Terri, my midwife, came in to evaluate my progress with a cervical check. The Foley had put me at 5.5 cm, which was exciting news. The baby, however, remained quite high in my pelvis at a -3 station. It was time to start Pitocin.
A Pitocin induction usually goes like this: they start the drip at its lowest level and increase it by twos every 30 minutes or so until you have a good contraction pattern established.
My doula, Brittany, showed up around 7:30 pm so that she could support me as I transitioned from what had essentially been my early labor, to what would now become active labor.
The IV was connected to my hep-lock and the Pit started flowing at a level 2. Nothing terribly exciting yet. The contractions were far weaker than the ones I’d been experiencing on my own all day (but which had stopped abruptly once the Foley fell out).
My husband and Brittany and I chatted while I alternated from bouncing on the ball to pacing across the room (now that I was hooked up to the Pit I was no longer free to roam the halls… or 7th street outside of the hospital). Every 30 minutes the nurse came in to crank up the Pitocin some more. I didn’t need to turn my focus to the contractions until we were at about a level 10.
At this point Brittany had me doing different movements and exercises during each contraction to help bring the baby down into my pelvis. These were not at all comfortable, especially when what your body wants to do during a contraction is tense up and shut down while you grit your teeth until it’s over. Moving through the pain — to me — felt counterintuitive. And exhausting.
On the ball, I tilted my pelvis and circled my hips in a figure 8 pattern, imagining that I was swirling the baby downward, like water in a drain. Standing, I did these (God-awful) hip dips which mimicked the same movement. It became more and more difficult to focus my efforts on these exercises as the contractions grew in intensity. We were well into the overnight hours at this point and I was losing steam.
In my previous labors, I always liked to brace myself against something, or to grab something to hold onto for both support and resistance during my strongest contractions. Once the Pitocin was kicking my ass at a level 18, I climbed into the bed in a seated squat position and Brittany and I used a rolled-up bedsheet in a tug-of-war fashion during my contractions. I’d dig my heels in, tuck my pelvis, and pull as hard as I could on the sheet while the contraction swept over me. This helped keep the pressure and movement in a downward direction. I could feel myself making progress; I could feel my baby’s body start to dislodge from my ribcage as she ever so slowly scooted down.
I ran out of steam once we hit a level 20, the maximum dose of Pitocin. I couldn’t bear the effort it took to work through my contractions any longer. I’d been vomiting and was depleted of energy. My body began to shut down. So I rolled over onto my left side and attempted to rest. The first few contractions in this position were excruciating. But eventually, I was able to relax through them and I drifted in and out of light sleep. My husband and doula took advantage of my self-imposed break and each fell asleep, as well.
At 6:00 am (10 hours after the Pitocin was started, and 20 hours into the labor as a whole) Terri came in to wake me and perform another cervical check. I was 6 cm, and baby had moved from a -3 to a -2 station. All that hard work had barely done anything. 10 hours of Pit and I had a half a centimeter and a still-floating baby to show for it. I was discouraged, to say the least. We agreed to keep things going for a bit longer before making our next move.
By 8:00 am (now 12 hours on Pit, 22 hours into labor) Terri suggested we turn off the Pit for 4 hours to give my receptors a chance to empty out and for me to rest. We’d restart the process later that morning.
Brittany went home, Ian went out for breakfast and to visit our children. I took a quick but satisfying shower and fell asleep in my bed before my skin had even fully dried.
I woke up at 11:30 am when Ian returned. Right on schedule, the Pit was hooked back up at noon, starting at a level 2.
Just like the night before, the first couple of hours were very mild. I snacked, chatted with my husband, corresponded with friends via Facebook and text who were eager to know where the eff my baby was. At some point, Brittany came back (I want to say around 3:00 pm, maybe?)
And, just like the night before, things got fast and furious once we’d hit that 10 or 12 level. Brittany and I worked on some new positions to help coax the baby down. She bound my belly tightly in her rebozo, hoping to encourage the contractions to push downward. She made me play dance music instead of my thoughtfully curated birth playlist so that I’d move my body as I labored. (This got a bit awkward as Jay-Z dropped several f-bombs for all to hear while my grandmotherly L&D nurse struggled for several minutes to get baby’s heart rate reading on the monitor.)
Then, I got bumped up to that level 20 again. And that stuff doesn’t exactly tickle. Brittany got my headphones out and told me to get my birth playlist on and “go inward.” So I did.
I rode each contraction while standing over the bed, moaning and singing my way through the peaks. During Of Monsters and Men’s “Lakehouse,” I was doing what could best be described as hum-growling while I did those damn hip dips again, groaning the melody out loud through gritted teeth.
I’ve made this analogy before and I’ll do it again: active labor contractions feel like a freight train is driving through your body. You cannot stop it; you cannot slow it down; and its force is so powerful and all-consuming that it truly feels as though you will split yourself into two halves.
I climbed on top of the bed and had my husband and Brittany raise the head to a 90 degree angle. I used that for support as I labored on my knees facing and gripping the mattress at the head of the bed. I was in tears now. The pain was no longer tolerable. I truly felt like I couldn’t go on any further.
Terri’s weekend shift was coming to an end and Angel, another midwife from the practice, would be taking over. Terri was disappointed that I hadn’t had my baby on her watch, though not nearly as disappointed as I was.
The midwives wanted to do another vaginal exam, which terrified me since my contractions were already excruciatingly painful; I could not fathom a cervical check happening while my body was already going through so much. But we did, and we discovered that the baby had actually receded and was floating even higher than before, up beyond a -3 station — she could barely find her head. No additional dilation, either. I lost it. I began sobbing wildly, feeling like an utter failure whose hope for a “good” birth was lost.
Had I been making any progress up until this point I could have kept going. If I was in or near transition, or if baby had descended to a safe enough level to where we could break my water and keep progressing, I’d have stuck it out. But this was not the case, and I hadn’t budged much since the Foley bulb stretched me to 5.5 cm more than 24 hours ago. I was exhausted and in so much pain. I knew my limits and I’d hit them. I requested the epidural.
It would be nearly an hour until I actually got said epidural since an IV bag of fluids needs to be administered beforehand. And let me tell you, that mofo drips slower than molasses. I was forced to ride out another hour of shoot-me-now/I-regret-everything-I’ve-ever-done-in-my-life contractions before I finally saw the smug face of the anesthesiologist. (Seriously, though, is it a job requirement that anesthesiologists be arrogant d-bags in order to have that job?)
The epidural went in at 7:00 pm on July 12, after 24 hours of Pitocin (less four hours for the break they gave me that morning) and 33 hours of labor total.
Shortly after the epi was in, I started to see stars and feel as though my chest was being crushed. My blood pressure had dropped to 70/40. I began to panic and everyone in the room started scrambling to untangle my lines (all of my moving and shaking during those Pit contractions did a number on my IVs) so that the anesthesiologist could give me a shot of something to get my BP back up. It was a little intense and more than a little scary.
But eventually my BP came back up and Angel settled me into place with a peanut ball between my legs (now that I was completely immobile, keeping my legs and pelvis open was my best shot at making any additional progress). I sent Brittany home to rest again and Ian settled on the couch to do the same. Exhaustion overwhelmed me and I gave in to it, closing my eyes for some desperately-needed sleep.
My nurse came in every 30 minutes to reposition my legs around the peanut ball. I could still feel the pressure of the contractions in my pelvis, but not the actual pain.
I rubbed my belly and cried, begging my baby to move down. I played music on my phone and held it down by my pubic bone, hoping she’d swim towards its sound. I promised I would guide her gently and lovingly earthside, that she’d come straight to my arms and that I’d feed her my breast, if she’d just move down.
But the writing was on the wall. I knew, deep down, that the chances of a vaginal birth at this point were slim to none. It was simply too early, she was too small and had too much room in my uterus to float around in. Had she been bigger, the contractions would have eventually “squeezed” her down and forced her to put pressure on my cervix to dilate it. But at just 37 weeks and an estimated 20th percentile, she was simply too small. And I knew it. I knew that lying in that bed with that ridiculous peanut ball stuffed between my legs was doing nothing but running out the clock.
At 4:00 am on July 13, after 33 hours of Pitocin and 42 total hours of labor, my fears were confirmed. A final vaginal exam showed absolutely no change in dilation or in baby’s position.
The tears flowed. Heavily. I looked over to my husband, desperate for his comfort, as I knew what was about to happen to me. He reached out his hand and I squeezed it. His eyes met mine, and I could see he was just as afraid and defeated as I was.
Angel offered to let me labor for a few more hours. She suggested more position changes, or another re-up of Pitocin to empty my receptors.
“I think I’m going to need a c-section,” I said in my bravest voice, which was shaking.
She agreed that it might come to that if I didn’t make any more progress on the Pitocin, but she was willing to keep trying.
I knew better, and was stubborn enough to want the decision about a c-section to be mine and not anyone else’s. So I told her that, no, I wasn’t willing to wait it out any longer, hooked up to drugs and lying nearly still while I awaited another disappointing cervical check. No, let’s call the OB now and do the cesarean now.
So that’s what we did.