Wednesday, July 18, 2012

J.B.'s Birth Stories: A laughing gas VBAC & A C-section in Africa

J.B. is an American ex-patriot living in Kenya. She is the only person that I know who came into this world via home birth (one of five kids her mother homebirthed!) so she is very aware of birthing world.  I always post my favorite birth first so her second birth is first below. Her first birth was medically induced and ended in a caesarian also below and is the second story below. I love J.B.'s use of the bath to recharge herself during early and late labor. I had no idea about laughing gas during labor. Supposedly it is incredibly safe and effective during contractions but too much exposure by medical staff can be dangerous so it is not used in the U.S. Let me know if you have more info on it.

J.B.'s Second Birth: A Laughing Gas VBAC 

It was a beautiful, sunny morning.  I was getting ready to go to my acupuncture appointment, when I started to feel a strange feeling in my lower abdomen (aka. the part of my tummy that I could no longer see).  It did not feel like cramps. It was not painful.  It was just there every few minutes and then would go away.  I headed to the acupuncturist and had treatment to encourage me to go into labor.  By the end of the session, I was pretty sure that they were very mild contractions. The acupuncturist told me that my body felt much more ready for labor then it had a week before. I felt a bit giddy as I thanked her and headed to my next appointment of the day with my good friend and Osteopath, Claire. I had slipped and fallen a few weeks before and my sacrum had been really sore afterwards.  Claire's treatments had really helped to take away the acheness  in my sacrum.  I told Claire about the contractions and she celebrated with me. 

 We both knew that I was really hoping to have a natural birth with my second child after having had an emergency c-section with my first son and I wanted go into labor on my own this time and deliver naturally. I had read about the risks of a VBAC and felt that I fell into the low risk category due to the type of incision I had had, and my overall age and health. The pregnancy had gone great and now I was 6 days overdue.  

I went home and decided that the contractions would probably let up in the evening and then start up the next day.  Ooops.  I was wrong.  In hindsight, a long afternoon nap may have been the best plan.  However, instead I had some friends and their kids over and we all had a lovely afternoon.

That night I was tired from the day but the contractions were strong enough that I could not sleep.  I was afraid of becoming too tired if this went on for a long time and was also feeling a bit nervous of what lay ahead as I became more and more convinced that I was really going into labor.  There was nothing to be done but be with it, so I got up and figured out how to be as comfortable as possible.  I found a hot water bottle on my sacrum to be really soothing, so I alternated walking and sitting with a hot water bottle, while listening to hours of This American Life.  I told my husband to sleep, because I knew that I wanted him as rested as possible for when I would really need him.  

By 2 or 3 in the morning I decided I wanted to try a hot bath.  It felt great.  I stayed in until the water had become tepid and then it was back to the walking and leaning on the bed.  It was around this time, that I notice that with every contraction I would pee a little bit.  I had never heard of such a thing but figured that the baby's head must be pushing on my bladder.  It was a really strange sensation but as I had stronger and stronger contractions to deal with and no control over it, I just threw a towel on the ground under me and didn't worry about it.

By 5:30, I was unable to talk through my contractions and I decided that it was time to take my son to our friends and head to the hospital.  When we got to the hospital, I was admitted and my doctor found that I was 5 cm dilated.  She said my contractions were strong and that we should have a baby around lunch time.  I felt so excited that the contractions were working and 5-6 more hours felt totally doable.  Once she left, I settled into my rhythm that I had found over the night and which was working really well for me.  In between contractions I would walk slowly.  Then when a contraction started, I would  lean on the bed or a bar and rock my hips back and forth while I counted my breaths in my head.  I knew that each contraction was lasting 14-18 breaths, so I knew that by 7-9 breaths I was over the peak and was heading back down again.  So that is basically all I did for the next several hours.  My husband made sure that I ate little bits, drank fluids, and would push on my sacrum during the contractions.  Sometimes I would also put the shower nozzle on my low back and still found that hot water felt really good.

When the doctor rechecked me three or four hours later, I was dilated to seven cm.  The good news was, that I was making progress.  The bad news was, that the baby was still high and that she and I had hoped that I would be having a baby around now.  The one thing that I now added to my routine, was nitrous oxide.  I am not sure how available it is in the US., but it was frequently used in Kenya.  I had read about it in "The Birth Partner" by Penny Simkin and felt that it was safe for me and the baby.  So at the beginning of each contraction, I would take 3 breaths through the mask and then do my rocking and counting.  I found the gas helped to "smooth out" the peak of the contraction.  Other friends of mine did not think that it did anything, but I found it helpful. Side note: The one side effect I noticed, with the gas, was that my throat was a little sore the next day.  When I mentioned this to my husband, he chuckled and said that he was not surprised, considering the amount of laughing gas I had sucked down the day before.  Now I had to chuckle, because I had already forgotten about using it.

By 5 or so I was getting really tired.  I was now 8-9 cm dilated but progressing slowly.  My contractions were 16-18 breaths, with a minute and a half rest in between.  My husband filled the tub and I lay in it, on my side, for one hour.  It was so great.  It took the intensity of the contractions down and I felt like I was able to recharge a bit.  I told him to give me an hour and then get me out, so that we could get back to work.

My sense of time gets extremely foggy towards the end, but I will do my best.  Once I reached 9 cm, my doctor broke my water and soon after I was fully dilated.  I was now on the bed on all fours.  I had put the head of the bed up and was holding onto the top bar.  My body had decided that it felt best if I pulled back against the bar with each contraction and made a deep gutteral sound.   It was not something that I was trying to do or thinking about. It was extremely instinctual and I just went with it.  The contractions seemed to be coming closer together and I really felt like I was able to push.  

Then my doctor decided that I was ready to deliver and had me turn onto my back.  She prepped me to deliver and then I was told to push with my contractions.  However, on my back I could not feel them as well and they felt very weak and ineffectual.  In hindsight, I wish that I had asked to be back up on hands and knees for a bit, but by that point I was so tired, that if she had told me to stand on my head to deliver, I would have tried.  I have no idea how long I pushed (it apparently was longer than I thought) but eventually she said that the head was almost out and that she would help me to deliver with the vacuum.  She put it on and one push later he was out and I got to see my son.  It was amazing to have this new little being laid on me.  He was crying and covered in slime and totally perfect and beautiful.  We wrapped him up and he latched on and started to nurse well.   I was in total, exhausted, bliss.

J.B.'s First Birth: Emergency Cesarian in Africa

How was this happening to me?  I had had a clear idea of what type of birth experience I wanted, even before I became pregnant with my first child.  My mom, a nurse, who had had all of us at home, had taught me all about the benefits of a natural, home birth.  So when I became pregnant while living in Nairobi, Kenya, I went about searching for a way to have a safe and supported home birth there.  Unfortunately, I did not find any midwives who had the experience and training that I felt was necessary, so I chose to use an amazing doula in the local private hospital.  I wrote a long birth plan and made sure that my doctor knew that I wanted as little medical intervention and interference as possible.  With my doula and birth plan, I felt that I would be supported in having a healthy natural birth. 

So how was it that after all of that preparation and a happy, healthy pregnancy, I going into the hospital tonight to be induced? While I had felt pretty comfortable with the idea of the challenge of natural childbirth, I felt quite scared of the medicalization of birth.  Mixed with my anxiety, were excitement at the idea that I would get to meet my first child in the next day and an acceptance that I had done everything I could to get this little one to decide to make its grand entrance on its own.  Despite doing EVERYTHING on the list of natural techniques to get labor started, he or she was not showing any signs of wanting to come out and my doctor felt that, at 12 days overdue, it was time.  
So at 8 o'clock on October 23nd I went to the hospital to begin the induction process. 

The first night they gave me a tampon-like thing that prepared my cervix with some medication that softened and thinned it.  I slept pretty well and was happy to feel slight rhythmic contractions across my lower abdomen the next morning. Our doula arrived bringing her loving and supportive presence and I felt so excited that by the next day, I would have met my child.

My doctor came in at 10 and said I had dilated from 2cm to 4cm and that she wanted to break my waters and give me pitocin to get things going.  My husband and I both felt that we would rather wait and see if my contractions would strengthen on their own since I had already dilated 2 cm.  She agreed and said she would be back in 4 hours.  

So now we got down to the business of trying to get my contractions to strengthen.  I walked and walked.  Jennifer, our doula, used acupressure points to stimulate stronger contractions.  I visualized my cervix opening and my baby moving down.  Every hour or so the nurse would come in and listen to the baby's heart beat which always was reassuring to hear.  

My doctor came back at 4 o'clock to check me and found that I was still at 4 cm.  I was disheartened to say the least but still felt like I wanted to give my body more time to labor on its own.  We agreed that if in four more hours nothing had changed, then we would move to plan B and break my waters and start Pitocin.

Again we walked and massaged and sat on a big blue ball trying to get my pelvis to open up.  The contractions were strong enough that I could not talk through them.  A tightness wrapped around my lower pelvis to my lower back with each contraction.  I found standing, while leaning on something and rocking back and forth, to be the most comfortable position. Sitting on a bed or lying down were not an option.  I was sure that these contractions had to be working and couldn't wait for the doctor to come back to tell me how much progress I had made.  However, when the nurse checked me at 8, I was still at 4 cm.  I was so disappointed.  My husband and doula both stayed really optimistic and supportive and tried to make me feel better about the interventions that were lying ahead.

My doctor arrived and she broke my water.  Then everything changed.  The amniotic fluid, rather then being clear, was tinged with fresh meconium.  My doctor said that this meant there had been a period of fetal distress in the recent past.  Considering that I was only at 4 cm and this was my first child, she needed to get the baby out faster then an induced labor could.  She said the baby needed to be delivered by c-section.  I was immediately filled with fear for my baby.  Was he or she okay?  I just wanted to hear the hearbeat so that I could know that he or she was still okay in there.  My mind was racing while I was also dealing with contractions that had just gone from a 3/10 pain to an 8/10.  

They told me to lie on my left side while they made preparations for the c-section.  Every time a contraction would hit, I would swear like a sailor and squeeze the bars of the bed.  The nurse listened to the baby's heartbeat, which was rapid but okay. Hearing that the baby seemed okay was an indescribable relief.  Things started happening so fast, I did not really have time to think about the fact that I was about to have major surgery.  I just wanted my baby out and healthy.
I tried not to think too much about the surgery and focused instead on my excitement at meeting my first child.  After what felt like a while, the doctor said that she was ready to deliver the baby and one of the attendants started to push on my stomach to try to get the baby to come out.  I was amazed at how hard they had to push. Then it was out and it was a BOY!!! The pediatrician took him immediately and checked him over.  He passed all the tests with flying colors which was a huge relief. Then they wrapped him up and my husband brought him to me.  

Wow!! Thinking back, I really cannot find words to describe the feeling of seeing him for the first time.  He was so perfect and I was completely in love.  I started crying. I was so happy and so relieved that he was okay.  

During the surgery, the anesthetist had offered to put me under light sedation during the sewing up part of the surgery.  I asked if I would be able to nurse afterwards and if I would get sick from the drugs.  She told me I would be fine to nurse and that I would not be nauseous afterwards.  So after I had met my son, my husband took the baby back to our room and I slept through the rest of the surgery.  I woke up as I was being taken back to my room and just wanted to get back to my baby and husband.  When I got back to my room, my husband, parents, and a good friend were all there with my son.  We were all so happy.  The nurses had to help me to settle into bed, as I was just beginning to be able to move my legs again. I held my son and brought him up to my chest.  The doula and my mom were both watching expectantly as he latched on and started sucking away.  They both seemed relieved that he had latched so well.  I had expected nursing to come easily and naturally, but after talking to other moms, I now know that I was really lucky in the nursing department.  

I said good night to everyone and then curled up with my baby and fell asleep.  Though my birth experience was not what I had expected, I had felt supported, listened to, and cared for.  I could not have been happier as I lay there with my son.     

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