Oh BOY oh BOY!

At one week late with my baby, my I'll-be-a-mom-by-Mother's-Day plan flew out the window. I really didn't want to be induced, because inductions are more likely to lead to complications, more painful contractions, etc., and most of all I wanted to avoid a c-section. The quick-do-an-emergency-surgery idea didn't appeal to me.  Many first time moms are overdue, so no big deal to wait for him to come. Now, in this community, the doctors really don't like to let you go past your due date because so many mothers are high risk. My midwife had to fight some battles for me in order to let me delay being induced - one of the reasons I love her.  But eventually, all big and bloated things must end, so an induction was scheduled for when I was 9 days late.

The night before my 7 am induction I was to report to the hospital at 9 pm for "cervix ripening."  I can't imagine a more off-putting name, can you? Right. At least it's not as bad as the name sounds. Each round of the medicine takes 4 hours, and they gave me 3 rounds before they gave up, since my dilation had only gone from zero to zero.  Plus I started getting grouchy when they'd come to check my dilation. When you're on this medicine, they have to have constant fetal and maternal monitoring, which means they strap these uncomfortable monitors to your belly that aren't so bad at first, but become surprisingly awful as time goes on with them smushing into your independently squirming belly.

I should mention that the instant I got to the hospital and got hooked up the monitors, the nurses said, "Oh!  You're already in labor!"  Hurrah for me!  Labor I couldn't feel!  Bonus! Oh yes, surely I was made to deliver babies.  This is my calling.  Forget teaching! Labor Warrior Woman am I! The contractions were 5 minutes apart, too, so I was on my way!

James, me, and the belly

I started feeling the contractions in the morning, but they weren't awful. They were maybe every 3 minutes apart. At around 11 am, the midwife decided that since the ripening meds didn't work, they'd start me on pitocin to make the contractions a little more intense, since that often helped you dilate anyway.

Enter pitocin.  Bam.  Instant increase in intensity, duration, frequency.  I had something they called "coupling labor," which I'd never heard of.  It means I'd have two contractions immediately next to each other and then the normal break until the next pair came along.  I no longer felt like Labor Warrior, Born to Birth Babies.  About 4 pm or so James pointed out that they weren't giving out any awards for avoiding pain killers, so I got a shot of something I can only describe as delicious and smooth.  I would look at my little contraction monitor and see that a contraction was, in fact, happening, and I could not, in fact, feel it.  Amazing.  James claims there were other side effects on my level of sanity, but I disagree. It was delicious and smooth. And and an hour later, gone.  The nurses told us that it only really works the first time they give it to you (bummer!) and the only other pain control option at this hospital was an epidural, which they only allowed once you reached 4 cm in dilation.  I was still at 0, with my double contractions coming one minute apart.  They told me that sadly, if I were dilating normally, I'd be pretty darn close to having the child, and typically with contractions like that I'd be much farther than a 4, but rules are rules.  Nothing left but to wait.

Around 9 pm or so the midwife came by to talk to be about my failure to progress. My water broke 30 minutes before she came. She knew I didn't want a cesarean.  She talked about how I could try laboring through another night, considering that my water did break, but as overdue as I was, and coming up on 24 hours of labor with nothing, it was unlikely that laboring overnight would change anything, and then I'd have 12 more hours of pain that might lead to a c-section anyway, with potential problems the longer we waited. Ultimately, after discussing it with the other OBs, the consensus was that the baby was almost certainly too big to be born vaginally. The midwife had warned us of this possibility at around 5 that afternoon when I still hadn't progressed, so I wasn't entirely surprised. But I was disappointed in my cervix. Still, I felt oddly peaceful about it.  She left so James and I could decide, and we both felt like this was what was going to happen, and that was okay.  It was kind of emotional, though.  I felt robbed of my chance to do that thing that women are supposed to do, and regardless of the "at least the baby's okay" aspect, it was still hard on me. I wanted to give birth. I had made conscious decisions to try and avoid this situation. My body wasn't adequate to do what women are supposed to do. It's still hard to think about it, and even though I now know it saved both of our lives, I still wish.

James, ready to go into the OR with me

Things happened quickly after that.  I think it's because so often cesareans are emergencies, but man, those nurses were speedy about things and it made it seem like an emergency. Quick: clean, change, move, catheter, hat, pillow, gurney! One blessed thing was that they stopped the pitocin.  Joy of joys!  I could function while contracting again! The contractions still happened but they didn't own me anymore. Around this time I started shaking uncontrollably (apparently that's common), and then I was in the OR. They gave me a pillow to hold while the wonderful, wonderful anesthesiologist lady gave me a spinal block, but a nurse let me hold her instead. I remember that when I walked to the operating table while they set up, I was more terrified than I'd ever been. I really never thought I would die, but the room frightened me, the speed with which they got me in there frightened me, my shaking and contractions frightened me. The lack of an alternative frightened me most of all. I had no choice - the baby was going to come one way or another, and there was no "another" in my case; this was how it was coming.  But eventually the spinal block made pain and fear dissipate.  Ah, glorious.

The operating table was very narrow, and I felt that with one baby kick I'd topple off, belly first. They strapped my arms down, which was also scary, but with my shaking I was kind of glad.  Finally, finally they let a scrub-sporting James come in and hold my hand.

Having a cesarean is a bizarre experience: you can't see anything, and you feel no pain, but you can feel things happening, like stretching and tugging.  It takes about 45 minutes, but the baby was born in about 4 minutes. He was born at 10:41 pm. The baby's the easy part!  I will never forget watching James's face as he peered over the curtain to watch the baby come. ("I can see your uterus!")  The doctor pulled the baby out such that the baby was facing James, so when the doctor said, "It's a..." it was James who said, "It's a little boy!"  The mystery of gender was revealed!  I'm glad I waited to know. It was something to look forward to during labor - an incentive, if you will. James's face was glued to that little guy, and I got to watch James watch them take the baby over to clean it or whatever they do. He kept me updated: "He's big! He's got a little bit of hair!" And then, in what was probably the single most riveting moment of my life, something started crying. This person who wasn't alive was suddenly alive and in the room with us.  This person from my belly was outside it. And he was mine. He came from me.  He was real. I mean, someone was crying in that room, and it wasn't me.  All of this was real, after all.

They let me look at him for about a microsecond, enough to let me touch his cheek, and whisked him away.  (I know it's a sterile room, small hospital, rules, operations, etc., etc., but I also felt that another thing I lost by having a c-section was that moment you hear about where moms get to bond right after birth. They took him away, and I never felt that overwhelming bond mothers talk about. I still worry that I haven't bonded with him in the way I should, had he come vaginally.)

About 4 days old

James went away with the baby, and they stitched me up.  The doctor doing the surgery talked to me about my pelvis as he did so.  The baby's head was big (the baby was 9 lb, 8.8 oz, and he was 21" long) and my pelvis was smaller than expected, and, as the doctor said of my pelvis, "there was no way he was ever coming out that way." His head never even entered my pelvis, never engaged with the cervix: that's why I never dilated. Unless I have a premature baby, I will never have a baby small enough to come out through my pelvis without a c-section. So that door is well and truly closed.  I am very glad that both of us lived, though.  Hurrah for the discovery and relative safety of cesarean sections!

About a week old, with mommy

I'm recovering well, I think. I turned a big corner from "ow" to "wow!" around two weeks after his birth. It was wonderful to have my mom in town to help, since I unexpectedly needed much more help than I'd anticipated, especially with James still taking finals at the time.

I don't really think Henry looks like either of us - but I don't usually view the world that way.  He just looks like Henry to me.  And he's cute! He's not one of those babies that you see and think, "Wow, he's a mini-whoever!" He's just him.

We're not solid on nicknames.  We call him Henry, mostly. Second most common is Hal (James likes that Henry B. Eyring's friends call him Hal, which is part of why we named him Henry to begin with). Occasionally he's Hank. But always he's my baby boy!

OSCE

Since starting med school, I've been asked many questions about the process of school and about what I do every day. Now that I have some sweet, sweet freedom for the next couple months, I thought that now would be the time to answer those burning questions that y'all have in an ongoing series of blogs. This one is about something that I get to go through periodically as part of my training: OSCEs.

OSCE (pronounced ah-skee) stands for objective structured clinical examination. They usually last 15 minutes with 10 minutes afterward to record what happened while we were in there. My school has a corridor that has 10 examination rooms that are set up just like you would find in a doctor's office. I am all alone in the room with my patient, but there is a camera and a microphone in there too so that I can be graded.

They are essentially fake encounters that I have with a real patient that happens to be acting out their problem. I get all dressed up in my snazzy white coat, wrap my stethoscope around my shoulders, and then act like I know what I'm talking about to my "patient". Before going into one of these, you have no clue what the actor (called a "standardized patient" or SP) is going to be complaining of. Naturally there is a fair amount of anxiety before doing one of these. The unknown is unnerving. The patient could complain of anything! Luckily for me, the cases haven't been too complex. The preceptors do try to make it funny sometimes. For instance, I got to treat one Whoopie Goldberg, a middle-aged white woman followed by a Jack Sparrow, a sober older gentleman. It was quite the afternoon.

So in the future, if you have any questions about the process of med school or whatever, let us know and we'll do our best to answer them. Until next time!