Well, we made it! Lillian is here, and she is beautiful. Both of us are doing well if not a little sleepy, but that was a heck of a ride there for a bit.
Honestly, I think the anxiety of cholestasis is the worst part of it. Well, sleep deprivation which ultimately feeds into the cholestasis anxiety. Clinically, my brain understood there was a super low chance of anything happening to her even if we did nothing. The stillbirth rate with cholestasis is low at about 3%. That is, however, a fair bit higher than in a population without it which is around 0.6% So my heart, however, screamed ‘Stat cesarean!’ every time I didn’t feel her move constantly the last few weeks of my pregnancy. Fortunately, I can’t make those calls. And again, you tell a sleep-deprived mother of an IVF baby that she’s got any sort of increased risk of stillbirth, and she’s likely to be a little stressed and emotional.
So, overall the induction was great, I think. It was much different walking into L&D, not in pain, not scared to death thinking my baby was already dead after an obnoxious amount of bleeding at home, and not feeling him move. That was Matt.
...This is probably gonna go long, so I apologize now...
PROLOGUE
There is this thing called being born en caul where your baby comes out inside an intact amniotic sac. To sum up my labor and delivery with Matt, he basically wanted to one up the en caul thing and just be born in my completely prolapsed uterus. His head was low enough (+1) to give me the urge to push, but I was barely dilated. It was stupid. Plus the bleeding from an unknown source...I was contracting frequently enough that the decision was made to go ahead and break my water. So I went from feeling every 3rd or 4th contraction to being on my hands and knees in the floor of my hospital room trying to call my own stat section with no relief between contractions and wanting to push. I felt like I was being torn in half. So I tried a hit of IV pain medication which only served to make me feel exhausted, nauseous, and still in pain. So then I went for the epidural. It took 4 attempts because I am 5 feet tall and have no extra disc space. When the epidural was placed successfully, and I finally got comfortable, it was time to push. I remember asking if I could labor down (when you let a first time mom continue to labor without pushing at full dilation to let the baby come down further into the birth canal), Martha my nurse, just shook her head and said, “You’re already labored down.” No rest for the weary. When I stopped fighting my contractions, apparently I went from nothing to complete in no time. Matt was out fast enough that my OB had to catch him barehanded. (Gross.)
Aside from being super cheesy (vernix and amniotic fluid really gross me out - I know...considering I came from antepartum and L&D as an RN...but it is my truth and I learned to work around it and dodge splashes as much as possible), Matt was beautiful and healthy. I am forever grateful to Martha and Liz, my nurse and doula for helping make what was a pretty traumatic start for us turn out so well. Even though Matt was only 37.2 weeks along (hence the super cheesiness) he did great and met all his markers to stay out of the NICU or need extra monitoring which I was warned he may need. Since he was a “wimpy white boy” (little white males are notorious for crumping in the NICU) this was a welcome relief. In fact the pediatrician that did his initial assessment asked if we were sure we had our dates right. I told him since he was an IVF baby, we were pretty confident.
Recovery-wise, I did end up itching from the epidural, and the next day, like the anesthetist warned me, it felt like I had been in a car wreck. My back felt sprained from the 4 punctures. It actually took a couple of weeks for that to resolve.
So that was my previous birth experience...nothing, then panic, then well, OK...and then praying for a stat cesarean because it felt like I was tearing in half with no relief between contractions, then fast and furious.
So again, just pleasantly checking in to L&D with no drama was a much better start. I was a little nervous since Lillian was so much higher, that this would go long, but, I mean...what else was I gonna do that day? If it meant I got to listen to her heartbeat longer, and I was in a place where we could get her out in less than 5 minutes if something went awry what’s the downside? We were escorted straight to our room, past triage. In two pregnancies, I’ve only been to OB triage once, and I was admitted, so I think that’s not too bad. As a nurse in this field, I always feared the “walk of shame” when they sent you home from OB triage because you were not in labor. Mission accomplished.
CHAPTER I- The Birth Plan...or lack of...
My nurse, Joy, popped in to introduce herself. She was incredible. She let me change into whatever I wanted so I put on my fancy maternity t-shirt and 7.98 athletic shorts from Wal-Mart. Annoyingly, Wal-mart was sold out of the 3.88 ones (#thanksCOVID).
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| My labor amongst friends look...with the “fancy” Wal-Mart shorts... |
We discussed my “birth plan” or lack-there-of. It was officially “One day, the baby will be on the outside.” I did enough OB and antepartum nursing to know that birth plans are basically a kiss of death. Less to nothing is absolutely more. I mean if you had a birth plan and it worked exactly as you thought it would, then I would consider you extremely blessed. But 99/100 times, things don’t go exactly the way you thought they would... For instance, I never thought I’d have to be induced. If anything I was a little worried I would have a premie since I was early term with Matt. Yet, here we were.
You may think since I hired a doula that I had this grand plan of giving birth in the woods and eating my placenta, but you would be grossly mistaken. I have to hire a doula to be my birth partner because BJ hates any and all things medical. He would prefer the waiting room 1950s sitcom style with a single-malt scotch and a cigar...God knows I love him, but let’s not waste time, and call a spade a spade. Honestly, BJ needed a birth partner so he wouldn’t panic.
So Joy had to ask me about each option since I had no plan to give her. This included an epidural, nitrous oxide (laughing gas), IV pain meds, birthing tubs, and movement. There are tons of options. And, there are tons of good reasons to choose any/all/your favorite combo platter of the above. I can’t stand the smell of nitrous, nor do I remember getting much relief with it when I was a child having to have some baby teeth pulled. I tried a dose of IV morphine when I was being torn in half with Matt, and all I got was really tired but in too much pain to sleep.
A birthing tub...I’d rather die, personally, than be in a bathtub stewing with my own...hmm...stuff. That utter, from the pit of my soul, disgust of amniotic fluid and vernix applies to my own as well. I hear people compare a birth tub to an epidural for pain relief and how wonderful and soothing they can be, but it’s just a hard no from me. [shudders...then wretches] Seriously, I’m not kidding about my issues with amniotic fluid.
I do like to move, be distracted, and not feel like a patient. Fortunately, I delivered at a hospital that has wireless fetal monitoring and allows for that. I eagerly employed that option.
Epidurals-they are incredible and despite the difficulty I had getting it placed with Matt, it very well may have saved me from needing a cesarean since I quit feeling the urge to push with an all but closed cervix. And it’s also super nice to have for any repairs. (Thank you Matt for giving me first hand experience with that, as well...) People choose to go without any pain meds for any number of reasons. Some women want to feel that urge to push...me not so much. I’ve been constipated before... Some think not having an epidural hastens labor. It’s been about 5 years, but the last study I read said epidurals only increased the time laboring by an average of 20 minutes. That didn’t persuade me one way or the other. I did have some itching with my epidural with Matt, and after not sleeping consistently for the last 6 months due to itching, this was a big con for me. Seriously, at this point the thought of anything that caused more itching made me cry. I also liked the idea of no puncture wounds to my back since that was an unpleasant addition to my recovery with Matt. There is also a lot to be said for being in control of your body- as in not paralyzed and being able to get up after your birth and shower...bc let’s be honest...birth is the messiest miracle I’ve ever been privileged to share with my patients or experience myself. [I’m not going to wretch this time...]
So, for me, to be completely frank, the biggest contributing factor in attempting an unmedicated delivery is that I have a deep-seated hatred of anesthesia bills. Apologies to all my friends in anesthesia...it’s not you, it’s your billing departments. Their timing is always the worst. You are feeling all well and recovered, you’ve received endless EOBs in the mail, and you’ve paid any number of medical bills. Then, when you are are feeling like life might continue after...oh, for funsies, let’s say a failed IVF cycle with no embryos to transfer for example, and you’re about to purchase a pair of brand new Tieks to show the world you are more than your failing ovaries, and then BAM- a $400.00 or more bill shows up out of nowhere. That’s at least two pairs of Tieks, y’all! Again, I get these bills either for a procedure that didn’t work, a surgery that didn’t answer any questions, so my motivation for going without an epidural was one of mostly spite with some of the above reasoning sprinkled in...I am who I am.
Anyway, I’m not some super-crunchy mom, in fact, I’m the opposite and a huge proponent of better living through chemistry in most every other situation. Whatever your reasons for choosing any number of options, nobody should judge you for that or make you feel like you have to justify it. You’re absolutely right about what you need pain control-wise for labor.
So yeah, that leads us to the other big things with the birth plan... Who will cut the cord? ...Well, not BJ. The goal for BJ is for him to not pass out or become a patient himself. He can’t do blood or tissue so an umbilical cord is a marriage made in hell for him. My fabulous and wonderful doula, Liz, would absolutely be cutting the cord. And if I need a cesarean, and can only have one person in the OR with me...I choose Liz...I love BJ, but we both know this is the only way our marriage would survive.
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| The one and only Liz...#myactualbirthpartner |
Joy asked about skin-to-skin, which means they immediately put your vernix-covered [wretch] 37 weeker on your bare chest. Forget the greatly increased pain of childbirth, vernix on my skin, whether it’s my patient’s baby or mine...always made me wretch, and there is no epidural for that. Newborns are hot, slimy, and purple before we clean them up, douse them in Johnson & Johnson, and let them pink up. Since I’m too miserly to pay for an epidural, I’m also too miserly to pay for formula. Skin to skin as soon as possible after birth is the absolute best for encouraging breastfeeding...so here we are. Only the best for my miracles, so...check (begrudgingly) on the skin to skin. Also being a healthcare worker in this field, I would feel very guilty refusing evidence-based practices, so...as my mom would often tell me, ’Buck up, Buttercup.’ There were maybe a couple other things like delayed cord clamping and baby meds, which I honestly don’t spend much time following the research on this end of pregnancy. I trusted my medical team so I was happy to comply with the standard of care.
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| The “No Plan” plan... |
CHAPTER II - Inducing Labor
So by 9:06, Liz was with me, I was on the monitors, had my IV, and receiving my first round of antibiotics. Dr. Barry came in to say hello and ordered an intermediate protocol of Pitocin which just means you can increase “The Pit” by 2 milliunits every half hour. Joy had my heart at her diligent titration of my Pitocin.
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| Taking the pit like a champ... |
You should know that as a former floor nurse, working with another healthcare professional as your patient falls into one of two categories. 1.) Super critical hypochondriacs that drive you nuts, shake all your confidence by questioning everything you do for them, likely to stress themselves into a crump, and are basically a nightmare. Or...2.) Embarrassed to be a patient, try to do everything for you because they are embarrassed to ask for help, assume you are too busy to help them, wait too long to report a problem to you because they try to rationalize it as normal until they crump, and are basically a nightmare. I am a category 2. I’ll adjust my own monitors and try to manage myself as much as possible as not to intrude. I apologize anytime my nurse has to do their job.
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| Exhibit A: When you’re a cat. 2 you reapply your own US gel and get the baby back on the monitor, yourself. |
I thought with both Matt and Lillian, that I would diligently be watching my tracings from the fetal monitors, but I can say, as long as I heard their heartbeats I almost didn’t care. Turns out I didn’t need the monitor to tell me when I was going to be in pain.
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| BJ, myself, and the trusty mascot of this pregnancy - my cherished back scratcher. |
It took a little bit for me to feel my contractions, but the plan was to break my water after my second dose of antibiotics was in which would be around 2:00pm. I will say, I was hoping it would just take a whiff of pit to get me going, but that was not the case. Unlike with Matt, Lillian was not so eager to be on the outside. So I “labored” by enjoying my company which included my mother, BJ, Liz, and Joy. We made fun of my labor playlist which included a lot of late Gen X favorites from Dave Matthews, schmaltzy love songs like Peter Cetera’s Glory of Love, Johnny Cash’s Ring of Fire, and an array of other things that were added to the list entirely for their entertainment value over their ability to induce a relaxing environment.
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| Trying to prove to Liz that I was feeling my contractions by appearing distressed. It didn’t work... |
So from 9:00 to 1:00ish, I had a grand old time. I used the exercise ball, peanut ball, walked the halls and visited with my former co-workers since I delivered where I formerly worked as an RN. Unbeknownst to me, Liz was using some spinning baby techniques to encourage Lillian’s head to drop. For most of the morning Lillian stayed on the monitors pretty well, or I was able to adjust and get her back on myself [category 2, remember]. I was starting to feel the contractions, but they were not near as hard or furious as when I had Matt. I was relieved for the lack of pain, but a little concerned that I wasn’t making much progress.
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| Feeling cute...might actually go into labor at some point... |
I got my second dose of antibiotics and the contractions were getting more real around 1:30pm. Lil started throwing some variable heart rate decelerations and my contractions were not picking up as well. I got a fluid bolus, changed positions etc. We went through this a few times and the extra IV fluids would fill my bladder which would make my contractions hurt worse, and possibly cause variables, so that’s a fun little circle you don’t experience with an epidural and a catheter in place.
Around 2:30 I was in the middle of my contractions being painful enough to make me laugh - because that’s what I do when things are moderately painful and you can’t do anything else about it - but the contractions were not tracing on the monitor very well so I wasn’t getting any credit for them as far as MVUs (Montevideo units that measure the intensity of contractions - important for Pitocin inductions because you don’t want to squeeze the baby to death or rupture a uterus). So I was in the middle of a position change, readjust the monitors, fluid bolus, peanut ball, waiting for the doctor to perform the AROM (artificial rupture of membranes, or when the doctor breaks your water with an amniohook) - kinda moments when all the sudden it felt like I got punched in the crotch. I actually said ouch and then started laughing, and then I felt a gush of fluid...SO GROSS. When I was the nurse for an OB patient about to be AROM’d...I had layered everything up with chucks and towels. I would try to wick up as much as possible so they would not experience this moment. And that’s how it was done for me when I was AROM’d with Matt. And here I was, caught unaware in what seemed like an endless tidal wave of mess...All I could do was laugh...and the last thing you want to do when your water breaks is rush to a vertical position until you’ve established that all is well and good. So it was a minute between getting the baby back on the monitor and making sure nothing complicated like a cord prolapse had occurred, before I could get up and put an adult diaper on. So I just laid there complaining about how gross it was like the trooper I am. [shudders...] (I am a proud proponent of Always Discreet Boutique for your intrapartum and postpartum...issues. I mean what says I am in control of my own body better than a black adult diaper?)
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| On my throne Liz prepared. Trying to get Baby Girl to engage... |
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| More Liz and Joy magic... |
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| EW...it worked...lemme up... Amniotic fluid all over my gown... #gagme |
CHAPTER III - Jesus Take the Wheel
I was mentally prepared to lose it right around now. With Matt, after my water broke it was just constant pain and pressure that I was not prepared for. So I was greatly relieved to realize the pain stopped when my contractions stopped. I also could feel Lillian pushing at the top of my uterus with her feet with her stepping reflex with each contraction which was pretty neat. So I’d have a little pain, then I’d feel two taps as her feet pushed against my fundus and then it got real, but only for about 30-40 seconds of each contraction. I walked the hall again with all the confidence a woman can have in her Always Discreet underwear. The big difference was that I went from wanting to stop walking during the contractions, to having to stop walking. I didn't have a lot of control over my lower half, or at least it felt like I couldn't withstand the pain and continue moving. Those hip squeezes Liz and BJ did were amazing relief. I don’t know how I would have coped without them.
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| I can have a contraction or ambulate... |
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| But not both... |
Joy had palpated a few of my contractions and still wasn’t happy with how they were tracing, so internal monitors were recommended. I was really hoping to have made some progress at this point, because I was not sure how long I could keep my happy-go-lucky, and overall pleasant demeanor. I had not made a lot of change at this point, but between Joy checking and Dr. Barry placing the internal monitors, in less than a half hour I’d made some progress. Once the internal monitors were set, you could see I was having strong contractions...I personally did not need to see that because I was feeling them.
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| When the external tocometer betrays you... |
Around this time I grew to have a better understanding of how people could become infatuated with inanimate objects. For me, the left side bed rail became my very best friend in the whole wide world. Not the right side bed rail... The right sided bed rail was a feckless dud, but my left side bed rail provided me with companionship and comfort during the worst 30 seconds of my life every two minutes or so. I mean Liz and BJ were great, but the bedrail was my comfort object. It let me squeeze the life out of it without ever leaving me. It never complained. So shout out to my LDR08 left bedrail for its unwavering support
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| I will never let you go! |
Lillian was still throwing some variables so I was back on the bed, getting extra IV fluids and changing positions. Liz texted her husband just after 4:00pm to say that I was just now in pain to give him an idea of when she thought she'd be home. The next hour was just sort of live through one contraction and you don’t ever have to do that contraction again...It is a finite experience one way or another, after all. At some point I was checked again, but I still had a bit to go. Liz was phenomenal at keeping me as comfortable as possible and aiding BJ in helping me.
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| Doula magic... |
Eventually all the fluid boluses caught up with me and I remember taking a contraction or two wondering if moving to the toilet would be worth the pain relief of emptying my bladder...Eventually my bladder couldn’t take anymore so I trekked the 10 feet or so to my bathroom. The contractions were pretty intense at this point. I couldn’t quite make it back to my bed in time to get into a position I could withstand a contraction, so I labored on the toilet for a bit having to stand up and lean over to make it through a contraction and then resting by sitting on the toilet. I knew I was in transition at this point, but I had no idea how long it was going to take. It wasn’t more than 5 contractions in the bathroom when I started losing my peripheral vision during the contraction like curtains were closing in. I also felt like I needed to poop...I mean it could have been baby, but what if it wasn’t... So I took that minute or two between that contraction and the next to decide what was worse...pooping the delivery bed, or giving birth on a toilet.
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| Weighing the pros and cons of a toilet baby... #transitiondecisions |
With the next contraction it was all I could do to stay up right. I also decided I didn’t want to be the ‘remember when the nurse practitioner from the fertility clinic delivered on the toilet’ story, so I told Liz “I think I’m going to pass out.” She quickly escorted me back to my bed and back to my beloved left bed rail. Then Carrie Underwood’s “Jesus Take the Wheel” came on... in my case the bed rail, but it could not have been timed better.
CHAPTER IV - “You’re so gross...”
So Liz mentioned to Joy that she might want to call in the delivery team because last time I rolled over and had a baby. My OB was performing a repair on another patient, but the charge nurse and the baby nurse came in. I don’t think anyone but Liz really knew at this point that Lillian was on her way. I began to burn up. Liz gave BJ a fan, and so his job was just to wave that and keep his back turned to anything happening below my neck. Liz was working her magic because somehow I did not spontaneously combust, but I think I got as close as a person can get and still be here to tell my tale.
I was trying very hard to not push because I’m a good patient (refer back to the paragraph on healthcare professionals as patients), and I had not been declared complete. I just kept gripping that left bed rail and thinking I may have an hour or more to go before I can push. I remember being checked and instead of getting a number and station it was, “Oh, hello baby head.” At this point, I did not have control of anything below my diaphragm. The charge who checked me and was my former coworker threatened to send me a Venmo if I delivered on her. There is a ton, and I mean a ridiculous ton of paperwork we had to do at the hospital I delivered at if a baby came without a physician or midwife in the room. So I got it...however, there was very little I could do at this point. Hello, Ferguson reflex...
I just shut my eyes and held on to the left bed rail. The next contraction I remember trying to mentally prepare for the pain and exhale, but instead, my body just curled up and whoops, Lillian crowned. Suddenly a resident appeared and introduced herself. She told me “everything was going to be ok” with all the confidence you have as a twenty-something in an awkward situation, and I remember thinking, ‘Well, yeah...Thanks?’ I was being rolled over and my legs moved for me, and I just kept my eyes shut. Then the next contraction Dr. Barry came in just in time for the delivery. Then I had the most beautiful, albeit the cheesiest, itty bitty baby placed on my chest. So I opened my eyes to see two beady little eyes looking at me like, “What the Hell, Mommy?” And I said to her, “You are so gross, but I love you.” We’ve pretty much been inseparable ever since.
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| All that cheese! |
Delivering the placenta was more painful than Lillian’s appearance. I also remember telling patients that if they had an unmedicated delivery and needed a repair they wouldn’t really feel the lidocaine injections because all those nerves are stretched out. Lemme take a second to say I am so sorry for lying to you. I mean it still feels like a bee sting in your already battered vagina, but having a cute, slimy, baby on your chest is a welcome distraction.
Anyway, since I agreed to skin-to-skin, I got to just soak in the moments...the birth of my beautiful baby, all the ick of a 37 weeker directly applied to my skin, the ability to move my legs, and the ability to shower by myself instead of having two techs come in with washcloths to wash my undercarriage. Overall it was a day I will cherish forever. My nurse told Liz she did not expect an unmedicated labor to go that calmly. *Curtsies* Why, thank you, Joy.
Lil is my little 5lb 12oz peanut. She is strong, gorgeous, and the answer to so many prayers. She was worth every itch, every sleepless night, every stitch, and every fallen tear. I can’t thank the team at the Fertility Center, and my delivery team enough, for helping us bring this little miracle into the world. Lillian, you and your brother are so loved by so many people. I hope each of you can one day understand how many people prayed for you and how powerful that is. Thank you for choosing us!
Peace, Love, and Sweet Relief!
Mary Katherine
