The Necessarean

My water broke in Payless shoe store at 12:40 PM on Saturday, April 3.

I was standing in line to pay for the girls’ Easter Sunday shoes and I felt a little gush. I went to the bathroom and there was a spot of brown on my pad, about the size of a nickel. I looked in the toilet and there was a big chunk of brown, so I figured it was just plug.

We got home and I went to the bathroom, changed my pad and when I stood up, another little gush. I looked at the pad. Greenish yellow. I had my daughter go and get me my Nitrazine paper. Initially it was negative. Another gush later, I tested again. Positive.

I called my midwife, D. She asked if I wanted to just go the hospital. I said I would rather not and asked what her protocol was. She said as long as the heart tones were good and reactive she was okay for now. She asked me to listen to the baby for reactivity and to take heart tones every hour. She gave me more information about cleanliness, herbs, etc. We discussed that she was not comfortable with me staying home longer than 24 hours considering the meconium and my unknown GBS status. I’ve been positive in the past and I’m pretty sure I would be again. I sent Preacherman out for some Hibiclens to use as a flush. She decided to wait a while to come because I wasn’t really having good frequent contractions yet.

We continued to talk every couple hours for the afternoon. Baby boy sounded very reactive, he was moving lots and I was having some contractions – no more than 15 minutes apart. When Posie would nurse, they would get down to 3-4 minutes apart and lasting about a minute. When she quit nursing, they would space out again. In all the leaking I had, the total amount of liquid lost was less than a cup. Probably 2/3 cup. I was wondering why it was so little amount.

I took a nap in the afternoon. When I woke up, I listened to the baby. When I put the Doppler on, it sounded like his heartrate was very low. I listened for a while finally feeling my own pulse. It felt like it was beating in sync with what I was hearing. As I listened, it gradually went up to normal. (midwife note: this means it WAS the baby, not me. It's a good thing I had a midwife instead of insisting on being my own.) I listened non-stop for a good 15 minutes and didn’t hear anything but a reactive heartbeat with accelerations. I convinced myself I had heart my own heartbeat. (I did tell the midwife about this when she arrived).

We ate dinner and Preacherman put the kids to bed. My midwife, D, arrived around 8 or 9 pm. I showed her my pad and she felt it was pretty dark color, but not particulate. She listened to Baby Boy and he sounded fine. I told her that when the contractions were further apart, they were stronger and longer, and when they were closer together they were weaker. I got Posie to nurse again and they picked up for a while. I alternated resting with trying to get contractions to actually DO something. I could tell from my lack of emotional changes that I wasn’t making any dilation progress. Baby Boy was never in the same position for long. LOA, ROA, OP, sometimes with his head oblique into my hip. I tried some homeopathics. I tried the breastpump. I even tried 1 T of castor oil (diarrhea, not bad, but no contractions).

By now it was about 3 or 3:30 AM. D had said the last thing we were going to try was some cervical stimulation, which we were holding off on because of the broken water. She felt that whatever we did, it needed to be done while it was still dark out because we agreed my labor would not pick up once it got light out. She told Preacherman and I to rest.

We laid down at about 4. At 5:35 AM it had been 21 minutes since the last contraction and we were both dozing. D was laying down in my office downstairs. I had a MONSTER contraction. It probably lasted 1 min 45 seconds or so and felt like that last couple contractions before you push. D came upstairs right away to listen. She put the Doppler to my belly and we heard… thump………… thump………. Thump…….. The heartrate was very, very slow. Like 70 bpm. “Is that him?!??!?!” I said. She told me to roll over to my left side. I did. She listened again. Thump……thump……thump…… She ran out in the hall to get her oxygen and put the nose cannula on me, telling me to breathe deeply. She listened again. Thump…….thump….. thump. As we listened, finally, it slowly came back up. She said, “I have to check you.” She felt waaaaay up inside. 3 cm. Thick cervix. Head nowhere to be found. She asked if we wanted to call 911 or take our own car. Preacherman said we’d take our own car.

We decided that even though my doctor did NOT have privileges at the closest hospital, we would go there anyway because of Baby Boy’s heartrate. We arrived at the ER there and told them what was happening. My water broke, was green, baby’s heart was too low. They put me in a wheelchair and took me up to the L&D floor while they had Preacherman filling out paperwork. We got up there and the L&D nurse came out in the hall and closed the door behind her, telling us that she was so sorry, but there was no doctor there and that they couldn’t call one in or touch me until I had been seen and examined by the ER doctor. They explained to me that my doctor didn’t have privileges there. I KNOW THAT. We came there because it was closest to my house! RIDICULOUS! They wheeled me back downstairs and wanted me to go into a triage room in the ER. I said that I wanted to get the baby on the monitor and listen to his heartrate. The nurse told me they had no way to monitor him in the ER and that they couldn’t touch me until the ER doc had checked me. After she walked out, D and I looked at each other and decided it would actually be quicker to make the 20 minute drive downtown to the other hospital than to deal with their crap there. I walked out and said, “We’re going to the other hospital.” The ER doctor told me I needed to sign an AMA form if I was leaving. I asked him “What for? You didn’t give me any advice or do anything other than jerk me around.” They wanted me to let him examine me and send me up to L&D. Which I pointed out, they had NO DOCTOR THERE anyway. I told the girl at the desk, who was still making copies of my insurance cards, to “Give me my cards.” She was all “It’s not my fault”. No one said it was sweetie, just give me my stuff, we’re leaving. She said she wanted me to sign a consent to treat form. I actually just laughed. We walked out. As we got in the car, I almost told D, but didn’t have time to say it, “I’m not scared. He’s okay.” I felt sure that Baby Boy was going to be okay. I think God gave me that peace.

In the car on the way to the other hospital, I sat in the back with the O2 on, D leaning over from the front seat to listen to the baby. He sounded fine the entire way. We arrived at the next hospital and they took me right into triage (my doctor has privileges at this hospital). They used nitrazine again and confirmed it was amniotic fluid. By this time the fluid was dark green. The triage nurse checked me and said I was 4 cm, 85% effaced and the head was well applied. D assured me that this was NOT her finding at home, and perhaps the baby had moved off his cord or whatever was happening.

As the triage nurse was leaving the area to get the doctor, I told her that if Dr. B was the dr. on call, that I would not allow him to see me. This particular doctor was abusive to a friend of mine and I knew psychologically I couldn’t handle having him attend me. They asked me who I wanted then. I said I would take whoever was accepting the walk-ins. They told me it was Dr. L. I was very surprised to hear this! Dr. L is who did my c-section with my fifth baby. His personality leaves much to be desired, which is why we didn’t go back to him. BUT, I know how to handle him, I know him, I’m comfortable with him.

They got me into a room and on the monitors. My nurse was wonderful! I was so happy to have such great staff. They were so respectful of my wishes, so nice about everything. Very willing to work with me. I was crying about missing my kids – overwhelmed with sadness that they would miss their brother’s birth. D suggested that since they allowed three people as support for me, that she would go home so I could have my two oldest daughters with me.

Even though the nurse suggested position changes, etc., I just didn’t feel comfortable considering the heart rate issues and possibility there was a problem with the cord. We were having a really hard time getting and keeping him on the monitor. We didn’t have a good strip of his heart rate.

Dr. L wanted a maternal fetal medicine consult, even though we had all of my regular doctor’s records right there, he wanted to repeat things like the ultrasound. So an ultrasound was done. Baby boy was posterior. (Quel surprise!) They estimated his weight at 7 lb 14 oz. I couldn’t believe he’d be that small. My other boys were about 8.5 to 9 lb, and I figured the baby would be too. The sonographer also said that there was no fluid left at all.

The perinatologist came in to talk to me about my history, etc., and while she was there, his heart rate went way down again. They said they wanted to put in an internal monitor. I knew it was the right choice, KNEW we needed to know exactly what was happening, but I also know how they are placed. I consented. As they were placing it, I just sobbed and sobbed. I could feel him moving and squirming inside of me, trying to get away from that sharp little lead. I couldn’t stop crying, knowing it was hurting my baby, but knowing it was what needed to happen. The perinatologist said I was 5 cm and 85% effaced. She didn’t say what station he was at.

I also knew that if I was stuck in the bed, with a posterior baby and unable to move, I was going to have to have an epidural. It seemed dumb to have an epidural for these sporadic contractions, but they continued to be extremely strong now and then, with smaller ones in between. Another decision I cried over. The homebirth midwife getting an epidural. Preacherman was so awesome and supportive. I also figured if I had to be in the hospital, I may as well enjoy having my baby as much as I could, and the amount of pain of being stuck in one spot was not enjoyable.

My two oldest daughters joined us. Violet, my really sensitive child, was crying along with me. I think they were both a little scared, and this was so different than what they’re used to with birth.

The epidural went in flawlessly and was low dose. I could still feel when I was having contractions, but it helped a lot with the pain.

Finally Dr. L came in. He said that our baby was giving us signals that he was in trouble. The meconium, (which had increased to a sludgy thickness), the complete lack of fluid, the lack of reactivity and the decels. Wait, what? Lack of reactivity? He said that he thought my uterus might be rupturing and that we should have a c-section. He checked me also and said I was maybe 3 cm and the baby was sky high. I still was not really having “labor”. Even though I was having contractions that were double peaking sometimes and lasting almost 2 minutes. We asked for a few minutes to discuss it.

After Dr. L left, I looked over the strip. He was right. Aside from the decels, there was a rather flat line. Beat to beat variability, but no accelerations with movement. He WAS still moving, so that was very good. Tearfully, we decided that for baby’s sake, a c-section was the right choice.

They topped up my epidural and gave Preacherman some scrubs. There was discussion about what would happen if Baby boy had breathing difficulties. I was worried about this also, as I know what they do with meconium babies at the hospital. I wondered how he could possibly NOT have aspirated during those deep decels with such thick meconium.

They got me all draped and ready, tested my anesthesia level and two minutes later I heard Baby Boy yell with all his lungs. They sounded clear and good. But wait, where was my husband? They were still getting him. He missed the birth. I can’t believe they couldn’t wait just a few more minutes. Baby Boy continued to cry lustily. I could hear he had no issues at all. The nurse said he peed on her. His APGARS were 9 and 10. The nurses were commenting that he looked like he’d been dipped in pollen. Mixed with the vernix, the poop looked yellow. It was up his nose, in his ears, under his fingernails and in the creases of his eyes. Once he was mostly wiped off and wrapped up, Preacherman brought him over to me to be cheek to cheek. He was so soft and warm and I was struggling not to sob and make my belly jiggle while the surgeon was working. I heard them estimate my blood loss at 500 cc. The average for a c-section is 800 cc, so that’s not bad at all. The nurse came in and announced that Baby Boy’s weight was 7 lb 3 oz and he was 20” long. So small for one of my babies! Why was he so small?

In recovery, even though it was “not allowed”, the nurse had Preacherman bring the baby back to me. I was able to put him skin to skin and he latched on immediately as if he’d been doing it for weeks already. I didn’t get the horrible shakes like I did after my othyer surgery and I declined any IV meds that would make me groggy, so I felt alert and awake and aware. It was a much better immediate postpartum in that regard.

Dr. L came back into recover to talk with me about the surgery. He said that he had been right, in that when he made the skin incision and retracted my bladder, there was “no uterine muscle left in the area of the scar. It was so thin [he] could see the baby’s face through it.” He also said that Baby Boy's cord was very thinly formed, with very little Wharton’s jelly protecting the vessels. This is probably why he was so small, with skinny little legs and not much ability to deal with the stress of the meconium plus lack of fluid.

I am so grateful to God for giving me D as a midwife, who gave me confidence, warmth and love during my pregnancy and helped me to remain calm through everything that happened. I am so grateful to God for Dr. L being the one on call – a familiar face that I trusted when that was a very important thing. I am grateful for my husband, who supported me in every decision, who assured me that it was okay to get the epidural, that he loved me forever no matter what. I’m grateful for the fantastic staff of nurses who were respectful of my wishes, never rude or mean, and willing to work with me on all of my strange requests. I am grateful that Baby Boy is so healthy, nursing well, gaining weight, sleeping well and being adorable and that he didn’t have any breathing difficulties or need to spend any time in the nursery.

I know I will never be able to labor again. I have an extremely strong feeling that I now have answers to why my labors with Blondie and Posie were like they were. I think my uterus was thinning even then and protecting itself as much as possible. I don’t even know that another pregnancy, even with an early planned c-section, would be a safe thing to do. I am mourning the loss of the dream of my peaceful home waterbirth, of grasping my warm, wet baby to my chest in ecstasy at the moment of birth. I am mourning the fact that no matter what, I will never experience that again. I am mourning the loss of my placenta (and its anti-depressive effects) which we decided not to keep as it had been marinating in meconium. I know I should be grateful for my 8 healthy children, and I AM. But still, this is a loss for me, and it is one that I will mourn.