"Consider it pure joy, my brothers, whenever you face trials of many kinds, because you know that the testing of your faith develops perseverance. " ~ James 1:2-3

Harper's Birth Story

Harper James

April 25th, 2009
12:32 AM
6 lbs 13 oz
20.5 inches

This long birth story comes courtesy of a 11 day hospital stay.

Harper's birth story actually starts a week and a half prior to his arrival. On Wednesday, April 15th, Tom and I had gone to have yet another biophysical profile at Maternal Fetal Medicine (MFM). I had been having weekly biophysical profiles at the MFM and weekly non stress tests at Carolina Ob/Gyn (the Ob's). At 24 weeks, they determined that Harper had Intrauterine Growth Restriction, or IUGR. This diagnosis is given to any baby who falls below the 10th percentile for their gestational age. We knew the due date wasn't far off given when I had taken pregnancy tests (one was negative, one was positive, which narrows down when I conceived). Also, my amniotic fluid was low. They encouraged me to drink lots of water.

Back to Wednesday, the 15th. We went to MFM, where they finally decided my water was too low, and wanted to induce me within the week. I was just over 37 weeks pregnant. They scheduled an appointment at the Ob's for the following day to determine the day and time of my induction. Thursday, I met with Dr. Vogel for the first time. I had only been in the care of the Obs for a week; until then my pregnancy was overseen by the midwives; two wonderful women whom I had met and gotten to know quite well. I was quite upset – everything seemed fine. The baby's heart rate was great, everything was reassuring and positive and I didn't really understand why I had to transfer care.

Talking with Dr. Vogel, I could tell that he was more sympathetic to my wishes of having a natural, vaginal birth. He was very open and honest with me, and willing to wait a full week before trying to induce me. He did a cervical check and determined that I was closed, thick and high. No dilation, no thinning of the cervix and Harper hadn't dropped yet. In those circumstances, Dr Vogel made it clear that an induction could take 3 to 4 days. In many cases, women become inpatient before then and end up with a c-section. By waiting a week, I was giving my body a chance to begin the labor process and I would have a much easier time of inducing my labor, which both Dr. Vogel and I felt would be best. We left the appointment both excited and frightened. We had a deadline! We began writing up a list of everything that needed to be done, and I scheduled the next week out so that I knew what I would need to do each day.

Also, I was hoping to do my best to prep my body for labor. Ideally, I wanted a natural labor, sans interventions. Induction was an intervention I simply didn't want, but even the midwife, Ina May Gaskin (in Guide to Childbirth), notes that low amniotic fluid was a good reason for induction. I figured that though it wasn't ideal, I was doing what was best for Harper and I. I still wanted to avoid epidural drugs and labor naturally, which I understood could be harder with the Pitocin, but I was committed to doing. But in order to be the most successful, I really needed to be prepared for this induction. I had a week to do so.

That afternoon, after my appointment, I contacted MFM to ask about a final appointment. The Ob's insisted that I meet with MFM one last time, since it would be a full week before I would be induced and I always had weekly appointments with them. When MFM found out that I would not be induced by the end of the week, but in the following week, they had me come in Friday morning. I had yet another biophysical profile in which my fluid had dropped in half. They told me I would have to go to the hospital that day to be induced.

I was floored. I had mentally prepared myself for a week left before Harper came to join us. A few hours was simply NOT the same. But I did remember my discussion with Dr. Vogel. If I could be patient and wait the 3 to 4 days, my chances of having a c-section would decrease considerably. Tom and I went home and packed for a few days stay, knowing that my induction would take a while. We called my parents and his, sent emails to everyone else and headed to the hospital.

It took a while to get checked in; my doctor was in surgery and couldn't admit me until he was out. Once admitted, the nurse told me to go eat, since the party line is that I only get clear liquids during induction.

By 1pm on Friday, April 17th, Dr Vogel had come in and inserted Cervadil to begin thinning my cervix. I would begin Pitocin in the morning. As with any induction drug, I was continuously monitored – a hardship since Harper is wiggly and uncooperative. Nurses were constantly coming in and rearranging my monitors, often stuffing several washcloths under the “belly band” to put the necessary pressure on my uterus to get a good reading. With the Cervadil, I was required to stay mostly horizontal for the first 2 hours. The day was boring, but easy. Tom and I played on the computer, watched tv, read books, fluids, talked and were generally excited. I had a private room; that's all this hospital has. Sadly, my room was on the side with fake windows – we had shutters that opened to a blank wall. It was terribly disappointing!

My mother was searching for a flight to come join us as soon as she could. At night, they gave me 2 Ambien to encourage me to sleep soundly. We had no idea when I might go into labor, and we wanted that I be as well rested as possible for labor and delivery. I slept like a rock. I barely woke up in the middle of the night when the nurse came in to remove my Cervadil. Tom slept on the hard couch, which folded down to be a twin size bed, but didn't sleep well. The next morning they checked me – I had thinned some (but not much) and had dilated to 1cm. Some progress at least.

Saturday morning they began the Pitocin. I was hooked up to a bag of fluids, a bag of Pitocin, and the continuous monitor. Even just going to the bathroom was a chore – I had to unplug the Pitocin, the fluids, the heart monitor, the tocometer (which reads the intensity of my contractions) and take off my blood pressure cuff. Then drag the iv pole with me, wrap the monitor cords around my neck to prevent me from tripping on them, and waddling off to the bathroom. Upon return, I had to “replug” all the monitors and cords, then try and sit in a position that would allow the monitor to catch Harper's heart rate. My mother arrived at 10:30 on Saturday night, after having taken 3 flights to get to me as soon as possible. She was hurrying to get to me before I gave birth – ha! If we knew then...

After this the days sort of blend together and become more a series of events as opposed to a day by day recollection. I was on Pitocin for quite some time. My mother was amazed; she had had Pit to augment her labor when she was pregnant with me and it had given her strong, painful, contractions and here I was, after several cycles of Pit and nothing was happening. Sometimes I would get tiny contractions, barely enough to even feel, but that was the extent of that. I would be on Pit for 12 -15 hours, working up slowly to the highest allowed dosage, then I'd get a break of 2 – 3 hours to shower, eat and walk around without the monitors attached. I lived for those breaks. Those and contractions, but the contractions were much more rare. Other noteworthy events included getting a real hospital bed with a cushy mattress to replace the hard labor and delivery bed that originally came with the room. This came something like 4 days after sleeping on that hard, miserable bed! It was a glorious sleep that night. It was actually an upgrade for all of us, my mother went from chair to couch, and Tom went from couch to labor bed. I got Ambien each night to help me sleep; it was the best sleep I had had in the duration of my entire pregnancy.

One day, perhaps Tuesday(?) one of the nurses got me outside! I hadn't seen the outside world in days, but since I had been there for so long, there is a patio in Ante Partum that they allowed me out on, since it was still on the same floor, just a different wing. I went out with my mother (Tom was getting more clothes from the house – which actually makes it Monday I think). I was able to convince different nurses at different times to let me hang out on the Ante Partum patio during my breaks. I must have met almost all the nurses over the duration of my stay. They would come back and visit me on their shifts if I wasn't one of their patients. Even housekeeping knew me by name.

At one point, when Dr. Vogel was back on call, we discussed other option to speed up labor, since the Pitocin clearly wasn't working. We had even gone back to the Cervadil to see if it would work better after the rounds and rounds of Pitocin. To be sure that induction was still necessary, I had another biophysical profile, in which my amniotic fluid was still low, too low to consider checking me out and trying to induce in a week or so. Harper really needed to come out, but his heart rate was very reassuring and strong, so they were willing to try methods which would allow me a vaginal birth, since I had been patient and was working hard to avoid the c-section. We discussed Cytotec, some odd seaweed stick thing (they insert sticks of seaweed into your cervix and as the seaweed absorbs your natural “juices” they manual dilate your cervix), a foley bulb, and continuing with the Pitocin. We decided to try the foley bulb. I had never heard of one before, and most people I talked to after had never heard of one either. Imagine a long piece of tubing with a deflated balloon at the end. The balloon end is inserted behind your cervix and filled with a saline solution, while the long piece of tubing is pulled taut and taped to your leg, pulling the saline filled balloon against your cervix in an attempt to manual open your cervix as the bulb is being pulled out of your body. It is extremely and intensely uncomfortable. It's difficult to move, as you are very sensitive to this item pressing against your cervix and you are terrified of just ripping it out if you aren't cautious enough. I couldn't even fully extend my legs or cross them – they were constantly bent and pushed together. The worst was trying to urinate – I couldn't even spread my legs to do that properly and had to use the spray bottle and a washcloth to clean myself each time. It was miserable, but I was really trying to do anything and everything I could to get labor started. I would do anything to avoid a c-section! Once the foley bulb was placed, they transferred me out of L&D and to Ante partum. Apparently L&D was getting busy, and since there were people who, to quote my doctor “serious about this whole labor & delivery thing” they kicked me out. The following morning, they moved me back to L&D, since those “serious” women had been in and out – lucky! When they moved me back, we were able to get a room with an actual window, so that I could see the sun each day. However, I was back to the hard labor bed. And for the rest of my visit, when I mentioned to a nurse that I had tried the foley bulb, they cringed. One nurse compared it to Medieval torture.

I can't describe the excitement when that bulb came out. I knew I was in luck when I could actually spread my legs to get out of bed, instead of the locked knee scootch hop to which I had grown accustom. Later that day, my mucus plug began to come out. It felt like such a successful day; the foley bulb had dilated me to 3 centimeters and I had my “bloody show” which was more than I had done in days.

I went back to Pitocin, but for only about half a day. The on call doctor wisely noted that this wasn't doing anything for me, even with the dilation and lack of plug. She suggested to try the more aggressive method, Cytotec. I was not a fan of this method – it isn't approved by the FDA and they've done no formal studies on dosage and safety in pregnant women. I asked for time to consider my options. We had done many other methods, none of which were working. Nothing had descended Harper far enough to safely break my water. I asked the doctors and several nurses if they had seen any adverse side effects, specifically ones involving serious side effects and none had, in their years of working with the drug. I was still not thrilled about the choice, but I felt that I had run out of options and I needed to trust that the doctors, nurses and other staff would be vigilant enough to protect me in the event of side effects. So the Cytotec it was. When they began the Cytotec, they also began the penicillin. That is quite uncomfortable going in – the burning sensation was concerning and annoying. They began it then because my doctor said that she never had to use more than 4 doses of Cytotec (which is roughly 16 hours) to induce labor. It should come as no surprise that by dose 6, I was still not in labor. However, I was getting mild, but regular contractions. Mild enough to talk through, but enough to notice and about 3 to 4 minutes about. This was not considered real labor yet. I recall asking a few of the nurses what was the longest induction they have ever seen, they each said “You.” I should get a prize.

Thursday evening, the doctor wanted to break my water, but Harper was still high up. There was a slight risk of cord compression, especially since my fluid was low to begin with. I choose to try one more dose of the Cytotec, since that was the only thing thus far that had really made any progress. When the Thursday night on call doctor came on, she agreed that it would have been too early and too risky to break my water then, and placed the Cytotec for another round as I slept through the night. Unfortunately, once that round of Cytotec was placed – my 7th dose – my contractions ceased.

Friday morning, April 24th, I was woken by the doctor at 6:30am to have a cervical check. It may be one of the most unpleasant ways to wake up. While performing the check, she declared that I had dilated to about 4 cm, and Harper had dropped just enough for her to safely break my water. So she did. I felt steamrolled! Tom and I had discussed that breaking my water would be the next step we took when it was safe to do so, but somehow, having it done within two minutes of waking up was slightly overwhelming!

Within the hour I began having contractions. These were regular and a little stronger than the night before. I was not on any medication at this point, the Cytotec having worn off. We were waiting to see how labor would progress “naturally.” And it did so fairly well. I began having much stronger contractions – ones that I could no longer just talk through. They were coming about 2 to 3 mintues apart and lasting about 60 seconds or so. I labored all throughout the day. We played episodes of Friends on the laptop to help distract myself. Using the restroom was odd, both relieving and painful. I began having to moan and hold on to Tom to manage the pain. At times, if I wasn't focusing hard enough, I would cry during the contractions, worried that I wasn't strong enough to handle them. I spent the first part of the day in various positions on the bed, laboring by myself. Soon, I need Tom to hold onto me, whether it was to stare into his eyes to focus, to squeeze his hands, or for him to hold me up so that I could relax my body completely through each contraction. However, despite the increasing strength of my contractions, they began spacing out. At times, they would be six minutes apart, and I would fall asleep between them. At one point (I lost all track of time) the nurse brought me a bright yellow birth ball, which is identical to the big exercise balls. I spent hours (I think) laboring on that ball, holding Tom's hands across the bed, staring into his eyes, or just above him to the green leafed tree against the pale blue sky out the window. If Tom wasn't available, my mother would come to rub my back and comfort me. She told me how proud she was of me and how beautiful I looked (a thought which still makes me cry days later). Between her and Tom, their words of support and encouragement really helped me make it through some of the harder contractions. After 7pm (and I only know this because the on call doctors switched), Dr Woodfill came in to check on my progress. I had been in labor for roughly 12 hours at this point. Dr. Woodfill was the first Ob that I had met at the practice, and I really liked him. He explained everything in detail, especially any procedure in which he would have to touch me, so that I was very prepared for the pressure or sensations that the procedure would produce (such as those miserable cervical checks). When he checked me, I was dilated only 1 cm further, to a total of 5cm and Harper had not descended any further. This was not progress! Not after 12 hours of labor!

Dr Woodfill suggested that my contractions needed to be augmented with Pitocin, which would have a better shot of working now that I was in active labor. However, since I had been in labor for quite some time and not progressing, he suggested that I get the epidural. It would help me relax and perhaps get me to progress further. At this point, 8 days into induction and 12 hours into labor, I still wanted to have a vaginal birth, even if the natural birth was out the window. I talked it over with Tom and my mother and decided that we would try the epidural. The anesthesiologist came and put in my epi, right in the middle of a contraction. At least it distracted me from the needle going into back. My husband held onto me, making sure not to look down at what they were doing to me.

Soon after the epidural began to take hold, my blood pressure plummeted. They were able to stabilize me and the contractions came stronger while my body became more numb. At one point I asked my nurse what I was sitting on, and she replied “Your butt.” What a weird sensation an epidural is. I “labored” for another 3 hours; though my contractions were stronger and closer together, it didn't seem like I could legitimately call it that. A little before midnight, Dr. Woodfill came in. I hadn't been watching the monitor, but Harper was not handling the contractions well – after each contraction, his heart rate would descend and take a while to return to it's previous rate. This indicated probable fetal distress. He checked me, and I still had not progressed any further. With the decreasing heart rate and not being any closer to actually giving birth, it was recommended I have a c-section. I was devastated at the thought. I had spent 8 days and exhausted every option I had to avoid this, and here I was. If I tried to continue this useless labor, the chance of needing an emergency c-section would greatly increase, and then Tom would not be allowed in the operating room.

I cried. I didn't want a c-section. I had been trying to avoid one since the beginning, and it was what had drawn me to a natural birth to begin with. I know that I was far beyond having a natural birth at this point; the need for an induction pretty much took care of that. But I had been hoping for at least a vaginal birth.

The nurses turned off the Pitocin, since the the increased contraction strength was what was distressing Harper. Very soon, Harper's heart rate returned to normal, while my contractions completely stopped. They began to prepare me for the section. We talked about what to expect, and my mother, who has had 4 c-sections, explained in detail what she had gone though, what had surprised or scared her so that I could be fully prepared for the surgery. She helped me figure out what questions to ask and comforted me. Tom held on to me, held my hand and told me how strong I was for trying everything else first. That it was okay that it had to end like this.

They wheeled me into the operating room, while Tom got into his scrubs and paced the labor & delivery room. They upped the epidural meds and painted my belly with iodine. I asked who each person in the room was and what they did. I began to smell something odd and realized that it was me, as they were cauterizing me as they made the first incision. I asked for Tom, and they realized that he wasn't in the room yet. They ran down to get him, and he showed up in plenty of time. He sat with me, avoiding looking over the curtain, holding my hand (which was getting numb) and talking with me to distract me. It wasn't long before I could feel the painless but unmistakable pressure of a baby being removed from me. Tom stood up with the camera and took pictures. I heard his baby bird cries immediately and began crying myself. They immediately brought him over to me, and I was amazed to see his eyes wide open. Then they took him to check him out; Tom went over to see him and cut the cord. We found out the the ultrasound that had predicted a birth defect at 24 weeks was wrong, and that our little boy was perfect. They weighed him at 6 pounds, 13 ounces and 20.5 inches long. Tom carried him back over to me so I could adore him. I kissed him and Tom left with the baby nurses while the doctors finished up working on me. I could hear them staple me together, and then they lifted me up to take out the epidural.My mom had briefly gone up the nursery while I was getting stitched & stapled up, but was back down waiting for me to get out of the OR. She came with me to recovery and kept an eye on me until I was too tired to concentrate. As she put it, Tom was keeping on eye on our baby, and she was keeping an eye on hers. I spent the next hour in recovery as they kept an eye on my blood pressure, which liked to drop with the epidural. I tried to sleep; I was exhausted but couldn't keep my mind from wandering all over the place. She then waited until I wheeled past and then came up with me to the Mother/Baby floor. We talked until 4am, when they brought Harper in. Harper was born at 12:32am, but I didn't even get to the Mother/Baby floor until 2:30, and then I didn't get to hold Harper until close to 4! Tom stayed with Harper in the nursery until they brought him to me, popping by to check on me and let me know how he was doing. He had made all the phone calls to family and friends while I was in recovery.

When I finally got to see my little boy, I fed him. He caught on right away and latched beautifully. After a little colostrum, my mother checked his diaper, and changed him. Before she covered him back up, I took him in my arms and looked him all over for birth marks, moles, anything. And as I said before, he was perfect.

Harper's birth could not have gone less like I would have wanted, but in the end, I have a beautiful, healthy little boy, and I couldn't be happier.


C and J said...

You are simply amazing! I am worn out just reading about it! Thank goodness for the wonderful support team you had! And we are so thankful for that beautiful bundle of joy! Much love to all of you!