Monday, July 18, 2011

Labor & Delivery

Long time no write!  I just had baby #3 about 2 weeks ago.  Thankfully all went well, but as I was going through the whole ordeal I kept thinking how it is true that doctors make the worse patients...

Since my due date was approaching and there were still no signs of baby wanting to come out, my induction was scheduled so I'd have him on his actual due date.  The plan was to go into the hospital at night to check for change and if there was no change to get induced with a medication called, cervidil.  Then the next morning the actual labor and delivery would occur.  So I decided to work my last shift (saw patients till 7pm) then go into the hospital by 930pm.  Yes, I took a chance that I'd go into labor during my patient hours and would have to rush to the hospital.  But I figured if I worked to the end, it would give me one extra day to be with my newborn on maternity leave.

I was actually contracting on and off all that entire afternoon.  In fact, right before my shift started, I actually believe I lost my mucous plug.  To me that was the first sign that my body was preparing to have a baby.  The contractions were not that intense and seemed far enough apart.

By the time I finished my shift and was gathering my things at home, I believe I was contracting probably about every 10-15 min or so.  Again, they were not intense so I did not feel an urgency to run to the hospital.  But I figured this is going to happen so the sooner we get in the sooner we'd have this kid... otherwise we are looking at a long night.

Well, the check-in process is routine.  I actually feel one of the worse parts of the entire labor experience is getting the IV put in!  My veins are actually not that bad and I feel for the patients who get poked and poked because nurses cannot find an adequate vein.  So what is it for anyways?  Since I am able to drink fluids, why do I need liters of fluids pumped into me?  Physicians like to be able to control as much as possible... and especially in obstetrics when something bad can happen very quickly and very suddenly... having access to a vein to give medication, fluids, or blood right away instead of trying to find a vein in an emergency situation can sometimes save a life.

Now it really is pretty uncomfortable just laying there on the hospital bed.  There is the IV stuck in one arm which actually really burned and was irritating every time I moved that arm.  Then the other arm has a blood pressure cuff that goes off every 15 minutes squeezing so hard at times that it numbs the fingers!  The pulse ox on a finger is a pain as well.  On top of all that, let us not forget the tight band wrapped around the contracting belly holding down two monitors, one for the baby's heart rate and the other to measure the frequency of contractions.  So every time if I move too much (and it is really hard to stay still in exactly the same position especially as the contractions got stronger) the monitor falls out of place and the nurse has to come in to adjust it.  I ended up just sticking a hand on the monitor and adjusting it myself so she didn't have to make so many trips.  Now imagine the ordeal that takes place every time I need to go to the bathroom (which is very often given all the pressure from the baby and then even more often once they start running the fluids)!

It really is no wonder some folks choose to deliver with midwives and in hot tubs etc

Now if one has a high risk pregnancy, it may be wise to be closely monitored.  In my case, I felt it was total overkill but protocol is protocol and nurses/docs/hospitals like to follow protocol.

From a physician point of view,  it is nice to have continuous monitoring which gives all this information instantaneously.  That way if something does go wrong, one can know immediately and can act quickly and decisively.  I'm sure it has saved many lives... both mom's and baby's!  However, as a patient it really can be a pain and I wonder if there is not a more intermediate way of things.

In any case... there I was stuck to the hospital bed with all these things attached.  When my OB came to check me, I was sure I was somewhat dilated because of all the contractions I was already having.  Nope.  I was completely unchanged and still pretty much closed.  However, because I was contracting so much on my own I can not get the cervidil.  Instead, I was to get pitocin, which helps make the contractions stronger and more frequent.  My OB's plan was to put me on the lowest dose pitocin and not increase until 4am.  He was planning on going to bed and coming back in the morning to deliver me.  He told me to try to get some sleep.  Ha.  He obviously has never been in labor before... how can one possibly get any sleep with contractions going off even if it was only every 10 minutes at the time?  I had a gut feeling that once the pitocin was started, it would just kick me into active labor.  I told my doc to not go to far, I had a feeling I was going to have this kid before morning and I was right!

Waiting was the hardest part.  OB left.  Husband pulled out the hospital chair bed and to try to get some sleep before all the action began.  I laid there, staring at my strip trying to calculate the frequency of my contractions... making sure my baby had adequate heart rate accelerations... and wondering when to call for the epidural.  I have to time it right because I knew it would take a while for the anesthesiologist to be called and for all the paperwork etc to be done before the epidural can actually be put in.  If I call too early, it may slow down labor.  If I call too late, they may not put it in if I'm too close to delivery.  Especially since this is kid #3, things can go very fast very suddenly.  Now, I know some women choose to labor "naturally" and prefer no pain meds whatsoever.  I am not one of those.  I rather have my med put in under somewhat controlled circumstance rather than rushed in case of an emergency.

Well, not to bore you with all the details (probably too late for that)... I did finally call for my epidural and pretty soon after that I was "complete".  The putting in of the epidural in my opinion was the worse part of the entire labor experience.  I found it almost impossible to sit still with my back arched while contracting so intensely and frequently.  But I really did not want the anesthesiologist to mess up her landmarks so I tried very hard, in fact so much so that I developed a terrible muscle spasm afterwards.

Then to make matters worse, I had to lie completely flat for what felt like an eternity.  They say it is so the medicine can be distributed equally.  I could barely breathe lying there with what felt like a ten pound bowling ball on top of me!

So soon enough... epidural was in... medication started to kick in... I was fully dilated and ready to push...  Had to wake hubby up at this point because he actually did fall asleep.  OB came back into the room.  I think I pushed probably a total of five times or so before baby came out.  It was 230 in the morning!  Overall, uneventful and routine... thankfully there was no need for forceps or vacuums or episiotomies.

Now into the postpartum period.. which will be subject for a different post...