Wednesday, January 22, 2014

The Couple That Cooks Together...had a baby!

We finally had our baby - a little boy named Matthew Ryan!  He was born Sunday 1/19 at 1:07am weighing 6 lbs 12 ozs and 21.5 inches long (a tall skinny boy just like his dad!).

I wanted to share our birth story.  Things didn't go at all how I expected.  I wanted a completely natural birth, with few if any medical interventions.  To prepare for this, we took a 12 week long class on the Bradley Method of Natural Childbirth.  The class was really helpful!  I also credit the incredible midwife group we delivered with.  They work in hospital, but are very committed to natural childbirth, so really, it's the best of both worlds: all the medical safeguards are there if you need them, but natural childbirth is still strongly supported.  I ended up with far more interventions than I had hoped for, but Matthew's birth was still a beautiful experience that I will never forget!

Matthew Ryan's Birth Story

On Friday 1/17, I was 41 weeks pregnant and went in at 8am for a routine non-stress test and amniotic fluid level check.  After the tech did the ultrasound to measure the amniotic fluid, she asked me to go have a seat in the waiting room while she found a midwife to review the results.  I thought it was strange that she didn't hook me up to monitors for the non-stress test but complied.  About 10 minutes later, a nurse came out and said there were no midwives at this office and asked me to head over to the hospital to see the midwife on call there.  It's just a 2 block walk, so I was there pretty quickly.  At this point I figured something was off about the results so I called Mike to let him know.  I still figured the tech was overreacting and the midwife, Laura, would send me home.

When I arrived at the hospital, they had me fill out a bunch of paperwork, put me in a delivery room, and asked me to change into a hospital gown.  They apologized that one of the rooms with a birth tub wasn't available.  I thought, "Why does it matter? It's not like I'm staying to have the baby."

When Laura came into my room, she told me that they weren't able to measure ANY amniotic fluid around the baby.  She said this is very rare and usually means the placenta isn't functioning well anymore, and that while they really don't like to induce, she would not feel comfortable letting me leave the hospital.  I got really emotional since this was a complete surprise, but agreed that since the baby's safety was at stake, induction made sense.  They got me started on continuous fetal monitoring.  Thankfully, baby's heart sounded strong and steady so Laura thought I could still have the natural birth I wanted.  I called Mike and he finished packing our bags then joined me at the hospital.

Early Friday afternoon, midwives Laura and Kelly met with Mike and I to discuss our induction options.  A cervical check showed I was 1 cm dilated and 30% effaced.  Mike did a great job asking all the informed consent questions we learned in Bradley class, and we settled on Cervadil - a drug used to soften the cervix.  They said they'd let it work overnight, at least 12-18 hours, then evaluate and potentially start Pitocin the next morning. They placed the Cervadil at 6pm and gave me an Ambien so I could sleep through all the hospital noises.  After walking the halls with me a bit, Mike went home for the night so hopefully we'd both be well rested for labor the next day.

Around 3:30am, midwife Alex, 2 nurses and an OB rushed into my room and said my body was having contractions (although I still couldn't feel them) and baby had just had a long heart decel.  They took the Cervadil out and said I was now dilated to a "tight 2" and 50% effaced -- some progress but not much.  I was drowsy so we didn't discuss much, but I figured this wasn't good news.  I went back to sleep and Alex said midwife Nora would discuss a plan with me in the morning.  Later that night I began to feel the contractions, and had my bloody show around 6 am.

About 9 am Saturday morning, midwives Nora and Kelly came in and told me the baby was continuing to have late heart decels, which are apparently quite concerning.  They no longer felt that we could induce since baby likely would not tolerate stronger contractions.  They wanted to try IV fluids as a last ditch effort to put a little extra amniotic fluid around the baby, but said I would most likely need a c-section.  Again, I got really emotional.  When Mike returned to the hospital, I filled him in on the news.  Then we curled up in the hospital bed together and watched a happy movie - the first Harry Potter - to comfort me while we waited to see if the IV fluids would do any good. 

Incredibly, around this time my contractions started to become more regular and grow steadily stronger.  Either the few hours of Cervadil worked or else my body just decided 41 weeks was long enough and went into labor on its own.  Around 11am, Nora and Kelly came back, finally with good news: baby was tolerating my natural contractions just fine!  They said I might be able to have a natural birth after all, but first wanted to give baby a labor test to see if he or she could tolerate stronger labor contractions.  The plan was to start Pitocin and gradually increase it until I had at least 3 contractions in 10 minutes.  If baby still didn't have heart decels, we could proceed.  However, as a precaution, they didn't want to start the Pitocin until the c-section team was ready just in case baby got into trouble.  There was already a c-section scheduled, so we'd have to wait 1.5 hours to get started.  

At that point, we called our doula, Mary, to join us at noon, and she arrived just as my contractions got too strong to talk through.  At my request, I was switched to wireless fetal monitors so I could move around the room, and the 3 of us labored together for awhile.  We tried many different things: standing, rocking, leaning on Mike while swaying back and forth, sitting on a birth ball, etc.  At first, I was really excited to finally be in labor, and was talking happily in between contractions.  But I soon began to feel nauseous and got noticeably more serious, and we all knew I was in active labor.  Nora and Kelly came back and said that my body had progressed all on its own to 3 contractions in 10 mins and baby was fine, so we were a go for natural birth.  I was so incredibly happy!  Another cervical check showed I was now at 4cm.

The penicillin IV (I was GBS+) was rough.  As soon as it started, I felt incredibly cold and started shivering uncontrollably.  In retrospect, we wondered if the penicillin was stored chilled, since this happened with each penicillin push.  I got in bed under 3 blankets, but still couldn't stop shivering and relax, which made me so uncomfortable.  Around 6pm, I got up to go to the bathroom, and while there, also started puking.  Immediately, lots of doctors rushed into my room - they looked like a surgical team.  Midwife Kelly ran into the bathroom and helped me back into bed and told me to lay on my left side.  Nora came in to report baby had another big heart decel.  Worse, when I moved around (like when on a toilet plus puking) the fetal monitor would lose baby's heart beat.  Alone that might have been no big deal, but the decels made the dropouts a big problem.  Nora and Kelly asked to insert an internal fetal monitor, which also meant breaking my water prematurely - two things I REALLY did not want.  

At that point, I was super frustrated by all these medical interventions, being hooked up to a bunch of wires and things, and now being told I couldn't even get out of bed.  All my plans for how I was going to deal with the worst of labor, like using the shower or tub, were out the window.  I seriously began to doubt that I could do it without pain meds.  I was only at 5 cm, and knowing I had another 5 to go seemed impossible.  And worst of all, I was worried that I might go through all this and still end up with a c-section.  I asked midwife Nora if we should consider an epidural.  Thankfully, she ignored me.  My doula gave the response we had rehearsed: "Why don't we try something else first?"  Although in my head, I was thinking, "What else CAN we try? I'm not allowed to get of bed or even change positions!!!"  Mike was very supportive and reminded me not to give up.  He later told me that he felt the midwives were fending the OBs off, and that they needed a good heart monitor signal or it would be out of their hands.  So I agreed to the monitor.  When they broke my water (which hurt more than I expected it would!) I immediately went from 5 to 7 cm.  For some reason, reaching 7 cm was was a mental game changer for me.  I learned in Bradley class that 7 cm was the beginning of transition - the most intense, but also the shortest, part of labor.  I was in the home stretch now, and knowing it would be over soon renewed my belief that I could do this.  I finally put the epidural out of my mind, re-committed myself and got down to business.

Mike, my doula, and the midwives were awesome coaches and helped me relax through the final hours of contractions.  Even after all our practicing, it was difficult to relax, but the deep breathing really helped.  By 8 pm, I was fully dilated!  Unfortunately, I felt no urge to push.  Midwife Nora explained that ordinarily, they'd let me "labor down" and wait until my body was ready to start pushing.  But the baby's continued heart decels made them feel it was important to get him or her out as quickly as possible, so she asked me to try pushing anyway.

Pushing without the urge was surprisingly difficult.  Even with Kelly and Nora coaching, it was hard to get the hang of it.  My contractions actually spaced out, became irregular, and felt less intense.  I tried pretty much every pushing position possible from bed, but it was really slow going.  After 1 hour, Nora checked me again and said I had a "tiny lip of cervix" in the way, but she thought I could push through it.  It was discouraging to hear I'd been at it for an hour and baby still hadn't gone anywhere because my cervix was still in the way!  About three hours into pushing, Nora suggested a "whiff" of Pitocin to speed things up.  They promised to go slow and not ramp it up quickly, so I agreed.  They were true to their word and it was a good call, because it made the contractions more intense and closer together, and pushing got much easier.  I finally got into a rhythm and they told me I was moving the baby down really well.  

I hardly noticed any pain while pushing.  I was totally focused, plus I think the pressure of the baby's head helped numb things.  In between contractions, it was uncomfortable, although not in the way I expected.  I felt no back labor pain, or even uterine cramping.  It was 100% in the front of my pelvis, probably from the pelvic bones separating and stretching my tendons and ligaments.  I would rock my hips back and forth in bed as best I could to ease the discomfort in between contractions.  

I thought crowning would be the worst part, but when I finally felt a burning sensation, I got excited because I knew it meant baby's head was coming and the end was finally near!  Around the 4 hour mark (midnight), the midwives offered me a break from pushing, but I said no - I just wanted to be done already.  All in all, it took almost 5 hours of pushing to get the baby out.  They think his head went into my pelvis at a funny angle and that was part of the problem.  He also came out clutching his own umbilical cord tightly, which they think may have contributed to the heart decels (for all that my bag of waters was empty of fluid, they couldn't find anything visibly wrong with my placenta).  When they finally placed him on my chest, it was magical.  He was alert with eyes wide open right from the beginning.  Mike cut the cord after it stopped pulsing and got to announce that the baby was a boy.  We spent an hour just cuddling him skin to skin before Mike took him to the pediatrician to get checked out.

Overall, I'm really happy with my birth.  There were a lot more interventions than I'd hoped for, but I also had what I think was a pretty serious complication.  We avoided a c-section in a situation where I feel many care providers would have insisted on it.  I found out afterwards that my midwives were getting lots of pressure from the OB's to do a c-section, and they stood up for me and shielded me from all that so I could focus on my birth.  I'm truly grateful to the midwives for their incredible patience with me, and for giving me every opportunity to have the natural birth I wanted.  Natural birth was tough but I'm so incredibly glad I did it!

Here are some pictures from right after Matthew was born:

His going home outfit was an adorable Winnie the Pooh outfit from Mike's sisters Mary and Kathy.  We did a little family photo shoot while waiting to be discharged:

We we got home, we had to introduce him to the cats!  They were curious, but so far have been very good about accepting him into the family (they pretty much ignore him completely).

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