Thursday, July 21, 2011

Labor and Delivery, Part 2

Picking up where we left off, I had wimped out and decided that the pros of an epidural far outweighed the cons. And those are some serious possible side effects. To recap quickly, those would include paralysis and death. The chances, however, of dying or becoming a paraplegic under the hand of a skilled anesthesiologist are pretty remote. It does happen, but not very often.

So it was about 3:30am (according to my mother's text updates to my brother) when I requested the epi. I assume it took about 5 minutes for the anesthesiologist to come in. We all remember Liz the anesthesiologist, right? The lovely lady who finally got my IV in? I was in luck, and she was still int he hospital. So when she came in I got to say "Hi Liz! You're going to make the pain stop, right?" and she got to reply "Hi Alix, yes I'm going to try" and then we got down to business. If i had not gone through the IV problem earlier, I would have had to do some paperwork and listened to the side effects and indications and confirmation questions at THIS point, when I was in pain and tired and shaking every time I had a contraction. Instead Liz just got out the needles and told me to sit on the edge of the bed.

The best part about the epidural is that the person it's being done to doesn't have to see any of the instruments. My mother, TJ, and Angela were not as lucky as I. Angela, a former fire fighter who has seen some pretty gruesome things in her life, later told me she had to sit down to keep from vomiting. My mother, a nurse, got eyes as big as saucers looking at some of the hooks and needles. My husband TJ was standing right in front of me and trying to keep me distracted, and he still says that watching me get the epi was the hardest part of the labor and delivery, including the parts with waves of blood.

The worst part about the epidural (excluding the anxiety of "OMG is this going to leave me paralyzed") is the Lidocaine. Remember how much I hate Lidocaine? Evil nasty painful burning stuff? Getting it injected into your back is not better than getting it injected into your hand. Liz however is a consummate professional. She talked me through every movement of her hand, from "I'm going to be putting some betadyne on your back to clean off the work area, and draping it now" to "I understand why you jumped there, and it's ok, I figured you'd probably pull away because most people do but you're going to have to do this again and then it'll be over" before I went almost completely numb. I say almost because you can still feel pressure. The threading felt to me like someone slowly running a finger down my back, but like they had somehow bypassed my skin and fascia. The only exception was what they called getting a "zing" in my back. It felt like a short electrical impulse, and was only on one side of my back. Of course I freaked out a little, but Liz assured me that it was completely normal, and what she was doing to fix it, and how it was going to effect the rest of my epi. Apparently she needed to withdraw a little and go around a nerve cluster, and the side of my back with the zing would be affected slightly differently than the other.

When the thread got seated I was instructed to run through some basic movements to make sure there was no damage, and then it was taped in place. By like half a roll of tape. Easily half a roll. I have a mild allergic reaction to some kinds of medical tape, so I had checked ahead of time what kind of tape they were using, and BOY was I glad. Usually I can stand the "wrong" type of tape when it's on something small, like holding a cotton ball over an injection site, but this amount of tape would have had me breaking out in hives you could have seen from space. Then she attached the threading to a dispenser, which she taped up over my shoulder, and helped me lie back in bed.

Then my body disappeared from the bottom of my rib cage to the tops of my ankles. I was expecting to not be able to feel them, but what I was not expecting was being unable to move them. I instantly freaked out again. I was sure I had just fallen into that .01% again. I say again because I've had mono 3 times and L. Itsababy was conceived while we were using condoms. I'm used to being a slight medical anomaly. But no, I was not paralyzed. When I calmed down I realized I could in fact feel pressure on my legs when people touched me, and that the nurses were not freaking out with me. In fact they were taking this time to prep a catheter for me. Suddenly the need to catheterize epi patients made a TON more sense. If my legs don't work of COURSE I have to be cath'd. The weird part was still being able to move my feet. It was like they were somehow floating below me, still attached but by some invisible thread only. Like when you light up last year's string of Christmas lights and there's a giant chunk in the middle that no longer lights up, but still relays electricity to the last few lights on the strand.

It was 4:30 am, I was 4 centimeters dilated, and I was more comfortable than I had been in months. I fell sleep and let my body do what it was going to do.

And apparently what it was going to do was progress VERY quickly. I woke up a few times when the nurses came in to check me, including once to say good morning to Hilary, my nurse from the observation room, whose voice I recognized without my glasses on (I have a negative 7 sphere AND am astigmatic, this is an accomplishment) but would promptly fall back to sleep. Around 9:30 I was inspected and told that I was at 9 1/2 or 10 centimeters, and they were calling the doctor in because it was time to push. I had progressed over a centimeter an hour for five hours. That is extremely rapid, especially for a first birth and an induction.

When Dr. Bader came in and introduced herself I was starting to feel pressure from L. Itsababy having fully dropped. There is no kind way to say this. It feels like you have to take a ten pound poop. The muscles you use to push out a baby are essentially the same muscles you use to have a bowel movement, which is why this skit involves the phrase "shameless bowel movement." Because a lot of women poop on the table. One more reason I was suddenly glad they had taken me off solid food.

Now there's one more thing I need to tell you before we get into the actual delivery. I did not go to any birthing classes. I went to newborn care classes, breastfeeding classes, infant first aid and infant activity classes, but when the time came for me to sign up for an actual birthing class, they were all full. Apparently the San Francisco Bay Area is experiencing a baby boom (remember the poor lady delivering in her observation room?) which is being partially blamed on the Giants making (and then winning, YAY! ) the World Series last year. But this means that I was essentially unprepared. I mean, I had read books, I had done my specialized exercises, I had researched what I was supposed to do, but no one had SHOWN me. I never really feel prepared until someone has seen me practice and told me I'm not wrong. So I was scared.

I didn't need to be. The best advice I got through my entire pregnancy came from my mother, and it applied to this situation more than any other: "Your body knows what to do, just get out of its way if you can't help." We told Hilary that I hadn't gone to any classes and she assured us that the nurses on staff all knew how to help me get this going right, and comfortably, and would be glad to help. It was 10:00 and they told me to push.

And wow did I push. Throughout my pregnancy I had been doing a particular type of isometric crunch in order to prepare these muscles. Essentially you take a normal crunch, get to the apex, and hold it for 30 seconds while you do proper kegel exercises. Now I know a proper kegel exercise involves not having your abdomen tense, but the important part here is to separate the abdominal muscles from the kegel, and to keep your rectum as relaxed as possible. The expectation is to be able to hold the crunch for up to a minute, while doing 30 kegels in that time. It takes a loooooong time to work up to this, so don't feel bad if you can't do it right off the bat. If you can hold a full crunch, with no pulsing, for 5 seconds at the beginning, you're doing better than average.

The reason these exercises worked was starting to make itself VERY clear. When you push, they have you curl around the baby, and bear down like you're trying to push out a huge bowel movement. You push with every muscle you can possibly push with, and you want to be able to be relaxed where you need to be (in the rectum) while you do it. This prevents a ton of tearing. Since they rarely do episiotomies anymore it's important to know that you probably WILL tear. With perineal massage or dilation it will not be as bad as it would have been without, and if there's a chance of third degree laceration they might still cut, but in general the faster the baby descends (like, say, from -3 to +3 in 5 hours... yay me) the more tearing should be expected. Also speed of delivery plays a large part in tearing, and since my delivery was particularly quick, I was extremely glad for the exercises that had taught me to keep control of the muscles I was using (and the few I was pointedly NOT using)

The first few pushes Hilary and Dr. Bader had me do in a style you see frequently in movies. They had my legs up, and I was to hold onto the back of my knees and use my arms to pull myself down while pushing as hard as I could. This worked pretty well, and we stayed like that for maybe 10 minutes. Then Hilary pulled out the stirrups and handlebars. No joke. Since I had 3 people on my support team this was optimal for me. My mother braced one leg, Angie braced the other, and TJ curled his big manly arms around my back and helped me push from behind. Which I had specifically requested since I was not for one instant letting a man with that much desire to photograph or video my delivery near an angle that would make that possible. I'm an open and progressive woman, but no one wants to see that. And i don't really want them to see it if they do. There are plenty of gross pictures out there, and he ended up taking one gross one anyway, so bah.

From that point the hard aprt was keeping L. Itsababy descended during the period of time when I was not pushing. They do pushes in sets of threes, with breaths in between. Each push takes 10 seconds, then deep breath and push again. Did the timing for the isometrics just click in your head? If you can relax your back and take a deep breath WHILE KEEPING YOUR ABS TENSE in between pushes, you can keep the baby from sucking back up into your body (a weird feeling, btw) and losing you your progress. My best advice during this part is to not laugh. My mother made me laugh and I lost my push big time. The pushes are in concert with contractions, so they're a minute or so apart, unless your doctor tells you to skip one and rest. Which is neither lovely nor painful, it is simply a period of time when your body is screaming "PUSH!" and your mind is screaming "NOOOOOOOOOOO" and then it's over and you can breathe until the next push.

I was pushing for 45 minutes. L. Itsababy was helping considerably. At one point I was holding my push, they told me to breathe, and the little sucker found foot purchase on my ribs and decided mommy couldn't do it on her own and he needed to intercede. When I finally DID get the head out the next thing out was his arm, followed by a little wave of blood as he LITERALLY HELPED PULL HIMSELF OUT. Talk about a weird feeling. Not painful (thank you epidural) but definitely odd. And then they put him on my chest and my whole world imploded into that tiny little face. If you've never believed in love at first sight, this experience will make you believe. Logically I know he was kind of grey and covered in blood and mucus and vernix, and that he pooped on me two or three times before they took him off of my chest to weigh him (8 pounds 11 ounces! POST POOP!), but logic has nothing to do with the way I felt in that moment. He was the most beautiful thing I had ever seen, he was my sun and my moon and my stars, and he always will be.

No comments:

Post a Comment