Miles' birth

Time is already passing so quickly since Miles arrived in our lives, and I want to try to write down as much about his birth while I can still remember the details.........

In the week prior to birth, the midwives and doctors that I had seen were becoming increasingly concerned about how over-due the pregnancy had become. While tests showed that the baby wasn't stressed, ultrasounds showed a rapid decrease in amniotic fluid levels. At my appointment on Monday, the 8th, the doctor asked if I was ready to be induced. I was dilated to 1 cm and ~75% effaced. Our vision of the birth was to have everything natural, no drugs, no induction. I asked for more time to let the process start naturally. She gave me two days - said to come back on Wednesday to repeat tests, but to be ready to stay. The big negative about this plan was that I'd have to see an on-call doctor, as she was to be out of the office. We waited......and had very few signs that labor would be impending.....

On Wednesday, September 10th, Cam took off work and came to Waimea with me. Conditions in the uterus had declined further as a result of going so far past my due date. The on-call doc was very nice, but was pushing induction pretty strongly. He also didn't seem to know how the admitting process worked at the birth center, which was frustrating and annoying. He was the on-call OB that night, and his unfamiliarity with the clinic/birthing center made me very uncomfortable........I was still very much wanting a birth with no interventions, but had to consider that those hopes were likely no longer in the baby's best interest. I wanted to talk with the on-call midwife Joanne (who would actually be attending the birth) before agreeing, which on-call doc was very reluctant to let us do. We were able to meet with her about 6 pm, and she stressed her agreement that immediate induction was very necessary. She said she would not have given me the extra two days - the low amniotic fluid levels could cause the baby too much stress very soon. We were starving, so we asked to leave to go to dinner, and then we'd return and get admitted to the birthing center.

We checked in about 8 pm and talked with Joanne about induction options. Given our desires for as little intervention in the labor as possible, she started with the mildest induction agent, cervedil, which is designed to ripen and dilate the cervix, with hopes that that would kick-start my body into labor. The drug was inserted into my cervix, and we went to bed, hoping that it would work its magic. Around 1 am, I woke with mild contractions, which became increasingly painful. At 2:30 am, I woke Cameron up, and we labored through some moderately strong contractions through the night. The drug is designed to last for 8 hours, so by morning it started to wear off and my contractions lessened. I was checked early in the morning, and had dilated to 3 cm. We were all encouraged by the progress, so they let us start another dose of the cervedil.

The birthing center is in the small north Hawaii town of Waimea, and, while it serves people from all over the island who want an alternative, more natural birth process, it is a very small facility. There are 5 birthing rooms where laboring families stay from admission to check-out. Normally. We were admitted at the very beginning of the biggest rush that they have ever seen. By Thursday night, there were 12 women in labor, and had been put into non-birthing rooms whereever the adjoining hospital could find room. We learned that two couples with whom we had taken birthing classes with, one of which we had become pretty good friends with, were also admitted. (They both had due dates 2 weeks after mine...GGGGGRRRRRRRRRRR). The midwives and doctors have on-call shifts of 48 hours, so on Thursday morning our attending midwife switched to Brigid, whom I had not yet met, but liked immediately. She had an amazingly calm personality, which was very settling amidst all the chaos surrounding the many labors and under-staffing issues in the birthing center.

The second dose of cervedil kicked in much more quickly than the first, and I was having strong contractions by late morning. The nurse said that if things went by the text-book, we'd have a baby by mid-afternoon. We called our doula, Sandie, and told her that we'd need her help soon. Contractions became very strong and painful, and by evening everyone thought that we must be near the end. It had been several hours since the cervedil had worn off, and we all assumed that my body had taken over and was laboring on its own. Late that evening, the nurse checked my progress, and I was still dilated to 3 cm, which was absolutely amazing and horribly frustrating given an entire day of intense labor. Sandie told us that she had talked with Brigid, who told her that "she learns something new every day", and had never seen such violent contractions from Cervedil, that the reaction I had was more like the reaction expected when someone is given pitocen with no pain relieving drugs. It was then obvious that we were going to have to try a different method of induction, but they wanted me to sleep through the night, so gave me sleeping medicine that would help me tolerate the contractions and get some rest. By midnight or so, the contraction started to subside, and I was able to get some rest.

Friday the birthing center was at its craziest, and since the baby and I were doing fine, I was low on the list of priorities. They simultaneously had 2 people going in for C-Sections, a baby on oxygen, and 3 moms on epidurals. They told me that they wanted to see if my contractions would start to build again on their own. I had mild to medium contractions through the morning, and was told to get outside, get some sun and fresh air, and walk around for a while see if that helped me relax and dilate. I asked the midwife if I could leave the grounds and she said I should get outside and get some sun, and not tell her where I went. We went to Dairy Queen and strolled around town a bit. The plan was that she would check me again at 2 pm, and we would start a new round of induction using Cytotec, which is a pill that is inserted into the cervix and is supposed to help dilation. I was still at 3 cm, so the pill was inserted. This drug can be repeated every 2 hours for up to 4 tries, so 2 hours later I was checked, and had dilated to 4 cm, and the contractions were bearable, so they inserted another dose. For another few hours, I had moderate contractions, but could still relax between them. Things got more intense as the night went on and by midnight or so, we were convinced that my body had taken over for the drugs again and that there would be a baby soon. Late that evening Brigid came in checked me, and I was still dilated to 4 cm. She said she'd let me go until morning, but that she was getting concerned about drops in the baby's heart rate. She'd be off shift by morning, but that Joanne would be back and I would really have to start considering pitocin to get labor progressing.

About 1 am on Saturday morning contractions were quite intense, and we labored through the morning until Joanne came in to check our progress. Still 4 cm. Very, very frustrating at this point. So we consented to pitocin, which means an IV, continuous fetal monitoring, stuck in bed for the rest of the labor. No more shower, birthing tub, walking around to help in pain management. This was a very frustrating step, as statistics have shown that pitocin-augmented deliveries have much higher rates of additional interventions. The baby's heart rate was dropping quite low at times though, and the staff assured us that this really was our best option - that the baby needed to be delivered one way or another very soon. They started the pitocin early Saturday morning, and labor got increasingly intense as the morning went on. Doses were increased at periodic intervals, and around noon it was reaching unbearable intensity. They checked my cervix again - still 4 cm. Joanne told us at this point that we were almost out of options. The baby had to come out soon. She would try an internal uterine monitor so that she could up the pitocin even more, but be able to better regulate dosage. They were near the maximum dose that my body could take. At this point I agreed to an epidural.........hey - I made it 59 hours w/o drugs.......I needed a break.

The epidural made the contractions very bearable. I could still feel them, and could move around a little bit, but couldnt walk or be disconnected from the monitors. Around 5:00 pm, Joann checked me again - still 4 cm.......she said it was time to call Dr. Lewis, the on-call OB - we had to get the baby out - heartrate was dropping too low during contractions. Then she got called away to deliver a baby down the hall. I was still feeling pretty good from the epidural, but started getting pretty nauseated and threw up a couple of times. Around 7:00, she came in again and said that Dr. Lewis was on his way. He wanted to check me and then we'd talk about surgery. Dr. Lewis came in around 7:30 and asked us if we knew why he had been called in, and asked to examine me. At this point we were, along with the hospital staff, pretty worried about the baby and were ready to consent to c-section. Joanne wanted to check my dilation before Dr. Lewis did, as she had been examining me all day, and would be best able to tell if there was any progress - and I was dilated to 7 cm! Dr. Lewis wanted to examine me too, but I was suddenly very nauseous again and threw up a bunch of times. He examined me a few minutes later and said I was 9-10 cm dilated - all the vomiting must have helped me progress! He took his gloves off and said he was going home - I wasnt going to need a c-section after all!

The nurses got the room ready for delivery, the doses of pitocin and epidural were lowered, and an hour later they said I was ready to push. It is apparently uncommon to be able to push with the epidural still working, but I was able to push fairly effectively, so all but the last 20 or so minutes of delivery were painless. I think it took about an hour and a half of pushing, and then he was out! He was pretty gray-blue, but gained color quickly, and was otherwise doing very well. We were quite surprised when Joann told us that it was a boy, but very excited.

It was amazing how well things turned out. Cam and I both feel very lucky that we had the baby in Waimea - anywhere else would have done surgery days earlier. While the labor was long and intense, I really cant imagine a better ending to the story. Had things gone easier early on, I dont think we would appreciate the outcome nearly as much. The nurses and midwives were spectacular, our doula was absolutely fantastic, and Cam proved to be an amazing labor coach.

Now the real adventure begins - parenting this little monkey!!!!