Tuesday, March 3, 2015

Makua's Birth Story

Short: Makua James Pahukoa was born on January 27th, 2015, at 1:14 AM. He weighed 9 lbs, 9 oz, and was 22.5 inches long.

Long: My due date of January 16th came and went... a familiar feeling by now, on this my third pregnancy. I was determined not to induce labor after my experience with Liloa. My delivery was complicated and painful, augmented by Pitocin and an epidural, and my recovery was long and even more painful. I thought that if I could avoid an induction, I could have a better delivery and recovery, and because I was still enrolled in school half-time and had two other young children at home who needed me, a speedy recovery was my top priority.

During the week after my due date, I had two NST's and AFI's to make sure baby's heart rate and the amniotic fluid level looked good. My doctor was okay with me going as long as 42 weeks even though baby would be pretty big by then. I was uncomfortable but willing to wait; I trusted my body and my baby to know what to do when the time came, and thought that no matter what, I could handle it.

On Monday the 26th, I had a checkup with my OB, followed by my second NST/AFI appointment at the hospital across the street. My OB checked me and found I was still 5 cm dilated and 80% effaced, the same as the week before. She stripped my membranes for a fourth time, and we discussed how I could possibly still be pregnant. I remember her saying "That's insane. That's a crazy check for someone who's not in labor," referring to my dilation and effacement. I just laughed, because of course I went past due. I'm not sure why I ever thought I wouldn't. We talked about how my first two babies were OP and I said I thought maybe that's why this baby hadn't come yet; he was in a bad position and not putting pressure on my cervix. She admitted it was possible and decided to do a quick ultrasound. We found that he was head down, but facing sideways and not engaged in my pelvis. Just as I'd suspected.

My OB decided that we could do the AFI right then, since she already had the ultrasound machine on me, then said we should just do the NST in the office as well to save me the trip. We discussed induction, and talked about her schedule. I wanted her to be the one to induce me if it came to it, so I was looking at either the coming Wednesday or Friday. Wednesday she was available all day and night, as it was her on-call day. Friday she was available off and on. Friday was 42 weeks.

After thinking it over during my NST, we decided Wednesday was better. We talked about starting the induction with methods other than Pitocin; she was of the opinion that she could just break my water and I'd take it from there with no problems. I was skeptical but thought it sounded better than Pitocin. I signed the paperwork agreeing to the induction and privacy practices, and let everyone know that that was it. We were scheduled to have a baby in 48 hours.

That evening, I was thinking a lot about baby's position, and how my first two were OP, and remembered hearing about Spinning Babies. So I pulled up the webpage on my phone and started reading. I found a few exercises for moving babies who were OP, and thought I'd try them, until I saw a link to another exercise that said "try this first." It was the side-lying release, meant to evenly open up the pelvis to allow a baby to engage. I read it over a few times, then enlisted Chris to help me (since you need a partner) and did the side-lying release for a few minutes on both sides.

While I'd had braxton-hicks contractions since 18 weeks, I remember thinking "These contractions kind of hurt" at around 7:30 pm, half an hour after I'd done the side-lying release exercise. I kept shifting positions to try to get baby in the right spot. I did lots of stretching. Lots of hands and knees, cat stretches, and hip circles.

At around 8, I helped the kids through their bedtime routine, finishing up their bath, tucking them in bed, and thinking "This might be it," as my contractions continued intermittently and uncomfortably. While I wasn't ready to admit it was true labor (I was scared to even think it for fear of jinxing it) I thought it would still be a good idea to finish packing my hospital bag and pulling together the last-minute things I thought I'd want.

Around 10, I was in bed, trying to rest. I had gotten really sleepy and almost wanted the contractions to stop so I could sleep, but they didn't. I'd downloaded a contraction timer app on my phone, which seemed silly at the time but was immediately helpful in watching for patterns. I saw my contractions get longer, and the intervals shorter, and finally texted my mom at 10:30 to tell her I was in labor but didn't need her yet. Originally I'd planned for her to come stay with the kids if it happened at night, but I decided I might want her with me instead. Stuck with the indecision, I just told her to wait. I can see now how that was kind of mean! I got her all keyed up and left her hanging. But after that, things started happening kind of quickly.

I told Chris about the few last minute things I wanted him to do. He kept coming into the room to check on me, but I was just laying on the bed in the dark, taking it one contraction at a time. I kept feeling like I needed to pee, so I was up and in the bathroom between almost every contraction. It felt good to rest between them until about 11 PM when Chris's mom came over. He'd called her to come stay with the kids in case I needed my mom to come help at the hospital. By that time, I was swaying a bit with every other contraction. Some of them I wanted to lay down for, some I needed to move through.

At 11:30, I was just thinking that the contractions were getting too intense. I had two back-to-back that were painful and immediately felt like I had to pee again. I got up and took a step toward the bathroom and felt a warm gush, and knew that my water had broken. I hurried the last few steps and made it to the toilet, peed, and tried to get the water to slow down. I had to swap out my undies for dry ones, but didn't think to put a pad on because I wasn't really leaking any more. I grabbed my phone and headed out to the living room where Chris and his mom were sitting on the couch. I said, "It's time to go. My water just broke."

Chris jumped up and started running around grabbing our bags while Bridgett helped me get my shoes on. There was a short discussion about which hospital to go to; I'd wanted to go to Southwest, even though we were closer to Legacy, because I'd had a better experience there. Bridgett wanted to know if I was up for the longer car ride but I knew what I wanted. We took the Blazer, and we still joke about how Chris "took his time, meandering down the back roads" to get there. Hah! I think we made that trip in record time. I had 3 contractions between our house and there, including the one in the parking lot, and my contractions were only about 3 minutes apart by then.

We got inside and went to the desk to check in. I wasn't sure what the date was so asked "Is it Tuesday yet?" Everyone looked at the clock, and the second hand swept past the 12. It was 12:00 AM Tuesday the 27th. Chris and I said "Looks like baby chose his birthday after all."  I was taken to Triage and checked out, contracting the whole time. I was 8 cm and 90%, and not at all sure I could do it without drugs, but wasn't about to ask for them.

I was helped into a gown in Triage, and things get a little fuzzy from here on. I remember most of it, but was so focused on my body that I lost my sense of time and wasn't able to communicate very well. The nurse who took us from Triage to our room was very nice, and she talked to me the whole time about her experience in Alaska, helping native women delivering, and talking about the beauty of birth. Her name was V (I think). We heard harps and chimes on our way to our room and she said "Ah, another angel has entered the world." I learned later that that music is played each time a baby is born there. A nice touch!

In my room, Chris put our bags away and everyone else got busy. V was prepping something. The on-call OB (Dr. Morgan) came in with a young male resident and asked if I minded if he tagged along. It's a learning hospital, and I was gonna give this kid a lesson in natural childbirth! I said I didn't mind, and went back to focusing on myself. Leaning over a table during contractions felt good, as did walking. I did both until I had to be checked again. I didn't want to lay down, but did it anyway, and found I was 10 cm and probably 98%. I just had "a small lip of cervix" left.

My nurse was very helpful and coached me through my contractions, reminding me "low, low" when I'd start to get breathy or breathing high. Eventually I was almost growling through those contractions. My doctor and nurse had left the room for... something. Just then, I started feeling pressure. I said so, to nobody in particular, and went back to concentrating on my body. Chris told me later that the resident was the only one there besides us, and he kind of freaked out and started suiting up like he was prepping for a natural disaster.

When the OB and nurse came back, there was a short discussion. Suddenly I felt like maybe pushing through a contraction would feel good so I pushed just a little. It did feel good. Then I was being ushered to the bed while trays of instruments were uncovered and wheeled over. My nurse coached me through a couple more contractions, saying I shouldn't push yet because of the lip of cervix. She had me doing the "he - he - he" Lamaze breathing technique to keep from pushing while the OB helped to push the lip out of the way.

Suddenly, I was told it was okay to start pushing. With the next contraction, I pushed. I was in pain but knew it would get better, and the most prevalent feeling was intensity. Chris had one leg and V had the other. I was on my back in the bed but feeling okay with it at that point. Baby had turned and was moving down exactly how he was supposed to. With that contraction, I got baby's head just to crowning. I could feel how far I was stretched. The OB was pouring mineral oil on me and massaging, trying to get the skin to stretch instead of tear. I lost my contraction there, with everyone cheering me on, and baby's head crowning. I remember thinking "I can't do anything but this" and panting a little as I just... held him there. I couldn't push, I couldn't let him slip back. I waited a full minute for my next contraction, just holding baby right there.

With the next contraction, I pushed again. The OB was telling me to push, Chris was repeating her, and V was offering praise. Baby's head came out and the OB said "Reach down and feel your baby!" I was in a trance at this point, overwhelmed by everything happening, and said "Oh, I can feel him all right!" But I didn't reach down. The contraction was still squeezing, I was still pushing, and baby's shoulders were stuck. One was out, one was in, and there was a scramble while I was told to keep pushing, keep pushing! and the doctor and resident both had their hands on me and baby, trying to get his second shoulder out. Everyone was saying he must big, and I knew I was SO CLOSE to delivering him and SO CLOSE to being done. I couldn't take it, and started yelling at them to just GET HIM OUT already. I pushed again, and felt his second shoulder come out, and V said "Just a little one now, just a grunt," and I gave a little push and delivered my baby, all natural.

There were lots of comments on his size, and when they put him on my chest I knew he was a big boy. I delivered the placenta and got 2 little stitches, all while snuggling Makua. When I was fixed up a bit, they took him to weigh him and everyone was astonished at how big he was, and how well I did. I felt really good afterward. I got that endorphin rush I'd missed with the other two, and even though it was just after 1 AM, I had enough energy to eat, drink, nurse Makua, laugh with Chris, chat with my nurses, and (finally) go pee.

We stayed the rest of that night and the following night, opting to skip the 2nd full night my insurance would have paid for in favor of our own bed. I had sore nipples from the start but requested a shield, shells, and lanolin, and met with a lactation consultant. My milk came in before we even checked out of the hospital, and Makua was a good eater, except that he'd fall asleep after only a short time on the breast. This manifested in other feeding issues, but that's fodder for another post.

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