Delivering Raphael
It's hard to know where I should start this story. 7:30am on Monday, December 10th is a clear dot on the timeline, so I'll begin there. It may be necessary, later, to begin sooner.
I checked into the hospital at the absurd hour of 7:30am. An hour or more before my usual wake time. I had a neatly packed bag of clothes, things to keep me busy, and a huge stash of my favorite trail mix. My parents were with me and Nick was home, waiting to take Desdemona into daycare. Everything was very organized and intentional.
I felt partly excited for the end of pregnancy, and for meeting the "nude baby" (Desdemona's pronunciation of "new baby," which I can't get over). But I also felt nervous and doubtful, because Monday, December 10th was a full week before Raphael's due date, and I was at the hospital for an induction. I sort of wanted it; I had been increasingly uncomfortable for weeks, and I felt in my gut that Raphael (who was just "the baby boy" at 7:30am on December 10th) was close to being ready for birth. But this organized and intentional plan of delivery went against all my instincts about birth, everything that lead me to choose (although I later abandoned) home birth for Desdemona.
I made a deal with myself: if I hadn't progressed on my own from 1cm dilated and 50% effaced (as determined at my 38 week pregnancy checkup), I would ask to reschedule the induction. If I had progressed and the doctor (Dr. Cowan, whom I'd met before, and liked) thought conditions were favorable for the induction, I'd go ahead with it.
I already can't remember the order of events in the early morning of that Monday, but this is everything that happened before Nick got there:
The nurses had a hell of a time getting my IVs started. I had to have two: one for the usual suspects (fluids, pitocin) and one in case I needed insulin (because no one understands that I never freaking need insulin). It took 3 nurses (first mine, then the NICU nurse, then the charge nurse) 6+ attempts to place the two lines. This was a totally foreign experience for me. I've been stopped in public by health care workers who just have to comment on how stickable my veins look. Apparently pregnancy changes that. I still have dark bruises around some of the failed attempts.
Dr. Cowan came in to check my progress. I was 3cm dilated and 60% effaced. Baby was at -1 or 0 station. Women can walk around like that for weeks without going into spontaneous labor, but the day had already gathered momentum and I decided 2cm and 10% effacement was enough change from the week before that I could go ahead with the induction. It helped to see that Dr. Cowan was incredibly confident that it would go well.
I thought I would have to take some drugs to ripen my cervix, and then sit around waiting for many hours, but apparently that's not the case when you're 3+cm already. Dr. Cowan broke my water (an unpleasant experience, if I'm honest) and had the nurse start me on 2u of pitocin before 9am. I was "allowed" to have breakfast, and I ordered a ton of protein, because I wouldn't be "allowed" to eat again until after the deliver. I had my stash of trail mix, but quickly realized the nurses would know if I ate anything because they were under instructions to check my blood sugar every 2 hours (every hour during active labor) in case I needed insulin (spoiler alert: I did not.) So anyway I downed 2 eggs and some oatmeal with peanut butter stirred in.
Nick got to the hospital around 9:30. I was having regular, noticeable contractions that were mostly exciting and not upsetting. We decided to walk around the unit, which the nurses encouraged, to help things progress. It was fun to walk together and just chat, passing nice photos of newborns and the encouraging smiles of the unit's staff. Unfortunately we were stopped every 3 minutes or so because my IV monitoring system started beeping. It turned out that after all that trouble getting my IVs started, the nurses had to put them in really unfavorable places: the crook of one elbow, and the crook of the other wrist. Natural movement and gesturing caused these joints to bend, occluding the IV lines where they were inside my body. It took an hour or more of intermittent beeping for us to figure out there wasn't a kink somewhere else in the line, and when we finally realized what was going on, I decided to give up on the walking.
Next, I bounced on a big exercise ball (which they call "birthing balls," in this context) in my delivery room. I also started a knitting project to help pass the time. it was a hat for the baby boy, and I had a little fantasy that I would finish it in time for him to wear it on the drive home from the hospital. It was extremely challenging to knit without bending my elbow or wrist too far for my IV monitor, (they moved my lines from one to the other several times in attempts to stop the beeping) but it gave me something to focus on as the contractions got more intense. By early afternoon, my pitocin dose was up to 8 or so and contractions were starting to require some deep breathing and mental gymnastics. We watched a couple episodes of the Great British Baking Show and I kept on knitting. I started to want some pain management, and I requested nitrous gas, which I didn't have available with Desdemona. According to my care team, the gas "wouldn't make the pain better, but I wouldn't care about it." My nurse had never set up the nitrous tank before, so she needed to call for backup, and I really didn't appreciate the untreated contractions while we waited.
The nitrous gas, when they finally got it going, didn't really help at all. It was distracting and new, though, so it wasn't a total waste of time. I started to wonder if I was eligible for an epidural yet. I had it stuck in my head that I would have to be 5+cm dilated, or within a certain time interval, before they'd give it to me. I asked the nurse and was surprised to hear that they would have given me an epidural as soon as Dr. Cown broke my water if I'd asked. Apparently I was already progressed enough by that point that they would be comfortable with it. I asked her when it would be too late to ask for one, and she said "ummm, when it's time to push?" Seemed like a pretty liberal policy to me. I asked to be checked for progress.
I was 5-6cm dilated and 90% effaced. I asked Dr. Cowan when she would recommend I get an epidural, and it was clear that she didn't think I was planning to get one. She was like "Now! The rest of this could go really fast!" So the nurse called down to anesthesiology, but warned me it could take 20+ minutes. I inhaled hard on the nitrous, hoping it would start doing something worthwhile. But, I was in luck. The anesthesiologist appeared like a fairy godmother in just a few minutes. I thanked her for being so prompt and she said "as a woman who has been in labor, waiting for an epidural, I make it my personal mission to get up here fast when they call." What an angel.
The epidrual placement was more eventful than last time. When she inserted the needle I got the weirdest ZING around my whole torso. I had to ask her to stop and confirm that was normal. She "changed her trajectory" and it felt a little better. Then I stopped caring how it felt because another contraction was coming. By the one after that, the drugs were working and I could talk again. I resumed my knitting and watching baking. I dozed intermittently. I went from 5-10 and 90-100% over the course of the next few hours, without a moment of fear or overwhelming pain. I could still feel and move my whole body. Epidurals are amazing.
Around 5:30, I said to Nick "I can't believe I grew a penis!" and he thought that was pretty funny.
Around 6:30, Nick went downstairs to get some dinner. Naturally, as soon as he left the unit, Dr. Cowan came in to check on me and said I was ready to push. She agreed to wait until Nick got back. After she left, the nurse advised me on the sly to put of pushing as long as I could - she said I would feel like I had no choice but to push eventually, and the longer I waited, the less time I'd spend pushing. So when Nick got back we waited for him to eat his dinner. Meanwhile, 5 women were checked in, in various stages of spontaneous labor! Dr. Cowan was about to have a very busy night, and even though I didn't feel like I had no choice but to push, I was ready to move things along, so we did.
My nurse and Nick each took one of my legs and I hooked my elbows behind my knees and got ready to start pushing. Nick asked if I wanted a mirror, like I had with Desdemona, to help me see when I was doing the most effective job. I said "Let's just see if I can push effectively without it, and we can get it if I need." The doc and nurse exchanged an appreciative glance and the nurse was like "These two know everything!" and the doc was like "They are a great labor team." I love compliments from doctors and nurses, so that was nice.
Pushing commenced just after 7pm. This was the only time, other than when they broke my water and when I was waiting for the epidural, that I was in pain that I couldn't master. The first few were ok. Then he started crowning and the stretching was just so painful. I kept pushing as well as I could (which got me more compliments - yay) but I was also whining that it really hurt. Dr. Cowan promised my baby would be here after the next push, and I pushed so hard she actually had to ask me to back it off (she was freeing one of baby boy's hands, which was stuck down by his waist) and then he was out. Unbelievable! It was 7:17pm, just short of 12 hours since I checked in. I had slept a full night before, and I'd be in a recovery room in time for bed that night. Double unbelievable.
They laid him on my chest and gave him a good rubbing. He was clearly breathing almost immediately and soon started to cry the softest, most "I beg your pardon" type cry. He was just over 8 lbs and 21 inches long - still a good sized baby, despite the treatment I got to keep him from growing "too big" like Desdemona. He wasn't too interested in nursing, at first, but he came around later that night.
As I write this I am struck for the millionth time by how DIFFERENT this was from delivering Desdemona. The most profound difference is that it didn't like, fundamentally change me or break my spirit. After Desdemona, I could barely think for 2+ days, barely walk for 2+ weeks, barely feel like myself for 2+ months. I felt wonderful compared to how I felt during my pregnancy with her, but what I'm realizing now is that her birth was pretty traumatic for me, and that not every birth is like that. Ever since having her I've thought that most moms push themselves to do way too much right after having a baby, now I'm realizing most moms are feeling a lot better than I was. It's weird for me that my hospitalized, induced labor and delivery were so much nicer to experience than my spontaneous, attempted home birth. It goes against my biases. But, that's my story.
Footnotes:
The only concern with my blood sugar the whole time was that it got too low, in the mid 60s, and they had to give me some juice. I knew I didn't need that 2nd IV.
My pitocin dose maxed out at 16u - not too bad in my opnion!
I did finish his hat in time for him to wear it home.