Here’s the epic story of Paulo’s birth! First is the recounting of the story from our doula, Leah, which gives the details of how things progressed. Next is my own recounting. Yes, it’s quite long, but so was my labor (47 hours!). All images courtesy of Leah.
47 hours later… Mom, Dad, and Whuff.
Your Mom started to feel contractions on Monday, March 7, 2011 in the afternoon, she went to Providence Place Mall and started walking and walking. We talked a few times on Monday evening and I encouraged your Mom to try to get some rest if she could.
On Tuesday morning we all met at Women & Infant’s Triage at 6:30 am, your Oma had arrived on Monday and labored with your Mom overnight. The triage doctor checked your Mom’s cervix and she was at 2 cm, 80% effaced and you were at -1 station with a bulging bag. After some discussion, your Mom decided to go back home to labor comfortably at home. We touched base over the course of the day and your Dad called to ask me to come help, I arrived at your parent’s apartment at 5:00 pm.
Your Mom was tired and discouraged and at a low point when I arrived. After releasing with some tears, I suggested that your Mom sleep while the contractions had slowed, then we would walk and get things going again when she woke up. She took a nice, hour-long nap while your Dad took your Oma to the hotel and got the car fixed! When your Mom woke up, we walked up and down the five flights of stairs and contractions fell into a regular pattern becoming longer, stronger and closer together. Back in the apartment, your Mom continued to labor instinctively and beautifully! She found that pushing against a wall helped, hands and knees and side-lying positions as well as moaning and vocalizing all worked well for her. She also shared that with each contraction, she thought the phrase, “You are one step closer to having America’s next top baby.”
By 8:30 pm, your Mom was trembling and working very hard, around 9:00, she wanted her Mom so your Dad called her to come back. We labored with your Mom on the floor and at 10:00, she was so tired and described feeling “funny,” yucky and queasy and like she might have a seizure. Your Oma spoke with Dr. J and we started to head to the hospital so your Mom could get an epidural and get some rest.
We arrived back in triage at 10:45 pm and the call ahead had nurses ready and rushing to help your Mom. At 10:55 pm, cervical check was at 4 -5 cm, 100% effaced and you had moved down to -2 station. This was very positive progress. We were moved upstairs by 11:07 pm into Labor Room #5 and the epidural request was made to anesthesia. Nurse M was a good support. Your Mom had a 30-45 second seizure at 11:38 pm and then got nausea medication and the epidural was placed at 12:00 midnight. Since you were going to sleep and you still had some time to get to complete dilation, I went home for a few hours and your Oma said she would call when you were fully dilated or if I was needed sooner.
At 4 am, your Mom’s water broke and at 7:12 am on Wednesday, March 9th, your Mom was checked and was fully dilated and you had moved down lower to +1 station. I arrived back at the hospital at 7:45 am. K was the new nurse on duty.
Your Mom started pushing at 8:14 am, you didn’t like when she laid on her back so she pushed on her sides with us helping support her legs. Dr. W checked your position at 9:14 am and said you were LOA (left occiput anterior) but not yet engaged. Your Mom was really uncomfortable so more medication was ordered and it was decided to allow you to passively descend and let your Mom rest some more. At 9:53 am, your Mom was still in pain so anesthesia gave another top off, by 10:20 am, your Mom was comfortable and napping.
Dr. W checked at 11:00 am and you had moved down further so we were ready to start pushing again and began again at 11:08 am. At 12:32 pm, we were seeing your head and your Mom was so strong in her pushing, she pushed effectively and with focus. Dr. B came on and your Mom had asked for some help, she explained the pros and cons of the vacuum extractor and your Mom wanted the extra help. She had pushed you down so far and so well, that she really did all of the work, the vacuum just helped her to meet you a little quicker.
Since there was meconium when the water broke, they took you for extra attention when you were born, at 12:40 pm. The placenta was delivered at 12:44 pm and your Apgar scores were 7 and 8 at one and five minutes. You were greeted with love, tears and your Mom couldn’t wait to get you in her arms! We called your Dad and he came in and admired you, too!
Happy Birthday, Paulo!
My birth plan was incredibly vague and basically amounted to “Give birth.” So, on the one hand, mission accomplished! On the other…
… NO ONE’S birth plan involves “I would like to be in labor for forty seven hours!” That’s not just me being fussy here, that’s just a sub-optimal outcome altogether. And yes, I was truly in real honest to Dog labor for that long. We’re not talking prodromal labor or Braxton-Hicks contractions or anything like that. I had contractions on average every three minutes (ranging from one to five minutes between, but never more than five) for FORTY. SEVEN. HOURS.
Let’s just say I was a little worn out.
Labor started on Monday afternoon at 1:30. I lay down to take a nap and felt a contraction that was distinctly NOT Percy, the Useless Contraction. I waited until I’d had said contraction regularly over the course of the next two hours to get excited enough to think that MAAYYYBBBEEEEEEE pregnancy would end. I know enough about labor to know that false labor is incredibly common and I was very, VERY wary about getting ahead of myself. I got in touch with my mom to start coordinating plans in case this really was actual labor and went to the mall to do laps. Yes, I walked around the mall for two hours during early labor as a method to try to encourage my uterus to keep on with the contracting. Later, I would walk up and down five flights of stairs. This is the most athletic I’ve been in EONS.
[PS: The only thing I *bought* in the mall was a bunny from Build-a-Bear to replace the elephant that was lost in the great Cat Barf Disaster of 11. I was on a mission and that mission was to WALK, not buy. Why the mall? Because it was windy as hell outside and this way my ears didn’t get all cold.]
After a while, the contractions were getting too uncomfortable for extended walking I knew I should save some energy for later (ok, well, I “knew” but y’know, LITTLE DID I KNOW), so Nuno (who had by this time joined me in my wanderings) and I headed home. On his way, he wanted to buy a lottery ticket playing the numbers of Paulo’s birthday – assuming it would be the following day – and I went along with him to 7-11. Now, I’m very superstitious and believe that the universe will totally mess with you if you start getting all high and mighty, so I wasn’t really keen on this… but he was so excited! What harm could it do? How could I NOT have the baby on the 8th? What were the odds?!
Well, whatever the odds were in the actual lottery… I totally lost the “universe thinks you’re funny” lottery as not only did we not win, but dude was not born on March 8th.
Over the course of the night, the contractions went from “uncomfortable” to “hurty” and in the morning, it was decided that it was worth it to go to the hospital and get checked to see if my cervix had made any appreciable progress. My doula met us at the hospital and upon getting the news that I was merely dilated to 2cm (but 80% effaced, so, progress THERE) we collectively decided that it would be best to just continue laboring at home and come back “later.” The OB resident (who, it should be noted, works the night shift and was just leaving when we saw her at 6:30AM) agreed and there was some talk of “see you in a few hours.” “A few.” Right.
Going home, the contractions continued. And continued. And continued. However, there was very little to suggest that they were really *doing* much. They did indeed get hurtier, but not to the point where one would think something was “happening.” There really was no point in going back to the hospital unless my water broke. Which, stubbornly, it did not.
What DID break though, was my brain. Around 10PM, I’d been in labor for over 24 hours and though I had “rested” between contractions, having said contractions approximately every three minutes meant that there really wasn’t any “sleep” that had been accumulated. Being that I have a pre-existing seizure disorder, my brain just totally threw in the towel and said “Screw you guys, I’m out of here.”
This was the point at which we threw in the “laboring at home” towel and went back to the hospital.
[ Total digression: During our first visit to triage, after we were discharged, my doula talked about finding ways to work *with* the contractions rather than feeling like I was simply trying to “get through” them. What I came up with spontaneously as I thought about that was the image of Tyra Banks announcing “Congratulations, you are one step closer to having America’s Next Top Baby” at the beginning of every contraction. Proof yet again that I am nothing if not totally ridiculous. (And y’know what? The mental image? TOTALLY HELPED.)]
There he is, America’s Next Top Baby.
I labored at home for so long that by the time I got back to the hospital to really check in for reals, I saw the same resident. Yep, she had time to go home and come back for her next shift. I use the term “saw” loosely as by this point, I was in so much pain during the contractions that I was off in another universe singing the song of the humpback whale and not really in touch with mundane things like “Where Am I Right Now.” Which made check-in difficult as I was asked the same million questions over and over and over again. And, of course, *I* had to be the one answering the questions – Nuno or my mom couldn’t do it for me. So, that was awesome. NOT.
The bad news, as already mentioned, is that I was checking in because my brain was about to implode. The “good” news? I made cervical progress over the 12+ hrs I was at home (note: that’s 12+ hours of labor on top of the laboring I had already done, we were at about hour 30 by the time I checked-in for reals). The part of the “good” news that made me want to tear out my own eyeballs? I had progressed to… four. centimeters. Four. By that rate, I’d progress to 10 cm. by July. One might imagine that I cried about this, and one would be right.
The resident noted that in terms of pain management and such, she was usually fine letting women decide if they wanted medication or wanted to manage with breathing and position changes and whatnot, but… in my case? She strongly, STRONGLY believed that I NEEDED an epidural. And honestly, despite the fact that I hadn’t planned on being medicated, I agreed wholeheartedly. After laboring that long, if I was going to avoid a c-section, pain management was totally necessary. (This is where I’d like to point out that my birth plan did allow for an epidural in the case of “extended” labor, and well, when I wrote that in I had no idea about what – exactly – “extended” could mean.)
My doula had warned me that the hardest part of labor can be the time between deciding that pain meds are necessary and actually getting them, and this was true for me, though not for the psychological reasons she’d mentioned. For me – getting in the car and jostling had kicked the contractions up a notch and Jesus H. Christ was that ever a significant notch in terms of “discomfort.” I went from a “8″ on the pain scale to a “10, no, wait, 15″ in the time it took to get from triage to my room. I had never intended to be one of those women screaming her head off in labor, but there I was. Literally screaming. Good thing I had given up on the idea of “dignity” hours ago.
Finally though, after answering ninethousand questions and waiting for a very overworked anaesthesiologist, I got the epidural and was able to at least “rest” for a while. The idea, of course, was for me to actually sleep – but even with drugz on board, that was not possible because I also had a self-inflating blood pressure cuff on board which oh so helpfully squeezed the hell out of my arm every ten minutes. But hey, I really didn’t want my blood pressure to tank on top of everything else, so I just settled for dozing between “bp cuff contractions.”
One thing that was specifically written down in my “birth plan” was that I wanted to labor in the tub as much as possible. At home, this translated to “shower” and was bagged once it became clear that showering actually slowed my contractions. In the hospital, I had to get the epidural toute de suite, so I did not get to enjoy any tub action. It was a busy, busy night for babies being born, so I might have had to take a number for the tub even if I’d been clear to get in. Not being in the tub is really the one thing I “regret” about the birth, and for a 47 hr labor, that’s not too bad.
Around 4AM, my water broke. Finally. Took it long enough. It was an odd moment as I could only sort of feel it (thanks to the epidural), but there was absolutely no doubt as to what had happened as both Nuno and the nurse in the room heard it. I guess it sounded like a little “pop” – like one would expect. Upon inspection, it was discovered that Young Sir had already gotten down to business in there. Fantastic. The meconium meant that baby would have to be taken over to the warmer and suctioned out before I would be able to hold him, which, y’know, disappointing. But hey, I don’t want my baby aspirating his own poo, so you do what you gotta do.
After my water broke, I got pestered every so often about feeling “rectal pressure,” which each time, I did not. I would like to say that either thanks to the epidural or the way dude’s head was all twisted sideways, I never felt that tell-tale “I have to poo” pushing feeling. I felt a lot of other things during pushing – such as simply the overwhelming urge to push – but never anything in my bum. At 7, the nurse got fed up with my lack of pressure and decided maybe someone should just check my cervix already. And lo and behold! Fully dilated!
So, we started pushing. Which is not as easy as it sounds. Especially not with an epidural. The situation was exacerbated by the fact that baby did not like it when I pushed lying on my back and I had a wicked hard time feeling where I was supposed to be pushing when I pushed on my side. After two hours, we decided to let him passively descend a little more and I totally passed out. I mean that literally. People were talking to me and I just fell the hell asleep. Blood pressure cuff and all. An hour later, I woke up and we went at it again.
Now, some people claim that pushing is the “fun part.” I guess some women in labor enjoy the feeling of actually doing something. And truthfully, the actual pushing part relieves the pain of the contractions a bit. It’s exhausting and difficult, but the pushing itself doesn’t really hurt. However, for me, it was miserable. The absolute worst part of labor was the pain that would hit after each push. I’m told this is due to the position of baby’s head (which, have we mentioned? SIDEWAYS.) and the way it pressed against my sacrum. In any case, that pain was worse than any of the contractions and there’s nothing an epidural could do about it. The nurse told me to “grunt it out” after each contraction and that totally helped. After another two hours of pushing, baby was nearly out and I was completely exhausted. Given how long this had all taken, I was told we could try a vacuum extraction but then if that didn’t work, we’d have to do a c-section.
(PS: This is the first time anyone spoke the word c-section in front of me, though behind the scenes the discussion had been going for a while. I’m immensely grateful that I was allowed to continue laboring and that no one threatened a c-section until it really truly was necessary. While my labor was long and difficult in many ways, baby’s heartrate remained steady and my contractions remained regular without pitocin – even on the epidural – so there were no medical indications for a c-section. However, if a vacuum extraction doesn’t work, the baby very likely goes into distress and then it is necessary. Which I knew beforehand, so this was not a surprise.)
I literally begged for the vacuum. I was so worn out. I was told that I would still have to do the work, and I did. I pushed harder than I had in the previous five hours – which I was honestly only able to do because psychologically, I knew it was finally my last push. With that push and the little bit of help from the vacuum, baby’s smushed up conehead (really, this poor guy and his sideways head – smushed and bruised, but y’know, still perfect) came out into the world. One more push and his squidly body followed. (Honestly, it felt like giving birth to a squid. Kind of slimy and full of noodly limbs.)
It’s honestly amazing that he never went into distress as thanks to all of his various acrobatics in utero, he managed to get his cord wrapped around his neck. Twice. Good show there, little guy. Good show. He was indeed taken out of the room to get suctioned – my mama went with him and Leah stayed with me and called Nuno to let him know that the deed was done. (Nuno not being present for the pushing because… yeah, he didn’t really need to see that.) It took a while for them to get him cleaned up and to get me put back together (though really, I only needed three stitches – which for a vacuum birth is pretty awesome) and then I finally got to hold my wee dude.
And it’s clichéd, but true, that nothing has ever felt as totally awesome. Ever. My little man, finally on the outside. It still amazes me when I see him that HOLY COW THIS WAS INSIDE ME. And of course, I love him so much I feel like I’m gonna asplode sometimes. I wouldn’t quite say “I’d do it all over again!” but I can go so far as to say that all forty seven hours were completely worth it in that they ended with me singing Happy Birthday to my son.