As my regular readers know, I was scheduled for an induction at 37 weeks for the cholestasis. Honestly I was relieved – this pregnancy was too frought with complications for my peace of mind. There was a little bit of scheduling for convenience involved – my OB wanted to be the one to deliver so she scheduled on a day that she was on call at the hospital.
I didn’t have any expectations for a perfect birth or anything – just wanted baby and me to get through safely and healthy. Actually no, I had one hope – that I not be starting from scratch (ie 0cm dilation). I think for me, my main fear wasn’t the pain but the additional time without food/nutrition – I knew my hospital didn’t allow anything beyond clear liquids and with my GD, juices were out.
The lead-up: On that Monday, I went to the OB’s for a checkup to see what’s the likely chain of events for the induction. Lo and behold, I was already at 3cm! (I hadn’t realized that the cervical check would be so painful!) Such a relief for so many reasons! I could skip the whole cervical ripening step. I didn’t feel like we were ripping baby out too early – he was on the way out anyways. The next couple of days, I was a bit on edge. When I looked up time durations for that stage of labor online, it looked like 3cm to 10cm could be several hours or several weeks and it was hard to tell where I was. I hadn’t really felt much – mostly some menstrual cramp like feelings. I was supposed to get admitted on Thursday evening but they pushed it back to midnight.
Mostly I just got increasingly antsy. I’m one of those people who get stressed anticipating something than during the process. I ended up asking my parents to come to the hospital until we got settled in for some extra moral support.
Early Labor: A little before midnight, we go to the hospital with all our stuff (there was so much!). My overnight bag with some clothes/toiletries/etc. Hubby’s bag. Electronics bag with laptop, tablet, chargers. Some snacks for us. We go straight passed triage into the L&D ward. It takes a couple of hours (mostly waiting for a room to open up) and then they hook me up to saline and pitocin. My parents head home around 1am.
At this point, the most painful thing is the failed attempt at an IV in one arm. They gave me a game plan for the induction — pitocin, breaking the waters at 4am and then wait and deliver. And then I doze. The nurses keep coming in and out to check on my stats. It’s kinda impossible to find a comfortable position to sleep. I can use the bathroom but it’s a bit of a production, dragging the IV line behind me. The monitors were actually kinda fascinating. I realized that the menstrual cramp type feelings I had been having actually were contractions. I figured if this was the worst of it, I could manage without painkillers but realistically knew that it would get worse the further along I got. I also get my glucose checked hourly and at some point, get put on a glucose drip.
Breaking waters: A little after 4, someone came in, used a hook thingy and broke my waters. That was not fun and I had to breathe through it a bit to manage the discomfort and pain. They also said that I was at 4cm which was rather a bummer – almost a week and I only went 1 cm! And they said it roughly takes an hour per cm so I was looking at ~6 hours of dilation and ~3hr of pushing. I continue to try and doze a bit but after that, the contractions start getting much stronger. I’m also starting to shiver at this stage which I’m told is normal.
Epidural: By 6:30am, the contractions feel like the worst of the menstrual cramps I’ve had – I’m curled up and just barely away from crying in the pain. From the beginning I said that I’d take an epidural if needed. They said that the anesthesia team rotates at 7am so I’d either need to get one now or wait till they change shifts. I contemplate waiting and then the next contraction is too painful so I ask for the epidural now.
Hubby’s been dozing at my side the whole time, waking up and helping when needed. For the epidural, he got kicked out and the anesthesia folks came in. I need help getting into a sitting position and hope that my contractions and shivering don’t mess up their field. My biggest fear with an epidural is them damaging something and ending up with migraines. I feel a pinch with the lidocaine shot and then not much else. It’s done relatively quickly and within 10 minutes, I get a huge amount of relief. They give me a button to press if I need more meds but it’s timed to release some every hour. They also insert a catheter because I can no longer stand up to go to the bathroom but I couldn’t feel anything by then.
Apparently when Hubby came back in, I had this look of bliss on my face. My legs were tingly but I could still move them. Beyond that, I didn’t feel much of anything. I could only tell that I was having contractions because the monitoring showed that. And when touching my tummy, I could feel my stomach harden.
In retrospect, getting the epidural was absolutely the best thing I could have done. I ended up dozing without pain for the next several hours. At around 10am, I told them that I was starting to feel rectal pressure (they told me to watch out for this since that’s a sign of the end-stages). I think they didn’t quite believe me but did a cervical check again (felt nothing this time) and voila, I was at 10cm!
This hospital was a fan of ‘laboring down’ where they let the body push the baby out further so the actual pushing needed by me was less. So I waited for another hour or so for the baby to descend further. This stage wasn’t painful per se (the epidural was amazing!) but it was increasingly uncomfortable.
Pushing: By a little after 11am, I had hit the point where baby was far enough and I could start pushing. This was probably the biggest surprise to me in the whole process – somehow I thought that pushing involved a few pushes and poof, baby comes out. Instead my OB was like, “first time mom, it’ll probably take 2-3 hours”. The nurse and OB taught me how to push (basically they grabbed my legs so I was lying down but my legs were in a squat and told me to push as if I was constipated). The whole process was really really hard work. Somehow I thought with the epidural, the hardest part of labor was taken way but pushing .. that was a marathon in itself. Both my nurse and OB were amazing – I definitely needed the encouragement to keep going because so many times over the next couple of hours, I just wanted to say, “can’t you pull him out?” With each contraction I had to push 3 times – they described it as the first two being needed to get back to the previous position and the last to advance just a little bit more. Two steps forward and one step back.
Hubby meanwhile was a surprisingly active participant. He’s always been a bit wary of blood but somehow was totally ok holding onto a leg and watching the process. And for all my natural prudishness, I was totally ok with my lower half being completely exposed and open for all and sundry. Not that there’s much choice. The nurse keeps changing the sheets under me and I have no idea if it was poop or blood or both. I ask how much I’ve lost and it’s higher than ideal but nowhere near the danger limit – something around 200cc.
I changed positions a few times – baby did better in some than others. I wanted to go on hands and knees but that’s also more tiring so I ended up switching between back and sides. When my OB suited up, I was so relieved – we’re almost there! Sometime after 2pm, he started crowning. Hubby told me later that he was a surprised at how little of the head he could see – just a sliver.
He’s here!: At some point, the biggest part of baby’s head is out and whoosh! in less than a minute his whole body slips out. Again a surprise – after all that hard work to deliver the head, the rest of the body took second to come out. Baby immediately starts crying – he’s here! He’s alive! And breathing! They lay him on my chest. I think he nurses, I don’t remember anymore. Mostly I’m crying and cuddling him and so happy. Baby cuddles up with me and clearly knows me. He stops crying after I shush him softly and we just lay there cuddled up while the doctors continue their thing.
Afterbirth: My OB massages my stomach and delivers my placenta. And I feel her doing things down there. I have no idea what’s really going on but another resident joins her and I feel occasional pinches from needles – so there’s some stitching going on. Through all this, I hadn’t needed any extra epidural top ups but for the stitching – I’m pressing the button like crazy. They try and take the baby for measurements but the same hormones that are helping keep him calm are helping me with the pain so they leave him on me. My OB says that I have a 4th degree tear which I vaguely know is worse than a 3rd degree which is really bad. It turns out that I have a ridiculously short perineum (which I’m still too scared to google to see where it really is) and even though baby was on the smaller side, it tore all the way.
We were lucky in that this hospital is one of the best in the area and there was a resident on call who specializes in 3rd and 4th degree tears. Between her and my OB, they spent around half an hour stitching everything up. The epidural did it’s job but (TMI), I did not enjoy the sensation of anything going into my rectum, be it needle or finger.
It took another hour or so for me to get cleaned up, covered and baby to get checked up. At this point, they gave me a dose of antibiotics and Norco. I have to say, I hated the norco. I have no idea if I needed it for pain relief but it made me so woozy that I was scared I’d drop the baby.
Doctors and nurses kept coming in and out to check in on me. At some point, an anesthesia doctor came to ask about enrolling in a study for 3rd and 4th degree tears pain relief. As much as it pained both of us to not be a participant in the scientific process, we ended up rejecting it because we didn’t want to be in the medicated arm – I had enough stuff going into me.
At some point my parents came to see the baby. I think they were rather stressed because it was a couple of hours between when we announced baby was here and they were let in and they didn’t fully know what was going on. Both were so happy – my mom kept tearing and my dad was happy in his gruff sorta way.
And with that, I was done and wheeled into the postpartum ward.
Afterthoughts: L&D was both easier and harder than I expected. Overall, I’m pretty happy with my experience. Getting the epidural was absolutely the best decision ever. It let me not get over-tired and rest before my actual effort was needed. It let my mind stay in the moment instead being consumed by the pain. I had expected to be walking around more and more active during labor but I realized what my OB meant by the work of labor is done by the induction — basically the point of moving is to help labor progress but since I was on pitocin, that was essentially managed for me.
Obviously I hadn’t expected such massive tearing but I’m surprised at how common serious tears are. I would tell a friend and they’d go “oh yeah, I had 3rd degree tears with all my kids.” My OB said that for a next baby, it would be better to go the c-section route since I’d almost surely have another 4th degree. Sigh, I can’t even imagine going through all this again.
Sometimes I wonder if I wasn’t meant to be a mom – I feel like I’ve been fighting against my body every step of the way. First all the meds and interventions to conceive him. Then all the meds and interventions to keep him (and me) healthy during pregnancy. And even during labor, clearly my body fundamentally wasn’t built for it. But at the end of the day, baby is safe and sound and present so maybe we can fight nature and it can turn out ok.
Still, it’s hard to imagine going through all this again. Another child will almost surely require the same interventions (even if PCOS comes under control with diet/weightloss/whatever, I have no idea what condition the tubes would be in). GD would almost surely reoccur. As would cholestasis. As would the 4th degree. Everything can be managed and intervened on but do I really want to put my body through this again? I don’t know. But I suppose I don’t have to decide this now.