – mostly still Brackston Hicks.
After giving them a buzz, DH and I went into the hospital for me to be checked out. All was fine, I was only 1cm dilated, and as my GBH was negative, there was nothing much to do other than to book me in for an induction (needed to be within 72 hours, so it was booked in for 7am Monday), check my obs, and sent me home.
Saturday morning around 9.00am, we went back into the hospital for a check in the morning, and all my obs and everything were still fine, so back home we went.
For the rest of Saturday, I took it seriously easy, legs up, reading, writing, watching movies, and just leaking and waiting for my contractions to pick up, and for labour to get established.
Contractions did get more frequent, but nothing too regular … I kept on waking up over night though, with regular, painful contractions – no more Brackston Hicks … so from 1.00am Sunday onwards, I kept on waking up with regular painful contractions, anywhere from 2 to 10 minutes apart... From 3.00am, they were consistent and painful to the point that there was no point in trying to sleep any more, so I got up ...
We waited until 7.00am Sunday, and went back to the hospital for my next 24 hourly check up. By this stage, contractions were every 3 to 5 minutes apart, and pretty painful, but not too ridiculous.
Naturally, the act of driving to the hospital made my body get out of regular contractions, and they again were between 2 to 7 minutes or thereabouts … at any rate, they didn't want to do another VE at that point (due to waters having been broken for a while) and based on the CGT etc, it all seemed that things were fine, and the midwife was happy for me to go back home and leak for a few more hours, until contractions were more regular …
We weren't thrilled about that, but knew that there no real point in sitting around at the hospital, and we may as well sit around at home – particularly as we still were wanting to stay intervention free, and hope that labour picked up, rather than having to be induced Monday morning...
The midwife and Drs did however send me home with some Panadeine Forte and Tamazepam, saying that it would let me get some sleep for a few hours, so that I would have some energy by the time pushing etc was needed.
I wasn't happy with the idea of taking medicine when I didn't think it was really necessary, but after talking with the midwife and DH for a bit, it seemed pretty clear that getting some sleep was going to be the best thing for the baby, rather than possibly going through several more hours of contractions with no real forward movement – and given that I hadn't really been able to sleep for some time, and we still had a long ways to go before Josh would be arriving. In the interests of avoiding induction etc, I went home, and took the drugs with the hope that I could get a few hours of sleep, and give my body a chance to get the contractions stronger and more regular...
So at home, I got into bed, tried to get comfy, took my pills, waited 10 minutes for the pills to go down, and then laid down to get some sleep. After a few contractions, DH and I did manage fall asleep … and then later woke up with a contraction … and again … and again – so I looked at the time, saw that I'd only been laying down for about 40 mins, and while I'd probably had about 20-30mins of sleep, there was no way that I'd be getting any more quality sleep, because every contraction was waking me up at this stage, and drowsing between contractions was no longer an option, because my body was tensing up in anticipation of the next one … oh dear!
Also, the contractions were pretty bad, and flowing all through my back and hips, because Joshua was angled slightly posterior and so was rubbing against my spine during contractions. Ouch!
I let DH know what was going on (he was enjoying his sleep!) and I let him know I was going to get into the bath, and see if that helped any. I love baths, and nothing relaxes me like a nice hot bath/spa/shower, so I figured it was my best bet, if drugs and laying down wasn't doing anything for me.
So into the bath I got – no bubbles or oils or anything, because of my ruptured membranes, no soap or scrubbing – just plain hot water, and me.
Almost as soon as I lay down, there was a noticeable improvement – and for reasons unknown to me, I found that if I lay tummy down (not putting weight onto my stomach, but supporting myself from underneath) I found that my contractions weren't really affecting my back and hips anymore. I guess Joshua was in a different position when I was laying that way, either because of gravity or maybe he moved to feel the warmth more or something … but whatever the reason, it was blissful and I found that when a contraction came, if I stretched my legs right out, pushing my feet hard against the end of the bath, the contraction didn't hurt anywhere near as much, and the pain was really very manageable.
So I lay in the bath, every 30-60 mins, I would let some water out (or DH would do for me) and I'd top up with hot water. DH brought me dry hand towels every now and then as they got too wet, and I stayed in the bath from 11.00am until about 7.00pm. The pain started getting worse despite the lovely bath from 3.40pm or so, but was still manageable...
I only got out at DH's insistence in the end – he was still keeping track of my contractions. He was pretty exhausted, and ended up getting the spare mattress from the attic, and setting it up just outside out bathroom, so he could lay down and doze between contractions too, but would be there to hear me if I called or needed anything. He's such a good man.
But after about 6 hours, he started becoming concerned that I'd been in there too long, and either (1) I was getting a false sense of security about the intensity of the contractions, and I might be much further along than I thought, and we didn't want to end up having Joshua in the bath accidentally! Or (2) I might be slowing the labour down, because I had become so comfortable and relaxed (between contractions!).
DH was calling the hospital every now and again to let them know what was going on, and to check whether it was time for him to bring me in.
One midwife said to him that unless my contractions were precisely regular, to the point where he could look at his watch, and “count me in” to my contraction (ie: “Your contraction will be starting in 5, 4, 3, 2, 1, NOW!”) that it wasn't time for me to go into the hospital yet. This is after he'd told her that I'd been having contractions for about 28 hours... I was seriously unimpressed by that midwife's comments, particularly given that I've known women whose contractions have *never* become regular, not even when they've gone to actually squeeze their bubba out. So to say that there's never any call to go to hospital if your contractions aren't like clockwork... And *then* when they are that consistent, we should wait for them to remain consistent like that for **an hour or two** (!) we should then consider coming in... I took an instant dislike to that midwife. It is lucky that my DH was on the phone at the time and not me, because I would not have wanted to be held responsible for what I may have said to her at that particular juncture... Oh, and she also said that I wasn't particularly far into labour, if I could still talk, and was not “slumping” into a heap after each contraction... DH said something along the lines of “you haven't met my wife,” and left it at that … considering I've been talking almost non stop since 18 months old (and was still conversing coherently the entire way through labour) and there was no “slumping” involved despite intense pain (a little crying, almost some shouting, but no slumping or foetal positions) we decided to ignore her, and just speak to someone else later.
Anyway, after 8 hours in the bath, I gave in and agreed (reluctantly) to get out, and see what happened. But with the caveat that I reserved all rights to get back into the bath, if it was safe to do so!
So I got out, and got dried and put on some clothes. There was an instant increase in intensity of the contractions, and I was using different positions, rocking, etc, but the pain was pretty bad – and the contractions were still around every 3 – 8 minutes, and lasting up to 140 seconds ...
After being out of the bath for a little while, I took some Panadol to see if it made any difference – but it didn't.
By 8.30pm, the pain was terrible, and although contractions still weren't regular it was time to go to the hospital, to make sure everything was ok, and check out what my progress was.
At the hospital, I got hooked up to the CGT again and it suggested that there may not have been much progress at all! Clearly, I was in labour (and had been for ages) but I was only 3cms dilated. So they wanted to give me more drugs for pain relief and to help me sleep, so that (again) my body could progress a bit, and I'd have some reserves by pushing time.
I still wasn't happy about it (particularly given that the Panadeine Forte and Tamazepam had done zilch) but had to accept that this would be best for Joshua. So they gave me an injection of Pethadine and Phenergan (after I checked that the Pethadine would be well and truly out of my and Josh's systems by the time he would actually be getting out, and needing to breathe and feed).
After getting the shot, DH and I laid down to try to get some sleep … not the easiest thing while contracting periodically and leaking a fair bit (I used packs of my maternity pads much earlier than expected!). But unfortunately, there was a pretty similar outcome: maybe an hour of sleep this time for me, and then waking with every contraction – and of course they are no fun while lying down! So up I got again...
I got into the shower (I wasn't allowed in the bath at the hospital, because my waters had broken) and I sat in there on a shower chair for quite a while... During contractions, I stood up and leaned over the chair or squatted, and the rest of the time, I sat under the hot water, and focussed on staying nice and calm.
I had to get out of the shower briefly around 3.00am to have a bung put in, so they could give me penicillin, due to the ruptured membranes. Penicillin was administered at intervals for the rest of the labour.
After another hour or so, they got me out of the shower again, for another VE by which time I was about 5cms dilated. This was a bit frustrating (lots of pain, lots of contractions, but only 2cms of progress from 9.30pm to 4.00am!) but at least there was some progress, and things were still moving in the right direction … I was still hopeful at this time that I might be able to avoid induction, and stay on track for an active (albeit not drug free) birth.
A little later than this, I noticed that I was feeling a bit off, and it felt like my heart was racing. I let the midwife know, and she took my pulse … which was up around 130bpm for no apparent reason...
So very soon after that, there was a Doctor or two and another midwife were in my labour room, with an ECG, sticking little dots all over me, and hooking me up to take pictures of my heart... during this, my DH was asleep on the couch (after the midwife had strongly encouraged him to have a nap). Concerned that my DH would wake up to an empty room, or to Doctors chopping me up to get Joshua out, or something similar! So after calling to DH several times, he finally woke up and said, “Ah? Yeah?” at which point I asked the midwife to tell him what was going on. She said of course, and turned around to do so, by which time my lovely DH was unfortunately asleep again …
Shortly thereafter, the Drs were happy with the ECG and decided that either I had an unfavourable reaction to the Phenergan, or I was dehydrated … either way, I needed to go onto a saline drip to get rehydrated and to get my heart behaving again. The fun just continued!
This unfortunately meant that I wasn't allowed back into my beautiful shower (and still wasn't allowed to have a bath) but I was still able to move around the bed, so they put a birthing mat down, got out the birthing ball, and moved the bed up and down as needed for leaning while standing, leaning while kneeling, rocking on the ball, etc... So I still had options, but sadly no more water therapy.
DH was doing his best with massage and a LOT of counter pressure on my lower back (bub was still a little posterior, so the contractions were still radiating like mad through my back, hips and pelvis) but sometimes the midwives (having been at the hospital for quite a while, we'd gone through a few midwives!) would do it, to give him a break. This was really bad, because DH had it down to a fine art by then, and knew I needed it really hard, and I found it much easier to give him instructions (harder, higher, left, again) than saying stuff like that to the midwives … stupid as it sounds, it felt really rude barking instructions to the midwives … so I was always really glad when DH took over again! He was a real champ throughout.
Around 5.30am, I started on the gas (the only drug that I'd been happy to have, was the eighth thing I ended up taking!). The gas was great – by really sucking it down, I found for a few hours that my contractions were basically transferred back into being uncomfortable pressure (like Brackston Hicks) rather than actual pain – both in my back, and also in my uterus. Huge, almost instant improvement.
Contractions still frustratingly were not “regular” and so by my induction time was drawing near, going to be getting induced, they were happy for me to wait another couple of hours to see what my body was doing...
By 9.00am Monday, another VE showed that I was about 5-6cms dilated, and 90% effaced. So yet again, we were looking at me having dilated maybe 1cm in the past 5 hours … not exactly the progress I was hoping for! And while the lovely midwife was hugely encouraging, telling me that I was doing great and progressing marvellously, I begged to differ... ultimately, it was clear that they needed to induce me, as they couldn't just let me keep labouring indefinitely, with ruptured membranes and such slow progress (not to mention no real sleep since Thursday night...) so the induction was organised to start around 9.30am.
As I had to stay on the saline (as I hadn't really been able to eat or drink anything much) they just whacked up a Syntocinon drip alongside the saline drip.
Around 10.00am, the Dr came in to check me out – but on his VE, he only put me at 3-4cms dilated! I was crushed! 33 hours, for 3-4cms? The Dr put in a foetal monitoring clip on bub's head, to get better readings of his heart beat and vitals.
And then in went the induction drugs, and they were raised and lowered periodically to try to get my contractions regular … and the Dr was going to come back in around 4hrs to see what progress had been made.
By this stage the gas wasn't taking away the pain, but it certainly still took the edge off, and in any event, it was much easier to put up with the pain while high as a kite. And by that stage, I had a routine up and running for how I was getting through the labour, contraction by contraction.
It felt like the labour just went on and on … I don't know how many times I moved, how many times DH rubbed and pressed and offered water or a bit of apple …
At some point in time around here, I decided that coffee was what I needed, and I drank three cups. Did I have barley sugar? Ice chips? Some cordial? No, three black coffees. Go figure.
At around 3.30pm, the Dr came back in for another VE – and announced that I was still only 7cms dilated and bub was still a little posterior (which I could have told him, based on the excruciating back, hip and pelvic pain which again accompanied every contraction).
Again, I felt pretty crushed. I asked how much longer this would take – I felt like I could put up with basically anything, provided that I knew what was coming. But not knowing – or rather, knowing that there wasn't any fixed point of when my labour might be over – and to make things worse, lots of my contractions were now coming right on top of an earlier contraction … so I'd have a 90 second contraction, it would peak and start to ebb away, and then another contraction would be right upon me – with no warning – and go for another 90 seconds. And from time to time, these “surprise” contractions were not being well received by the baby, and his heart rate was dropping during them – sometimes down to 120bpm, sometimes under 100bpm, and a couple of times close to 80bpm. So the midwife was trying to get me to lean over to the left to make it easier for the baby, but all up, it looked like both my body and maybe the baby's body was getting too tired to keep this up for too much longer.
The Dr basically said that there was no way that he could say how much longer this would take – that maybe the Syntocinon would do the trick and I would be completely dilated in another hour, but maybe it would be another 6 hours, or maybe my body just wasn't going to progress any further on its own, and I would need to have a c-section.
So the Dr strongly recommended that I have an epidural, for a bunch of reasons.
I specifically didn't want an epidural, because of the increased risk of c-section, increased risk of further intervention, tearing, episiotomy, and all the rest of it. But with no ability to know how much longer the labour would take – or even whether I was going to be able to give birth naturally at all – I had to consider the epidural. I spoke with DH for a bit, to get his opinion, and we ended up agreeing that the best thing for Joshua would be for me to have the smelly epidural... we'd already long accepted that I wasn't going to be having the natural, active, water birth I wanted, and that I just needed to go with the flow and (within reason) do what the Dr thought best. He was pretty surprised that I'd agreed to the epidural, and he had the Anaesthetist in there in mere minutes!
So around 4.00pm I had the epidural. I sucked down the gas until I couldn't see straight, got a local anaesthetic, then in went the epidural and a catheter. I had to stay completely still while the epidural was going in, and contractions were thick and fast by that time – so I just inhaled the gas like my life depended on it, telling DH that he had to make sure I stayed totally still until the Dr and Anaesthetist said it was ok to move … so with a cast of thousands (two midwives, two doctors, a med student, the anaesthetist and a junior anaesthetist) I got up onto the little trolley, hunched over and inhaled my happy air, told them when contractions were coming, so that they could wait for them to pass … and then got up onto the bed, where I was going to be for the next few hours...
Once the epidural kicked in properly, I gave up the gas, and DH and I were both able to sleep for a while (at last!) though I still couldn't eat or really drink anything (didn't even want coffee by this time). But DH and I slept (him on the couch, as there was blood and plenty of amniotic fluid on the bed by this time … no more track pants and pads for me – just a hospital gown which I hadn't bothered swapping for the nightie I'd brought) in and out for a while. I still was waking up pretty regularly from the contractions, but they weren't hurting me any more – again, they were back to being an uncomfortable pressure, rather than actually causing me pain.
The Dr came back in to do another VE around 7.30pm and thankfully this time, I was almost fully dilated, and baby was properly anterior. His head was still very high however, and the Dr was concerned that it may simply be the case that his head was too big, and I wasn't going to be able to give birth naturally. Given how long we'd been doing this, I was just wanting to wait and see – bub wasn't in distress any more (I was laying on my left side as much as possible, given the epidural, to optimise blood and oxygen levels going to him) and as long as they kept the epidural topped up, I was fine to give it quite a while longer, to avoid a c-section.
By 9.30pm, I was fully dilated and effaced, and ready to start pushing – not the easiest thing in the world when the whole region is totally numb, but I did my best. It was tricky, because you don't want to tear yourself by pushing too hard, or pushing incorrectly, but you also don't want to end up with the baby not being able to get out, because you aren't pushing enough! I erred on the side of pushing too hard, and just went for it.
After about 2hrs of pushing (the last half hour in stirrups) the baby's head was still about 2-3cms in, and not budging. The Dr was happy that it would fit, but it would definitely need assistance.
I had to wait another 30mins for the more senior Dr to get out of theatre to do the delivery – they wanted to go forceps, I asked them to try vacuum first, to try to avoid an episiotomy. They understood what I was saying, but said that a vacuum just wouldn't work here, and I might end up tearing worse (I'd already torn in two spots from my pushing, apparently) and they'd still need to do the forceps anyway. I was pretty upset about this, but again just had to accept that this wasn't going the way I wanted, but it would all be over very very soon, and I would have my son (or daughter? everything else was topsy turvy, maybe they'd got the gender wrong too?) very soon, and this would all be in the past.
Once I agreed to the forceps and episiotomy, things happened very quickly, and the next thing I knew, at 12.13am a very warm purple baby with a very long purple umbilical cord was born and put straight onto my tummy. He was beautiful! I pulled him around to look at him better, and patted/rubbed him a bit. I was very surprised at how quick it was, and I asked the midwife whether it was a boy. She wouldn't tell me, and told me to see for myself. I of course couldn't sit up or manoeuvre him much, but then yes, I could see that he definitely was a little boy. I said hello, and that I loved him, and what his name was, and all the usual things. I couldn't see DH then – I found out later that he was cutting the cord – but very soon I saw him, and he looked very happy too.
Another injection of Syntocinon to get the placenta out – only took one or two pushes, and out it came. It was huge too!! But the midwife said that was normal – big baby, big placenta, etc... Because it was so late at night, we couldn't donate the cord blood or anything, and we weren't planning on keeping the cord or placenta ourselves, so other than showing them to us, there wasn't much else to be done...
They left Joshua on my chest for quite a while, while they stitched me up and everything, and DH was patting Josh and patting me, and I was doing the same. Lots of rubbing and towelling off brought Josh's colour right up, and it was incredible how much he looked like me! There's a photo of me as a baby, and my brother as a baby, and Joshua could be another little sibling of ours, he looks so similar.
Shortly after, they weighed and measured him – 4.170kgs (9lbs 3.5oz), 51.5cms long, 36.5cm head circumference, and perfect.
First sneeze, fart, visitors, feed and everything else followed, and we've been happily learning all about each other ever since :)
LATER – at around 1.00am on Monday 31 May 2010, I was showering and carefully washing down under, I noticed something … well, nasty … I had a bit of a feel around, had another look, and a third time – well, it certainly appeared to be poop! In my gynie! That's not where it goes … that's not where I put it … that's not the kind of multitasking I'm into …
But after a bit more inspection, I was pretty sure that's exactly what was happening … I told DH and we agreed to call the midwife team (again!) to say what was happening, and ask whether I should come in.
I felt pretty daft, but there was just no accounting for it – I'm fastidious about wiping from front to back, and some of this poopy was right up in there … feral, I know.
Anyway, the midwife checked with the Dr, the Dr spoke to me too, they all said to come straight in, we went in (Joshua has spent more time in hospital than at home!) they checked me out, and determined that there was a “defect”.
Cue tears, prayers, more tears, yet more tears, a bit of breastfeeding, different midwives and Drs saying different things …
Loooooooooong story short – I had to get a bung put in for blood tests and then antibiotics (multiple attempts, multiple bruises) and had to stay in the hospital for about 40 hours until multiple Doctors and specialists who each told me about how rare this is, and gave me every story from it possibly healing itself, through to needing a colostomy immediately and a serious operation in 8 weeks, and then another op to remove the colostomy bag a couple of months after that. I also was getting different impressions about what I could and couldn't do between now and then, and what implications this all has for future pregnancies … I wasn't happy at all, and have spent a lot of the past two days in tears.
Eventually, I got to see the butt doctor/specialist/surgeon (that's not his official title … I don't remember what that was …) and he had a good look, and told me that the fistula was about 3-4mm and over the next 2-3 months, it will heal to the size of a pinhead. Over the next week or two, the poop should be coming out my fifi a lot less … and in a couple of months, when the stitches have done their thing and the swelling has all gone down, and the scar tissue has arrived, they will then do a serious operation cutting and pulling some of the muscle over the hole and the weak spot, and sandwiching in some of the fat from my labia and stitching it all together there … really doesn't sound like any fun, and apparently will take 2-3 weeks to recover properly … but that's what it will take, so there it is...
The surgeon was also was able to confirm that I am totally able to have more kiddies, but any further births will pretty much have to be by c-section.
So I'm booked in to see the surgeon again in another 4 weeks to check how everything down there is going, and then we'll book in the surgery.
And while I will keep “leaking” for a while, I hopefully will not be leaking much after another week or two … as far as maintenance goes, I need to have a salt bath for 20 minutes after every poop (and up to 3 a day, if required due to seepage), I am on a “bland residue” diet, and other stuff...
Not what I'd planned, not terribly happy, but positives are that (1) I can have more kids, (2) it's fixable, (3) it should start improving pretty soon, and (4) it's just me, and Joshua is fine.
DH and I are praying HARD for a miracle, and that when the surgeon checks me out he will be shocked and amazed, to find that there is no longer any fistula, and I am all beautifully healed up … after all, DH tells me that I've been having these ridiculously rare things happen – maybe me healing completely will just be the last rarity – and one that we're happy about!
