A May Birth in July, Part 3

Once I gave the green light for the cesarean, the room came alive with activity. Nurses I’d not seen before came in to prep me for surgery. The OB stopped by to introduce herself and answer my questions, of which I had a ton. I was crying and shaking uncontrollably and admitted to her that I was terrified. I asked her if I would die. She assured me that I wouldn’t, but I wasn’t so sure.

I called Brittany to tell her what was happening. I was literally choking on my tears as I explained everything to her. I felt guilty for wasting her time over the past two days leading up to this point. She worked so hard and on such little sleep for me to have to birth this child surgically instead of vaginally. For that matter, so had I. She said she’d meet me in my room once I was out of surgery.

A nurse began to shave the top portion of my pubic hair, which was humiliating. Another covered my head with a surgical cap and rubbed that orange stuff all over my stomach. The anesthesiologist returned to give me a stronger anesthesia that would completely numb me from the chest down.

Ian called my parents, and I must have reminded him about ten times to grab the camera so that he could take photos of her when she was born. He donned a cover-up that reminded me of Bryan Cranston’s meth-making suit from Breaking Bad.

He walked behind my bed as they wheeled me to the OR, which seemed so far away. They were about to take me in when I begged them to let me kiss my husband first. They obliged, but a nurse tried to reassure me that he’d be sent right in as soon as they finished prepping. What nobody understood is that I was convinced I wouldn’t survive until then. In my mind, I was being marched to my death. Surgery terrified me, and surgery while awake was my actual living nightmare. I tried to accept the fact that these would be my last moments alive and that I’d never get to meet this sweet baby. I kissed Ian and cried and told him I loved him so much. “You’re going to be fine,” was what he said.

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The OR was frigid. I’d been shaking for hours from the epidural but was now practically convulsing from a combination of adrenaline and the icy temperature. I asked for blankets, which they draped over my neck and shoulders since the curtain wasn’t much farther in front of me. I felt like I was suffocating.

“Throw up. I’m going to throw up,” I said through chattering teeth. I was laying completely flat on the surgery table and could not sit up at all, so the anesthesiologist made me turn my head sideways and held my face down to keep it there so I wouldn’t choke on my vomit. I puked once, then twice into one of those bean-shaped bins. My mouth was incredibly dry and I begged for an ice cube, a wet sponge, anything. My throat was so dry it was choking me.

So I began to panic. I told the anesthesiologist that I was blacking out and my chest was heavy. All I could see was the edge of the blinding florescent light overhead, and the blue drape obscuring my view of everything they were doing to me.

The anesthesiologist assured me that I was fine, that my blood pressure was fine, and that I was not dying. I struggled to move against the restraints of the wrist straps that held my arms, outstretched to either side, in place. I tried lifting my head. I needed to move. This had to stop. This was a mistake and I had to get out. It was too bright and too cold and I didn’t like feeling trapped and I was going to die as soon as they started cutting. I needed to leave.

They struggled to keep me still. The anesthesiologist was no longer tolerant of my anxiety and he became very clearly irritated with me. I begged for something to help with the panic and he told me I’d have to wait until the baby was out. I started asking every few minutes if they were cutting yet, if it was over yet, how much longer, etc. I counted backwards from 100 in increments of three to try to distract myself. I reached for Ian’s hand. I prayed that I would live.

Suddenly, I heard a cry.

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“Is she okay? How is she? Am I okay?”

She’s fine, they told me. The NICU team is taking her over to examine her now.

“Why is NICU here? Why are they taking her over there? Can’t I see her? Am I hemorrhaging? How much blood have I lost? Is the surgery going okay? Ian, you need to go over there and be with her so she’s not alone.”

Instead of relief to hear my sweet girl’s cries and signs of life, I became more panicked than ever. Once again I struggled to move, and I fired my questions at rapid pace, desperate for reassurance that everything was okay.

This was the last thing I remember for a few hours. The anesthesiologist gave me a dose of Propofol which hit me instantly. Apparently, though, one wasn’t enough because my husband told me that several minutes later I came to and started panicking again. So another dose was administered. My husband tells me that a remark was made about the amount of drugs I was on and how I needed a lot more than what’s typical to quell my particular brand of panic.

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I came to in the recovery room. I hadn’t met my daughter yet, or at least had no recollection of it if I had. I looked over and saw Ian sitting in the chair next to my bed, holding a tiny bundle in his arms. I wanted to know everything. Every detail. What color was her hair? Her eyes? How much did she weigh? What time was she born?

Mavis Thressa Terry was born on July 13 (my birthday), weighing 5 pounds, 10 ounces, and measuring 18 inches long. She was born with blonde hair and gray-blue eyes. She was healthy and perfect, with Apgar scores of 8 and 10.

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A nurse heard me wake up and hurried over to help me undress so that Mavis and I could do skin-to-skin and nurse. I was still quite groggy and numb and needed lots of help. I was so out of it, in fact, that I was scared to hold her at first.

But once she was in my arms the fear went away. I had lived, she had lived, and here we were. It had taken 44 hours (and 37 weeks) of work to get us to this moment and it all seemed so very worth it. She was breathtaking. Tiny and delicate, but visibly strong. Her head control was exceptional for someone who was just an hour old. She skillfully hunted for my breast, opened her wee mouth wide, and latched perfectly onto my nipple as if she’d done it a hundred times before. We’d finally found one another, we were finally together. And my body, which had failed me for the 43 hours leading up to surgery, was suddenly working perfectly. It gave my new daughter her first meal. This union of she and me, our little dyad, was almost too much to bear. The exhaustion and elation, the agony and the ecstasy, washed over me and soaked me in such splendid love.

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It was over. The pregnancy was over. The birth was over. The surgery, the fear, the pain, over. I could heal now. I could be better because of her, my sweet baby May. Born on her mama’s birthday because we are, and had been, so closely entwined for the last nine months that it was only fitting for us to share a birthday.

In my darkest hours of the pregnancy, the ones when I thought of ending it all, the ones when I spent another sleepless night in the ER begging for the pain to stop, the ones when I’d vomited up yet another meal I couldn’t digest as the numbers on the scale went down instead of up… In these dark hours, I stayed alive for her. And she, in many ways, stayed alive for me. She was my lifeline, and I hers. This was a special child. My baby May, born in July.

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In hindsight, my ongoing fears of a c-section were a bit of a premonition. I believe that I knew all along, deep down, that she would be born this way. I believe that I exhausted my efforts to prepare for the induction and a vaginal delivery so that I’d be able to say that I’d done my very best and feel good about that, when all was said and done. I believe that I knew that this epically difficult pregnancy had to end with an equally epic difficult birth. There’s no way that nine months of pain and suffering were going to end with me sneezing her out. Her birth happened the way it did simply because that was the way it was supposed to. I had to face my biggest fears to get this girl Earthside. I had to fight my demons and survive and come out stronger on the other side. That’s the kind of mother she needed. I had to become that kind of mother for her.

And our family of five is complete. The bigger kids are smitten and so are we. I’m happily, gratefully, and proudly closing the pregnancy and birth chapter of my life. Bringing my babies into the world have been experiences like no other, and each child’s birth story is beautiful and special in its own way. My first daughter made me a mother. My son made me humble and forgiving. My youngest made me a warrior.

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You have my eternal gratitude, Mavis Thressa. Bless you and your life that we fought for, you and I.

A May Birth in July, Part 2

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.

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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.

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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.

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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.

A May Birth in July, Part 1

My pregnancy was awful. See here and here to get caught up on the details and info on why I was to be induced. Click here to read about my intentions for a birth plan.

The day before my scheduled induction, everything began to fall apart.

It was July 9, my and my husband’s 9th wedding anniversary. We were planning on an evening out — dinner and an acupuncture session for me — while my parents watched our two kids. That afternoon, though, I received a call from my midwives’ office telling me that the OB who would be on call for my induction would not approve our plan to do a membrane sweep and Foley bulb insert in the office in the morning, then letting me go home to start labor on my own. I would now need to be admitted to the hospital at 6 pm the following evening to have the Foley bulb inserted there, and would not be permitted to leave the hospital once it was in place. My hopes of spending at least part of my birth — my early labor — at home, were dashed.

I was already anxious and stressed and sad about the pending induction as it was, so this eleventh hour bait-and-switch plan change sent me into a crying fit and a feeling of despair for the rest of the day. I told my husband I wanted to cancel our plans; I was too depressed to fake my way through a date night. Once he arrived home from work, I spent the rest of the evening hiding out in our bedroom, barely speaking a word to my family. It was the first time we ever skipped an anniversary date night.

I was certain this induction, despite being medically necessary and despite my utter misery for 37 long weeks leading up to it, was a mistake. I became convinced that I was going to end up with a c-section. That all of my efforts to prep my body for this labor would be for naught. I couldn’t shake these feelings and I got very little sleep that night.

The next morning — July 10, Induction Day — I started my preparations with a trip to the chiropractor for an adjustment, followed by a visit to the midwife for a stretch and sweep of my membranes (this was terribly painful, but yielded lots of bloody show so things seemed promising), then a final appointment with my acupuncturist.
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I was having light contractions throughout the day, especially after the membrane sweep. Back home, I bounced on my birth ball, sipping a Chinese herbal concoction for uterine stimulation that my acupuncturist made for me, rubbing clary sage and myrrh oils on my belly, all while hooked up to my double electric breast pump. Can’t say I wasn’t trying.

My son and dog and I took a walk down the hilly road across from our house (and then walked back up it, which REALLY kicked those contractions up a notch). I baked my Groaning Cake with my children and we licked the bowls and beaters clean. I had several good contractions while we mixed and measured the ingredients. I will forever remember that cake and the fact that we baked it together in anticipation of our baby; I’m so glad it happened that way.

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Walking some contractions out with my boy and my dog

Once the cake was out of the oven we tossed a few last-minute items into the suitcases and headed to my parents’ house to drop off our kids and dog. Since we didn’t have to report to the hospital until 6 pm, there was enough time to have a make-up dinner date for the anniversary we hadn’t celebrated the day before, so we went to our favorite Vietnamese restaurant. I wasn’t able to eat much but it was so nice to spend time alone with Ian; quite possibly our final hours of quiet before we became parents of three.
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I called the hospital at 6:00 as instructed to confirm that my room was ready. It wasn’t. They said check back at 8:00. It was a beautiful summer night so we took advantage of the extra time and walked around downtown Frederick, window shopping and people watching. We held hands and told jokes. It might have been one of my favorite anniversary dates ever.

By 7:45 I’d had enough walking and my contractions were annoying enough that I wanted to get off my feet and into a bed. We decided to drive over to the hospital since it was just a couple of minutes away.

The charge nurse in Labor & Delivery was not pleased that we showed up without calling first and she reprimanded us like children who don’t follow directions. She said that they still couldn’t get me into a room and it would now be 10:00 before I could be admitted. Now I was pissed.

We went back out to the lobby (which was too crowded, so we ended up sitting in a hallway by the hospital’s main entrance) and weighed our options. I was exhausted and worried about starting an induction so late at night without a fresh bout of sleep under my belt. But we didn’t really want to delay things and push it off to the following day, either, since my parents already had our kids and since the induction was medically indicated by a condition (cholestasis) which is known for growing more dangerous by the day once a mom reaches 37 weeks.

After an hour of trying — and failing — to get comfortable enough for a nap on a bench in that hallway, we threw in the towel and decided to head home, too exhausted to be angry anymore. We were told to report back first thing in the morning and that my room would be ready then. As soon as I was home in my bed my contractions stopped altogether and I drifted off into a deep sleep.

And so we arrived once again at the hospital at 8:00 am the next day, July 11. My hep-lock was put in place, registration checked us in, and I was dressed in my chosen labor outfit (a microfiber bralette and jersey midi skirt with a foldover waist — comfy and practical) in no time.
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Terri would be my midwife for the duration of the weekend. She arrived and chatted with us about our plans, made jokes and told funny stories about her shift thus far, then finally got herself elbow-deep into my cervix to insert that damn Foley bulb. That process was horrific and I’m thrilled beyond words that I never have to do it again. We were off and running.

After 20 minutes on the monitor to be sure baby was handling the Foley bulb and the subsequent contractions well, we were given free reign to go for a walk around the halls. Our hospital isn’t very big, though, so the short hallway loops didn’t appeal to us as much as fresh air and sunshine did. So we went AWOL and walked around outside instead.

I started to build up to some strong contractions once we got outside and I could lunge, squat, and climb stairs. I never timed them but if I had to guess, they were probably in the neighborhood of 4 minutes apart and 1 minute long by lunch time. I stomped and swayed around the cafeteria in my bra and skirt while my husband waited in line to order himself some food. The service was exceptionally slow and I had to roam around until I found a more private hallway nearby to work through my contractions, as I’m sure the diners wouldn’t have cared much to watch me doing my Ina May “horse lips” while I squatted against the wall.

We made several more back-and-forth trips from our room to the outside as the day wore on. A few minutes on the monitor to check on baby, then we’d go rogue again. (At one point I actually returned to my room to discover a tick on my leg. It figures that Lyme disease would be my punishment for breaking the rules. Fortunately, the tick wasn’t really latched, nor was it a deer tick.)

Eventually, I began to get discouraged.

I was a third time mom who showed up to this induction already dilated to 2 centimeters — why was it taking so long for this bulb to fall out? It was designed to get me to 5 centimeters. Have all of these contractions and all of this walking I’ve been doing not gotten me those three little centimeters yet? The fear of a c-section crept into my mind again. I couldn’t shake the thought that this wouldn’t end the way I’d hoped. And so I started to cry. I blubbered on and on to my husband about how this Foley bulb wasn’t an aggressive enough choice to kick off the induction since it obviously wasn’t working and my body was so clearly not ready yet and this was such mistake and…

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Suddenly, the Foley bulb fell out, along with my mucus plug.

I danced around the room, hugging my husband and cheering gleefully. It was working! I had dilated! We were really having a baby, and probably soon!

I pushed the nurse call button and shouted into the intercom, “My Foley bulb fell out! Get my midwife!” I was SO ready for Phase 2 of this birth.

The Plan

I’ve had lots more appointments since I wrote this, and not much has changed. The induction is still on and the cholestasis diagnosis still stands. I’ve had plenty of time — and a few therapy sessions — to make my peace with it. And that’s exactly what I’ve been doing.

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33-week belly in the lake

I’m not only making my peace with it; I’m taking an active, driver’s seat role in my birth, regardless of the fact that it will be an induction. I’m making lemonade from my lemons (though I’ll need an extra dose of my GERD meds if I want to be able to drink it), and my midwives and I have jointly come up with a gentle induction plan to ease me and baby girl into labor with as few interventions as possible.  The plan, as it stands now, looks like this:

– The day before I’m scheduled for admittance to the hospital, I’ll go in for an office visit with the midwives to have my membranes swept and a Foley catheter inserted. At that point, they’ll send me home for the night to dilate and begin labor on my own, bypassing the usual overnight cervical ripening via Cervidil in the hospital. (There’s lots of good info on the Foley bulb method here. In sum, it’s just as effective as a pharmaceutical cervical ripening method, but less stressful on the baby. Which, with ICP, is definitely the goal.)

– The following morning, I’ll check into the hospital for the induction. If I’ve dilated well and am having some good contractions at this point, the midwife will break my water bag instead of introducing Pitocin.

– If I don’t progress well enough on my own with my waters broken, we can start Pitocin at the lowest possible dose, increasing slowly and gradually as needed.

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Belly selfie whilst lounging in the A/C

To help things along, we’ve discussed and agreed to several complementary labor augmentations to ensure the induction is a success.  These include:

– A chiropractic adjustment by my Webster-certified chiropractor before my office visit for the membrane sweep and Foley insert.

– A visit to the acupuncturist to help with labor induction. A skilled acupuncturist can administer a specific treatment with the needles to stimulate oxytocin production and encourage labor. This is common in China.

– Consumption of red raspberry leaf and squaw vine herbs beginning at 35 weeks (though I’ve already been drinking about a quart of Nora Tea, which contains red raspberry leaf, for about 10 weeks now).

– Application of a blend of Geranium and Clary Sage essential oils, diluted in a carrier of castor oil, directly to my abdomen after my membrane sweep and Foley insert. These oils are commonly used during labor to encourage contractions, and according to Wise Woman Susun Weed, topical application of castor oil is effective at stimulating the uterus (and safer than consuming it).

– Nipple stimulation using my breast pump in the evening once I return home from the membrane sweep and Foley insert.  According to this study of randomized control trials, nipple stimulation was far more effective at bringing on labor than any other method (sorry, spicy food fans — there’s no evidence that Indian takeout will do anything but give you heartburn).

– Dates! I’m making homemade larabars like a madwoman trying to get in my daily dose of 6 dates a day. Why? For a shorter labor and more favorable birth outcome, according to this study.

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My son, midwifing me and the baby

I’m kind of psyched about this plan. Given that ICP babies are at a higher risk for meconium passage due to fetal distress, my overall goal is to minimize the amount of medical/pharmaceutical interventions employed during the induction. With the help of my doula, my husband, and my handy dandy TENS machine that my chiro ordered for me, I hope to avoid requesting an epidural for as long as possible.  Again, this is for the safety of my baby; I’m well aware that no medals shall be rewarded for an unmedicated birth.

It feels good to have a plan and to be well-supported by my providers and my birth team.  I’ve got just four weeks left to cook this little girl until we collectively evict her. Let’s all hope that she peacefully exits the premises without putting up a fight.

Be Careful What You Wish For

Remember this post?  The one when I got super dark and confessed feeling so miserable about my pregnancy that I just wished it would end sooner than later?  Well, I’m obviously a) a monster and b) capable of sorcery because, unfortunately, I’m going to be getting my wish.

After several weeks of pain and discomfort, I’ve finally been diagnosed with Intrahepatic Cholestasis of Pregnancy (ICP).  WTF is that, exactly?  From the ICP Care organization:

Intrahepatic Cholestasis of Pregnancy (ICP) is a liver disorder which occurs during pregnancy. This condition affects the normal flow of bile. Bile acids are chemicals in the bile of the liver that help with digestion. With ICP the bile flow begins to slow down in tern the bile acids build up in the blood.

The symptoms are utter crap:  Intense itching, — and I mean intense — usually on the soles of feet and palms of hands, but otherwise anywhere; right upper quadrant pain (that’d be directly under the right breast) that varies from a stabbing to a throbbing ache to a burning sensation, like having heartburn in your liver; nausea, vomiting, and fatigue.  It sucks.  It sucks big time.  And what does it mean, other than extreme discomfort?    From ICPcare.org:

ICP poses several risks that are of great concern. It is associated with an increased risk of stillbirth (intrauterine fetal demise), preterm labor, fetal distress, respiratory distress, maternal hemorrhaging and meconium passage in utero…  With active management that include the two most important factors in the treatment are reducing the bile acids in the bloodstream with the medicine Ursodeoxycholic Acid and delivering the mother as early as lung maturity will allow, often by 37 weeks gestation.

Yikes.  After my appointment with the perinatologist yesterday, it’s been determined that I’ll need to be induced at 37 weeks to get the baby out of what can quickly become a toxic environment.  I’ve exhaustively researched this disease and every source concludes the same: the baby’s gotta come out early.  This is an instance that truly qualifies as a medically necessary induction.  I’m heartbroken and terrified.

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My sweet girl's little face.

I’m a birth advocate.  I advocate for normal birth, for choices in childbirth, for access to midwives, for evidence-based practices, for safer births, for better outcomes for mamas and babies.  I, myself, was a homebirther (with transfer) for my last pregnancy.  Being induced isn’t something I’d have ever sought or wished for myself (despite my anxiety-induced ramblings that temporarily suggested otherwise).  That’s just not how I birth.  I let my babies come when they’re ready.  I cook them until well done.  This diagnosis is a big deal to me.

To compound the fear of being induced, I also learned yesterday that my little girl is quite small.  All those weeks of not eating during the second trimester did her no favors.  She’s hanging out somewhere in the 6th percentile, which would put her at about 5 1/2 pounds at birth (and three weeks early, to boot).  So I’m on strict orders to up my protein intake which is no easy feat considering how limited my diet is.  I’ll be adding two grassfed whey protein shakes per day to my food intake and hoping for the best.

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Look at that belly. Sure doesn't seem like a 6th percentile babe is hiding in there.

Terrifying, right?  I mean, this pregnancy is just relentless.  It’s been one thing after another (I could write a whole post on my ongoing DVT scare that’s fortunately turned out to be compartment syndrome in my left leg, but is nevertheless excruciatingly painful). 

And I can’t help but feel depressed about the fact that this is yet another example of my lemon body failing me like it’s done so many times before.  “Trust birth!” us birth advocates say.  “Trust your body!  Women’s bodies were meant for this!”  Well, what was my body meant for, then?  Because I’m 0 for 3 now on being able to birth a baby without medical intervention.  And THIS time, I was crazy stupid healthy when I got knocked up.  I wasn’t obese and sedentary anymore.  I ate an excellent diet, exercised regularly, had my anxiety at a manageable level, and got my BMI down to a normal range.  I was supposed to have a healthy, active pregnancy and an easier labor this time.  I feel cheated.  I’m pissed.  And I’m scared.

If you’re the praying type, send some up for me and my little girl.  If you’re the happy-thought-thinking type, send those vibes out, too. 11 8 weeks to go.

Signs of Life

If I say out loud/type it in black and white, does it jinx me?  If I knock wood (in this case, the particleboard compressed wood product that makes up my IKEA nightstand will have to suffice), can I outrun Murphy’s Law? 

Okay, here goes.  I’ll whisper-type it:

Things are better.

While I nervously glance over my shoulder, let me explain that I think this happened for a few reasons.  The first of which was my Lexapro finally kicking in.  Me on meds and me not on meds is like Jekyll and Hyde.  My anxiety and panic disorders are an illness and they need to be treated.  I know that now.  Life is better when I am getting what I need to manage my illness.  It’s that simple.

I’m also eating real food on a regular basis again.  Living on Ensure shakes and chicken broth was beyond depressing for someone who loves food and cooking as much as I do.  With an increase in my GERD medication (two different meds, four times a day) and a very strict diet (no fat, no FODMAPs, no nightshades, no gluten, no dairy, nothing spicy, no chocolate, no citrus; and meals must be small and strictly timed to coincide with my medication, which must be taken an hour before i eat), I am chewing and digesting actual, tangible food.  It’s been challenging and I’ve had to learn a few tricks to make it work (like “NOmato sauce,” though I made additional modifications to recipes like the one linked above, such as using green onions in place of white since they’re safer on the FODMAP scale), but any food is better than no food.  So once again, I credit pharmaceuticals with creating a huge improvement in my quality of living.

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GF tagliatelle with nomato sauce & goat's cheese

And what else happened that’s making the pregnancy not cripplingly and unbearably awful?

The world changed.  Literally.  A bit more of a turn of the dial and our Blue Planet finally found Spring on this side. 

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After a brutal and seemingly neverending winter, the sun came out.  The snow melted and gave way to greenery dotted with buds and blossoms.  Life happened.  To everything, turn, turn, turn.

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Getting my children outside to play in the sunshine — and standing in it myself — has done loads of good for my spirit.  Things are growing and blooming and coming to life.  And the little one inside of me is no exception.

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She kicks and wiggles and hiccups all day long.  She likes the sunshine, too, as most of her active hours are during the daytime and she settles down when Mama sleeps.  Let’s hope she keeps that schedule when she’s Earthside. 

Sure, not everything is roses and unicorn farts, but I’m making every effort to focus on the positive and not wallow in self pity.  I count down each day and celebrate its passing before I close my eyes.  Every day that I survive this pregnancy is a victory.  And according to the charts (and assuming they mesh well with Baby Girl’s plans), I’ve got just 108 more victories to go.  That’s doable.  And for me to say that 108 more days is doable is huge progress compared to where I was just weeks ago.  Like the fresh flora and fauna to whom Spring has given life; I, too, have grown.

Broken

This has been a difficult post to write.  I’ve shared some of my pregnancy journey on my personal Facebook page, but I’ve left out plenty of details.  Details, perhaps, that might be better off kept to myself and not confessed to the wide web.  (Not that there are many beyond a couple dozen who actually read my bitty blog.). But I’m compelled to share for two reasons: 1) Writing is cathartic for me.  It heals me to transform feelings into words.  2) On the off chance that a pregnant woman googles a combination of symptoms or fears or feelings in hopes that someone else has experienced a similar misery, I want her to be able to find this blog post.  Because part of this struggle is feeling utterly alone in it.  And so, I share.

My body, my brain, and my spirit feel broken.  This baby — a girl, we’re told — is literally sucking the life from me.  According to ultrasounds (of which I’ve had many), she is thriving and is as healthy as can be.  Whereas I feel like I’m dying.  It’s hard not to think of her as a parasite, stealing all that is good from me and using it for herself.

Doesn’t that sound crazy?  What kind of mother thinks of her baby as a parasite?  What kind of horrible person has actually fantasized about having a miscarriage so that the nightmare of pregnancy can finally be over?  What kind of monster has actually wished for a premature birth so that she can get it over with faster?

Me.  I’m the crazy, horrible monster who has thought those things.  No need for pitchforks; I beat myself up enough over these feelings more than an angry mob ever could.

In my 16th week of pregnancy, I was taking Zantac daily for my excruciating GERD.  And we’re not talking heartburn — I have crushing pain in my sternum from esophageal spasms every time I eat, no matter the food.  It radiates up my shoulders and straight back to my spine.  Food will literally regurgitate itself and sit in my esophagus while it painfully contracts (imagine a vise or a strong fist squeezing your esophagus over and over) until I either live through it or force myself to vomit it up to make the pain stop. 

The Zantac managed things okay, but during the two weeks that I was taking it, I began to have severe panic attacks and manic-level anxiety.  I called a suicide hotline one day.  I visited the ER three times in one week.  My heart rate, usually around 50-60/bpm would climb to over 100/bpm.  They had to give me oxygen in the ER when this happened. I would shake violently and uncontrollably.  I had horrible, stabbing chest pains, which scared the doctor enough to think I was experiencing a pulmonary embolism. I had a CT scan of my chest done, for which I’ll feel eternally guilty over exposing my unborn child to radiation.  I left with no answers, and was terrified to face another day living like this.

On a hunch, I looked up the words “Zantac” and “anxiety.”  Well, who’d have thought that yes, Zantac CAN trigger wild panic attacks, rapid heart rate, chest pains, and a whole slew of other (uncommon, but completely real) side effects.  I tossed the remainder of the pills in the garbage and like magic, the symptoms stopped.

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My daughter using the doppler to find the baby's heartbeat at my midwife appointment.

But the damage to my mental health was done.  Spending two weeks in the throes of the highest level of anxiety I’d ever experienced had changed the pregnancy for me.  I lived on edge, always afraid of the symptoms coming back.  I didn’t sleep.  I was a zombie by day, snapping at my kids and obsessively googling every ache or pain that popped up, convinced I needed to be back in the hospital. 

It tore my soul in two to do it, but I made an appointment with my doctor and got back on Lexapro, albeit at a very low dose of just 5 mg.  I exhaustively researched the risks of SSRIs in pregnancy and felt confident that “no data” did not necessarily equal “bad outcomes.”  I was also reassured by the fact that I was well into my second trimester and far out of reach from the delicate early formation stage of the pregnancy.  I found comfort in knowing that my low dose of 5 mg was unlikely to cause any withdrawal symptoms in the baby after birth.  Above all, I leaned on the words echoed by nearly every reputable medical source I read: When the benefits clearly outweigh the risks.  And boy, did they.

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I was genuinely excited to learn that we're having a girl.

Now on Lexapro but off Zantac, I was treating one illness but not the other.  I resorted to an all-liquid diet to manage the GERD.  I subsided on Ensure and chicken broth.  I starved.  And I was still in pain. 

This went on for a couple more weeks until I managed to get an appointment with a GI specialist, though her office was 40 miles away.  Nobody in my immediate area would see me for five weeks, if at all (one place told me they don’t treat pregnant women).  I was put on 40 mg of Protonix, twice daily, as well as a liquid called Carafate that I was to drink before each meal and at bedtime. 

After the Zantac nightmare I was quite nervous to take another anti-acid medication, though I was assured that Protonix was in a completely different pharmaceutical category and is generally well tolerated. 

The GERD is slightly improved with these medications, though I can’t eat anything after 4 pm and still rely mostly on liquids.  Additionally, my gallbladder has begun acting up (another ER trip) so I’m even more limited as to what I can eat so as to not aggravate THAT problem.

I vomit almost daily and am nauseas most of the time.  My sternum still throbs in pain, though it’s not as severe.  When I crave food, I chew it up to get the taste of it then spit it into the trash so as not to actually swallow it.  Yesterday morning, I had an absolutely terrifying spell of hypoglycemia where I almost lost consciousness and couldn’t see or hear anything for nearly 20 minutes while my husband helped me to the sofa and fed me Ensure.  My bloodwork is terrible — all levels of everything are “low” and I’ve developed iron deficiency anemia.  And guess what happened when I tried to take an iron supplement?  Yep.  GERD attack.  Because iron and GERD don’t mix, apparently.

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Oh, and I have a hernia in the middle of my stomach, a few inches above the belly button and to the left.  Right over the bowels, where possible strangulation can occur.  And it hurts like a mofo and there’s nothing anybody can do about it.

I’m starving and live in constant pain.  I’m anxious all the time.  I feel disconnected from this baby and fear that I won’t bond with her when she’s born.  I feel tremendous guilt for all the medication I’m taking when I never took so much as a Tylenol with either of my other pregnancies.

And nobody gets it.  I’m supposed to be grateful that I get to have a baby and that’s the only emotion I’m allowed to have.  I’m supposed to put myself before my child and think of her needs above mine, so taking Lexapro and the other meds is very selfish of me.  Not to mention, as noted above, that I’m a monster for wishing that it would all just go away. 

I want this baby.  I do.  But my God, I do not want to be pregnant anymore.  I am miserable and I feel like I’ve lost myself.  

I am 21 weeks, 2 days pregnant according to an early ultrasound.  I am 22 weeks, 1 day pregnant according to the conception date. 

40 weeks can’t come soon enough.