intensely trivial



Michael’s birth

Monday ended with Sondra being sent home from the hospital. She was barely dilated, after almost two days of contractions. I concluded she wasn’t in labor after all and attributed her contractions mostly to her dehydration. In hindsight, maybe those contractions really were part of labor; Sondra considers them labor. I usually tell my clients that you often don’t really know when labor is starting until you look back on it after the birth. That was certainly true for Sondra.
She was triumphant when her water broke at 5 a.m. Tuesday. Finally, she’d have something to prove she was in labor. She’d been in pain for a long time; she was fatigued and looking forward to getting an epidural so that she could rest. Contractions did intensify some. I prepared myself to take charge when I got to her house Tuesday morning; I was hoping to bring some sanity and calm to the place, because what Sondra was doing to cope with contractions wasn’t working. I could tell, even as Vince talked to me on the phone at 5:18 (that’s what my alarm clock said) and I heard Sondra moaning in the background. (I think making noise is great, but in Sondra’s case, I was worried her noises were keeping her from actually breathing oxygen. Also I believe your chances of giving birth vaginally decrease as soon as you immobilize yourself with an epidural, so I was hoping she could find more natural ways of dealing with pain, a goal she’d told me about prenatally.) So when I got there, I went right into the bathroom with her, looked her in the eyes, and gave her some straight talk about getting on top of things. I became her water nazi. Then I made her breathe in and out with me. I think she focused better that way, and she didn’t waste so much energy making noises instead of getting oxygen to herself and her baby.
Still, she wanted an epidural. As soon as Dr. Meanie was done with his shift, we packed up everything and headed to the hospital, again. (He made her feel violated by a strange vaginal exam during the night; she wanted to avoid him at all costs.) They put us in the triage room and verified that her membranes had actually ruptured. And finally Sondra got to go into a labor room, where the bed was just slightly more comfortable. She didn’t have the energy to stay upright or move much. She just wanted to rest. She was 1 cm dilated. The midwife on the floor came to talk to her about how they planned to start pitocin soon, because “your body’s not doing it.” That comment really distressed me. Sondra didn’t want pit that soon, either, and asked for some time to see what her body would do on its own, and she didn’t want pitocin to distress her baby. One really good thing: Sondra got an IV. Thank goodness. She wasn’t hydrating herself successfully, for various reasons.
As soon as possible, an anesthesiologist came in, with an intern (there were interns everywhere, practicing on my client!), to put in the epidural. Sondra’s a big girl, and the spaces between her vertebrae are small; it took multiple tries to get the epidural started. But when it did, she got some relief from the contraction pain. A doctor came in to explain the VBAC plan and the reason for pitocin. He was very friendly and was willing to let her labor for “4-8 hours” (he said this time limit is different for every doctor) to see if her body would dilate on its own.
(Can I just interrupt one more time to say I think this kind of thinking so undermines women’s confidence in their ability to birth. Yes, her body would dilate on its own, if you just left it alone! If you could be a mouse in the corner of a hospital labor room, you would start recognizing how often it is implied that women and babies *can’t* do it. I think that is a tragedy, and a lie.)
Anyway, she was allowed to hang out and sleep in bed till 1 p.m., at which point the midwife checked her cervix, and excitedly said she was 3 cm dilated! This was a big turning point for me. Yes, of course her body could do it. I got pretty excited about that. Then we went back to waiting. Sondra was relatively comfortable for a while, until the epidural started wearing off in this one spot on her right side. So she was basically stuck lying on that side so the epidural medication could run by gravity into the corresponding area. Of course, that concerned me, because you have to have some shifting or rocking when you’re lying in bed in labor, or the baby might not find just the right position for coming through the pelvis.
(Sorry if all my doula comments bug you.)
Slowly, she started needing to breathe again through her contractions, and then she started needing to moan again through them. All the boluses the nurses gave her in her epidural seemed ineffective. Meanwhile, she had dilated to a “loose 3,” so not much more progress. We (nurse, midwife, and I) recommended she try to breathe through her contractions more and do a little position-changing, but no position was comfortable, so it was back to her right side.
At 7 p.m., Dr. Meanie was coming back on duty, but Sondra planned to ask for Dr. Lang, Dr. Meanie’s backup. She felt comfortable with Dr. Lang. However, Dr. Lang refused to come in, even though Sondra refused treatment by Dr. Meanie. So much for that. Sondra’s midwife had said that tactic should work, and it should have (patients’ rights and all). I hope Sondra and Vince include this in their letter of complaint to the hospital after they’ve had a few nights of sleep.
Eventually, around 6 p.m., the anesthesiologist recommended just redoing the epidural, because, apparently, when you get an epidural too early, it can wear off and you’ll need another one. It was important to her to have the epidural working, because the medical staff had decided she needed some pitocin, since she wasn’t dilating fast enough for them. Sondra felt she couldn’t sit up for the epidural, so she lay on her side for this epidural insertion. Each time, getting the epidural was very scary, and she would sing the Lord’s Prayer to get herself through it. I kept my hands on her, too, and kept encouraging her. I kid you not, it took the anesthesiologist a full half-hour of pokes, lidocaine, saline, and eight (?) tries (I don’t know how many threading attempts) to get the epidural in with her on her side. You should see her back now. It’s not pretty. This was a very good anesthesiologist, too. I think it was just hard to get it in right with her body lying down. But Sondra was very brave, and she made it. I hope she doesn’t have nightmares about getting epidurals inserted.
That second epidural was supposed to work. It didn’t, at all. And suddenly, she was having back labor. Contractions were stronger now, too, with the little bit of pitocin she was getting in her IV. She didn’t feel able to move to deal with the back labor; she just suffered. It was hard for us all, waiting for the relief that never came.
So in came the anesthesiologist again, to try once again on the epidural insertion. This time, Sondra had to sit up for it to increase the chances of success. It did work, and I imagine the anesthesiologist gave her one big ol’ bolus of medication. She was so out of her mind with pain and fatigue by then that as soon as she lay back down in bed, she was practically asleep. And Vince ran out to get sandwiches, because he and I were both famished.
And then her blood pressure plummeted, because that’s what happens a lot when you get an epidural. They have drugs to help with that. But sometimes there’s not time for that, or maybe she had just had too much epidural medication or too many sticks? I don’t know. But down it went. And then down went baby’s heart rate, because when mom isn’t pumping enough blood, baby doesn’t get enough oxygen for his heart to beat fast enough, either. The heart deceleration lasted about 5 full minutes. In rushed tons of nurses, the anesthesiologist, and Dr. Meanie, who was back for the night shift. Dr. Meanie said, “Get the OR ready NOW. This is a true stat c-section.” And Sondra was looking wildly around, trying to understand everything through the fog of drugs and fatigue, and Vince was gone, and I was frantically trying to figure out Sondra’s phone so I could call Vince and tell him to get back here now! (Oh the skills a doula has to have.)
(I knew Sondra’s highest priority was not to be separated from her baby and to have the proper bonding time, and a stat c-section meant she would undergo general anesthesia. Neither Vince nor I would be in the OR in that case. So I was casting about for ways to make sure she still had a voice, even though the VBAC plan had gone south in a matter of minutes.)
Even though Dr. Meanie said this was a true emergency c-section, baby’s heart rate did stabilize again after the deceleration, and it was no longer an emergency. I kept asking questions, like was there any chance she would not have a c-section? was she going to have to have general anesthesia? could Vince go into the OR with her? any chance I could go in? No one was communicating with Sondra, so I risked being highly annoying to the nurses. (I was not annoying during the crazy heart decel episode.) They were busy shaving her and having her take jewelry off, and it was pretty obvious to me that they were headed toward a c-section, but there were some mixed signals. Vince got back, terribly worried, of course. I was glad things had calmed down so he didn’t have to be there in the really crazy time.
Well, they finished prepping Sondra and rolled her out to the OR. I wasn’t allowed in at this hospital, but Vince was. Vince was so worried, pacing and talking to himself about how this doctor had better be competent. This was Dr. Meanie, remember, who had mistreated Sondra the night before. Dr. Lang was going to assist at the surgery. Finally, they called Vince to the OR, and baby Michael was born at 9:24 p.m.
I wasn’t there for this part, but later Sondra told me everything she remembered about it. She said everyone was really nice to her during the birth. Baby Michael came out a little purple at first (apgar of 7), but quickly pinked up. Vince told her how amazing she was and kissed her. He brought Michael over after he was initially examined and held the baby to Sondra’s cheek for a couple of minutes, so there was *some* early bonding time.
At this hospital, there is no real nursery, so babies come back to their mothers’ rooms after a c-section and are attended there under warmers. I was there when the baby and Vince came back to the room. I wished I could have been near Sondra, but you do the best with what you have. Vince actually took his shirt off and had some cuddly skin-to-skin time with Michael. Michael was doing all right except for some respiratory distress. You could see him struggling to breathe, as his stomach retracted behind his ribs, his nostrils flared, and his cries were grunty: telltale signs that his lungs hadn’t expanded fully. Babies don’t make the transition to breathing air as easily when they haven’t had the massage of squeezing through the mother’s birth canal. (Amazing design, right??) Since Michael’s oxygen saturation was too low, they took him to a glorified supply closet that houses special equipment and put him under an oxyhood, where the oxygen saturation of the air was higher than room air. He was there for a couple of hours, until his internal oxygen saturation went to a more normal level.
I stayed in the room, waiting for Sondra to return. Soon, she did, under blankets and lying there, tired but awake and in some control of her emotions. The first thing she said to me was “I’m OK. I’m really OK.” I was worried, because really, this birth could have been just as traumatic as her first birth, the memory of which she was trying to expunge through a healthier, more empowered birth the second time around. So I kept talking to her, being near her, putting my hands on her, just to make sure. She asked me to brush her hair, so I did, and put in a new ponytail. I served her as gently and lovingly as I could to try to heal some of the wounds she was surely hurting from.
I told her everything Michael had done while he’d been in the room, and I told her where Michael was now. I told her Vince had done skin-to-skin with Michael. I tried to validate Sondra’s motherhood, even though the baby was far away from her. And I asked her about the birth and wrote down every detail she told me. I plan to put those details in the timeline I’ll write for her. I wanted her to help me create a record before she conked out from exhaustion. I think she felt heard this time around. She asked questions, asked for time, tried to make her preferences known. She didn’t get everything she’d wanted, but at least she could speak up for herself.
Eventually, the pediatrician came in and told Sondra that Michael would probably be able to come out of the oxyhood within the hour. I was thankful for that. Sondra was excited to breastfeed. Breastfeeding was the one thing that had gone well after older brother Bryan’s birth, and she was confident about it this time.
When she was ready to nap a little, I hugged her and said goodnight to her, and then I left.

This has been a really long story. I’ll try to write more later, because there are updates, and I have more comments. (You didn’t think I was done talking, did you?)

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