Thursday, January 08, 2009

How all this all began

Beth is one today. One! And we forgot to get her birthday present in time. And she and I have spent most of the morning doing housework. Don't tell her any of this on her 21st, please.

How all this began is ...well, it was in England, but that's the grown-up part of the story. Otherwise, this all began with Beth's birth, and that began on 6 January 2008.

About two hours after this photo was taken, in fact.

Beth had been due on the first or the fourth, depending on calculations (in our hospital in the UK, the ultrasound and prenatal wards were at war on the subject), and I was frankly fairly huge and puffed up. It was a really hot day. I had spent it out, including a long walk on the foreshore with Mum and Nanna (Mum kept asking me to check if Nanna's feet were in her wheelchair, but she wouldn't slow down when she asked, and I couldn't move fast enough to get in front to check), and later a milkshake with some old schoolfriends. Melissa insisted that Beth had dropped, and I launched into a tirade about how NOONE WAS TO TELL ME THE BABY WAS IMMINENTLY TO BE BORN BECAUSE CLEARLY SHE WAS NEVER, EVER COMING OUT.

I think we had a roast dinner for tea at Mum's. We went to bed quite late; after 11pm. And I lay down and felt a tiny pop, and immediately started having contractions almost exactly four minutes apart. When we came back to Australia, we had planned to have Beth at the low-intervention Belmont Birthing Centre with Grant's aunt, who is a midwife there, as I wanted someone we knew with us and wanted noone buggering around with my innards. Unfortunately that plan went awry with that tiny pop, as when I went to check in the bathroom, my waters had broken and they were stained swampy green with meconium. This ruled us out of Belmont's policy. Aunt was kind enough to ask us to come out to check if Beth was OK (she was hoping I would against all the odds have a super fast birth before anyone noticed I wasn't supposed to be there), but that meant we had to be admitted to hospital in early labour rather than wait until things were well and truly going as we had intended. That and the meconium also scared the hell out of me, which led to an adrenaline burst, which stalled things. So overnight my contractions grew further and further apart for the next 7 hours and then stopped (while having been close enough together all night to stop me sleeping), and then the real fun started when we were transferred to John Hunter, to a labour ward room that looked like an operating theatre, and
a nice fat drip full of syntocin to "augment" (ie restart) my labour was jammed in my arm and a permanent foetal monitoring belt attached. Thereafter I had contractions about every 2-2.5 minutes, of a lovely nasty back labour kind, as Beth was posterior. I was also chained to the bed with the monitoring equipment and the drip so could do nothing more than stand and shuffle and vocalise and bang my stress balls for pain management. Thankfully my friend the masseuse was with us, and she did very little other than massage my back for the next twenty hours or so. Between Grant coaching me with vocalisation and focus and Deirdre's massage I think we did remarkably well for a syntocin/posterior combination torture treatment. Humorously, after getting me to the maximum syntocin dose, the hospital kept wanting to ramp it up. Because if the maximum dose isn't working, obviously what you need is MORE.

On syntocin, one is supposed to have cervical dilation of 1cm every hour. Because of Beth's posterior presentation, I managed a cm about every 3-4 hours, and I had already been awake since 7ish the day before. Because I was dilating so slowly, I was still technically in pre-labour after having had contractions for 18 hours, which meant that the only pain relief option the hospital would offer was morphine. I remember I was cold and my legs were shaking in a way that felt like shock before I eventually gave in at about 6pm on the 7th, and had a dose of morphine. It brought immediate relief. My legs stopped shaking and I felt much warmer. After that I managed to lie down and dose for an hour or so, but then the contractions were unmanageable again and I had to move around. The midwife showed us a Belmont trick of turning a baby by propping your leg on a chair and pushing your belly against it with a contraction, which was excruciating, but may or may not have helped. A few hours later I had another dose of morphine, which frankly made me off my face without really helping with the pain. This was about 11pm, I think, although I don't remember the passage of time very well. At that point I had finally managed to get to 5cm dilation, which entitled me to get the epidural I had never ever wanted but could not manage without, as I really needed a rest.

The epidural was slightly ballsed up in that it only really worked down my back. They kept topping it up and all it did was give me a numb bum and back of legs while I could still feel the contractions through the front, but as most of the pain was in my back anyway it did help. I had another lie down, and when they came to check me half an hour or so later I was almost fully dilated. I frankly did not believe the doctor when he said this. At this point, everyone was still arguing about whether Beth had fully turned or was still posterior; the consensus was that she had turned kind of sideways. I remember a really weird feeling of quiet expectation, and I asked the midwife what a pushing urge felt like the minute before I had an enormous one. She told me not to push, as they didn't think I was fully dilated, but then she checked again and gave me the go-ahead.

I wanted to turn over rather than push up-hill from sitting, and Grant and Deirdre helped me turn over, even though my legs were quite numb. But pretty soon after that the syntocin drip ran out, and my contractions stalled again. This is not supposed to happen in second stage labour, but my body really, really did not want to be in labour, possibly because I was so alarmed by the hospital environment and because I really had very little to eat (discouraged more than once by midwives but I suppose I wasn't that hungry anyway) and was so tired.

They got the drip and the contractions restarted and rolled me back over to pushing uphill position, citing the epidural as the reason I had to do it that way (in hindsight this really ticks me off, as Grant can lift me over his freaking head, and could have held me in whatever position would have twisted Beth out the best). I think I had a few more pushing urges, but after that they stopped. The midwife asked me when I had last eaten, and I remember thinking "well, now we're f___ed." After that I pushed for about another 2 hours with nothing to help but worn-out contractions and engine fumes. It got to a point where pushing was agonising, like my pelvic bones were jammed somehow; pushing hurt both front and back. I think I was getting nowhere because Beth had failed to turn completely from posterior to anterior (only got halfway) and therefore I was having a lot of trouble pushing her head around the "U bend" at the last minute. Then the midwife basically called it, as I had been pushing for 2.5 hours by then and apparently there is some sort of benchmark for the permitted time for such things. I suppose I was sort of relieved because I didn't have anything left to put into the birth, but it also seemed like permission to quit trying which probably didn't help matters.

Beth's skull was mashed up from enduring such frequent contractions for so long, although the miswife preferred to blame us for this because I had had the temerity to stand for pain relief rather than lying down (!). This meant ventouse was not an option, so forceps were planned. Unfortunately the hospital won't do forceps these days outside an OR, so we had to consent to a C-section before they could try forceps. It took them a while to arrange this, I think, as in the end my second stage went for 4.5 hours before Beth was delivered, and I remember the contractions while that was happening were doozys as the epidural had largely worn off by then. They shaved me (undignified) and gave me something to drink to neutralise my stomach acids in case they had to do the surgery, which made me throw up - nice of them not to warn me about that, I thought. Then they wheeled me into surgery and did a full spinal block anaesthetic which hey, actually worked. They hoiked my legs up into stirrups like in all the tv shows and slung up a sheet so we couldn't see my belly, only the faces of the doctors. It was completely surreal.

They will only do a forceps delivery in fairly perfect conditions due to the risk to the baby. I was pretty sure I was going to end up cut, and after all that time trying! But then the obstetrician and consultant looked down behind the sheet, and they had huge smiles on their faces. "The baby's so low!" on of them said. I had gotten her to +2 station, apparently (which makes me think maybe someone should have given me a lolly and a huge pep talk and got me to have another crack at it, but anyway). Forceps went in; I couldn't really see. Then they asked me to push. For the first time the whole labour, a medical professional complimented my pushing efforts, and a few seconds later she was out. It was 5.50am on Tuesday, 8 January 2008, about thirty hours after the first contraction.

But that was only really the start of the bad part.

They passed her over my chest as if to put her on my chest, but she was pretty grey and not breathing, so they rushed her to the side of the room. It took a long time for her to cry, and it wasn't really the lusty cry you hope to hear. They put her in my arms and she was staring at me, but every time she tried to breathe her lungs were deflating and she was making a horrible squeaking noise.
I was fairly disconnected right then. There was no instant bond. I was really worried for her, but I didn't love her yet. It didn't seem like she was mine, I suppose; for ages, I thought they had just yanked her out of me - "taken birth" - which didn't help the connection, I guess. It wasn't until Grant showed me the photos with the forceps removed that I realised that they had certainly helped, but I had pushed her out.

Beth was taken to the NICU with respiratory distress after only a few minutes with me. I sent Grant with her (and later she had visits from Mum, Deirdre and I think Sue while I was still in recovery), while I was wheeled into the recovery ward and basically left to my own devices for an hour or so (helping my recovery how I wonder?) while everyone rushed around the woman in the screened off bed next door, who I think may have been dying. Mum came in to see me, and Grant brought pictures of the baby, as he had sent Deirdre to sit with her while he came to see me. Beth looked in such bad shape. It felt like my fault. It still does, even though in hindsight and with further reading I know that two major causes of respiratory distress are syntocin and early clamping of the umbilicus, both of which of course were done. And that even though morphine is also a cause of respiratory distress, I had been put in a situation which was not really survivable without it.

Apparently as a special favour, rather than take me straight to the maternity ward, a maternity ward midwife met me in the NICU in my giant hospital bed with my paralysed legs, and I got to see Beth for the first time properly. I couldn't hold her, as she was covered in tubes. She knew my voice though. She turned her head towards me when she heard me, even with all the tubes.

That made me feel a bit better.

Then it was back down to a ward of 5 women who all had their babies with them, while mine was in NICU. Mum made me a cheese sandwich. I still wasn't very hungry, but it was the first thing I'd eaten in days. Aunt Sue helped me express some colostrum, so she could take it up for Beth. I think I slept for about an hour, my first sleep in three days, and then I went back up to the NICU in a wheelchair, as the anesthetic still hadn't properly worn off. I got to feed Beth for the very first time of thousands.

She was a natural, which is just as well, as there was noone there to help us get started.

But after this we had to leave her behind, as once a baby gets into the steely jaws of NICU they will find a reason to hang onto her. In fact, the way I knew I had finally bonded to my beautiful girl was when she was a month or so old and I started bawling my eyes out, because it was suddenly intolerable to me that we had had to leave her, with strangers, a brand new baby who knew nothing of the world except my voice and my smell, stuck in a freaking hospital ward by herself, without the slightest thing to give her comfort.

Beth had had a high lactate reading at birth from the long labour, so was at risk of hypoglaecemia, so even though her blood sugar readings which were all 2.8 or above were considered normal by the maternity ward (above 2.5), they weren't by the NICU (2.9 or above), so she had to stay while I dragged my wounded self up three floors rom the maternity ward to the NICU to feed her every three hours and at one stage every two hours (all while trying to recover from a 30 hour labour on top of a 16 hour day awake), even though it seems to me that the best way to elevate a baby's blood sugar would be to, I don't know, MAKE IT EASY FOR THE MOTHER TO BREASTFEED THE BABY. If I weren't such a stubborn bugger, she would have been on formula; the miracle is that anyone leaves the NICU breastfeeding.

After that, she had borderline bilirubin levels and therefore ended up in a light bed for a day. But finally, finally we were allowed to have her in our room, and a day after that we were the hell out of there, and home at Mum's.

And after that we didn't leave her anywhere by herself, ever, and anyone who has a problem with that can put themselves through all of this before they pass judgement.

Some months later the hospital finally sent me my discharge papers. They look like a train wreck. Meconium staining, augmentation, hypertension (apparently my blood pressure started skyrocketing during labour, so of course they decided to make the situation even more comfortable by adding a blood pressure cuff to the mix), forceps, respiratory distress, hypoglaecemia, jaundice, the whole shebang. And it made me cry, because that "maternal exhaustion" seemed such a glib way of passing off what I had made it through. But I'd do it all again tomorrow, for Beth. And I'll keep cuddling her to make up for it as long as I live.

1 comment:

Karen in Bendigo said...

Happy Birthday Beth!!

- and Loz.... I had no idea it was that rough for you. But geez wasn't it worth it.

The things we go through eh?