Josie’s Birth Story

Thanksgiving day, we welcomed our daughter, Josephine Robin, into the world! I tried to take notes during labor and wrote up her birth story when it was fresh, but haven’t gotten a chance to post it (#newmomlife). This is going to be quite long, since Josie’s birth was anything but straightforward. Luckily, the birth was the hardest part and she’s an actual dream baby (so far!), but more on that later. Highlights/TLDR: atypical pre-eclampsia, successful induction, unsuccessful pushing, routine c-section, post-op hemorrhage, transfusion, frenulectomy, mom and baby girl home after three days.

 

The long version: I was diagnosed with “mild preeclampsia” at 39 weeks and 5 days pregnant on Tuesday 11/20 at my regular appointment and sent for an induction that evening. I’d had borderline high BP readings (135/92) when my normal blood pressure was always quite low (closer to 110/60) and what seemed like elevated and increasing blood liver enzymes and protein in my urine. At that appointment I was only 1cm dilated and -2 station so not too much going on. I left my appointment, called Matt to tell him the plan, picked up the dry cleaning (lol), and packed a bag. My “birth plan” was to have an unmedicated birth at the Birth Center, but as soon as I had too many high blood pressure readings, I “risked out” and would be delivering at the hospital instead. On top of that, being induced meant that I probably wouldn’t go unmedicated. So birth plan went out the window! I got to the hospital for the induction around 6pm and took my first dose of misoprostol at 8pm.

Misoprostol is an oral medication that causes uterine contractions. It did its job, and I was given a Benadryl around 4am to help me sleep through it. I was up to 2cm by the 8am next morning (Wednesday) and losing a lot of mucus plug. To keep things moving, they inserted a foley catheter bulb around 1:30pm. Basically it’s a little balloon inflated in your cervix to help it dilate. This was the most unpleasant and uncomfortable part of the process. Luckily it worked quickly and was gently tugged out around 6pm. Wednesday was a pretty easy day, I was eating and napping as much as I could. I had a mini Harry Potter movie marathon and read on my kindle a bit. There’s a Whole Foods about an 8 minute walk from the hospital, so I kept sending Matt out for meals from the hot bar rather than eat the hospital food. We did this postpartum too, to the point where the nurses thought I might have some sort of eating disorder because I kept rejecting meal trays. Really I’m just a diva.

The misoprostol was still working at that point but in order to speed things up they switched me to pitocin around 9pm on Wednesday. This was an IV administered drug instead of an oral one, so it’s a bit easier to control and you can stop or decrease it if it gets too intense. With the oral medication, you can’t un-take it once you’ve ingested it. They started me at 1 and increased the dose every half hour, so I was up to 18 by early the next morning, which was Thursday, Thanksgiving. I took 2 Benadryl to sleep that night. I wasn’t really having strong contractions but a cervical check in the morning put me at 4cm so they went ahead and broke my water around 5:30am. That’s when things got really intense. Those contractions were tough, even after they knocked the pitocin back down to 10. I tried all the positions and had pretty bad back labor so I got these sterile water back injections which STUNG but worked for a bit. It felt like four synchronized bee stings in my lower back. The midwife and three nurses administered the injections at the same time. They went just under the skin like acupuncture and it BURNED but after that my back felt much better for almost two hours. When that wore off I got into the tub, which also helped a bit.

The whole time I was laboring, the contraction monitors didn’t work very well because my belly was “all skin and baby” and felt firm all the time. I had originally wanted an unmedicated birth but after being induced there was no way that was happening. So I got the epidural at 9:30am and have no regrets. This was after I’d been in labor for 36 hours, with the last four being very intense. After that I was able to rest and sleep while they turned the pitocin back up and things progressed quickly. I used a big peanut shaped ball to keep my hips aligned and lay on one side, then the other, and finally in a “frog” position on my back. I was fully dilated and 90% effaced at 1:30 pm, so we decided to start pushing at 2pm. We were very excited to push! Matt put on our labor playlist and the nurses got the infant warmer and everything ready. And that’s when things kind of hit the fan. I pushed for 4 hours without much progress. The midwife and nurse seemed to think it was due to:

1) the baby’s position being transverse/sideways, she was facing the side I think?

2) the epidural making it hard to time pushing with contractions, especially since the contraction monitor didn’t work for me and

3) first time moms just taking longer.

After the first two hours they had the OB examine me and consult. He said I could keep pushing since the baby was tolerating the pushing really well and I still had a good amount of energy. But two more hours after that I was done. We talked about a vacuum assist, but I couldn’t push anymore. The baby wasn’t coming out, so I told them I was ready for a c section.

No one made me feel like I was making the wrong choice even though it wasn’t “medically” necessary. Since the OB couldn’t promise that we wouldn’t end up with a section after even further interventions, I just opted for sooner rather than later. Waiting for the c-section was uncomfortable though. They’d turned down the epidural and turned up the pitocin to try to get me to feel the contractions more for pushing, and didn’t adjust them for when I wasn’t pushing anymore. So being in pain and knowing I was headed for surgery was pretty brutal.

The good news was the baby was happy as a clam the whole time. Her heart rate was excellent and she tolerated pushing better than anyone expected. Also despite being induced for pre-e I didn’t have a single high blood pressure reading the entire time I was in labor. They did run my blood labs again once I got to the hospital and my liver enzymes were elevated further though, so they are calling it “atypical” pre-eclamsia.

I went for the c-section right at the change of shift so it was all new/fresh doctors except for the nurse who had been with me all day, Beth. She was incredible through the pitocin, epidural, labor, pushing, and c section. I knew what to expect from reading other birth stories, so I was mostly just surprised at the amount of people in the room. They had the curtain up by my neck and brought Matt in right after the test incision. I think they cut into you at first without your spouse in the room, so in case you aren’t numb enough yet and you scream, your husband doesn’t freak out. He held my hand as much as he could but I was shaking so badly it was tough. Apparently that’s a very normal reaction but I had the shivers and shudders for a good hour after surgery too.

We could hear the baby before we saw her. She cried right away and then we were all crying. Matt went over to stay with her while the pediatrician checked her out and he took photos on his phone and brought them back to show me while they took care of her. Her poor head was bruised from being pushed up against my pelvic bone and it was clear she wouldn’t have fit. She had what looked like a rug burn on her forehead from being pushed back and forth for 4 hours and there was a ring around her head where you could see how far she made it through my pelvic arch and that the rest was not going to make it. Apgar was 9. Once she was wrapped up, they let Matt place her cheek-to-cheek with me while I got sewn up. Then he went back to the room with her and did skin-to-skin while they finished with me, taking out the epidural, giving me more pain meds, switching me back into a bed from the table, etc. The staff was in pretty good spirits considering they had to work on Thanksgiving! We were all joking about all the pie we were going to eat after the surgery.

 

My family arrived in our room shortly after I did with a Thanksgiving dinner we couldn’t eat — me due to surgery, Matt due to nerves! They had driven up to Boston and rented an Airbnb with a big kitchen so they could cook here and we wouldn’t have to travel at 40 weeks. So it was convenient that they were already here but inconvenient that we missed the holiday. They stayed with us until we transferred from labor and delivery to postpartum.

Our postpartum experience was almost as dramatic as the birth. First, Josie had a significant tongue tie that needed revising. Not a huge deal in the grand scheme of things, but not what you want to deal with right off the bat. They cut it for her on her first day of life and it literally took less than a minute and didn’t seem to bother her a bit. Other than that, she was perfect. I, on the other hand, was not so perfect. I had a reaction to the morphine that caused itchiness everywhere which was super annoying. Then I apparently passed a baseball sized blood clot that was holding in a lot of other blood, causing the nurse with me to freak out that I was going to pass out from blood loss. She was legitimately scared and then Matt freaked out too. He always says when hospital staff is walking, things are fine. When they are running, there’s a problem. Well, she called in other nurses convinced I was going to drop to the floor at any second and they ran and then Matt was very concerned. Honestly I really felt fine though. They monitored my levels and decided that the pre-e threat was minimal but my blood loss was pretty severe and my platelet and red blood cell levels kept dropping despite no further loss, so they gave me a transfusion of 2 units of blood. I really wanted to avoid it and I felt fine without it, but I got it and really did feel better afterwards. I didn’t bleed much since that episode so I think it was just a one time hemorrhage. I did some research later on as to why this happened. I think because I went through a 30+ hour induction and 4 hours of pushing, my uterus was just super tired. It’s a muscle after all! The placenta is attached to the wall of the uterus with lots and lots of tiny blood vessels which are left open after it’s delivered. The uterus is supposed to contract after birth to stop those vessels from bleeding, but mine was so tired it couldn’t, so I bled a lot into my uterus and then since the cervix is still wide open, that’s how it exits the body. I also had TERRIBLE postpartum swelling. I hadn’t heard anything about that, but my whole body including my face was swollen for a few days, and my feet and ankles were the worst. Even my hips were swollen. And my forearms. Apparently I lost all of the water through night sweats though because I would wake up in a puddle every few hours and need to change my gown. It was magical.

Despite all of that, they let us go home after 3 days, so we packed up on Sunday and headed home. My parents drove back to NJ Sunday morning and my mom took the train back to Boston on Monday and stayed with us for a week. She wasn’t planning on coming right after the birth, but with the pre-e and the c-section it was good to have her here.

 

Having our baby girl home was (and still is) such a miracle. I would do it all over again exactly the same. In hindsight, the induction and the c-section were 100% the right choice for me despite being the opposite of what I originally wanted. Maybe if I’d gone into labor naturally my pelvis would have had more time to open up and I wouldn’t have needed the surgery, but then again maybe Josephine would have kept growing and I’d need it anyway. My recovery from the section was really smooth. I only took two of the opiods the entire time, managed the rest with Tylenol, and was relatively mobile within the week. Two weeks out and I felt maybe 95% myself.

I’ve read since that your “birth story” isn’t yours, it’s the baby’s. It’s whatever they decide, and you can plan all you want, but you won’t get your way. Josie’s birth was nothing like I expected, but in the end, mom and baby both healthy and whole, and who could ask for more? And despite things not going to plan, I felt safe and informed, and well cared for the whole time, so massive massive thank you to the midwives, NURSES (extra shout out here!), OBs, surgical staff, parking attendants, literally everyone at Cambridge Hospital.