Evelyn Mae's Story

Warning: My version of this story is LONG! See Jonathan's blog for the condensed version. :)

Well, I suppose it all started last summer. But I trust that you've been following along since then, so we can cut to to the latest journey for Miss Evelyn: birth.

Yesterday (Tuesday, March 9th) was a long day. I was feeling somewhat bored and discouraged about being on bedrest and having to collect bodily fluids for testing. (And yes, I was on bedrest for ONE DAY. I am horrible at resting. I can thank my mom for that.) I was frustrated after our appointment at the Birth Center because I felt like nothing was happening and yet I wasn't feeling so great. I had bad headaches and just felt generally sick, probably because my blood pressure was spiking. So, as you saw from yesterday's post, we waited and waited and waited to get the results of the protein test back from UNC. We waited at the coffee shop, we walked around a bit in Chapel Hill, and finally we went to Nantucket Grill for dinner because it was free cake Tuesday! I had about 2 bites of clam chowder and neither of us had cake, because dinner consisted of back-and-forth phone calls with the Birth Center about the next steps... and we were both just a little beyond caring about cake at that point. Even Nantucket's cake, and that's saying a lot.

So the plan was announced: my protein count was 138 and the cut-off for mild preeclampsia is 130. I'm not sure what kind of scale this is, so I don't know if that's really far above the cut or not, but I didn't really care once the decision was made because I had a raging headache and a belly full of baby and I was ready for something to happen. (Later, I would look back at this train of thought and wonder why I hadn't hoped to be sent home for more rest instead of to the hospital for induction... but that's just the fresh memories of labor talking. I didn't really have an option.)

We drove to UNC and made the long trek from the parking garage to the Women's Hospital. During the walk, I remember telling Jonathan that sometimes women die in labor and that if I did, I just wanted him to know that I love him very much. I never said I wasn't dramatic about health things. I think I had this talk with him a few hundred times before I had my wisdom teeth surgery. He was great about diffusing that conversation and moving right along.

So we checked in. Our nurse was Cathy and she had a student nurse from NCCU with her, Wanda. I immediately liked Wanda because I like students. I was okay with Cathy, but she didn't seem too fond of my "low intervention" birth preferences. She liked to offer me ambien and pain meds because "rest is so important" and such. I told her I'd let her know if I needed anything. Then she proceeded to attack me with needles. IV insertion attempt #1 - hit a valve in my left forearm. Attempt #2 - didn't get blood flowing in upper left arm (meanwhile, lower left arm was bleeding all over the place). Attempt #3 - left hand... nothing. Then she gave up and had another nurse come in. She wasn't cheerful about giving up; she was actually quite grumpy. I was of course nice and patient even though my arms were throbbing. So new nurse came and jabbed me in the right wrist, where I still have an IV port that is providing continual annoyance and low-grade pain due to it being right there. But enough whining. Wait, no, there's more! I lost count but they tried at least a couple more times to just draw some blood (after the IV was in) for the lab. Even then, with a butterfly needle, Cathy struggled. I felt kinda bad for her but not too bad since she was so huffy about the whole ordeal and kept blaming my veins.

Anyhow, the IV was in. It was somewhere around 8 PM. They hooked up the external baby monitors, two belts with little monitors on them wrapped around my belly to measure Evelyn's heartrate and my contractions. They also hooked me up to a blood pressure cuff that was on a timer to measure my BP every 15 minutes. It had the added bonus of making my arm throb in all of the places where it was pricked earlier. Oh and lest we forget, I had the joy of a foley catheter. That was by far the most annoying part of early labor. Maybe the most annoying part of labor in general, since I was asking them to take it out right up until the end.

Next, introductions and various decisions were made. When we checked in to UNC, I was still under the care of the Birth Center. Sarah, a midwife from the Birth Center, was going to be in charge of all decisions regarding my care at the hospital. However, once she and the doctors saw my vitals and reviewed the situation, they decided that the safest thing would be for me to go on magnesium sulfate during the induction. Mag is given to reduce the risk of seizures in moms with preeclampsia, and if someone is on it then they are considered too high-risk for Birth Center care. So it was with some fear and sadness that we switched over to the care of the Family Practice docs at UNC. However, Sarah remained at the hospital and she was available to us all night. We met the Family Practice doctors - an attending who was a really nice guy (reminded me a lot of Tom, one of the pastors at our wedding), and his resident who ended up catching Evelyn. I should probably remember her name. She was really sweet and calm and in and out all night checking on me. We also met the anesthesiologist, who gave us his little speech on pain management. I nodded along politely. The Family Practice docs asked lots of questions about our birth preferences, which was super kind of them. They were very accommodating and understanding of our situation - that we really wanted a low-intervention birth and that even being at UNC meant that our "plans" weren't going quite as we'd hoped. But they did such a good job listening and letting us make whatever decisions we could.

The pain management policy was that we'd hear about our options and we'd be flexible, but we didn't want to be repeatedly offered drugs. Sarah and the doctors agreed to a deal with us that they would not bring up medication unless they saw that pain was stalling labor. I thought that sounded like a good deal. Too bad we couldn't get the nurses in on this arrangement, but thankfully it was nighttime so I didn't really talk to them that much and they didn't have too many chances to push drugs. I'm probably making them out to be horrible, which they weren't. But every good story needs a villain right?

Okay so all was decided. It was maybe 8:30 PM or so. Cathy and Wanda came in started the saline solution and the Magnesium through the IV. I was warned that the mag would make me really hot and tired and flu-like. Yep. That was a fun way to kick off labor. After the bollus (or something like that - I was trying to be informed and ask what they were doing but Cathy didn't really want to teach me) of mag was done and the regular drip was rocking, they hooked up the dreaded Pitocin. Bum bum bum! Pitocin is an artificial form of a hormone that the body naturally makes to help kick off and sustain labor, Oxytocin. The difference is that Pitocin generally gives a person much stronger contractions that are longer in duration than "natural" contractions. The result of that is that many women who are on Pit end up having all kinds of interventions (drugs, c-sections, etc.) because it's ridiculously hard for the body to manage these unnatural contractions. So that's the fear with Pitocin. I just kept reminding myself that I knew at least three women who had Pit and still avoided other pain medications, epidurals, and c-sections. At this point, with a lot of my other ideal birth preferences out the window, I was pretty determined to make things work without more intervention.

Drip, drip, drip went the IVs. Squeeeeeeeze went the BP cuff. And Jonathan hit the sack on the most uncomfortable-looking couch ever. We spent the next 7 hours or so trying to rest. I had to have my reflexes checked every hour because the mag can do weird things to the brain. I also kept flipping sides on the bed to try to get comfortable (they should have just told me comfort is impossible with a catheter), and my movement always brought Cathy and Wanda in to adjust the monitoring belts. They upped the Pitocin every 30 minutes or so until I was at a maximum dose of 36 (not sure what that means). I think maybe they upped it quickly because they could never get a read on my contractions. As in, I was most assuredly having contractions but they could not see anything on the monitor. That was frustrating because I felt invalidated and then doubted myself as to whether I was indeed contracting. But looking back, I know I was. They just couldn't see it. I was managing the contractions alright though, feeling them but letting them pass. I didn't really need to breathe through them or anything.

I got checked a couple of times - Sarah checked me right when we checked in and she said I was maybe 4 cm and 60% effaced and 0 station. The resident checked me later, around 5 AM maybe, and said I was at 4 and 80% effaced. That was frustrating to hear. I was starting to think we'd be there all day, and staring to wonder if maybe an epidural might help. But I didn't say anything about it. I just decided to give it some more time, take it one contraction at a time, and see what happened.

I woke up Jonathan around this time. The Pitocin was almost maxed and the contractions were starting to hurt more than I could handle on my own. I needed him to count for me. The magic thing about contractions is that they peak in intensity at 30 seconds. So if you can make it to 30 seconds, you know that it's not getting worse. Jonathan counted and counted and counted, letting me know every time I hit 30. It was so incredibly helpful. I started to kinda hum through the contractions and he ran his hand down my back in sync with my humming, which is another technique we learned in our Bradley class that was amazing to me in labor. I had a couple of contractions without Jonathan, when the nurses would be in the way checking things or he was getting a drink or something, and those contractions were the ones where the voice in the back of my head whispered sweet nothings about epidurals. But when he was there to help me, all I could hear was his voice telling me how strong I was and that I did it and to just do one at a time. Man, he's awesome.

So I was still flipping side to side in the bed, contracting, not really thinking about much except either getting through the current contraction or resting between them. I have no idea how often the contractions came or how long they lasted. But suddenly it was 7 AM and that meant shift change.

We met our new nurse, and I don't remember her name. There was a new attending - don't know her name either. Can you tell I was bit preoccupied at this point? Sarah, the midwife, came in just a bit after 7 to tell us goodbye and let us know that Leighanne (another Birth Center midwife) would be coming in to be there for us through the day. When she came in, she saw me humming and probably looking extra miserable - and not being my cheerful self of course - so she decided to have me switch positions. She put the back of the bed all the way up and put some pillows at the top and helped me get on my knees, kinda leaning over/hugging the top of the bed. Then she encouraged me to rock my hips back and forth, which simulates walking for the hips and can help the baby navigate through the pelvis.

I responded to her hard work and encouragement by puking up all the purple gatorade I'd been drinking (shhhh - they told me only ice chips but I was having none of that). Luckily she and Jonathan were right there with basins and cool washcloths and support. They both stayed there, rubbing my back and just being helpful. I really loved the new position. Being able to move a little during contractions made a world of difference.

I think it was at this point that I started trying to get Jonathan to take all my pain away. He had been doing so well up to this point that I couldn't understand why he wasn't being more helpful now. I would motion to him what I wanted him to do during contractions, since I couldn't really talk during them and I didn't want to talk between them. I would try to get him to push harder or softer or make circles one way or another and I was getting so frustrated that it wasn't working! Maybe this was the transition stage for me. It hurt. It wasn't getting better. I was humming through contractions (usually saying "aaaaahhhhhh" but at one point I mixed it up and gave Jonathan a laugh by running through all the long vowel sounds during a contraction. I was not amused that he giggled).

Oh, also, starting sometime around 5 AM my water broke. It was like a little spill or pinhole for me, because when the resident checked she could still feel water around Evelyn's head. It was another situation where I swore to the nurses that something happened and they did not appear to be convinced. Jonathan said that there was a lot of fluid when Evelyn was born, so maybe it didn't really all break until then. But I know some of it came out earlier.

Okay, so it's maybe 7:30 AM. Sarah checked me because she could hear that in addition to humming through the contractions - and humming louder and louder - I had started to make this sort of grunting noise at the end of the humming. We heard about this noise in our birth class too - our instructor did a great version of it that made us all laugh because we weren't in labor and didn't really get it. But once I was there making the noise, I got it. It's a hard work noise, like when you lift something really heavy. Or, you know, when you're about to give birth. Well, she checked, and in my haze of pain and focus on survival, I do distinctly recall her saying that I was ready. And to call the doctors.

In came the doctors, nurses, janitors, students, random audience members - who knows. There seemed to be a lot of people in the room. I didn't really care. Actually, I didn't care at all. All I cared about was getting through the next contraction. I was aware on some level that pushing was coming, but I wasn't really convinced that they knew what they were talking about. After all, didn't they tell me that I wasn't really even having contractions (since they couldn't see any on the monitor) and that my water hadn't broken? Surely I was not ready to push the baby out.

Sarah kept reminding me to listen to my body and do whatever I needed to do. I pushed quite a bit through one contraction while I was on my knees. They were monitoring Evelyn's heartrate still and I remember Sarah saying that it seemed low at one point, so they then had me switch to laying on my back so that they could get a more accurate read. Then they asked if I was okay pushing on my back. Had you asked me this before that moment, I would have most likely said no and remembered everything I've read and learned about how pushing from the supine position is actually more difficult for moms than pushing from a squat or kneeling position where gravity can help rather than hinder progress. However, in that moment I think they could have had me push upside-down and I would have done whatever they said. This is where trusting your healthcare team in birth is essential because you get to a point where you can't really make decisions and need them to be made for you.

So there I was on my back with my feet on the pushing stirrups and the audience (and GIANT light that hid in the ceiling but came out for fun things like catheter insertion and birthing) and Jonathan and Sarah on either side of me. I remember hoping that no one yelled at me to push. That was one of my fears and preferences - that no one say "push!push!push!" while I was in labor. I figured I'd know when I needed to push and probably didn't need a chorus telling me such things. Oh and no counting through pushes either. Well somehow they all knew - or maybe they don't routinely do that stuff anyway - and they all just let me do my thing.

The first contraction I had on my back, I totally forgot about this idea of holding your breath while pushing. I'd been so focused on breathing through contractions and relaxing all of my muscles that I tried to basically relax and breathe through pushing. Um, not so effective. They let me get through the contraction and then Sarah and Jonathan reminded me to hold my breath for the next one. I think I might have actually laughed at this point that I'd forgotten that part. For the next contraction, I think I did much better. They told me that they could see her and I was still not fully convinced. No way! This was happening too fast! Maybe they were confused! But then came another contraction and boom.

At 8:17 AM on Wednesday, March 10th, 2010, Evelyn Mae was born.

They let us look to see her sex, per our request, and we saw that she was a girl. Evelyn. Beautiful.

They put her on my chest. The resident cut the cord. Jonathan cried. I was in shock and just overwhelmed.

Then they did all the fun after delivery stuff. I'll spare you the details there.

Evelyn is perfect. Her birth was not exactly what we had been trying to prepare for and hope for, but in some ways it was even better. Jonathan and I were a team together in the face of all of the challenges that came up, and we made it.