OPC

Well hello there.  

Last post I was clumsy with 8 weeks until my due date; I am now 11 weeks postpartum.  The time in between seems a giant blur, but there was one rather eventful day.  And apparently when my husband dutifully texted close family late at night he had rather vague phrasing - "Everyone is okay, considering" - that left more questions than it should have when mixed with rather beat up looking newborn pictures.  As my sister in-law asked, "Considering what?"

Tuesday 3/8

Last scheduled OB appointment four days before my due date.  I was 3 cm, which surprised me, but my OB credited the fact that I was able to run (or, rather, slow waddle for progressively slower paces and shorter distances) throughout the entire pregnancy, with my last waddle-run the day before.  My sanity was very grateful for this, though my ego laughed in my face every time I saw my shadow from the side.  My OB performed an "aggressive" check with hopes that it would make things happen sooner than later, though with the knowledge that I could still have days or a week or more to wait.  

Wednesday 3/9

3:00 a.m. 

Waking from sleep, not exactly uncomfortable but somewhat restless.  Able to turn over and go back to sleep for brief bouts.  Not totally abnormal from the occasional insomnia I had during third trimester.  

4:00 a.m.

Gas? Constipation?  Braxton Hicks?  The real thing?  I was up and about, dutifully reading and rereading the retro-looking pamphlets from my OB's office.  "I can talk, and I can move through it."  I said it out loud to my cats as proof, but they didn't signal any yay or nay.  I noted each time in a note on my phone, many with question marks.    

5:00 a.m.

Nathan woke up and found me with elbows on the counter, which helped me realize that I didn't need to over-analyze any more.  Nathan showered while I grabbed a few more items to add to my hospital bag and off we went to the hospital in Alamosa.  Even if it was too early to be admitted our plan was to at least get to Alamosa to a friend's house since we live 38 miles away and didn't want to risk making the drive too late.

6:30 a.m.

Arrive at the hospital, admitted under observation status.  Contractions every five minutes but of alternating strengths.  Measured 4 cm.  Kept walking around the hospital room to help things along.  My OB happened to be on call that day, and she would be in at 7:00 or so.  

8:30 a.m.

Admitted for real.  Gave me a simple breakfast tray but I could only muster a few bites.  Alternated 15 minutes on the monitor with the rest of the hour walking or moving around.  We went into the halls, realized I was the sole patient in OB.  Renovation of the OB wing was still taking place, and most of the crew had recently replaced the floors in the outpatient building.  They'd seen me grow huge over time.  "Your turn now, eh?"  Sure is.  

10:30-ish a.m.

Still alternating strength of contractions.  I could handle the ones that stayed in my belly and back, but the strong ones radiated through my hips and thighs to my knees.  They nearly made my legs give out each time and impeded my ability to walk or move around the room.  I had wondered throughout my pregnancy if being active would help (my body being used to contractions) or if it would be a hindrance (able to create strong contractions that would be too much).  Laid in bed for 20-30 minutes, legs rocking like windshield wipers.  Somewhere in there my OB said I was 6-7 cm even though my nurse thought I was only at five.  My nurse continued to mention pain control options, repeatedly asking if I wanted an epidural.  I kept saying I would wait and see.  

11:00-ish a.m.

Got up to use the restroom just before a contraction hit.  My legs involuntarily flexed and nearly gave out on me.  Still at the same level of dilation but the contractions were getting stronger.  How much stronger still would they get?  I called the nurse and gave in, requesting an epidural.  While she went off to put in the request I told Nathan he was free to go to the car to get a few things since we had a bit before things would happen.  

I was still internally questioning if I needed the epidural despite the pain being ridiculously intense, especially since I had never experienced anything so invasive before, but once I was alone in my room I realized I had been fighting the idea when others were around - easier to keep a straight face when performing, but cracking when it was just me.  I remembered one of the other OBs saying that epidurals can reduce pain-related stress and thus help prevent excessive reactions (trying to push the baby out too fast) that would cause tears.  My pregnancy was deemed healthy and low risk, so my main fear going into labor was of tearing.  I repeated her conversation in my head to help me feel better about my decision.  

11:30 a.m.

Anesthesiologist arrives.  I could not stop shaking during contractions while the epidural was being inserted, even with my head on Nathan's chest.  Once it kicked in I was finally able to breath, but it was hard to find a position that kept baby's heart rate happy.  The heart rate was variable and rebounded quickly - both good things - so while there was no great concern voiced the team was still watching the monitor closely.  "Let's try the peanut. Everyone loves the peanut."  Imagine an exercise ball version of a peanut shape, placed between your knees while laying on your side.  I did not like the peanut but kept quiet since this was about baby's vitals.  Turned out baby didn't like it either.  Try laying on the other side?  Nope. Back to quarter-turn right with simple pillow support for my left knee.  

I had multiple hypotensive moments once the epidural was fully in effect, with waves of nausea and/or narrowing vision.  Ultimately was given ephedrine and lots of IV fluids.  Puked up the few bites I'd eaten and all the fluid I'd had since waking at four that morning.  Great.  

12:30 p.m.

Still at 6-7 cm.  My contractions were now spaced out, at every ten minutes, since getting the epidural.  And my water was still intact.  My OB tending to something at the moment so had a nurse midwife assess me, and the midwife ultimately decided to break my water.  Out came more than a little meconium.  

They were still watching baby's heart rate while not raising the flag of true concern.  Midwife wants to try the peanut.  "We LOVE the peanut!"  Sigh.  Okay, sure.  I still did not like it; still kept my mouth shut.  Baby's heart rate still didn't like it.  Back to quarter turn with butterfly legs.  

My feet and calves were painfully burning, like a crazy version of restless leg syndrome but without the physical ability to fidget.  Only mild relief when I made Nathan dorsiflex my ankles over and over since I could not do it myself.  I also still had a mild headache related to the epidural.  My nurse agreed that a lower titration would probably work well.  Called back the anesthesiologist, who took some convincing but ultimately agreed to try down titrating from 10 units to eight.  Within minutes the painful tingling went away.  Contractions felt like pressure but no pain.  MUCH better.  But baby's heart rate was still off.  Nurses flip and flop me until we resolve to return to quarter-turn right with butterfly knees held by pillows.  

Unclear how much time passes before I want to munch on crackers to get something in my system.  Fifteen minutes later I puke it up again.  I am now relying on the IV bag and don't even try sipping water.

4:00 p.m.

Finally some progress - something like 8 cm, though now with growing concern about baby.  My OB tries to place a fetal monitor three times, but each time the insertion tool breaks.  Back to the belly monitor.  S/he had "good reserve" - moving frequently, heart rate recovering somewhat from the weird drops - but ultimately the weird drops were becoming more worrisome.  They added saline back into the placenta, which took enough pressure off of baby to stabilize their heart rate to a satisfactory degree while also flushing out some of the meconium.  

Somewhere thereafter I am able to sleep for 45 minutes.  Helpful since I had only slept about three or four hours the night before.

5:30 or 6:00 p.m.

9 cm.  Nurses keep wanting to rotate me as standard procedure for someone unable to turn on their own.  Baby won't have it.  I stay in quarter turn right with frog legs.

7:00 p.m.

Finally 10 cm.  OB is getting prepped.  

7:30 p.m.

Pushing commences.  Baby's face is oriented forward, 180 degrees from the ideal crowning position, so my OB tries to turn them during each contraction.  Baby is a fighter and has quite a sense of humor, repeatedly maneuvering him/herself back to its face forward orientation.  This continues for an hour and a half despite my OB maintaining her hand on baby's head practically the entire time.  

I am given 10L oxygen via mask between each round for baby's sake.  As time passes my OB and nurse are making quiet comments to each other.  I work in a hospital; I know what that tone means.  I just don't know the extent yet.  The pediatrician on call is asked to be present for the birth due to baby's unknown status and the large amount of continuous meconium throughout the day.  I am grateful it's the same MD I plan to use for baby once s/he is born.  But I am getting nervous.  They keep saying s/he has reserve, but the monitor is all over the place.  When I look at Nathan he is getting nervous too.

9:15/9:30 p.m.

Still pushing, not much progress.  My OB the says she thinks baby is getting too wedged.  The options: vacuum extractor, which she isn't fully confident would work; forceps, which might work; straight to cesarean.  I look at Nathan because I'm a foggy mess and I don't know how to make decisions at this point.  Nathan doesn't know either.  I want what is best for baby, but OB wants to try other methods before surgery, so I agree despite her reasons being vague.  (Vague as in not making things too confusing with too much info.  This is probably a good call in hindsight.)  A second OB who is very experienced with forceps is called in to assist.

9:40 p.m.

Second OB is now present - the benefits of this being a small town.  Holds up what looks like giant metal salad tongs that could double as a weapon.  Describes the risks.  Instructions are given.  We can try with three rounds only.  If it doesn't work we go next door for cesarean where the anesthesiologist already waiting on standby.  I don't know if that is reassuring or unnerving.  I am still in a fog and am behind the oxygen mask.  I look at Nathan and take his hand.  His eyes look worried and he looks pale.  

9:45/9:50 p.m.

Pushing with forceps.  The exact moment they were inserted I feel excruciating pain unlike anything I've felt before.  Had an epidural not been established I'd likely have kicked all the doctors and nurses, and likely Nathan as well.  I have a PT moment - epidurals work with dermatomes, and dermatomes refer to soft tissue.  What I felt was metal on bone, and it wasn't fitting easily.  

Two rounds pass without much that I can tell from my end aside from static pain.  I'm pushing as hard as I possibly can, feeling like my head will explode.  Thinking, for the umpteenth time, of the patient in NYC who had a stroke while giving birth.  She was in the adult neuro unit while her baby was all the way over in the neonatal ICU.  I don't know whether to be scared of cesarean or not at this point, so I'm still going for it and hoping.  Before the second round I am given an episiotomy.  I'm getting disoriented and losing focus while my head gets heavy from the pain, but my original OB stern-talks to me and keeps me there much like one does with someone nearly passing out.

Last round.  We get through three breaths without a result.  I think I yell "Keep going!" but it likely was just in my head.  I didn't want the OB to release the forceps yet; I was scared of going next door.  For sure I am nearly screaming and pushing again and again without pause and long past the contraction.  I hadn't thought the pain could get worse, but on the fourth or fifth push I can feel the head on the verge and I am desperate.  I cannot hold the contractions or my breath for any actual pattern, so I'm just pushing as continuously as I can while screaming through it all.  Somewhere between six and eight pushes, and with the OB laying back for leverage with the forceps, baby finally comes flying out.  The release is immense.  I open my eyes just in time to see a literal triangle of a head held by the metal tongs.  Quick glance to Nathan, who is ghostly pale with wide eyes.    

9:54 p.m. 
After more than 15 hours in the hospital we have a boy.  Owen Prentice Cockrell.  Stats: 7 lbs 9.5 oz., 20 3/4" long, head circumference 14".   

I don't know his condition but the commotion is too much for me to compute, so I lay back with eyes closed.  Cord is cut and baby Owen is at the warmed before I can take a breath.  I want to cry so badly but cannot.  Eventually I hear a newborn cry instead.  Apgar score initially 6, improves to 9.  

The pediatrician jokes with my crying boy, "What's the matter, big fella? You don't even know who Trump is yet!"  Nathan gets to clamp the cord stump, having proven the nurses wrong by not fainting.  My OB delivers my placenta and shows me the massive extent of meconium.  It is entirely a pukey-olive green color.  Owen is placed on my chest, his right eye and left jaw bruised with a cut at the lateral right eyebrow - battered, but whole and fully functioning.  Did this really happen?  I really made a tiny human?  

I get stitched up in at least four places, a mix of internal and external.  The necessary events are completed with a mere ten minutes left of my epidural.  Once the pitocin has completed its run I have had five liters of IV fluid in total.  The first feeding is attempted with help from the baby's nurse.    

Nathan calls parents and texts siblings, then dutifully goes to find food in a rural town after midnight.  I end up eating a giant Walmart sub sandwich, my first food and fluid intake (that stayed down) in nearly 36 hours.  Now that hormones have changed I can keep down food and fluids easily.  We still have to do baby's first bath and other education.  Our first inkling of a half hour of sleep comes after we have been awake for over 24 hours.  But we have a baby, and we are all in a good place despite having such a rough ride. 

*************************

Turns out Owen had a nuchal cord, meaning wrapped around his neck and, in Owen's case, pinched under his wedged occiput.  He also had an initial facial nerve palsy for a minute or two due to forceps compression, meaning a droopy right half of his face (sort of like with a stroke), despite his initial Apgar score of six.  Also turns out Owen's head was so wedged that my OB was worried that a cesarean would be complicated and harder on Owen (and me) than the forceps - despite cutting open my stomach they would still have to un-wedge his head to get him out.  We got lucky that he inevitably made it out vaginally.  

At my six week follow up, which was with the OB who employed the forceps, he could not say with full conviction though highly suspected the issue was the size of my pelvis.  I had worried about this even before getting pregnant, and I repeatedly asked everyone in the OB department if the head size could be projected as early as the 20-week ultrasound.  Each time they chuckled and said not to worry, I will be surprised, hormones make things stretch all over the place, my pelvic outlet was probably fine despite looking narrow from the outside.  Now when friends or coworkers ask how the birth went I simply say "My pelvis?  Yea.  It didn't.  It just didn't."  

But ultimately I was where both Owen and I needed to be, and multiple health professionals noted my birth story is an example of their anti-home birth preference.  Owen needed the warming table with immediate lung suctioning.  I needed help getting him out.  Were we living 100 years ago would Owen, or either of us for that matter, have survived?  As I tried to sleep that first 30 minutes in the wee hours of the next morning, the metaphor was not lost on me of cows getting "pulled."  A cow's birth stalls for whatever reason or the calf is breach, so chains are inserted around the hooves and the rancher uses their body weight to pull back while mama cow is having a contraction.  Sound familiar?  Right down to the metal apparatus.  I've watched from 10 feet away, and this was merely my turn.  

The enormity of that day did not fully set in until the next night, when a patient in the ICU (the floor above me) coded (read: cardiac arrest) at 3 o'clock in the morning.  When that happens a call goes through the entire hospital and everyone on staff comes running.  Granted it was called incorrectly, but when I heard "Medical emergency, room 304" over the intercom the tears that didn't flow before then poured out in buckets, grateful that the call for medical back-up was not related to Owen or me.  Owen did not enter this world a purple mess of respiratory distress; we did not have to be emergently flown to Children's Hospital in the Front Range; I was not sawed in half so as to un-wedge my wedged baby.  And other than the scar under his eyebrow and the possible change to his hairline, you'd never know he went through so much.  

By the time Owen was born there was one other mama in the OB unit.  It was her second kid.  Two pushes and out came the baby.  Both OBs tried to reassure me that the next kid, once (and if) Nathan and I get there, would have a good change of a much smoother entrance into the world.  I'll believe it when it happens.