Thursday, February 4, 2010

"I ended up with an unplanned and unnecessary c-section..."

By Emily Dickey

Ryan Tyler was born on December 27, 2009, and he’s the love of our lives! A pretty adorable one, too I ended up with an unplanned and unnecessary c-section… You can find our entire birth story here:


Going into labor
I’d say slight contractions started the night of Christmas Eve. Of course, I’d been having contractions for the past 2 months so when I say “slight contractions started,” I mean different contractions… stronger contractions, just enough to make me uncomfortable. And just enough to make us all sure I’d be at the hospital on Christmas day.
Christmas baby? Nope. Steve and I spent the entire day at home because my contractions were stronger and I was super uncomfortable. But they never progressed into something closer, stronger, longer. That night… they got worse and quite painful. We both tried to get some sleep around midnight. I woke up at 2:30am from the contractions, which were about 4 minutes apart and I couldn’t talk or walk through them. So I woke up Steve and we got ready to go. Maybe it was too early, but after being in early labor for an entire day, I was probably just wishing it was time to go so much that I told myself it was time to go.
So how did we start labor?? There are so many ways to attempt inducing labor on your own and I had made a list:

Honestly, I think it was just time and we didn’t do anything that actually worked. We may have done things, however, to help push it along AFTER it had started.
Christmas Eve:
*I started taking Evening Primrose Oil (orally and topically)
*Steve’s brother yelled at my belly, telling the baby to come out (this is probably what did it! lol)*Sex (using evening primrose oil)
*Nipple stimulation (warm pad)

Christmas Day:
*Continued the evening primrose oil orally and topically
*Relaxation–slept on the couch a LOT, took a couple warm showers
*Nipple stimulation (warm pad)
*Massage (we used a DVD: how to massage your pregnant partner–and fyi, the “pelvic rock” made ctx pain less, but only for awhile)

Anyway… Steve called the OB on call, who replied “is she the one who was supposed to be induced today?” Yes, I was, but it was moved to Tuesday. Steve got off the phone and said “great, they all know who you are.” – haha.

We loaded the car with our bags, boppy and birthing ball. I called my mom and texted some friends. It was baby time! We got to the hospital around 4am
pain meds



We arrived around 4am and got right into a room (the entire place was empty!) where they hooked me up to the heartbeat and contraction monitor. The nurse was asking all these questions and every time I had a contraction, I’d have to concentrate and not talk–she seemed almost annoyed or impatient with that, which made me feel rushed. That was surprising because… isn’t that their job? Don’t all women in labor get quiet during a contraction? Anyway, she checked my dilation and I was only at 2-3 cm. After being in early labor the entire previous 24 hours?! And for being in so much pain? I nearly started crying when she left the room and turned to Steve and kept saying, “I can’t do this, I can’t do this.” He told me I could.

The nurse said they’d wait an hour and check me again. The hour actually went pretty fast, except during the minutes I decided to stare at the second hand on the clock–they really should remove those from rooms, haha. SO, my next check was around 6.. I was STILL at 2-3 cm with contractions 3-4 min apart. I cried. The nurse told us she’d call the doctor and update her and that we may be sent home. I said- how will I know when to come back if my contractions are currently 3-4 min apart and really painful? and she said – they’ll get much worse and will make you cry. Come back then. AHH! I was already wanting to cry!

The doctor was gone delivering another baby so it took her another hour and a half to come. She checked me (7:45 am) and by then I had reached 4cm! So we were going to stay… they moved us to the labor and delivery room.

Looking back at this timeline (accurate, thanks to my twitter updates), I’m AMAZED it was 4 hours we sat there while I dilated to 4cm. I would have guessed it was like 1 hour. The pain was BAD and I can’t believe I actually sat through 4 hours of it… it makes me think I could have made it, I could have gone longer. But moving to L&D, they told us to expect 1 cm per hour… meaning, on average, it would take another 6 hours. I couldn’t handle hearing that…. I caved and asked for an epidural (8am).

Before I asked, I discussed it with Steve. For the past 9 months he has been hearing how I want a natural birth and how important it is to me and how he MUST talk me out of an epidural if I ask for one at the hospital because I don’t really mean it. So he was in a hard spot and didn’t know what to do. He DID try to talk me out of it, in the nicest way possible, and I appreciate that. He was so nervous to tell me it was OK to get the epidural because he didn’t want me to regret it later. I finally told him that I wouldn’t blame him, that I wouldn’t regret it, and at this point I needed him to back me up. So he did.

And I don’t regret it. I mean, I regret the way things ended up and I do believe it all started with the epidural… but we’ll get to that later. What I mean is, I really couldn’t handle the pain and I don’t know how some women do it. I was miserable, hating labor, dreading every passing minute. Once I had the epidural, I could actually smile and think about our lil baby boy who was coming soon.. I could ENJOY it. And I don’t regret that.

The anesthesiologist was amazing–the nurse said he was the best and he was SO nice. I was really nervous to get the epidural, but it was really easy and I don’t really remember any pain, just some pinches. It started working really fast.


My legs felt numb, but I could still feel touch–I could still feel Steve rubbing my feet, etc. The meds reached a “peak” during which I couldn’t really move my legs at all. The nurse came in to check me and told me to lift my knees–I laughed. I can’t! But once that peak passed, I could actually move just fine. If I concentrated, I would notice the contractions, but only as very slight pressure.

Steve and I slept… a lot. I woke up around 11am and they checked me: 5cm, 0 station. The nurse asked if they could give me pitocin or break my water. I said I didn’t want either. The nurse told me that the doctor recommended pitocin over breaking my water… I said let’s wait longer. I was having contractions just fine on my own, every 3-4 minutes, and the baby was doing great. The concern (according to the nurse): the contractions aren’t doing enough, fast enough, which is a worry because I was late at 41 weeks.

Hmm my tweets show the nurse came in and checked again at 11:30… that would be a half hour after the previous check. Funny I didn’t notice that while at the hospital… it wasn’t the hour they said they’d give me. Wow. Anyway… I was still at 5cm. Nurse brought up pitocin and water breaking again and I again said no. She asked me why, what did I have against doing those things? I said… I don’t want to force my body to do something it’s not ready to do. She said ok.
I sat straight up in bed, indian style, hoping to help the baby move down.

Alright, it’s now about 12:30pm. They pulled out the big guns–they sent the OB in to talk to me instead of the nurse. She told me my white blood cell count was low and they were worried about an infection. Again, she checked me and I was still at 5cm (another worry). Looking at my tweets, the doctor said that at this point I was stuck at 5cm for 3 hours, but it would appear I was only there for 2 hours. She said we could tell if I had an infection or not by breaking my water. Clear = OK. So… I said yes. How could I not? I didn’t want an infection to put risk to baby (& I thought I was at 5 cm for the last 3 hours).

Water was clear = no infection.
1pm: Steve wakes up, we watch TV.
1:30-2:30pm: I took a nap.

They checked me (2:30pm) and I was STILL at 5cm. Again, the doctor was sent in to talk to me about it (because it was much easier for me to say no to the nurse… harder to say no to the doctor). So what happened? I ended up with pitocin.

epidural to pitocin

The reasons I think I ended up getting pitocin (when I went in not wanting it AT ALL):

1) when you’re asked 4 times if it can be given to you, each time wears you down
2) I was told I should be dilating 1 cm every hour, on average, but that I was “stuck” at 5 cm for 4 hours
3) A huge reason I never wanted pitocin was because of the more painful contractions it causes. But because I ended up getting the epidural and could feel no pain, I figured… why not?
4) With the nurse and OB pushing the idea of pitocin every time they entered the room and for the reasons above, I forgot my grounds of not wanting to force my body to do something it wasn’t ready for. Yes, I’m frustrated by this.

We started at 1 ml/hr of pitocin and the nurse said she’d raise it by 1 every hour.

Tweet at 3:04pm:
"I can’t believe I’m on pit. But dr very convincing. Said it shouldn’t take much as I’m having own contractions and that it has very short half life…. so if we decide to stop it’ll be out of system quickly."

Too bad that wasn’t true. I stayed on pit until we were at 24 ml/hr….

Twitter friends kept suggesting I get up and walk, but I was on an epidural and they wouldn’t let me. I asked I could get up and they said no. (I know, I shouldn’t have asked, I should have just done it.) At 4pm I was having contractions every 2-3 minutes and with the pit, I could feel them–just pressure, no pain. At 4:40pm my contractions slowed to about every 5-6 minutes… then I slept for an hour.

Checked at 6pm: 6-7 cm. Pitocin working and I was starting to feel lower back pain… really low. Baby’s head? Anyway, I fell back asleep! I was sooo tired. Slept for another 2 hours and woke up around 8pm. They checked me and I was still at 6-7 cm and still at 0 station New symptom: shaking. Like, teeth-chattering-shaking. The nurse was excited like it was a sign of labor, but the doctor said it was an effect of the epidural. Hmpf.

At this point I was at pit level of 10 ml. As dilation wasn’t moving, they started upping the pit by 2 every half hour.

At 7:30-8pm I got the night nurse. I loved the day nurse, she had great personality and was really friendly. The night nurse? Awful. She never smiled, she’d turn up my pit without telling me so I’d have to ask every time, and when I asked her if I could at least just stand up next to the bed with Steve’s help, she said “absolutely not.”

9pm check: a “good 7″ and still 0 station. Pit level: 12. I started to feel pain through the epidural so they made me lay down and they upped the epidural. They wanted me to lay down because the epi works with gravity… so sitting straight up as I was (trying to help baby move down) was concentrating the epi more in butt area, than helping with uterine pain.

10pm check: dilated to a “soft 8″ meaning a bit more than 7, stretchable to an 8. Around 10:45, I wrote on twitter that the back pain was worse, stronger with contractions. Almost like needing to go to the bathroom (urge to push), but not quite… dr said it was baby’s head.

11pm check: still at 8cm. +1 station. Moving along! But still sooo tired, couldn’t keep eyes open… went back to sleep.

My next tweet didn’t come until 1am so I’m guessing I slept till about midnight and then they checked me and I was still at an 8. So they put in a catheter to measure the strength of contractions (I shouldn’t have let them and I wish I hadn’t. But… when you’re in the moment, it’s like you don’t know what’s going on and you just want things to go well and you figure what’s the harm in looking at contraction strength?) We waited awhile… the nurse came in at one point and I asked about the strength and she said it looked like they were NOT strong enough, which would mean I need a c-section because the pit isn’t working. I couldn’t stop crying. But.. we still hasn’t heard from the doctor.. now 1:20am and they’re still upping the pitocin: 22 ml.

Keep in mind the MAX level of pitocin is 20ml. The day nurse said that and it said it all over the IV machine. With the doctor’s orders, they can administer more. I ended up going up to 24 ml, which finally was my doctor’s personally set max level. In this time, the pain came through the epi full strength and I thought I’d die. The pain came back suddenly and brought tears to my eyes–people say to concentrate and distract yourself–the pain was so bad that doing anything else was impossible. I asked for more epidural, but the nurse said that if I was progressing and IF it was time to push soon, I couldn’t get more epi…. so we had to wait for the doctor to check me. (Why couldn’t the nurse check me? I don’t know). It took the doctor like 45 min to check me and I was STILL at 8cm. So I got more epidural. I asked the nurse later if the doctor had other patients and the nurse said no. Hmmm… why did it take her 45 min to come then, when I was writhing in pain?

3am: doctor came in, still at 8cm and she said the contractions WERE strong enough to be doing something so the worry is why they weren’t doing anything. The reason she said: the baby is too big to fit out vaginally and I should get a c-section. Her little speech went something like: we could wait forever to eventually make it to 10cm, who knows how long or how much pain at 24 ml of pitocin, and after all of that, we could get to pushing and it may not even work if he really is too big to get out.

Wow. That sounded like pure misery. I started sobbing – and this emotionless doctor and nurse just stared at me. Not a word of comfort or understanding. So Steve asked if we could have a few minutes to talk about it and they left the room. I honestly felt like we didn’t have a choice. I really thought we’d go through all the time and pain and have delivery not even work (by what the doctor told us). She came back in the room like 5 minutes later wanting to know our decision. I told her I felt like we had no choice and she said we do, but she recommends the c-section and that although that may not have been part of our “plan,” a healthy baby was part of our plan so let’s focus on that.

OK. Time for a c-section. 3:30am. The next post will be a bit harder to write–why I ended up with the c-section and what I think of it now.
pitocin to c-section

After writing the pitocin post yesterday, I cried for awhile. Just one of those nights. I talked about it for awhile on twitter (actually, I more just read what other people had to say and didn’t do much talking). Two things I noticed:

1) An incredible amount of people have a similar story. Why is it so “normal” to receive a c-section these days, especially unnecessary and most likely unwanted ones? What is wrong with medical staff that this is what it has come to? Everyone just wants to get home and when someone arrives who is moving too slowly (like myself, who was at the hospital for 24 hours before the c-section), the surgery is pushed rather than waiting for the natural, magical experience of birth. And it’s sick.

2) People keep telling me I’m amazing and strong and I don’t get it. I didn’t do anything… I sat on a delivery bed for 24 hours before being strapped down and having a baby pulled out of me. I didn’t do a thing. It’s part of what hurts the most–that I’m disappointed in myself–but thank you for the comments.

Anyway…. we had the c-section around 3am. They took me in first and about 5 people surrounded me to get everything ready–it was quick and confusing. They strapped down my legs, laid my arms out crucifix-style, and numbed nearly my entire body. I kept asking when they’d let Steve in and finally, he was there.
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I NEVER in a million years thought I’d end up with a c-section so I had no idea what to expect, I hadn’t read anything about them. When they were sure I was good and numb, they started. I could feel everything, but no pain. They cut through 5 layers of skin and muscle, at one point tearing through with their hands (I read about it after I got home) until reaching the uterus. They were moving so quickly, my entire body was jerking around on the table and I was squeezing Steve’s hand. To get the baby out they had to press on my upper abdomen (I don’t know why)–1 push, pull out the baby’s head… 2nd push, pull out the baby’s body. Yes, the pushes hurt–intense pressure, but only for a second.

When the baby was fully out, it was a crazy feeling… my back arched upward, I made some sort of groaning sound, and it was a huge weight lifted, pressure removed, sort of sensation. So hard to explain. I liken it to the feeling a woman must have when the baby is pushed out during a natural birth… and I hold on to having that.

They took Ryan over to a table to clean him off and everything–I couldn’t see a thing, but Steve could. I kept asking him if Ryan was ok and if he was cute and I was wondering why there was no crying, but I didn’t want to ask. I could tell Steve wondered too–his face was full of fear. Steve later said they were rubbing him/dropping him and the nurse was getting frustrated or something, shaking his head. But no worries, a short bit later we heard him cry and all was fine APGAR scores of 6 and 9.

They called Steve over to cut the cord and get some pictures, etc. then they brought baby over to me so I could see him. I was so happy and so excited, but I didn’t cry. Every time I thought of this moment for the last 9 months, I’d cry. But when it actually happened… I think I was so doped up I couldn’t. But no matter, I was happy. They took him away and Steve went with. The anesthesiologist suggested I take a nap. I tried, I sure felt like it, but they were putting me back together with more pulling and it wasn’t much of a napping environment lol. It took a half hour? Then they rolled me to recovery… Steve came to check on me and brought me ice chips because my mouth was SO dry and I had a terrible taste in my mouth. I was also shaking uncontrollably–from the morphine they gave for the pain. It was awful. I kept telling Steve to go back to the baby, but he was so worried about me, he was reluctant. But, of course, he went back to baby.

I think I stayed there for about an hour. I couldn’t sleep because of the shaking and I was trying SO hard to not shake every time the nurse came by because I thought they were waiting for that to stop before letting me go to the Mother/Baby unit. Fianlly, I went. I breastfed and we all fell asleep. It was probably about 5am by this point

C-Section thoughts and advice

Alright….

I do believe I ended up with a c-section because of my decision to get an epidural. As I said in my first birth story post, I don’t regret the epidural. I can’t. The pain was unbearable. So in that sense, I guess I should be ok with the ending c-section. But I also strongly feel that I was talked into it. I was worn down. And… after sitting in the hospital for 24 hours, I was exhausted.

For some women, an epidural helps labor progress because it takes away pain/tension and allows contractions to do their job. For probably the majority of women, an epidural slows labor down, and that’s where I fall. This led to breaking my water… then pitocin… then c-section. Why did I agree to pitocin? I’d rather have that work than end up in a c-section. Sadly, for me, it didn’t work.

A few months ago I was reading a story about how hospital nurses were starting to come forward and talk about how doctors were administering pitocin in high doses to purposely cause distress in the baby (“pit to distress”). Yes, I wonder about my OB… she had no idea who I was, we had no connection, she had no emotion. Plus, she upped my pitocin to a level of 24 when the max is supposed to be 20. Luckily, our baby never went into distress. His heart rate did rise from around 140 to around 160, but they never said anything about it.

What do I wish? I wish I had denied the c-section, at least at that time. I wish we had waited to see if I could get to 10cm and if I could have pushed this baby out. Too big to fit? Please, have you seen him?! 7 lb, 9 oz. I don’t think your body makes a baby it can’t fit.

But… no woulda, shoulda, coulda games. Right? It is very hard when people tell me that I got a healthy and happy baby and that’s all that matters. Of course it matters. And of course I’m deeply in love with Ryan. But it’s not the ONLY thing that matters… it doesn’t change the fact that I missed out on giving birth… one of the most incredible, natural, amazing experiences of life. I missed it. And when they were prepping me for the c-section and I asked the nurse what my chances were of ever having a vaginal birth, she said I most likely never would.
I know that’s not true. But I’m pretty terrified of it. Just a few weeks ago I overheard the receptionist at my clinic say a woman had just died when her uterus ruptured during a VBAC (vaginal birth after c-section) and that my clinic doesn’t even take VBAC patients (no loss there, I hate my clinic).

Yes, I’ve heard of ICAN and I’ve visited their site. They have no chapters where I live… I need to look into it more, just haven’t had time.

Yes, I’m disappointed in myself. And my advice for others??? If you’re completely serious about having an all natural birth, I’d look at a birthing center (or homebirth).

But, if you’re planning on getting an epidural and going to the hospital… I’d recommend a doula. I feel like if we had one there, she would have been able to remember for me what we originally wanted. She would have been able to stand ground for us when we were exhausted and confused. Who knows, I could have denied the c-section and still ended up needing one later. But at least I would have tried. I was at 8cm.. so close.. and I didn’t try.

Also.. just know what to expect. Know how things work these days and that it’s very possible you end up in a c-section or end up trying to be talked into one. Know what pitocin is and what it does. Know what you want and write it down to have it by your side–in the heat of the moment, I basically forgot what I wanted or why. Have an open mind.

I researched so much.. I knew exactly what I wanted and didn’t want… and this is how it turned out. Anything can happen. I wish I had known that.

Some of you mentioned you had questions for me… I’d love for you to ask. Anything, really. It will help me to help you. If you’d prefer to ask privately, email me erdickey(at)gmail(dot)com
Thanks again for all the wonderful support, it’s greatly appreciated and extremely helpful.

2 comments:

  1. I have noticed the same thing, that a lot of people have similar stories. My own c-section was due to fetal distress (I later learned was most likely due to the pitocin being up too high). It's known as a "cascade of interventions." In my case, it was slightly reversed, the pit led to the epidural which led to the c-section. I wasn't as well researched either and totally believed whatever the doctors said was in my best interest. Thinking back on it now, I would have spent a lot more time outside of the hospital (even though my water had broke and I thought I *had* to be there). And I, too, would have insisted on avoiding the pitocin. But one thing I did do which I am quite proud of is insist on having a VBAC, something I have done successfully three times now. VBACs themselves are not unsafe, although there are certain factors (type of scar, whether or not you're induced) which can affect the outcome. I also believe in having a supportive caregiver (for me, the best was a midwife, but I've a doctor and nurse who were also supportive). I just don't believe in letting fear stop one from looking at their options.

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  2. Uhg. What I don't understand is why, if your contractions were apparently strong enough, but your cervix wasn't dialating, that they didn't give you CERVAGEl instead of freaking pitocin! Cervagel (and I could be spelling it wrong, sorry!) softens the cervix and makes it dialate! And it sounds to me so I'm so confused why they didn't even offer it and only offered pitocin!
    I'm mad for you mama! I wanna kick some ass! I swear they just wanna have that baby on their schedule and they know how "weak" you are because of how out of it you are. They could probably tell you that...I dunno. If you didn't get an epidural your baby would come out green and you would believe it!
    And that stuff about HAVING to break your water to check for infection sounds like total bull to me. I'm sure it's an indicator (not for me though! Ty pooped while he was in utero and we both came out perfect and healthy! He got a 9 out of 10 on BOTH his APGARs!) but you can also tell just by taking your temp.
    And I know that they can monitor your contractions internally, but that's also why they put one of the two monitors on you when you're in bed! (I had two anyway, one that measure how strong the contractions were and one for Ty's heartbeat)
    If you make the decision to go for a VBAC, try a hot bath/spending time in a whirl pool (they had them in all/most of the rooms at my hopsital and I made sure to ask for one!). I jumped like 3cm in an hour and half in the tub! You just can't argue with that! lol
    I actually thought about a water birth (like our amazing Hethir!) with Ty and I thought about it when I was in there laboring but I don't think they would have let me do it in that tub because it was more of a bathtub that a tub they could have easily accessed me in and they probably wouldn't have all been able to fit in there anyways, haha! lol
    It's definitely going to be something I consider more seriously and discuss with my OB for this baby! :0]
    Best of luck mama. Just know that you made all the best choices for you and your baby considering the options you were given!

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