He’s oddly blonde, for now, with grey-green-blue-who-knows eyes that, despite being forced out at his 37th-something week of gestation, look deep into you like they’re thinking more than a newborn ever could think, disecting whatever blur and lines in front of his face into something meaningful and not terrifying. He could somehow still be cooking in the womb for another 1-3 weeks, but instead he’s out in the world with all of the energy I’ll never have again. I’m icing all my bits that helped him slide out into the world. I’m a mom again.
My maternity care and childbirth was free, thanks to an HMO and decent insurance from my empower. I splurged $750 on a virtual doula who turned out to be invaluable support in this particular experience, and may be splurging on a social-distanced family photoshoot which I count as part of my childbirth costs, since I didn’t have to pay anything else to safely deliver this nugget. Even then, I’ve paid far less than most people who have kids in this country.
My childbirth was not the healing one I sought after the one I had two years ago, though it had its positives. Two years ago, after 2 days of labor, one scary deceleration that almost led to an emergency C section (and a horrible moment of being forced to wear an oxygen mask which made it impossible to breathe due to my claustrophobia-induced hyperventilation), and then my son ending up in the NICU with low oxygen saturation for 36 hours, and then my dad dying a week later after a long battle with cancer and a number of other health issues (unrelated), and flying out to the east coast days later to attend his funeral that my mother said wasn’t going to be a funeral and then ended up being a funeral (so I’m glad I went) but dealing with my own blood pressure issues and concerns after the induction for gestational hypertension, well, that whole experience was just bad and I wanted this birth to be different. I knew it would hurt, because that’s what childbirth does, but I wanted it to be more of a “normal” birth. One free of major complications. One closer to what I expected the first time around.
For my first son, my blood pressure approached dangerous territory at 39 weeks, and my doctor said I should induce. When I go to the hospital and they asked if I had a birth plan I said “it was to not induce” so that was out the window. While I had vaguely studied pain relief for a natural birth, I had no idea what was involved in an induction. In my head, I wanted to go into labor naturally. I didn’t understand the risks with my borderline blood pressure, or that making it to 40 weeks was basically already a huge success and induction at that point wasn’t that big of a deal. I pushed back a bit on the induction timeline and spent a night in triage with my blood pressure being read every 15 minutes. While the doctor did not want to let me go home, by morning she was convinced it was safe to let me go as my blood pressure levels were down significantly. But then an amniotic fluid check and finding of low fliud confirmed that I should stay. And the induction began.
All while I was having my blood pressure checked overnight, I was reading about the horror stories of every induction drugs and tactic on the market. One of the worst offenders, it seemed, was a drug called misopropital (cytotec), which is an ulcer drug not approved for use in labor, yet used all the time in labor (I don’t really understand how off label use is allowed when the manufacture is very opposed to it and has warnings saying to not use in pregnancy.) I opted to turn down the cytotec and instead have a foley balloon placed to “ripen” my cervix, which is the first step in an induction. The goal of the cytotec and/or balloon is to get you to about 3cm so they can start you on Pitocin, which is the better-known induction drug. Pitocin makes you have ridiculously hard and frequent contractions which move the baby down the birth canal and help you push the baby out…
While I felt good about refusing cytotec for baby one–and first births are known for being long so it’s impossible to know had I taken it if It would have changed things at all, or for the better–I did end up with a very long induction. I did manage to get an epidural after hours of painful pitocin contractions which had me screaming and moaning. While the epidural needle was not an issue for me, I got the epidural shakes after (which are apparently very common) and they were horrible. After that, it was all a bit of a blur until my son came out after 2.5 hours of pushing and despite crying was blue and taken swiftly to the NICU. All I could think of was the video they showed in our breastfeeding class about how the baby is placed on the mom’s stomach and crawls to the breast to begin to breastfeed, and how I was robbed of that moment they made such a big deal out of (and later I learned that also meant I would have a long and challenging journey to make breastfeeding work, requiring round-the-clock pumping and attempting to feed from the breast for 8 weeks straight.) And then, being paralyzed by the epidural and told I couldn’t go to the NICU to see my baby for hours, left me alone in the delivery room thinking my son was going to die and I couldn’t even be with him.
My son didn’t die. While it was scary to see him hooked up on all sorts of tubes and having low oxygen levels, he was released two days later and we never found out what happened. Apparently he just needed time to adjust to the world. And I spent the next 2.5 years reading all about birth trauma, and found my story wasn’t nearly as bad as most trauma stories. I read about women who were put to sleep for an emergency C-section and woke up to no baby in their arms, or those who were cut into while the numbing drugs weren’t working correctly. I read about some who were not induced when they should have been and were left to birth babies too large or in the wrong positions. Women who had every last symptom of preeclampsia yet who were ignored until it was too late and they had seizures and died on the delivery table, only to be ressuctated and brought back to life to live another day. I realized my story was barely traumatic–and yet, for me, it was something I didn’t want to relive.
So when I got pregnant with my second, I both feared a worse childbirth, but also felt optimistic about my odds of having a good birth, whatever that means. I even started looking forward to my delivery–what laboring at home would be like. What I would be doing the moment I felt my first contraction. When would baby decide to come on his own? Could I handle natural labor pain better than one induced with pitocoin? Could I get through labor without an epidural (no way!) or, how far could I progress before asking for the epidural (I made it to ~5cm last time, which is pretty good. I made a goal in my head to make it to 6 this time. Maybe that would prevent a NICU stay. Maybe getting the epidural too early slowed down the labor last time? Who knows.)
But a totally natural labor was not to be for this little one either. My blood pressure started creeping up and because I had gestational hypertension with my first, suddenly borderline readings that my doctor ignored with baby one were indicators to induce me super early. My OB looked at two BP readings, including one I took a home during a virtual visit, and said I should be induced at 37 weeks.
In the back of my mind I figured I might end up induced again at 40, but hoped that I would go into labor naturally before that. With an induction at 37 weeks it was practically a guarantee I wouldn’t go into labor naturally. My hopes and plans for a natural labor were again out the window. With such an early induction, I worried, would this be even worse than my first one? After all, with baby one, at a day before my due date my body hadn’t even dilated 1cm. Would this be a worse experience? Would I end up with one of those horrific emergency C sections I read about? Would I need the oxygen mask on my face for an extended period of time? Would my baby make it out alive? Would I?
In researching 37 week inductions I found that they were quite common for medical indications. However, while 37 weeks used to be considered full term, it now is concerned early term. Elective inductions are now required to wait until 39 weeks–because baby is still forming in those 37-38 weeks. Kid’s IQ is a bit lower for each week they are unable to bake. While 37 weekers tend to survive well outside the womb, I felt delivering at 37 weeks was taking something away from my kiddo. I felt like a failure to have high blood pressure so early. And while some of it may be my fault due to gaining too much weight again this pregnancy, many thin women also end up with blood pressure issues. If the precursor to preeclampsia, which it could be, then it is related entirely to placenta failure. Every comment from well-meaning friends and family to just reduce my stress in order to bring my blood pressure down reminded me how little is understood about these fairly common diseases of pregnancy–the same ones that make America one of the top developed countries for maternal mortality, often from conditions related to blood pressure.
While I was grateful my OB took my symptoms seriously (I’ve seen many women on my Facebook groups note that with similar blood pressure readings and other issues like headaches, abdominal pain, etc, which signify something more serious happening, they are ignored) I still felt like the actual date I needed to induce was not clear. The 37 week recommendation was based on one study from 2009 of 600 women and it didn’t sort out people who had mild high blood pressure vs those who had very high blood pressure, and it also had diagnostic criteria that were changed since the study and brought down. Some reviews of the study noted the recommendation was for induction at the END of the 37th week, and others noted they were for the beginning. I started to hope that maybe I could make it to week 39, go into labor on my own, ignore my liable blood pressure that was slowly spiking higher and higher at random, and the issue would just go away.
I switched OBs. My new OB agreed with me that my levels at the time were not high enough to merit induction. But then I also started reading about what happens during childbirth if you let your blood pressure get out of control. Things could get bad fast. I joined a preeclampsia group on Facebook and read stories of women who had no blood pressure issues at all one day and were seeing 180/110 levels the next. I read about the infamous magnesium drip that makes you feel warm and like you have the flu during your childbirth and recovery, but minimizes your risk of seizures. I read stories of women who died because their blood pressure readings weren’t taken seriously. I started to chicken out from my plan to put myself on bedrest and stay the course. I made a silent agreement that if my numbers went over 140 or 90 and didn’t immediately come down, I’d go for the induction. My new OB supported my taking readings at appointments after I came in to the doctor’s room and sat for a while. We discussed my anxiety and white coat syndrome, and she agreed that the first reading when I get to the office without time to relax may not be accurate enough for a diagnosis.
I made it past 37 weeks. A huge win. But I also started seeing some high readings at home. Some that probably should have sent me to L&D. But I’d go into bed, breathe deeply, wait a while, and retake the reading and it would come down. The final weekend before I ended up inducing I was having two friends over for a social-distanced dinner in my backyard when my felt my heart pounding a bit. I went to take my blood pressure just to check I was ok and it came back at 150 over something. I started to panic and throw things in my hospital bag and awkwardly asked my friends to leave. My husband had me get in the bed and calmed me down and my BP came back to normal levels. We decided not to rush to L&D, but to get some sleep and reevaluate in the morning.
Every day I didn’t go to L&D felt like a win in my mind. Another day for my son to grow and get closer to full term. Another chance of hitting 39 weeks and/or going into labor on my own.
Unfortunately, my new OB was scheduled to be on vacation the first week of January, so I had an appointment scheduled with a new doctor at 37+5 (37 weeks, five days.) I knew it was a make-or-break appointment. I expected my blood pressure to be high, but did not expect the readings I got. Or that it didn’t come down on a second read, or when I took it on my home machine that I brought in to the office (which was lower but still too high.) The OB, who was quite nice about things, said I should go to get induced today and put in a call to the hospital to schedule my arrival in two hours. She quickly did a cervical check and membrane sweep, which hurt a bitch, and told me I was 1cm dilated (of 10cm) , 50% effaced (of 100%) and -3 station (you want to be +”3″ to deliver a baby.) In other words, while I was ever-so slightly more ready to pop out a baby compared to my first induction, it wasn’t significant enough of an improvement that I had any faith this forced labor would go smoothly. I felt sad and spent the next two hours mourning the “natural labor” I wanted and wouldn’t get, at least not this time around.
When I checked into the hospital I also synced with my virtual doula–a woman who used to be an RN who also had a lot of experience with evidence backed birth. We discussed options and she encouraged me to take the misoprobital this time. I agreed because at least it was something different. I was a little worried about the reports of it overstimulating the uterus and causing too many contractions which could put the baby in distress and harm the mother (possibly causing her to lose her uterus.) But, it sounded like the worst side effects were still pretty rare, and my nurses at the hospital ensured me it was a common and cautious course — they start you on 50mg, a ‘half dose’, and watch your reaction for 4 hours. If that goes well, they give you 100mg and wait another 4 hours. They do the 100mg up to 5 times. The whole process could take an entire day. I liked that — at that point all I could think about was how to delay my son’s birth so he could cook a little longer in utero. This would buy me an entire day. I was game.
The first dose made me feel a bit flushed, but didn’t seem to do anything else. The following doses similarly did little. I felt a few contractions here and there, but nothing that a doctor would consider active labor. This is normal with the cytotec, apparently, as its job is to ripen the cervix, not to cause contractions. Its side effect is that it can cause contractions. But that’s not its main objective. It always is used as a precursor to pitocin, my archenemies chemical concoction of childbirth. There were stories of, rarely, a woman going into active labor after taking cytotec. I thought–wouldn’t that be great, if I could avoid the pitocin altogether! What if cytotec puts me into a normal active labor? Maybe this could be a good birth after all!
When I finished the 5 doses of cytotec, including 4 hours after the last dose, the midwife on duty at the time met with me and suggested we immediately start pitocin. My cervical check showed I was 3cm–which was actually really good for the cytotec. I wanted to get to 5cm before starting pitocin, and I also decided to get an epidural before starting pitocin this time, so I wouldn’t have to feel those horrible forced contractions. She agreed to give me 2 hours and then we would start the pitocin. The plan was always to just see if I could dilate a little more on my own, get an epidural, start pitocin, have baby when baby was ready to come out.
At that point I started to feel a few fairly strong but short contractions. My husband and I asked if we could walk the hall and we were given the ok as long as we wore our masks. Over about an hour and a half my contractions went from non-existent to very hard and very consistent. I realize now they weren’t being picked up on the monitors, but because they were so frequent I had my husband track them on my iPhone app. Looking back I see they were coming every 1-2 minutes and were intense for 30-45 seconds. I’m not sure what happened during that 1.5 hours, but my body went from not ready to have a baby at all to…
3:30pm. I get back to the room and I’m telling the nurse things are getting really painful. I suddenly am thinking 4pm, my check in with the midwife, is too far away. I am ready to throw in the towel and get the epidural now. Start the pitcoin. I’m a wimp. This hurts. I’m told that these contractions are my own, that the cytotec is mostly out of my system. The nurse doesn’t seem to believe me I’m having such frequent contractions. We discuss taking a shower to help me make it to 4pm. She knows my goal of dilating to 5cm before the epidural and pitocin. She is trying to help me get there. She sets me up for the shower, wrapping my hep lock in plastic, starting the water…
A minute or so later, I fold over in crippling pain. I almost find the pain funny, as I might have laughed in horror at that moment. I knew something suddenly changed. I felt a slight trickle of water down my legs and I thought (wouldn’t it be funny if that was my water brea…
Then, bam, out came a Hollywood-style pouring of water onto the floor in two giant bursts. I could tell my nurse knew that meant the show was really starting. Meanwhile, I felt my body immediately change. I can’t explain it. I just felt super scared. I didn’t know that I was about to have a baby so soon. I just thought I was going to have to ensure this level of crippling pain for a long time before I could get an epidural. I screamed out. I need fentynl (which I planned to get one dose of before the epidural like last time, to take the edge off), I NEED AN EPIDURAL, I NEED IT NOWWW….
Just as I was beginning to panic, I started to be hit with wave after wave of really fucking painful contractions. I screamed in agony. The nurse scrambled to get the anesthesiologist and drugs. I somehow made it to the bed. It was about 3:45pm at that point. Suddenly a bunch of people were in the room. My eyes were mostly closed. The OB was there, sitting next to me, saying she needs to check me. I didn’t know what was up or down. All I was thinking was how am I going to survive this until I get this epidural?!?! Just as the OB reported out loud that I was 5cm, I informed the room that I needed to both go to the bathroom immediately and vomit and I would be doing both in due time whether they liked it or not. The fentanyl dose was administered about then as well, as everyone said I cannot go to the bathroom on the drug. I was like, well fuck that, I’m going here and no one can stop me. No one seemed to be telling me not to poop the bed, everyone seemed focused on not letting me vomit on myself… they gave my husband a vomit bag and asked him to hold it to my mouth. I pushed it away as it made me feel claustrophobic and I was like fuck this I don’t want a vomit bag on my mouth why can’t I vomit all over myself I’m dying anyway just let me vomit on myself…
At the same time, I started to “poop.” Well, I wasn’t pooping. The midwife said “you’re pushing past your cervix.” I had no idea what that meant but it sounded maybe not good? The next thing I hear is “you’re crowning.” I think at that point I let out an audible “what??” The next phrase out of my midwives mouth was “that’s the head.” Both my husband and I said “huh?” at this point, as she continued “one more push and your baby is out” and at that point I couldn’t not push, so out came baby.
He was put on my stomach and looked ok and seemed to cry a bit but moments later they said he was having trouble breathing and he was taken away to the NICU. Even though I didn’t have an epidural this time, I had flashbacks to my first son’s birth of him being taken away, and I was again told I couldn’t go to be with him. Instead of that happy after-birth moment with my husband and new baby, I was left on the delivery table with the nurse pressing my stomach to get all the blood out and ensure I wouldn’t hemorrhage, and my husband was off to the NICU to be with our son. No breast crawl like the video. No skin to skin (after the initial minute.) No feeling that good feeling you get after you go through something horrible but end up with a healthy baby.
This time, at least, in an hour they brought my son back to me. He actually latched well and breastfed for a long time. We all went to the recovery room together. We had a little time to enjoy together before my son began having respiratory distress again and ended up back in the NICU the next day. He seemed to have a lot of amniotic fluid that wasn’t pushed out of his lungs due to the precipitous labor, but no one really knows what happened. The doctors all said it wasn’t because he was 37 weeks, but I’m not sure I believe any of that. No one seems to really know. I wonder, most of all, if the cytotec caused the precipitous labor, or if that was really all me after it was out of my system. Why weren’t my frequent contractions picked up on the monitor? Was I having overstimulation at that point? Should someone have been administering a drug to slow down my contractions? Was there any damage caused to my son in that labor that wasn’t just due to my own body having a baby really fucking fast?
Well, baby is here now and after a few days of adjusting and sounding like he was drowning due to being filled with fluids, he is doing quite well. Everyone who sees video or picture of him notes that he’s “so alert,” which I guess is a good thing for babies. My pediatrician also said this, and then noted that he’s strong and active, and that he will probably be an athlete. My husband and I frequently note that he doesn’t seem like an early-term baby, especially compared to our 40 weeker first child who came out acting much more like a premie than this guy. He seems healthy now.
After all of that, you might think I’m bat shit crazy (I am) but I want another child. We’re still looking into IVF for gender selection, which I’m partial towards due to also being able to do genetic screening of the embryo, which helps as I’ll be around 39 and my husband will be 40/41 when we try for our third and final child. Even though that’s a bit of a ways off, and maybe will never happen, I’ve got a wish for that delivery… no high blood pressure. No induction. No NICU stay.
It could always go far the other way. But in my heart, I still want that moment. Closure. That “golden hour.” I want to end the trauma that is labor–even in its best form–with the reward that its meant to bring–a sweet, healthy poop machine lying on your chest, ready for the world. Can I at least have that?