The results from the non-stress test, where they monitored the baby’s heartbeat and contractions for 20 minutes, were fine. Great even. I still hadn’t really felt any contractions, but the monitor indicates that a few had occurred. The second test was the measurement of amniotic fluid using an ultrasound. This is where things didn’t look so optimal. Normally, you would expect to see about 10 centimeters of fluid in the uterus, with 5 being the cutoff for an acceptable amount. We were told we had 2.5 centimeters and to go straight up to labor and delivery to be induced, which was a little shocking because we expected to have a conversation with our midwife before making such a decision. But we went up and talked with her, and she decided to have a doctor on the floor do the ultrasound again. She found 3.2 centimeters of fluid, which was more, but still not ideal.
We went back and forth for several hours about what to do . The plan was to have as active and natural of childbirth as possible, and induction meant a highly medicalized experience that might not necessarily be better of me or the baby. The midwife examined me, and I had dilated another centimeter since Friday, so that was a positive sign that things were progressing. The other option was coming back on Wednesday for the same testing again and potentially being induced then. After a lot of deliberation, we finally decided to stay for the induction. We had lunch in the hospital cafeteria, and I decided that I would go for one more vigorous walk just to see if I could help things along at all. I walked over to the School of Public Health – they don’t call it Chapel Hill for nothing, so it was a good jaunt.
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Everyone was optimistic that things would progress pretty quickly – as you can see in this photo, the nurse was sure that Nikhil would arrive that day (the 30th).
To get things started, they inserted a catheter in the cervix to move along dilation before administering the dreaded Pitocin, the drug that is supposed to simulate the natural Oxytocin that women’s bodies produce to make the uterus contract. It took about 4 hours for the bulb to do its job, during which time I did feel some contractions but not a lot. We spoke to the midwife, who told us they would start me on Pitocin at 6 a.m. the next morning. Alvaro and I settled in for the night in the room, knowing that this would be our last night of good sleep for awhile! So we thought.
Not long after we went to bed, I started having contractions, but we weren’t really sure what was going on. We were so out of our element that we didn’t quite realize what was happening. We finally called the midwife, who checked me and found that I was 5 centimeters. Though I was beginning to feel a lot of pain, we were pretty psyched that our labor might occur more naturally than we thought a few hours earlier. I took a hot bath, which was great for the contractions, and went ahead and got an epidural. It was really difficult for me to focus and relax in the hospital environment, and it seemed like there was a good chance that my labor would be augmented by Pitocin, which I did not want to experience without some pain medicine. After the epidural, we were able to rest for a bit, but I woke up with some pretty intense pain on a small area on my right side. It turns out that epidurals are often not so effective all over during labor (though my dad the anesthesiologist scoffed at this when I said that). The epidural was finally redone by another doctor, and it worked all over.
This is where the real fun begins. Now that the epidural was doing its job, they started me on a very slow Pitocin drip. After awhile, the nurse came in and turned the drip off and had me lay on my side. She didn’t tell us this at the time, but Nikhil’s heart rate had dropped a bit, so they wanted to get it back up before starting the meds again. Once it was stable again, they started the drip again. After about two hours, several nurses rushed into the room. Nikhil’s heart rate had dropped again, so they turned off the Pitocin, had me lay on my side and started me on oxygen. At this point, the midwife came in and said we needed to have a conversation about our next steps. The level of Pitocin was being increased about every half hour. It was still very low, but once it got to a certain level, Nikhil’s heart rate would drop to around 80 or 90 after every contraction. He basically wasn’t tolerating the contractions that would get me dilated enough so he could be delivered. At this point, the dreaded c word was mentioned. The midwife had told us earlier that morning that another midwife had made a note in my chart that my pelvic arch was really small and would only tolerate delivery of a small baby. This was news to me and certainly something I wish I’d known in advance! We had no reason to believe that Nikhil wasn’t small, but this little anatomical feature increased the likelihood of a c-section.
Of course, a c-section was not what we wanted. The midwife said we could try the Pitocin one more time, but it was a three strikes and you’re out situation. She checked my cervix again, and I was dilated to 8 centimeters. We asked if we could try the Pitocin once again but rather than increasing the dosage every 30 minutes, we would wait one hour. She also broke my water, and they put a monitor on the baby’s head so they could more accurately determine the strength of the contractions. We watched the contractions and baby’s heart rate on the monitor in the room, and everything seemed to be going okay. But, then again, all of a sudden, there were about 10 doctors in the room. Nikhil’s heart rate had dropped again, so continuing labor in this way wasn’t an option. The midwife checked me again and thought I was still 8 centimeters, though the two obstetricians who examined me thought I was at 10 centimeters. Despite being fully dilated, the position of the cervix was too far back, and it seemed like it would be difficult to push him out, especially since he wasn’t tolerating labor too well. They mentioned the possibility of using a vacuum to try to get him out, but it sounded like it was going to be difficult, and I wasn’t really sure how it would work if I wasn’t naturally having contractions and not receiving Pitocin. Though I really didn’t want a c-section, the last thing I wanted was to push and then have major surgery anyway. At this point, Alvaro and I were feeling that there really weren’t any other options but the c-section. Nikhil’s heart rate had come back up again, but this time to over 200, which wasn’t too good either. (A normal baby heart rate is 140-170.) However, since it was better than being too low, the doctors said that the need for a c-section wasn’t so urgent that they needed to put me totally under with general anesthesia.
So not long after, off I went to the operating room. Luckily, the second epidural was doing its job, and I did not need any further anesthesia. This also meant Alvaro could be in the room for the delivery. After they had gotten things started, he was allowed in the room to hold my hand. Not long after, they pulled Nikhil out, and we immediately heard him cry and squeals of, “He’s so cute!” from the two wonderful nurses that had spent the day with us. Despite it not being the birth experience that we had hoped for, nothing could ever match the moment where we heard our son’s entry into the world. Because the midwife had seen meconium when she broke my water, the NICU team was in the OR, so they took him immediately to clear his lungs before we got a chance to see him. After what seemed like forever, they finally brought him over for us to see, and he was just beautiful. Very alert and responsive to the sound of our voices.
At this point, I started feeling not so great. It felt like all the blood in my body was rushing to my head, and I was very nauseous. They finished sewing me up and took me over to the recovery room, where we were finally able to hold Nikhil. Actually, Alvaro spent quite a bit of time holding him. I was still dealing with some bad effects from the surgery, particularly having trouble breathing and shivering uncontrollably. Things finally seemed to be better with my lungs, but I couldn’t stop shivering. Though I was dying to hold my son, I was afraid I would drop him! But it turned out that he was just the remedy I needed because as soon as I held him, I stopped shaking.
So that’s it. We stayed in the hospital three more nights. I didn’t get out of bed until about 36 hours after the c-section, and it was incredibly painful. My first outing was to the farmer’s market with my mom on about 10 days after Nikhil’s birth, as well as a short stroll around the neighborhood a few days later. Both left me quite winded, but I feel much better now and ready to be active again. Just waiting to get the approval from the midwives at my 6-week postpartum follow-up next week.
Looking back on the whole childbirth experience, I’m not disappointed. I have heard of women who feel like failures if they have to have c-sections or go into deep depression because they did not achieve the birth experience they wanted. Of course, things didn’t go at all as planned, but I think it is naïve to expect that something as unpredictable as childbirth can be planned. I do think a lot about the what ifs. What if we had waited until Wednesday? Would I have gone into labor on my own? Nikhil was fine before the Pitocin was introduced – we should know, his heartbeat was being monitored for 27 hours! What if I could have labored on my own, would gravity helped move his head into a better position for a vaginal birth? The OB who did my c-section mentioned that she thought I would really have trouble giving birth naturally and that if I were in her family, she would tell me just to get a c-section in the future. In the end, it doesn’t really matter. Our son is healthy and beautiful – isn’t that what childbirth is really all about?
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