Tuesday, March 27, 2012

Four Years Later: Reflections on 40 Weeks of Feeling Like a Failure

38 weeks pregnant with the baby then known as Pie.

This is the story of much of my first pregnancy.  A pregnancy that was high-risk and subsequently highly-medicalized.  This is the story of how I became Bean's mom.  Some is also a story of how our maternity care system is flawed - especially for those of us who do not have the safe option of avoiding the medical model altogether, and who need some medical intervention.  I'm sure my readers who are particularly knowledgeable about birth will shake their heads at least a few times.  Some might say "Ah well.  He arrived.  You are safe."  And that is true, and I am grateful - every day - that the end result is what it is.  It didn't always need to be the way it was, though - so frightening, so detached.

And I went on to have a calmer second pregnancy, and a very normal, beautiful, wonderful birth of my second son.  And we are healed now - The Beast, and I.  (He was there, too.  And he, too, was scared.)

Four years ago today, I was exactly 39 weeks pregnant with a baby we called Pie.  I had been on strict, side-lying bedrest for 9 weeks.  I was in excruciating pain and often had trouble walking, getting up from sitting or laying down, rolling over, and even getting my pants on. 

I had by that time spent two nights in the hospital with fears I was in preterm labor - once at 24 weeks, and again at 34 weeks.  The 24-week hospital admission was only slightly terrifying.  Our baby was barely considered viable, and there I was having small contractions every 10 minutes like clockwork after heading to the hospital because I kept doubling over with abdominal pain.  But I somehow knew that these contractions weren't "the real deal."  My cervix was found to be closed up tight, the fetal fibronectin test negative (a good indicator that labor is a ways off), and eventually - with the help of a Coca Cola of all things - my contractions petered out and I slept for a few hours - with the help of an Ambien.  Hospitals are not great places for rest or relaxation, and definitely not for sleep!

I was sent home feeling like I'd run a marathon on my uterus.  Diagnosis:  "irritable uterus."  And maybe some round ligament pain.

Sometime around this point, I had told my OB about pain I was having in my pelvis.  "That can happen," was his response.

::Fast forward through my blood pressure creeping up, finally going completely haywire, and landing on bedrest at 30 weeks::
At my 34-week appointment, I had a non-stress test (NST) to check on Pie's well-being.  I had these at every appointment after 30 weeks, when my blood pressure went haywire.  The night before this 34-week appointment, I had lost my mucus plug.  I didn't think much of it.  When the nurse asked how I was doing, I told her I'd lost my mucus plug, felt pretty good aside from the nagging pain in my pelvis, blood pressure was controlled on bedrest, etc.  She definitely perked up at word I'd possibly seen my mucus plug, because it indicates the cervix is changing in preparation for birth.  I was aware that I could have some changes but still go beyond my due date, 6 weeks away.

The nurse got me hooked up to on a contraction monitor and a fetal heartrate monitor, gave me a button to press when Pie moved, and had me relax in a recliner.  I had some tightening in my belly and chest - a common occurrence that I chalked up to Braxton-Hicks contractions, which I had with some frequency throughout that first pregnancy.

I had this tightening four or five times during the 20-minute NST, and the arcs of the contractions on the monitor looked large.

A nurse practitioner was summoned to do a cervical exam.  A really. uncomfortable. cervical exam.  Wow.  After some tears - from both fear and pain - the nurse practitioner told me I was "50% effaced and a fingertip dilated.  Baby is at 0 station"

I bawled.  But I took comfort in saying to The Beast "they can stop it.  If it's labor, they can stop it."

My OB came in and told me that, as I was 34 weeks even, they would not stop it if it was labor - there was no benefit to stopping it at this point.

Eventually I was wheeled over to the OBICU's triage area, where I was kept for a few hours.  Despite sipping copious amounts of water and juice, I contracted regularly - about every 3-5 minutes at the most frequent.  Exams still showed I was "50% effaced and a fingertip dilated.  Baby is at 0 station."  The contractions weren't causing my cervix to change.  But I still would be staying until either the contractions stopped or I had my baby (so, I guess until the contractions stopped, one way or another).

After the contractions petered out in the night, they were again attributed to "irritable uterus," but this time paired with another prescription of bedrest, as well as "pelvic rest" - which is essentially a euphemism for "no sex." 

From that ordeal, I did more reading (not much else to do when you're on bedrest!) and found out that the contractions likely looked "strong" because I am thin.  Those external contraction monitors don't account for how much fat is between the uterus and the outside world.

Understandably, The Beast and I were showing some wear at my next appointment.  After some discussion with my doctor (including the fact that amniocentesis to confirm the baby's lungs were mature-enough for birth was a poor option because of the location of Pie's placenta), we scheduled an induction for 37 weeks, 4 days.  I was not feeling like I could mentally handle the ups and downs and sometimes-terror of the pregnancy anymore...

Eventually, after much soul-searching, discussion with my obstetrician, and research, The Beast and I decided to forego the induction.  A day or so after the induction had originally been scheduled, my pelvic pain worsened.  (For anyone keeping track at home, this was right around the time I called BABS because I couldn't move, and a doula named Molly came and helped me take a bath.)  I went to see my OB, hoping he could do something about this debilitating pain. 

Another NST was administered.  To this day, I don't know why this was done, since the pain I was having was musculoskeletal.  I suppose because it was an obstetrics practice and they didn't know how to deal with a mother's musculoskeletal pain, but they did know how to get a listen to a fetal heartrate?  In the end, I would feel that this entire appointment was torturous and at least a little humiliating.

They couldn't get a solid trace on the baby's heartrate on my left side, so The Beast picked me up (as I screamed in pain) and turned me to my other side.  Still not a good trace.  He picked me up (as I again screamed in pain) and laid me on my back.  Perhaps a minute or three passed with tears welling up before I felt a different sensation and said, "I'm hot.  I'm so hot."  There was no ventilation to be had.  A damp washcloth was placed on my forehead and the nurses assured me we were "almost done."  I was becoming increasingly uncomfortable and agitated.  And then I was panicking.  "I'm going to throw up or pass out.  What is happening?  I'm going to pass out!  I'M GOING TO PASS OUT!"  All while stuck on my back.

I couldn't even sit myself up because of the pain for which I had come to the office.  It turned out that laying on my back was the culprit for the nausea and light-headedness.  There is a reason pregnant women are advised not to sleep on their backs (and why they don't feel comfortable sleeping that way anyway)!  My uterus and its contents were putting pressure on my inferior vena cava

The obstetrician came in and essentially gave me another "that can happen."  He then looked at my chart, measured my belly, and said, "well, this baby is big.  You weren't induced, and you're going to get to 40 weeks and this baby is going to be too big to deliver vaginally." 


Then, finally, I said, "and what about this pain?  Can I do anything for this pain?"

I left with a prescription for Vicodin and the feeling that my doctor didn't give a sh...hoot.

The Beast and I returned home to finish out my house arrest pregnancy.

The pictures of me at this point all look, well, young is my first impression.  But I also look a bit wary.  I am scared.  I am tired.  I am self-doubting.  Have I made the right decisions for this baby?  For myself?  For my family? 

And always, since I had sat alone in my car with a hand on my still-flat stomach and asked my newly-discovered occupant to please not kill me, there was that nagging, horrible question:  Am I going to die?  Are we going to die?

At my 39-week appointment I saw a different doctor, as mine was out of town.  She was a brusque woman and I was annoyed that she didn't know my history.  My regular OB was clinical and cynical and not particularly warm, but at least he was familiar.

I told her I had been admitted at 34 weeks, on bedrest since 30 weeks, and the cervical exams I'd had to this point had all concluded that I was "50% effaced and a fingertip dilated.  Baby at 0 station."  I was really hoping for progress since I would be induced in about a week (going much beyond my due date has never felt like a good idea in my pregnancies - I feel like a ticking time bomb by the end, wherein my body is counting down to devastating illness and/or the birth of my baby).

Completing the exam, she had a disapproving tone as she said, "50% is generous.  Maybe 25%.  Still just a fingertip.  I'll give you 0 station.  Barely."

And so I left the office feeling like I had failed.  Had my body gone backwards?  Had I really been admitted to the hospital for potential preterm labor - twice - only to have my body decide never to give birth?  I knew the baby would be forced out of me one way or another...but it felt like my body was flipping me the bird.  It also felt like the doctor I saw disapproved...or at least didn't give a sh...hoot.

I still recall, vividly, walking with The Beast from the clinic to the parking garage and starting to cry.  "I'm so sorry," I sobbed.  "I'm so sorry that I am so bad at this.  I'm sorry I'm a wreck.  I'm sorry you have to take care of me.  I'm sorry my body doesn't work.  I'm so sorry."

He held me in the breezeway while I cried.  36 hours later I woke up in labor.
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