So, before I forget, I thought I'd mark this day with Miss Anni's birth story. :)
Where did we leave off? I think I'd updated on here once I'd been officially diagnosed with severe preeclampsia on Thursday, September 30. After initially deciding to hospitalize me for the duration of the pregnancy, my OB reconsidered and sent me home on strict bedrest, taking my blood pressure 3 times daily and coming into the hospital/clinic every other day for a non-stress test.
On Friday, Sue, James' mom drove down to stay with us for the next few days. Shortly after she got here, my blood pressure went up past the limits my doctor had given me, and we headed into labor and delivery. After being in triage for a couple of hours, having labs redrawn, etc. they decided it was just a fluke bump in BP and sent me back home. Saturday I was scheduled to have a NST at L&D which I went to as planned. During that visit I was on constant BP monitoring and the doctors decided the numbers were consistently higher than they wanted them to be, so I was put on a blood pressure lowering medication and sent home again. All went as planned, and in fact my pressure numbers did drop a bit after a couple of doses of the medication. We were settling in on Sunday for another week of bedrest, and even had a clinic visit scheduled for first-thing on Monday morning. Just before we headed to bed on Sunday night, I had my blood pressure checked again. It was high again, very high--148/98--and I called the on-call doctor as directed. She directed us to come in again and the plan was to hospitalize me at that point.
After arriving in triage at about 11pm, we realized it was a VERY busy night in L&D. The until was swamped and during the course of the night they were laboring not one, not two, but three mothers due to deliver twins! Needless to say, the pregnant lady not having contractions was a bit low on their priority list. We sat in the triage room for the next several hours--various residents, doctors, and lab techs were in and out. Labs were run again, and I was put on the monitors both to check on how baby was tolerating the high blood pressure and keeping tabs on my blood pressure. It dropped a bit again once I got into the hospital, but it still wasn't low.
Finally, the attending physician came in and conferenced with us. Even though I appeared to be stable at the time, she told us, she was recommending we proceed delivery of the baby--that night. After the roller coaster of the previous five days, it was not a shock, we had been anticipating the arrival of our baby sooner rather than later, yet we'd had the plans changed so many times it hardly seemed real.
It was now about 2am on Monday morning, and I'll be honest, I was quite nervous about beginning labor without any sleep. I was curious however to see what kind of progress my body had been making on its own, if any. I'd been having frequent Braxton-Hicks contractions during my whole third trimester and I was favorable for so long with Lydia I was hopeful that maybe we'd have some progress. Unfortunately, not so much this time. When checked after being admitted I was a fingertip dilated, not effaced, and very posterior. Great--not good conditions for beginning an induction five weeks early. At that point I was prepared for a long journey. My IV was started, and by 3:30am the resident had placed the cervical ripener, Cervadil, given to hopefully start the induction process. It takes 12 hours for the drug to work, so we were in a holding pattern until the next afternoon as long as my condition remained stable. Thankfully it did, but wow, that was a long 12 hours! Contractions, albeit mild ones, began almost as soon as they inserted the Cervadil. They were fairly regular at about 7 minutes apart and definitely noticeable, especially since I wasn't allowed to leave my bed except to use the restroom. I was again hopefully when the resident came in to check me that because I'd been able to feel the effects I would have made a lot of positive progress. And I'll tell you, it is a sad day when you're hoping someone will tell you it's time to start Pitocin!
During the 12 hours letting the Cervadil do its thing there was a change-over of the residents. I really liked the woman who was on during the night, I wasn't so much a fan of the daytime resident. There was nothing really WRONG with her per-say, we just didn't really click. She came in around 4pm to check me and pretty soon dashed my hopes of having a Monday baby. Per her exam I'd progressed to about 1cm, effaced to about 30%, and was still very posterior and high station. Needless to say, not the progress we were looking for. The resident tried to be empathetic, but I'm fairly certain she's never been a laboring woman herself. Her condolence: "don't get discouraged, cervical ripening can be a slow process, this might take days." Um yeah, thanks for that--very helpful! The only nice thing I can say about the woman was that when I complained that I was afraid that between no sleep and not eating since dinner on Sunday night that I'd have nothing left when it came time to really labor she shocked the whole room. She informed me that she always lets her cervical ripening patients eat--yep, not just jello or broth, but meals from the cafeteria. That information would have been nice to know all day, but I wasn't complaining, I just wanted my food STAT. Once she left the room the nurse brought me the menu and the phone and confided that she'd never seen a doctor let someone eat before, but by all means go ahead and get something. I still think that was perhaps what allowed me to get through the next 12 hours.
Anyway, back to the induction process, since the Cervadil had been so ineffective it was decided that we should try the other drug used for cervical ripening, Misoprostol. The best news about the new drug, it only takes 4 hours for each dose. It was about 4:30 or so when the new drug was placed. We went back to what we'd been doing all day, trying our best to rest. About 6pm, Sue brought Joshua and Lydia in to see us, it was nice to have them visit and helped take the strain of the process off a bit. I felt more relaxed and confident after their visit. At 7pm the staff changed out again, this time for the better. Not only was I assigned a nurse that I really clicked with, but the resident from the previous night was back on (someone I found out later is a good friend of one of my friends) and it was almost time to see what progress, if any I'd been making.
8pm arrived and with it good news. Not only had I made progress, I'd made good progress. Although I was still quite posterior and she was still very high, I was now dilated to 4cm and 60% effaced! The downside was that because she was ballotable (not fully engaged) rather than being able to break my water and let nature take its course, I would still have to be started on Pitocin.
In all fairness to Pitocin, I've never labored without it, so maybe it's just that labor is wicked, but Pitocin is evil stuff. My body does really weird things while on Pitocin. First of all, it doesn't seem to get the message that no matter if my body is making progress, it needs to show up on the monitor, or the staff will just keep cranking the levels. With Joshua the Pit level was so high that by the time my body got the message and contributed it's own labor I was hyper-contracting and he went into distress. For awhile with Lydia, even though I was feeling intense contractions, on the monitor they were showing up as negative (or dipping/inverted) contractions. This time was no different, though I could feel the intensity progressing the monitor was showing barely any contractions of significance. They got closer together, but to someone not experiencing them, they didn't appear to be actively making progress.
The rest of the evening passed as pleasantly as any labor can, I think. While uncomfortable, the contractions were still manageable, so we got comfy. In fact there was a period where the nurse, resident, and I were swapping birth stories. I gained new respect for the resident, who I discovered was a mother of four pre-school aged kids, the last of whom was born this spring in a flurry that the attending physician barely arrived in time for. The nurse and the doctor had working at each others deliveries, both earlier this year, so they were comfortable together. I was able to share that once things had gotten going both of my previous deliveries had gone FAST! Though it was just a conversation at the time, it turned out to be one of the most important bits of information I shared all night.
Monday crawled to an end, and I realized that all of my kids would be born on Tuesdays, and I was hopeful that they would all be born during the wee hours of the morning (Joshua was 3:08am, Lydia 12:29am) but I thought it was actually most likely that my doctor would deliver this baby as well sometime after she came on duty at 7am. I started feeling a lot of pressure around midnight, and while it didn't really feel like the pushing sensation I was familiar with, I asked to be checked. During the past four hours of being on ever-increasing doses of Pitocin I'd moved from 4cm to 5cm, but was unchanged other than that. At that point I realized it could still be a long process and I began to really think about my pain relief options.
I intended to get an epidural during the course of my labor with Joshua, but was barely dilated when I started discussing it with my nurses, and they convinced me to try a narcotic first. During the couple of hours the narcotic was in effect, I progressed VERY quickly, and by the time I was sure I couldn't tolerate the pain any longer I was 8.5cm dilated and being headed to the OR for a probable emergency C-section. (That didn't happen, but that's a story for another day.) With Lydia, when my induction began I was already 5cm dilated and 80% effaced. Because Lydia was also ballotable, I was on Pitocin for a few hours, but because I was able to be up and walking around I was able to get through the contractions. When I finally felt like it was time for some pain relief I was 9cm dilated and pushing just a few minutes later--too late again! So this time I wanted to be more intentional. After delivering two babies without an epidural, it wasn't that I thought I couldn't do it, it was just that I wasn't sure I wanted to. I also knew that things would probably go very quickly at the end, so I wanted a plan. I debated asking for the epidural back and forth, but finally settled on asking for a dose of narcotic pain relief. The plan was for me to get the narcotic right before my water was broken, and I figured it would be fully in effect during transition and pushing. Given my history, I was doubtful labor would last more than a couple of hours after my water was broken, so I'd have some relief, but not more than needed.
It was a nice plan in theory, however nothing over the past couple of weeks had gone as planned, so I'm not sure why I thought that would! After being checked at midnight, I was pretty much on my own through the next few hours. The nurse popped in and out, but I didn't see the doctor again. The contractions continued to intensify slowly, but nothing noteworthy seemed to be happening. I tried to rest as much as possible and James was dozing on the couch. The monitor continued to show only little blips of contractions and I'm sure everyone thought this would drag on for a very long time. I know I was starting to...
At 4:21am I had another contraction just like the hundreds I'd been having over the past 24 hours, except...during the peak of the contraction I felt something like a rubber-band popping internally. It happened twice and my contraction instantly intensified tenfold. I wondered if my water had broken (it had been broken by the doctor in both of my other labors), but there was no fluid gush, drip, or leak. Just the weird internal popping noises. I told James what had happened and went ahead and paged the nurse. During the next contraction my water began gushing. During the midst of that contraction a nurse I had never seen before walked into the room. She calmly informed me that I should get up and go to the bathroom and she'd change the bed. Um, yeah...about that, I was pretty sure I wasn't going anywhere. At this point the contractions were coming nearly one on top of the other and they were INTENSE. To her credit she seemed to figure that out pretty quickly and backpedaled on the request for me to get up, she just put new padding down. She was not, however, taking me seriously that this was going to happen fast. I requested a doctor so I could be checked, because I was pretty sure I was transitioning and was starting to get the urge to push.
Though there are some very great nurses, I'm always surprised that they seem to think they know better than the mom, especially if the mother has had a child before. When I told the nurse I was starting to feel like the baby was coming quickly, she told me that contractions always intensify right after water breaks, but they'd settle down and come more slowly after a few minutes. She was obviously not getting it! I asked for my doctor and my nurse again and was told my nurse was assisting with a delivery in the next room. At this point I knew whoever was there or not there this baby was coming SOON. My body was starting to push unbidden and I felt the incredible urge to join it. The nurse was still taking her sweet time until I mentioned that Lydia had been born 45 minutes after my water was broken. That got her into action, she then paged the doctors again and started trying to prevent me from pushing. She checked me and told me I wasn't complete. That was very concerning to her, much less so to me, I knew it was only a matter of minutes (seconds?) before I would be--but she was very insistent I couldn't push. Again, I always wonder, have you done this??? There's nothing else you can do when you get to that point. Finally after what seemed like hours, but was really only minutes the doctor and nurse arrived. The nurse kept protesting that I wasn't complete--the doctor re-checked and I was in fact complete. It all happened in a blur after that. I knew she was coming and I didn't think it would be long. I pushed a couple of times and then could feel she was crowning. The doctor was scrambling to get her second glove on while she was born. And then it was over. There hadn't been time to get the bed transformed, the doctor wasn't gowned up, and the attending didn't even make it into the room until after Annika had already arrived. The best part of the whole labor--no tears--what a great thing!!! :)
At 4:43, just 22 minutes after the first "popping" contraction, Annika Caroline joined our family. You all know the rest of the NICU story, it wasn't what we had hoped and planned for, but we survived it, and couldn't be more pleased to have Annika as part of our family. We are in love! Happy Due Date baby girl, I'm so glad you're here snuggling with me. :)