May 27, 2013

Birth Story: Kira, The Sixth - A Hospital Birth

It's time. You keep asking. I get in the mood to write and do. Then I'm not in the mood to edit. So you wait some more. Baby Kira is almost 2 - so not even a baby anymore. I'm taking her birth story off my to-do list and publishing it tonight.

My dear sweet Kira. I'd probably think she was a perfect child if it weren't for the fact that she took her sweet little time making an appearance into this world. Now she's got a couple of molars coming in and has told Tymon and I every day for the past 4 days that she hates us, the sweetness factor has definitely diminished.

In July 2011, I described Kira's 28 hour labor as a living hell. And that I had many life lessons to contemplate before I could write about them. I don't recall what all of those lessons are now, but we'll see how many I remember as I write this post....

I had planned on delivering Kira at home with my trusted midwife, Heike, who has seen me through 4 pregnancies and attended both Elliott's and Jocelyn's births.

Due to Kira's heart anomalies (discovered in the 20 week ultrasound) and not knowing how her heart would behave after birth, it was heavily recommended that I deliver in a hospital. Not just any hospital, but one with a NICU and pediatric team that could handle her if she needed any life saving interventions.

When I mention "heavily recommended", what I really mean to say is that we were left with no choice but to do everything the doctor said. I want to make it clear that Tymon and I will do everything in our power to make the best medical (and other) decisions for our children that we can. It's just in this case, it didn't matter what we as parents thought was best. Or that we disagreed with the doctors. Our views were moot.

If I delivered at home or in a birth center (next to the hospital) and Kira had breathing issues, we would have taken her to the ER. And as soon as we took her there, hospital personnel would take emergency custody of her making it impossible for us to direct any of her medical care. This would happen if we chose to do something against a doctor's recommendation. Apparently, not agreeing with a medical professional means that you are not acting in the child's best interests. Bleh.

While my opinions about corrupted medical power and CPS evoke strong feelings, I'll leave that be for now and share this, I'd heard stories about CPS and didn't want them involved in my life. Ever. We chose one of the best hospitals in Seattle (the only one with midwives) and I transferred my care during the last month of pregnancy.
Laboring in the tub.
Getting to know a whole new set of midwives was exhausting and frustrating. They didn't act like most midwives I've met before. We didn't see eye to eye on the direction of my pre-natal care. Looking back at that time and after talking to Kira's cardiologist, I realize that I should have set up a phone conference between the cardiologist and the midwives. The cardiologist was surprised to hear that the midwives turned my pregnancy into something in the "high-risk" category. Because I wasn't. I'm a low-risk type of girl. Communication would have helped tremendously. The midwives and high-risk OB specialist didn't believe me when I said I was low-risk and Kira had no heart issues as long as she was in the womb.

Why oh why won't she just come out???
When I went into labor about 4 pm on Sunday afternoon, it wasn't like my previous labors. It was slow. I ate dinner with the family and didn't throw it up. We took our time dividing up and delivering our children to various friends and family. I didn't know how long we had, but we felt like we didn't need to rush around. I had no doubts about actually being in labor. It felt like it and I was 41 weeks along.

I called Heike to be my doula. Her answering service told me that she wasn't on call. Bummer. I should have called again the next day. Another lesson learned. But I thought I'd have Kira soon...not 28 hours later.

We got to the hospital by 8 pm. I didn't want to officially check in. We did go to the nurse's station though to tell them we were there. My plan was to wait in the waiting room and come in when it got serious. They checked on me a few times as I was walking the halls and around midnight a nurse checked to see that I was 4 cm dilated. We made a run to Dick's Drive for a "last meal" and checked in about 2 am, Monday morning.

Nothing was really happening that night or the next morning. My first nurse was nice but she went home at 7 am. As did the midwife who had been on call that night. I didn't feel very comfortable with the second nurse but she was nice enough and didn't do anything terrible, so I didn't feel like I should request a new one.

Tymon and I walked around the hospital grounds trying to get my contractions going regularly (they were sometimes strong and sometimes not, sometimes close together and sometimes not). The nurses had brought in a birthing stool and birthing ball and anything else that I thought I might want. They were very flexible with anything I wanted to try. The only rule was that I couldn't deliver in the tub. That was against the hospital rules. They were very nice and didn't make me wear a continuous fetal monitor. Phew!

The midwife who came on duty that morning was the only midwife in the practice that I'd never met before. During our first meeting, the anesthesiologist came in to offer his services. I thought that since my birth plan indicates that I would have a natural birth then I wouldn't have to sit through an infomercial about epidurals.

I knew my hospital midwife was different than Heike when she took one look at the birthing stool and said I could use it as long as we put it on top of the end of the bed. Her knees are bad and she doesn't kneel down. Just picture that in your head. A birthing stool on the wobbly end of a bed. Not so stable. Fairly dangerous. I tried it. It wasn't going to work.

Who's ever heard of a midwife who doesn't kneel down? That's like a mechanic saying they don't get under a car to fix it. I'm pretty sure kneeling is a core requirement in any midwife's job description.

I believe the final straw to my discomfort with my midwife came in a conversation about her daughter and grandson's birth. She acted as doula for it and mentioned that she wouldn't feel comfortable delivering a baby outside of a hospital. She'd be too afraid that something would go wrong. When she showed no confidence in her own abilities and neonatal resuscitation skills, my anxiety increased. I felt ill-at-ease with her and my body decided to hold Kira in...perhaps until the next mid-wife came on duty the next morning. Yikes!

Hours passed. I vomited my lunch, which is a positive sign. I thought I was progressing. But I wasn't. I'd been dilated to a 7 pretty much all day. The midwife mentioned to me that she may send me home to labor there. What?! I'm 41 weeks and dilated to a 7 and you want to send me home? A couple of hours passed. She mentioned a few ways to get things moving...they involved drugs. Another couple of hours passed and she mentioned that it'd be best to deliver before 5pm so that the very best neo-natal team would be on duty. I wonder how the B team (night shift) doctors and nurses would feel if they knew she'd expressed her lack of confidence in them.

About 5pm a new nurse came. Hallelujah! I really liked this one. I labored in the tub. My contractions seemed strong to me. Kira still wasn't coming. And another hour passed. The midwife started talking options. I think she was tired of me. I was certainly tired of her. I felt a lot of pressure.

My mom was with us the entire time. She's diabetic and didn't bring her insulin since she was expecting a faster birth (my previous labor was just over 3 hours). She was encouraging me to do whatever option the midwife talked about to speed things along. She needed food. And sleep. And she kept talking on her cell phone to everyone and giving a play by play. That combined with us updating a status or two on Facebook created an unseen but powerfully strong social pressure to get that baby out already. And get her out now! It was intense.

My mom left about 7:30 pm and we discussed our options. Doing nothing wasn't an option. We could either do pitocin or break my water. Though at this point, I was considering very strongly the possibility of a c-section. The "safer" options each carried their own risks. And it seemed so easy just to plan a c-section.

A 28 hour labor messes with your head some. I found myself (the natural childbirth queen) welcoming an unnecesarean. And while I'm pretty sure we would have crossed a real c-section conversation if the two lesser interventions hadn't worked, I was surprised at how far my levels of acceptance had come.

After the midwife left us mulling over whether to choose pitocin or breaking my water, we let the nurse in on our conversation. She told me that Kira's head had descended enough that the chance of a prolapsed cord was small. And the only benefit to pitocin was longer and stronger contractions. My nurse then asked me the magic question...the one that resolved any concerns we had with our options.

"How strong are your contractions?"

Meaning, are they strong enough to birth a baby? Yes. They are. I've never had any pain meds for the 4 babies I've delivered previously. These contractions felt much the same. We decided to break the water.

Soon the midwife came back with a plastic hook that looks an awful lot like something used for knitting. She couldn't break the water. But she really upset me while trying. I may or may not have yelled something about her getting that thing out of me. It seriously hurt worse than giving birth. Maybe she was nervous and shaky. Maybe she didn't like me as much as I didn't like her. Regardless, she got another hook. This time metal. I heard it referenced that my bag of waters seemed to be made out of leather. A few more shouts and a bit more pain and the water broke. The midwife left.

I should probably mention that with each one of my births, after my water breaks, I deliver a baby within a few pushes. I hoped that this labor would be the same...even though nothing else had been. And as I lay there feeling uncomfortable, I asked to labor in the tub.

The nurse unhooked me and helped me to the bathroom. Tymon sat on the ledge of the tub. I got in. The water was warm. I felt like I needed to poo. If I could just poo then I could relax and end my misery until Kira decided to come. A few minutes later the nurse came in. I told her I was going to poo. Tymon reached in the water and found that he could feel Kira's head. The nurse told me not to push. I disobeyed.

We asked her if she could just deliver the baby since I liked her a lot more than the midwife. She couldn't. I didn't realize that labor and delivery nurses have never actually delivered babies. Their contracts won't let them. Crazy.

So picture Tymon, who has also been up the past two days, whispering in my ear, "push" and "just do it". So I did. I trust he could deliver a baby if needed. And apparently, I needed it now.

The nurse rang the alarm. The same one you've seen on House or any other medical drama. A red light flashes outside the door and the whoop whoop of the alarm calls everyone and their dog to your room. The midwife came rushing in. She asked me to hold onto her arm and she'd help me get to the bed.

I told her no. I was squatting and had a head between my legs. I wasn't going anywhere. She got down on her knees and frantically moved her hands from one side of my leg to the other. She didn't know what to do. I was in the wrong position. I quickly realized that in all her decades of practice, she'd never been involved with a tub birth. But I have. I know what to do. I calmly turned my back to her. She could see Kira's head and calmed down.

The pediatric team was in the room rushing to get everything ready. The doctor was at the door ready to rush Kira to the warming table to provide resuscitation, if she needed it.

The cord was around Kira's neck. The midwife untangled it. Kira's rear shoulder was birthed first instead of second. Then the rest of her slid out. The midwife reached for the clamp for the cord. Tymon thought it was to cut the cord and reached for it. High stress moment while they got that figured out. She was barely 30 seconds old before they had her out the door.

Phew! She's finally here!
I consented to going to the bed to deliver the placenta. We banked her cord blood on the off chance she would need it for a heart surgery. We got enough. Everything looked good. She was breathing normally (the tell-tale sign that her heart is pumping enough oxygen for her to live).

Our favorite nurse...
We got settled into a new room and Kira's breathing was monitored for a couple of hours to make sure it was okay. In the morning she had an echo and we entered the "wait and see as she grows" holding pattern. Almost two years later, I'm happy that her heart anomalies have more or less resolved themselves.

So what are the great lessons of this birth? Even if I think that I'm okay with delivering in a hospital, the bottom line is that I'm not. And my body will not behave normally when I don't trust my caregivers.

Facebook and cell phones are nice after a birth. Not during.

Bigger than those....If I can't get what I want then I'm going to struggle to control whatever I can. So if that means getting my midwife onto her bad knees to attend a tub birth, then so be it.

Oh, and one more lesson. Even if you make decisions based solely on not getting involved with CPS, if God wants a CPS experience to be a part of your life, you will still get one.

Kira's 1st Birthday Party
Last week my two barfy babies skipping school.

3 Riveting COMMENTS:

  1. Ay yi yi... That is quite the story! Thank you for sharing. It gives me lots to think about!

  2. I found your birth story very entertaining...but not in a mean way. It just reminded me of so many of my birth experiences, which were all in the hospital, with whoever was on call, and drug-free (except for the stupid, horrific first one, that put me off of epidurals forever).

    Labor and delivery nurses can and do deliver babies, and shouldn't be there if they're afraid to catch one now and then. ...but they get a lot of crap from the doctors when they do.

    The midwife you got stuck with sounds terrible. You probably needed a couple of years before writing that one.

  3. Wow, what a story! I'm glad she is still healthy! That's a huge blessing. But what the crap is up with the midwife who won't kneel down? How odd.


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