Wednesday, August 12, 2009

Birth Story, from the moment of crowning.

I really want to hear your birth story. Shoulders rarely truly get stuck. --

I was answering in the comments, but it got ridiculously long. I still don't seem to be up for writing the whole birth story, but I can jump to this part:

I'd been pushing for about half an hour, maybe forty minutes. The nurse had positioned something called a squat bar over the bed and tied a sheet to it, so that I could pull on the sheet in a way that repositioned me a bit. It really seemed to be helping to bring the baby down, which had been the obstacle so far. She was very excited, and told me she could see "lots of hair"* and that I was almost there. I couldn't tell her that at this point, the baby felt like an afterthought and I just wanted the pain to be over. I got to the point of the famous 'ring of fire' and was actually, literally afraid that I was getting ripped in half. (The nurse told me later that it was at the moment of crowning that she realized Robert was a larger-than-average baby.) Somebody-- the nurse? Don? the doctor?-- exclaimed that the head was out! I remember wondering, why the pain hadn't lessened at all yet. Then my doctor said, "shoulders stuck". Suddenly, everything seemed to stand still and speed up, at the same time. My focus snapped back from myself to the baby. The doctor or nurse must have hit an emergency button, because a team of medical personnel rushed into the room. The room felt very quiet, and very focused. The doctor asked me to stop pushing for a minute-- he repositioned my legs slightly-- then told me to push as hard as possible-- simultaneously, the nurse sort of pushed on my abdomen from the outside-- it was this kind of rolling motion-- while the doctor reached inside me to reposition the baby (felt about as pleasant as it sounds, but I wasn't caring)-- then the whole baby rushed out. He was covered in blood (mine, but for some reason I thought it was his) and they rested him on my stomach for an instant, just long enough for me to try to grab at him-- my hands were all bloody for some time afterwards. The nurse exclaimed that he was huge, I asked "so he's a boy, then?", she said that she actually couldn't see and asked the doctor, who confirmed, a boy. Just as quickly, before I could do more than touch him, the baby nurses and pediatrician hurried him to the back of the room and started checking him over.

The whole time elapsed between Robert's head emerging and the rest of him being born was easily less than a minute, and yet I can remember each fraction of that minute as though it were an hour, like a car crash. It was probably less than another minute later, that the baby team on the other side of the room confirmed that he was just fine, no nerve damage or anything else. Robert was bawling by this point, and I was too.

Everything after that point was clean-up. The nurse added some Pitocin to my IV (I was on intravenous antibiotics for Group B strep); I delivered the placenta; the doctor called for the materials he'd need to start the stitches. He informed me that I'd suffered third-degree lacerations and that it would take him some time to get me "put back together". Gave me two shots of a local anaesthetic since I hadn't had an epidural and started sewing, but for some reason when he got to a certain point I could feel it. I was still screaming and crying, partly because I was still in tremendous pain, partly just from being totally overwhelmed. I could hear Robert crying from his end of the room (they never took him out of the delivery room, everything was right there) and was irrationally worried that they were going to do something to him that I hadn't authorized (I don't know what-- a quick circumcision, maybe, or the Hep B shot?-- but I was not exactly rational at this moment.) I kept asking Don to go over to that side of the room and be with Robert, but he wouldn't leave my side, said that the baby was in good hands. At this point, I got the shakes and realized that I was freezing-- my hospital gown, pillows, everything was drenched in sweat, but I hadn't noticed; thankfully, the nurse did. She tried to change my gown and pillows without moving me too much, since the doctor was still parked at the other end of the bed with the needle. The baby team finished up with Robert, bundled him up in a blanket, and handed him to Don. Don brought him over to the bed, but there was no way I could hold him, I was shaking like mad. The nurse tentatively offered me a general painkiller that could go in my IV-- something morphine-like-- that was very fast-acting, would warm me up, and leave my system just as quickly. I accepted, explaining that the baby was out and it was only him that I didn't want drugged. I'd take whatever she had! Almost as soon as she added the opiate to my IV, I could feel it take effect; it was as though the room had suddenly gotten much warmer, as though I were under a warm blanket. I could still feel the very weird sensation of the surgical thread being pulled through the stitches, but not any pain. I relaxed, stopped shaking, stopped crying. I noticed Don in a chair holding the baby; they seemed to be in deep conversation.

Finally, after about forty minutes, my doctor finished sewing. He put the end of the bed back on so that I could stretch out, and Don brought the baby to me. The nurse asked if I wanted to try to put him to the breast, since he was awake, and we tentatively tried nursing for the first time. Somewhere during that time, the doctor shook my hand and Don's, and left. The nurse went to try to find me some real food, since the cafeteria had closed by then. She brought back a salad, talked about the labor and birth with me a little bit (post-game analysis, you know); mopped up some of the blood on the floor, brought the placenta over for me to see, walked me to the bathroom. After all this, she said that we could try moving from the delivery room to the room I'd be staying in until we left.

Shoulder dystocia occurs in 0.6 to 1.4 percent of births of babies between 5 pounds 8 ounces and 8 pounds 13 ounces. The occurrence jumps to between 5% to 9% of babies in the 8 lb 13 oz-- 9 lb 14 oz range**. Robert was 10 pounds. While his head circumference was in the normal range at 14", his chest circumference (14.5") was both larger than average, and somewhat unusual in that it was bigger than his head. I didn't have any of the risk factors for shoulder dystocia (gestational diabetes, maternal short stature, past-due pregnancy), nor any of the labor risk factors, like a forceps delivery, but Robert's size alone made us susceptible.

His size was also a big surprise, to everybody. My obstetricians had estimated a birth weight of about eight and a half pounds at our last ultrasound, three weeks before the event. I had no trouble believing it. There is no history of big babies in our families. Looking back, I don't know whether or not I would have wanted to know ahead of time, that he was going to be that big. It may have affected my belief in whether or not I could do this natural-no-drugs delivery; it may have affected my doctor's treatment of the birth. I suppose it could be argued that the doctor would have been better prepared for dystocia had he suspected a big baby, but I don't see how the process could have been any smoother: they worked like a machine as it was, with no notice at all. I think it was for the best that we all went into the birth expecting an eight-pounder, and getting the other two pounds as a bonus, so to speak.

Robert only ever lost 8 ounces of his birth weight, and had already started gaining it back by the time he was discharged from the hospital. (The pediatrician looks from the scale to me and says, "Well, I guess I don't need to ask you if your milk has come in yet!") At 11 weeks, he is still at the very top of the growth charts for both weight and length, so it doesn't seem to be a fluke so far; he is just a big dude.

*This is Robert at two days, so she wasn't kidding!

** I read somewhere that the average head circumference of ten-pound babies is not any larger than the average head circumference of eight-pound babies; the extra weight is all in the body. This is probably why the potential for problems during delivery of the chest and shoulders increases with larger babies.


ayla said...

I'm glad that you're happy with the care you received.

Bella said...

Wow... that's amazing that you did that naturally! I would have been crying and cursing for sure... and I HATE needles (never mind all my tattoo work, that's not the same thing).

Zephyr had a 14.5" chest too and got stuck (and I had a C-section!) and they did the same thing with me, though I was gloriously numb on that venture but it is amazing when they finally pull them out. What's so funny is how BIG Robert was! Z was just over 8lbs (they thought he was going to be 10lbs thus the C-section) so you are totally my hero for going all the way.

Mara said...

Bella, I think you could have done exactly the same thing. Seriously! I'd be more scared of a c-section!

Bella said...

I'll say this much... it wasn't my preferred method at all and next time (if we can EVER get my body to agree to a next time) I'm going au-natural damnit. I hated the drugs (cause I'm a cheap date and I could barely hold Z let alone keep from throwing up).

I'll take a couple of hours of adrenaline and pain over heavily medicated any day!