Tuesday, January 3, 2017

Declan's Birth Story

Possible subtitles:

"There's No Easy Way to Birth a Child"


"It's All Bad"

or, perhaps more positively:

"Thank Goodness I Get a Cute Baby Every Time I Go Through This"

Okay, so let's dive in, shall we? First, a little background...

The story really starts immediately after Marshall's birth (May 2014), which was a 33-hour ordeal ending in a C-section when we had planned for and attempted an unmedicated vaginal birth. With Marshall, my water broke at 38 weeks and he ended up forehead-presenting, a situation that almost always requires a C-section. You can read that full story here.

After Marshall's birth, I was devastated. I felt I had failed and that I had done something (or a lot of things) wrong. I also felt so sad that I hadn't gotten to push my kid out (although I did "get" to push for almost three hours) and might never know what that experience is like. I felt like less of a woman somehow and also felt like less of a mother.

Over the next two-plus years, I worked hard to process Marshall's birth--what had happened, why it happened, why the C-section was necessary. It took a LONG time for me to finally acknowledge that having a safe, healthy baby was far more important than my own experience getting him here. We were so lucky to have almost no complications with Marshall after his birth (he did have jaundice, which required two extra nights in the hospital, but we felt reassured that it wasn't serious). It also really helped to hear others' stories and to know that some people I admire most have had their babies via C-sections and are truly wonderful mothers.

It also took me a long time and lots of repeat conversations with my husband, friends, and family members to come to a place where I could be okay in the event of another C-section. Luckily, the little baby in my belly helped with that idea. As I grew more and more excited about meeting our new baby, I finally put my own desires for a vaginal birth behind the main priority, which was to get this baby out safely. By the end of my pregnancy, I knew I just wanted a baby at the end and that a vaginal delivery would be a (wonderful) bonus. 

So at 35 weeks, I ended up in the hospital due to early contractions; my doctor administered a shot to stop them and ordered me off work. For two weeks, to get to full term, I was on bed rest, and then I bumped up to "light/modified" bed rest (literally lying on my left side as much of the day as possible). All that time I was still having regular (though not painful) contractions, likely Braxton Hicks or very prolonged early labor. I did get to enjoy a few days of my pre-baby maternity leave with a little baking and some organizational prep to make sure things were in order for Marshall's care when I went into labor, so that was nice, though I had hoped for a few more days than that!

The day before the 38-week mark (one day before my water had broken with Marshall), I dropped Marshall off at school and came home with a severe, consistent back ache. It felt like I had tweaked my lower back really badly, and nothing relieved the pain. I looked it up and found that it was likely early labor--exciting! For so many weeks, we had been trying to stop labor, so I had to convince myself that at this point it was okay if baby was ready now. I started texting a few people out of excitement/nervousness and called Terry and my parents just to keep them in the loop.

Over the course of the morning, I watched a movie, rested on the couch a lot to see if that would stop the pain, drank water, ate a small lunch, and puttered around the house thinking of things I needed to do in case we would be heading to the hospital soon. Finally, around 12:30 pm, I called Terry and asked him to come home. I wasn't convinced it was labor, but the intensity was high enough that I wanted him home.

Terry got home by 1:15 or so, and we spent the next few hours going back and forth about whether or not we thought it was labor. While the back ache seemed like a labor symptom, the lack of obvious contractions had me thinking maybe not. We tried timing the contractions and came up with a really inconsistent number--every 4-6 minutes with varying lengths. Luckily, I knew from my experience with Marshall and my friends' experiences that labor doesn't have to be incredibly consistent to be real. The pain intensified a bit and eventually I was unable to find any positions that felt comfortable. We tried a bit of our labor relaxation exercises, and again I struggled to feel comfortable. Terry asked if I wanted to watch a show to distract myself, and I surprised myself when I said no! Looking back now, I know I was already in serious concentration mode. Terry still wasn't convinced it was labor, which made me doubt it, too, but finally we called his parents to let them know they would need to pick up Marshall from school. At that point, around 3 pm, I thought maybe it was the real deal, even if lots of doubts still lingered in my mind. We finished packing up our hospital bag and continued trying to find positions that were comfortable for me. I knew I should walk around to get the baby low, but walking hurt my back so badly (when I stepped on my left leg, pain shot up the right side of my back), I couldn't convince myself to do it! We worried a little that baby might be posterior ("sunny side up"), but we also knew a normal delivery would still be possible if that was the case.

A few hours later, maybe 6 pm or so, Terry looked through all his notes about labor and when to go to the hospital and decided it was time to head out. Suddenly HE was in serious concentration mode! I wanted to wait until Marshall came home so I could say goodbye to him, and when he got there I was surprised by how emotional I felt. Marshall climbed up into bed with me and wiped my tears and asked, "Mommy, you're crying? You got tears on your face?" It was so sweet to cuddle with him. My heart broke a little saying goodbye to my little boy for the last time before he became a big brother, even though I knew we would all be okay. I am certain I will never forget that moment.

Finally, Terry loaded up the car and I sputtered my way through one more goodbye with Marshall as we headed out. We called the doctor on the way and then called my parents, who had already packed and were basically on their way (even though the five-hour drive would get them to LA close to midnight!). I kept apologizing to Terry, worried that we would get there and it wouldn't be real labor. Within a few minutes we were at the hospital, and I couldn't help thinking about how different this check-in process was. Last time, my water had broken and I was so scared but physically fine. This time, I struggled through contractions and tried to maintain focus as I got out of the car and we made out way to Labor & Delivery. I remember vaguely thinking about how many people were standing around and wondering what they thought of the couple obviously heading in to have a baby. But also, this time I felt extremely confident, ready to meet our little one, hopeful that we wouldn't have any complications this time.

We entered the labor ward and one of the nurses saw me and said, "Whoa, you are concentrating!" It got me a little excited that she was able to see I was in the "serious" phase of labor. We checked in and, much to my relief, were assigned a room that was NOT the room we had been in for my last attempt at delivery! The nurses' shifts were about to change over, so the nurse who started my check in would be leaving soon and said she wouldn't check me (it's ideal to avoid having multiple checks by different people, especially since each nurse has his or her own way of checking; it's best to have a consistent measurement). But the first nurse did give me a huge boost, because she learned we were attempting a VBAC (vaginal birth after cesarean) and got all excited. She told us she loves VBACs and that she felt we could do it, and it was just the perfect way to kick things off!

A little after 7:30, our new nurse arrived and finished the check in process and finally checked me. I was 6 centimeters dilated! YAY! It was such a huge relief to know I was actually in labor and that things had already progressed so far. Our nurse also happened to be one of the nurses who had been there during my LONG labor with Marshall, so it was awesome to have someone familiar. She was awesome, too; at one point she stopped with all the check in questions, took my hand, and asked, "What is it you really want for this birth?" I told her I would love to deliver naturally, but that ultimately our priority was getting baby out safely and getting all of us home. I felt listened to and comfortable and respected, which is what I loved most about our hospital experience.

While we had hoped for zero medical interventions, we learned almost immediately that it just wouldn't be possible to avoid them entirely. Apparently it was a busy night and three C-sections were already "on deck." The anesthesiologist on call came by to say that if I wanted an epidural I would need to have it in place immediately. I knew I didn't want an epidural, BUT I also knew the likelihood of having a C-section was higher for me than a typical delivery and that if I skipped the epidural and needed a C-section, I would have to be put under via general anesthesia for the surgery. Of course, I wanted to be awake for the birth of my child, so the nurse suggested an epidural catheter, which is where they essentially "plug in" the epidural but don't administer the medicine. Then, if a C-section were to become necessary, they could easily just plug in the catheter again to administer the medicine and allow for me to still be awake. We decided to go for it.

So the anesthesiologist went ahead with the epidural catheter (and I had to have a bag or two of IV fluid too to make sure I was hydrated enough for it), but she also administered a "test dose" of the medicine to make sure it was placed properly. Unfortunately, the test dose was stronger than I (or the nurse) expected, so I was unable to walk around like I had hoped. I did get some relief from the back pain, which was good, so I took the opportunity to rest. Within two hours, the meds faded and I was able to feel the contractions again and--more importantly--able to walk around to get the baby low. We tried a labor ball, which did not help at all, but ultimately I just wanted to stand and kind of sway a little.

When the nurse checked me again at the request of my doctor at 10 pm, Terry and I were nervous that we wouldn't see any progress, since I hadn't been able to move much yet. But I had progressed to 8 cm! Yay! Still, we wanted baby to get lower, so I continued standing and working through our relaxation exercises. Terry was amazing at coaching me through, and honestly I don't remember much pain during any of this part, so it wasn't too bad!

At 11 pm, the nurse checked me again and had me at 8-9 cm and felt baby low, so she called my doctor. He arrived at midnight and agreed I was 9 cm, 90% effaced, baby not quite low enough. He said it would probably be another hour or so but decided to break my water and then headed out.

And then...YOWZA. The next contraction immediately intensified, and I felt the urge to push with the one after that. In these few minutes I tried so hard to stay calm and use all our relaxation techniques, but the pain was truly intense. I told Terry I wanted the epidural to be plugged back in and told him I couldn't handle the pain. He tried to remind me that the intense pain was good and that it meant progress, but I couldn't focus. I told him and the nurse that I was panicking and that I needed to push. They all urged me not to push because I wasn't complete yet (same scenario I had faced with Marshall), which was absolute agony. I told them I couldn't fight it, and on the next contraction the nurse checked me again (being on my back for that contraction was AGONY) and said, "Oh, well that's why! Baby's right here!" She encouraged me to try a push on the next contraction, so I did, and then suddenly the room was a flurry of activity as my doctor came back in, more nurses came in, and everyone got ready for me to push. I had expected to feel excited, but I just remember looking at Terry and saying, "They're going to let me push?" I was probably a little excited, but mostly I felt desperate because the contractions were SO intense.

The next few minutes were the fastest for sure! My doctor warned me to push slowly and asked for oil to help with perineal massage to assist with getting the baby out. I remember hearing two nurses pop their heads into the room to ask if everything was okay and then hearing my nurse say, "Yep, baby dipped but came back up." When the contraction came, I followed everyone's instructions but felt baby crown and yelled out. My nurse was awesome; she told me, "If you're screaming, you're not pushing. You need to hold your breath and push." Terry told me he could see the head, which was super encouraging. I felt confident I was going to do this.

On the next contraction, I screamed a little again and my nurse said, "NO!" Ha! I immediately shut up and pushed. I won't lie; that push was definitely painful. That was probably when I tore (see below), and it was not fun, but also totally not as bad as I had expected. During the next pause between contractions, someone told me the baby's head was out, and I remember thinking, "Why aren't you guys more excited? I pushed the head out?! That's incredible!" They did, however, excitedly tell me that baby had turned face down, which had been a concern with all the back labor. And finally, the last contraction came and I pushed one more time to get the body out. Someone told me to grab the baby, and I took him from my doctor's hands. Terry announced it was a boy (!!!) and I pulled that wiggly little body up to my chest.

My doctor had broken my water at 12:09, and Declan was born at 12:30 exactly. Crazy!

Over the next few minutes, my doctor went on and on about how great the umbilical cord was and kept saying that we would have a very strong baby because the cord was so thick. So apparently that's a thing. Terry got to cut said cord, and the flurry of nurses around us took care of all my doctor's requests without missing a beat. But as I snuggled our little boy and breathed a sigh of relief that it was over, I started to notice how much pain I still felt, and my doctor announced that I had a second degree tear. He also had to do an internal exam to check for internal tears, because he was worried about how quickly I had progressed to complete and wanted to be sure hemorrhage was not an issue. Luckily all was clear. For the perineal tear, since I didn't have an epidural, he had to use local anesthesia to numb me, and there were several spots that simply didn't get the numbing meds! I could feel a few of the stitches go in, and between the tear itself, the stitching process, and the contractions that were working on getting the placenta out, I was hurting. Terry was particularly awesome during this part because he helped me continue to use all our labor techniques to get me through that pain as well and really kept me calm.

At some point, the nurses and Terry took Declan for his check up on the other side of the room. A funny little anecdote: As he was stitching me, my doctor kept asking the nurse why the light was moving. After the third time or so, I finally realized that I was (unconsciously) scooting away from him while he stitched because I was shaking and essentially trying to get away from the pain of the needle. Oops!

7 pounds, 13 ounces
20.5 inches

Eventually, Declan came back to me and we snuggled some more. My doctor finished stitching me and I stopped shaking. Terry and I relaxed a little and were able to joke around a bit. Most of the nurses left and gave us space to hang out alone. Declan nursed a little bit and we all just breathed a little after the chaos of the birth. I asked my nurse a million questions about the tear, the healing process, why certain things hurt so much, and more. My doctor came back in and congratulated us and told us he was so happy we were able to have the birth we wanted. He also jokingly commented that he didn't know I could scream like that. Ha!

A few notes and thoughts about this birth:

I really thought that having a natural birth would be euphoric, painless (at least after the baby got out), blissful. I had read hundreds of VBAC and natural birth stories to learn about and prepare for my attempt, and I can't remember any that described the experience as anything but joyful and empowering. Unfortunately, my experience wasn't that way. I truly felt agony as soon as I tore, and the stitching process hurt terribly. I thought I would feel waves of pride for this accomplishment, or at least something similar to pure elation. Instead, I felt physical pain, of course, but also a bit of a let down. 

With Marshall, the entire labor and surgery process felt so long and scary, and then as soon as Marshall was in my arms I felt incredible joy. It was a moment that matched no other. With Declan, I was thrilled he was out, but I didn't get that calm, nothing-else-in-the-world-matters feeling. Then I felt guilty and awful because I didn't cry when he was in my arms for the first time. Did I not love him as much as Marshall? Was I less excited this time? 

Looking back, I realize that the births were SO vastly different that I shouldn't have expected to feel anything similar, and I should have lowered my expectations about how a VBAC would feel. Yes, it was an accomplishment, but expecting joy and bliss and no pain after such a difficult task was unrealistic. Also, it's possible that some women, in retelling their birth stories, might exaggerate a bit about how pain-free and joyful it was. I'm here to say that mine was painful, not as difficult as I expected, and not at all euphoric. 

Still, the emotional recovery was fantastic. I got to snuggle my cutie without all the tricky emotions I had experienced with Marshall's birth. I got to focus on him instead of myself, and I got out of the hospital WAY faster, which was amazing.

Oh, and Marshall meeting Declan for the first time was absolutely perfect. We made sure it was just the four of us, so Marshall wouldn't be overwhelmed, and we lucked out with a view of a construction site from our window. Marshall bounced back and forth between watching the crane and saying hi to his brother, which was a great way of easing into being a family of four.

But physically, my tear made for a very tough first 10-14 days. After they discharged me from the hospital, Percocet was no longer an option, so I was allowed ibuprofin and ice packs. The other suggestions for pain management--sitz baths, epsom salt, sitting on a boppy like a donut pillow, etc.--did nothing for me. Terry made some frozen ice pads for me, which were great for relief, and I counted the hours until each dose of ibuprofin, which is funny because with my C-section I didn't even take my pain meds in the hospital! In general, I felt best while lying down, but that's not the most realistic position with a toddler and newborn. It was a really, really hard week or two. 

Very slowly, I started to heal. I was able to walk to the car without intense pain, I was able to go to the bathroom without crying, and I could function normally again. (Jenn helped immensely with reassuring me about returning to normal life, thank goodness.) I still feel some pain now and then (at 13 weeks postpartum), but generally I'm able to exercise and live my normal life without incident.

Overall, given the choice, I'd still say that my vaginal birth was far easier in terms of recovery than my C-section. But it still hurt during and after, and neither one was great or fun or blissful. I'm really proud of myself for advocating for myself and working hard to get my VBAC. I am also able to say that--now that I have experienced both types of births--they are both beautiful. They were both natural (natural complications led to my C-section, and thank goodness that modern medicine got me and my baby through it alive. Subsequent C-sections would have been natural as well, because any method of extracting a child from a body is birth and should be recognized as such). They were both healthy, safe ways to welcome my babies to the world. They were both difficult, during and after. They both required my amazing husband to be there with me every moment for support and encouragement. They both sucked in some ways. :-) The important thing was that I had choice, and my health care providers listened to me and supported my choices. I wish the same for all women, especially in birth.

The important thing now is that Declan is here, and he has filled the hole in our family that we never knew was there. I may not have cried when he was born, but I absolutely love him the way I love Marshall. He is perfect, humongous, adorable, and sweet. His birth is just the start of our journey together, and his journey through life. Birth in general is only one aspect of becoming and being a mother, and I am not a better mother to one child just because of how he arrived here.

Okay, that's a pretty long wrap up, but I'm sure there's a lot I left out. Please let me know if you have questions or would like to know more!


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