On December 1, I was still on holiday call and as I mentioned before, the Thanksgiving holiday call was busy as ever. December 1st started out with two deliveries at the wee hours of the morning, a nap and then cleaning the garage as I wrote about in my last post. After we finished the garage, Ryan and I were relaxing in the living room. Zoey was looking out our front window and I realized that I hadn't snuggled with Zoey in a while since I'd been working so much. I picked Zoey up and brought her to the couch with me to give her some snuggles. Being pregnant and having a heightened sense of smell, I quickly realized that Zoey was in need of a bath. Ryan agreed and went up stairs to start the tub. I got all of Zoey's bath essentials together and Ryan put her in the tub once it was full. Ryan started her bath and then I can in to help. Our toilet is right next to the bathtub and seeming as I was pretty pregnant at this point, there was no way I was getting down on my knees to help scrub Zoey. I sat on the toilet so I could just lean over the tub and wash away.
It was around 7:15 pm when I sat down, leaned over the tub and then felt a gush of fluid. I looked at Ryan and said "I think my water just broke." Ryan looked over at me, got a huge smile on his face and said "Really?!?!" I told him that I thought so but it could have been that I wet my pants too - even though I was pretty sure that I didn't pee my pants. I wasn't contracting so I told Ryan that I was going to take a shower and see if I continued to leak fluid. Ryan {quickly} finished up Zoey's bath as I was in the shower. When I got out of the shower, I found Ryan pulling out the duffel bag to pack some clothes. I told him I was still leaking so I likely wasn't peeing on myself. {I had to make sure before I went in to be triaged that I was actually ruptured and not just going to the bathroom. Since in my mind, I'd be embarrassed being the OB resident getting triaged for rule out rupture just to be sent home not being able to control my bladder - ha!} I also told him that I wasn't contracting {which is not ideal when your water breaks} and that it was likely going to be a long night so he didn't need to pack a bag. Ryan convinced me to just toss a couple things in the duffel bag just in case. I grabbed a pair of sweatpants, a sweatshirt and a couple t-shirts and tossed them in the bag. We also grabbed the baby name books since at this point in time, we still hadn't decided on a name and in my mind, we were in for a long night since I was likely ruptured and not contracting. I made a deal with Ryan though that the bag was going to stay in the car until I was actually confirmed to be ruptured and admitted to L&D. {Again, I didn't want to lug all this stuff up to L&D thinking that I was ruptured just to be sent home with bladder control issues - ha!}
I called my OB, she didn't answer {she's was out on maternity leave herself but had planned to come back for my delivery}. I then tried calling my co-resident who was on night float - no answer. So I called the L&D charge nurse {I have to say, it's kind of nice knowing all of these people's phone numbers!} to let her know that I thought I was ruptured and that I'd be coming in to be triaged. I then gave the in-house attending a call to see if she would triage me {since both resident on L&D that night were male co-residents - thanks but no thanks} - no answer again. Apparently L&D was pretty busy at this point in time. I sent the in-house attending a text to let her know I was on my way in. Right after I sent the text, she called and I gave her the heads up. In the back of my mind, I was dreading going into labor and delivery since I was preterm (36 weeks 6 days gestation), I wasn't contracting and was likely ruptured. These three things combined made me think that, under normal situations, my cervix would be unfavorable and that I'd likely be having a long drawn out induction of labor which was going to increase my chance of having a c-section, blah, blah, blah. {See, sometimes knowing too much is not a good thing!} Just before we were about to leave the house and head into the hospital, my OB called me back after noticing she missed my call. Bless her heart, she said that she would drive into the hospital and triage me. I told her that I'd just have the in-house staff triage me and then we'd keep her posted.
When we left the house, it was kind of a surreal feeling. Ryan and I knew that was the last time that we'd leave our house as just the two of us. The next time we came home, we'd be a family of three. Ryan drove and I could tell that he was both excited and nervous. Twice on the drive in I had to scream "Ryan! Look out!" as, well, how should I say this - he was a little preoccupied. We called our parents on the drive in to let them know that we were headed into the hospital. The first thing my mom said to me was "You're early?" She was keeping good tabs on me :) yep I was early. It takes around 20 minutes for us to get to the hospital and about half way there I started to feel some cramps but it only happened two times or so and they weren't strong, they were just noticeable.
We finally got to labor and delivery around 9:00pm. I was still feeling pretty comfortable and we were laughing and joking around as I was checking in {this is not a good sign to any seasoned OB care giver - if you are smiling and laughing while you are checking in, you are not in labor. Again I was thinking about how my cervix was likely unfavorable and how I was in for a long drawn out induction of labor.} We had to wait just a few minutes before they brought us back to a labor room. I did the obligatory pee in a cup and put on a hospital gown. It was so weird being a patient and not the provider. They hooked me up to the fetal monitors. Our baby's heart rate looked good and I was indeed contracting every 5 minutes or so but they weren't intense. My co-resident wheeled the ultrasound into our room in anticipation of my unfavorable cervix so we could confirm the kiddos head down position if needed. Since labor and delivery was pretty busy when I showed up, I had a few different nurses help get everything going. Eventually my in-house attending came into the room, collected a swab to confirm rupture of membranes and checked my cervix. To my surprise I was 3/90/+1{this means 3 cm dilated, 90% effaced - this is the thinness of the cervix - you need to get to 100%, and at a +1 station which means that the presenting boney vertex for the fetus was engaged in the pelvis - you are crowning at a +4 to 5 station} and our kiddo was indeed head down. The first thing that crossed my mind when my attending told me I was 3 cm dilated was "yes, no cytotec and no foley bulb!" which are two different methods of ripening an unfavorable cervix. This meant that if I didn't go into labor, they'd be able to start pitocin to induce contractions. Being 3 cm when your water breaks is WAY better than being closed and barely effaced when your water breaks - less chance of a c-section. Since I was still pretty comfortable at this time, everyone left the room to get everything needed to admit me and I needed to make some phone calls since I was still on call at our private hospital.
The high risk desk actually paged me after I had gotten my cervix checked but before I got the official 'we're admitting you' word. I told them I was actually getting triaged and that I'd give them a call back if I got admitted to let them know another resident would be taking over call for me. Once I got the official 'you're admitted' word, I called my attending to let him know what was going on. I informed him that unfortunately I had only made it 36 of the 48 hours - ha! {If you read the last post, you'll get why I said this.} He wished me luck and that was that. I called my OB to let her know what my cervix was and I had a couple stronger contractions while I was on the phone with her. After that, I called one of the other residents to give her sign out on the high risk service. While I was talking to her, I swear I went into full-blown labor. I started having really strong, painful contractions and they were coming every one and a half to two minutes. I'd make it half way through a patient before I'd have to stop and breath through a contraction - it was unreal how quickly the contractions turned from "yeah, I'm aware I'm having contractions" to "OMG, these are painful!!" Lol. At one point I remember saying "oh my gosh, these hurt so bad! How do people labor without pain medicine?!" To which my other co-resident replied "I don't know, I didn't do it without pain medicine" as she just had a baby less than three months prior. I finally made it all the way through sign out - it seemed like it took forever! Anyways, it was still just Ryan and I in the room and I was thinking to myself "where is everyone, I need to get my labs cooking so I can get an epidural!"
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| Here I am bracing myself during a contraction while I'm on the phone giving sign out. |
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| Still giving sign out - this is the last picture of me pregnant with Westin. I kind of have mixed feelings about that since you can't even see my baby bump and as you'll read, labor went really fast and so we have no pictures from when I was in labor :( |
I ended up pressing my nurse call light after getting off the phone and asked the front desk "can you send my nurse in to start my IV? I think I need an epidural!" My nurse showed up shortly there after and I think she was surprised at how much pain I was in since just a little while before I was all smiles and laughing. Anyways, onto the IV insertion. I've never had an IV before so I didn't really know what to expect other than anticipating that it likely wasn't going to feel good. But I was contracting so frequently and they hurt so bad at this point that I didn't really care though. Unfortunately I was super dehydrated - not surprising the way I had been running around on call for the prior 4 to 5 days on holiday call and delivering patients in 80 degree ORs - so actually getting an IV in proved to be difficult. What made getting IV access even more difficult than being really dehydrated was that I was contracting one on top of the other and only had a 15-20 second break between between contractions where I was actually able to hold still. This has to be one of a labor and delivery nurse's worst nightmares. It took three attempts before my IV was in and labs were drawn. After my labs were drawn I asked "Can you make sure those labs are in stat? I need an epidural." Ha - doctors make the worst patients :) Just to describe how dehydrated I was, I was given three liters of IV fluids before I actually could go to the bathroom! Below are pictures of my battle wounds from the two failed IV attempts. I bruise easily :( The eventually got IV access in the back of my hand.
When I showed up on L&D, since they were so busy, they put me in the only open labor room. They had a labor room with a jacuzzi tub open up and wanted to move me in there so I can get in the tub. Under normal circumstances, I'm not a big labor-in-the-tub person, but people say that being in the water significantly helps with labor pain. At this point I said I would try anything to help with pain so I agreed to transfer to the jacuzzi labor room. My in-house attending came in before I moved rooms and said she better check me before I moved rooms since I was so uncomfortable. She kind of laughed and asked "what are you going to do if you are still only 3 cm?" to which I replied "I'll be the biggest weeney because these contractions hurt." So she checked me again and I was 5cm and 100% effaced - this was only 45 minutes after my initial cervical check - I was progressing through labor pretty quick. {Most first time mom's change their cervix about a centimeter an hour - so to change 2 cm in 45 minutes is pretty quick.}
I was thinking to myself 'ok - 5 cm, my platelet count will be coming back soon, I'll get in the tub and then when my platelet count comes back, I'll get out and get an epidural.' I got into the tub and continued to contract every one to two minutes. The jacuzzi was not helping at all. In fact, I hated the jets being on me - I thought they hurt and being in the warm water didn't take away any of my pain. My nurse said I could get out of the tub but when I had my 15 pain-free seconds between contractions, the last thing I wanted to do was move. Then another contraction would start and all I wanted to do was get out of the tub! Ahh! This I-want-to-get-out-of-the-tub/I-don't-want-to-move thing went on for a handful more of contractions until I firmly stated "Shut the jets off, get me out of here and someone get me some flipping IV pain medication!" Lol - oh man, I was so uncomfortable - it was unreal! I got out of the tub, dried off, tried to go to the bathroom - I couldn't because I was still dehydrated, and just as I was about to get into the labor bed I got a super intense desire to push. Yep, I was starting to involuntarily push, i.e. I was likely complete or close to being complete {10 cm and 100% effaced - what you have to be before pushing to have a baby}. After my first involuntary push, my nurse said "No, don't push. Breath." All I could say was "I'm sorry, I'm not trying!" {I will never again tell an un-epiduralized patient to not push when they have involuntary pushing - it's impossible} and all I could think was "$#!t, there goes my chance of getting an epidural, I'm going to have to do this without pain medication" which literally brought me to tears.
At some point during all of this, my OB arrived. I don't actually remember when because I'm not sure I actually saw her. I couldn't even open my eyes since I was in soooo....much....PAIN! Someone checked my cervix when I got back into bed - 9cm and this was 45 minutes to an hour after my last check. Ugh - I was flying through labor. I was in the process of getting IV pain medication when they said I was 9 cm so I only got a half dose of pain medication which doesn't do squat for pain. {IV pain medication suppresses an infant's respiratory drive so ideally you don't want to have IV pain medication on board when a baby is born so they can transition from the in-utero environment where they aren't breathing air to the ex-utero environment. If infant's do have IV pain medications on board, we do have medications to reverse it but it is best to avoid the situation in the first place.}
At some point in time, they checked my cervix again and I was complete and could start pushing. People always say when you have an unmedicated labor, it feels better to actually push. Nope, it still hurt like crazy. Being an OB provider, I would have thought I would have been better at pushing. Afterall, how many times have I coached a patient through "three big pushes" with each contractions and to "relax your bottom and push like you are having a bowel movement"? {lol, its true!} Too many to count. Even knowing what to do, I couldn't get it together to actually do it. I'd get one good push in but rarely made it through a second push and never made it to a third push with any of my contractions. In my own defense though, I was still contracting every one to two minutes {the medical term for this is tachysystole} and I was exhausted {after all, I had been on call with only minimal hours of sleep during the prior days and after all, this was my third delivery of the day}. I remember my nurse saying how they rarely have to turb {a medication that stops contractions} patients but the ones they do are natural tachysystole {more than 5 contractions in 10 minutes} patients whose fetuses don't tolerate the rapid fire contractions. I was then reassured that our kiddo continued to look great on fetal monitoring and that he didn't mind the frequent contractions at all. At this point, all I wanted someone to do was give me some turb to stop or at least slow down my contractions!
I felt so out of control. I could not get it together. I kept thinking to myself, if I could just get it together and get three good pushes per contractions, this pain will be over a lot sooner. But still even knowing that, I could not get three pushes. I couldn't relax, even though I knew that it would help. I couldn't push, even though I knew I should. People talk about this 'ring of fire' during natural child birth. Well let me tell you - I felt it but I would describe it more as a blow torch to the perineum! Sorry, I'm trying to leave some of the more graphic descriptions out of this but there's no other way to explain it. Ring of fire just doesn't really do it justice. And the pressure. Oh, my the intense pressure sensation! That and also the feeling that my bottom was going to rip in half {sorry again for being kind of graphic}.
I honestly don't know why people willingly chose to have a natural child birth. I thought it was awful! All I can remember saying in between contractions is "this is ridiculous" and "I just want these contractions to stop!" Ryan and one of the other people in the room told me that they were trying to not laugh at me during this whole process as I was apparently being funny with what I was saying. Two things: 1) I did not think it was funny when it was happening but laugh at it now as my form of therapy so I do not develop PTSD and 2) good thing I couldn't open my eyes {due to the severe pain and pressure} to see them smiling as that likely wouldn't have made me very happy.
So I'm pushing, pushing, pushing for what seems like forever since I felt like I was a bad pusher {I pushed for something like 45 minutes}. At one point, I asked what station he was at. I was told +2 and I freaked out that his head wasn't yet under my pubic bone. So more pushing, more blow torch, more pressure, more ripping sensation - ugh! I remember looking at the clock, it was 11:45. I told myself to get it together and push this kid out before midnight. As midnight approached, I was closer and closer to delivery. Finally at 11:58pm I gave birth to our little baby boy who came out with a full head of hair and apgars of 8 and 9. They put him immediately up onto my abdomen/chest for skin to skin. I just laid there and cried - tears of happiness, tears of joy and tears of utter relief! I held him and could feel his warm little body wiggling all around but I still could barely open my eyes - I was exhausted! Ryan was able to cut the cord {no pictures - camera was still in the car}and all I could think of was how I couldn't wait for the placenta to deliver because I was hypersensitive. Anything that touched me hurt. Even when I was pushing, having the fetal heart rate monitor on my abdomen hurt. I have no idea why everything was hypersensitive and was actually quite surprised by it as I've heard people talk about being hypersensitive but I had no idea just how hypersensitive you can be. I could tell when my placenta was ready to deliver and I didn't wait for my OB to grab the placenta bucket, I just pushed and delivered it - I wasn't waiting for anyone. Lol. My OB had asked if I wanted to see the placenta. At that time, I still couldn't open my eyes so I said no, but now in hindsight, I wish I would have. Opportunity lost - bummer :(
Westin was pretty calm from the get go. He was perfectly content on my chest looking around. I can't even image what that transition is like for infants. To go from a warm, dark place to a wet, bright room - it must be a crazy experience. I remember looking at Westin - he was absolutely perfect and had a tons of hair. I looked at Ryan and besides being over-joyed that Westin was here he had this stunned look on his face. I asked Ryan "not really what you were expecting labor to be like, huh?" His response was plain and simple - "No."
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| My first look at Westin. Yep I look like crap and yep I posted this picture on the internet. It's all about the memories people! What I had just been through was not glamorous by any stretch of the imagination. |
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| Our first family photo! {Don't mind my half-nakedness - we're skin-to-skinning it.} |
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| Side note: Notice all the tap holding my IV in my hand. My nurse worked hard for that IV and by golly, she was not going to lose it! ha! |
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| Hello world! He's just perfect! |
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| Our tiny little peanut. I'm glad that he wasn't much bigger! |
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| So in love with this little face :) |
I eventually did call the high risk desk and the conversation went something like this:
"Hey this is Ashley."
"Oh hi Dr. Thorson. You never called back, so we figured they must have sent you home."
"Well, actually, since the last time I talked to you, I was admitting to labor and delivery, started laboring, flew through labor and gave birth. Things went pretty fast so I didn't have a chance to call. Just wanted to let you know that I'm no longer the resident on call."
What a whirlwind of a day! Not many new moms can say they worked 12 hours and cleaned the garage on the day they gave birth. And not many new moms can say they worked 85 hours the week they delivered either. I think that Westin was telling me that I needed to slow down some. What an absolutely crazy experience! Who would have thought when my water broke at 7:15 pm that we'd have our baby in our arms by midnight. Good thing Ryan convinced me to toss somethings in that duffel bag - even if the duffel bag didn't even make it up to labor and delivery until the following morning :) Who would have thought that I would have that I would have PPROM'd {preterm, premature rupture of membranes} at 36 weeks and 6 days. Who would have thought I would have had a precipitous labor lasting less than 3 hours {that's rarely heard of for a first time mom}! Who would have thought that I could make it through nature child birth. While the pain I experienced during labor is still fresh in my mind - I'm worried that my next labor could be just as fast if not faster since that is was typically happens. Ryan, in the mean time is worried that he is going to have to learn how to deliver a baby in case we don't make it to the hospital next time - ha! Regardless of the events of the day, regardless of Westin being two minutes preterm, regardless of not having an epidural and experiencing the worst pain in my entire life - we have been blessed with the most wonderful miracle we could have ever wished for. We love Westin more than words can describe!
~Ashley
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