Birth story

Just to get the important things out of the way:  he’s here, he’s healthy, and mom is healthy too.

As you can guess, the past 24 hours have been a little crazy.

I woke up just after midnight on May 7 with very mild contractions.  I was excited—he’s coming!!  But they contractions were so mild and spaced so far apart (10 minutes?) that I was able to fall back asleep.  I woke again a little after 5am and they were the same.  A trip to the bathroom also demonstrated my “bloody show.”  (My mucus plug had been falling out for a few days, and at that time there was a lot of it tinged with blood.) 

After I got up, showered, ate, and got ready for work, though, the contractions stopped.  I called my doctor’s office, and they said that’s normal, but try to walk around and see if you can get things moving again.  So I drank my raspberry loose leaf tea and ate my dates and went to work.  Between a couple meetings I had that day, I went for two very long walks.  The first one, in the morning, I walked for over an hour to a park near where I work.  The second, in the afternoon, I walked the opposite way towards the river, again for over an hour.  The day was hot, and I was pretty sweaty, which worried me because I know stillbirths can spike in hot weather.  Between the two I walked for around 2 ½ hours and I’d guess over 2 miles.  (So I guess it was something between a walk and a shuffle.)

But, for all my efforts, I still didn’t get those contractions going.  (Although I did get more bloody show….)

Then I had a 2:30 afternoon meeting.  (Ironically, with a number of the women at my firm.)  While in the meeting I had a strong contraction, and then another one 10 minutes later.  I stood up, announced I had to leave before I threw up, and went home.  On my drive home I had two more very strong contractions, again about 10 minutes apart.

And then nothing.

Annoyed, I did some quick research only to discover that this stopping and starting of labor is not uncommon and can go on for days.  BOOO.  The good news is that this process (sometimes called early labor or prodromal labor) actually does move the labor process along—i.e. your cervix is dilating etc.—and can make actual labor faster. 

I called and talked to the doctor’s office, and they told me that I should come to the hospital if my labor pains were less than 5 minutes apart and I couldn’t talk through them (a stage I never actually got to with my first!) or if my water breaks.  Since absolutely nothing was happening, I wasn’t super worried about figuring out when we should go to the hospital.

So I just laid in bed resting (I was tired after all of the walking I did!) and texted my parents/hubby letting them know that, counter to what we thought, it did not seem like baby was making an appearance that day.

My husband called to check in on me around 4:30.  He said, “where are you?”  I said, “at home resting.”  He said, “no, where exactly are you?”  Confused, I responded, “in bed.”  He’s like, “okay, just please don’t sit on my new chair [his 40^th birthday gift from me—a fancy post-destructive baby phase piece of furniture, ha!] unless you have a towel or something, in case your water breaks.”  I decided not to condescend to tell him that it’s really rare for your water to break when you’re not in labor—that’s just in the movies.

We hung up, I laid back down, and not minutes later I feel (hear??) a “pop” and, hand to heart, my water breaks.  So, I guess we ARE having a baby after all!!  I call hubby and tell him to home, change my clothes, call the doctor, call my doula, and run downstairs for a quick snack.  Around 4:45, I had my first contraction—a pretty strong one.  When I talked to both my doctor and my doula, they said there’s no big hurry to get to the hospital after your water breaks, but we decided since my labor was pretty fast with my son, and we’ve heard to expect a faster labor with successive pregnancies, and because we were going to be driving in rush hour traffic, to leave sooner than later.  As my husband is quickly grabbing a snack I have another contraction, and as we time them we see they’re about 5 mins apart and strong—time to go!

The drive to the hospital took less than half an hour.  At the beginning the contractions felt like strong period cramps, but got stronger and stronger as we drove.  And they were about 5 mins apart.  When we got to the hospital we went to the assessment area (which I basically skipped last time around because I showed up ready to push).  They check your blood pressure, weight, etc. etc.  At that point, they also checked my cervix—3-4cm, 80% effaced, so that early labor did make some progress, but we had a way to go.  While we were there my contractions were getting stronger, so we decided to call my doula and have her come.  I think we were there for maybe half an hour before going to the delivery room.

In the delivery room, things started to move fast.  My contractions were getting really strong, and I wasn’t breathing through them as much as I was moaning hard.  My doula showed up around 6:30, and by that time I was in significant pain.  (My husband said he does not remember me being in as much pain with my son.)  I’d been feeling nauseous for a while, and at one point I grabbed a barf bag and vomited so hard I got a nosebleed.  There were fluids coming out of both ends!  After that I definitely said I don’t know if I can keep doing this (especially if we still had hours and hours to go), but the doctor checked me and I was 9cm dilated!  She said let’s see about trying to push.  For maybe 8 mins I was “pushing” but not really, and then I had 6 very painful and very hard pushes.  At one point I screamed bloody murder.  On my final push I cried out, “get him out of me!”  I don’t know if I was talking to the doctor, myself, or God.  But my pleas were answered and he was out.  7:40pm, just a few hours after my water broke.  

Man, that was intense! 

We got a little nervous at the end because they were monitoring baby (which was really uncomfortable) and both of us worried that we were going to hear, “baby is in distress, we have to pull him out now.”  (With my son, I don’t think I was really even monitored.)  But that fear did not come to pass.

He cried right away, had an Apgar score of 8/9, and weighed 8lbs 5oz (just a little bigger than his brother was).  He’s been fully checked by doctor, and is healthy as can be.  I cannot tell you what a relief it is to have him here and healthy.

I’m doing well too.  Labor was super exhausting.  Especially the pushing at the end.  It’s one thing to just be in pain, it’s a whole different animal to be in pain and have to exercise through it.  After I ran the marathon this fall I remember saying I never wanted to be done with anything more in my life.  Umm, yea, labor is way worse!!  I had one small second degree tear, but a few stitches later I feel as good as new!

I really, really cannot believe this is how this chapter in my life ends.  Two beautiful healthy kiddos!  Who would have thought, after all these years, that this is how my two week wait would end?

Getting ready to evict this baby

This baby shows no interest in coming out.  I had my weekly appointment (38w5d) yesterday.  The doctor brought up induction, noting that because of my age (just under 40) and loss history, they would generally not want me going past 40w6d and that we could consider induction starting at 39 weeks.  We talked about it a lot, and I said on one hand I was not interested in inducing early unless there was a reason, and on the other hand I remain REALLY nervous about this baby being born healthy, and since he’s clearly alive now I do feel tempted to just pull him out.

She seemed to understand.  She suggested just checking my cervix to see if induction was even an option.  Spoiler: it’s not.

Apparently they use something called the “Bishop score” to determine whether induction is a good idea/likely to be successful. 

https://en.wikipedia.org/wiki/Bishop_score

Here’s the information from Wikipedia:

Parameter	Score				Description
	0	1	2	3
Position	Posterior	Middle	Anterior	–	The position of the cervix changes with menstrual cycles and also tends to become more anterior (nearer the opening of the vagina) as labour becomes closer.
Cervical Consistency	Firm	Medium	Soft	–	In primigravid women the cervix is typically tougher and resistant to stretching, much like a balloon that has not been previously inflated (it feels like the bottom of a chin). With subsequent vaginal deliveries the cervix becomes less rigid and allows for easier dilation at term.
Effacement	0-30%	40-50%	60-70%	80+%	Effacement translates to how 'thin' the cervix is. The cervix is normally approximately three centimetres long, as it prepares for labour and labour continues the cervix will efface till it is 'fully effaced' (paper thin).
Dilation	Closed	1–2 cm	3–4 cm	5+cm	Dilation is a measure of how open the cervical os is (the hole). It is usually the most important indicator of progression through the first stage of labour.
Fetal station	−3	−2	−1, 0	+1, +2	Fetal station describes the position of the fetus' head in relation to the distance from the ischial spines, which are approximately 3-4 centimetres inside the vagina and are not usually felt. Health professionals visualise where these spines are and use them as a reference point. Negative numbers indicate that the head is further inside than the ischial spines and positive numbers show that the head is below the level of the ischial spines.

Here's another article:

http://perinatology.com/calculators/Bishop%20Score%20Calculator.htm

And another one suggesting it’s a poor indicator of labor induction success:

https://www.ncbi.nlm.nih.gov/pubmed/23283806

And here’s another one suggesting a “simplified” score (considering fetal station, cervical effacement, and parity) does predict success:

https://www.ejog.org/article/S0301-2115(16)30289-5/abstract?code=euro-site

She said they would look for a combined score of 7 or above before seriously considering inducing, at least at this stage.  I was a 6.  I was 30% effaced (score of 0), dilated about 1cm (score of 1), cervix was medium (score of 1).  She told me baby was still pretty high, but did not give me a number, and did not mention position of baby.  Presumably to get to my score of 6 baby is in anterior position (score of 2) and fetal station was -1/0 (score of 2).  In other words, this baby’s not looking to go anywhere for a while.

If I were a totally healthy young mom with no history of issues, I’d be like “cool!”  (I’m sure that’s how I was with my son.)  This time, though, I’m nervous.  I confessed to a friend that I remain very, very worried about the outcome of this pregnancy, and she was like, “me too!  I won’t rest easy until that baby’s in your arms.”  That made me feel better (validated) and worse (it’s not just my imagination, I’m still at risk) at the same time.

So we’re going to check again next week (39w5d, although hubs and I think my due date is a few days off/early) and then decide if we want to schedule an induction (if it’s even an option) or try something else to get things going like sweep my membranes.

From what I’ve read/what my doctor has told me, the potential benefits to membrane sweeping are: can reduce the need for other methods of labor induction such as oxytocin or prostaglandins, and can reduce the duration of pregnancy.  One medical journal article I read said that “To avoid one formal induction of labour, sweeping of membranes must be performed in eight women.”  Another article suggested, “We concluded that sweeping of membranes was ineffective to reduce the need for formal induction of labour.”  So it’s either not particularly effective, or just effective rarely.

The risks are: discomfort during the procedure, bleeding, and irregular contractions.  There is also a risk that your water is broken, with one article saying 1 in 10 (although my doctor said it’s never happened to her).  I’ve also read there could be an increased risk of infection, but the medical journal study doesn’t seem concerned about that.  So the big risk is just discomfort.

https://www.ncbi.nlm.nih.gov/pubmedhealth/PMH0010678/

https://obgyn.onlinelibrary.wiley.com/doi/full/10.1111/j.1471-0528.2002.01193.x

https://evidencebasedbirth.com/evidence-on-membrane-sweeping/

It’s unclear to me that there’s much benefit, and it sounds like it’s pretty painful.  I think I’ll hold off until closer to the date they would induce to consider this option.  But if things don’t look like they’re going to start moving, I think I will schedule an induction sometime after 40 weeks, and have my membranes swept a few days ahead of the induction.