Sunday, 10 August 2008

Labor and Delivery, Part One

On the Friday of our last ultrasound, Dr. O had scheduled us for an appointment to begin induction on the following Monday morning. We spent Saturday trying to be as normal as possible. In the morning we painted faces at our church's booth at Custer Street Fair, in the afternoon we attended a graduation party for one of Jeff's good friends, and in the evening we dropped by a get together for our church's worship team (Jeff plays electric guitar). Jeff and I spent Sunday morning in church, then we chose potential names for the baby, did a little last minute straightening up, and left for the airport. My mom, Mary, flew in from California to be there for labor and delivery. I needed someone with experience to coach me through labor. We had been signed up for a Lamaze class, but canceled as soon as we got the bad news. Under no circumstance was I prepared to sit through a class on labor with couples experiencing normal pregnancies, and I was likewise not excited to read or watch labor preparation videos, so mom did all that for me. We picked her up at Midway, and went home to rest and get ready to go to the hospital. Of course we got to sit in an hour of Chicago traffic first.

We packed our clothes, hit the library for books and movies, borrowed season two of The Office from a friend, and made a big bag of snacks and drinks for mom and Jeff. I had been advised by friends to eat a lot the night before, because often you can’t eat after you begin induction. We went out for dinner to the Cheesecake Factory. It was the first place Jeff and I had gone out to after learning of our pregnancy, so it seemed appropriate. We stuffed ourselves with food and cheesecake. I ate what can only be described as a mountain of chicken fingers, as well as mashed potatoes and part of a burger. I was a machine. After dinner we stayed up late finishing things and making preparations for the family members arriving in the coming week. We had begun to work on funeral arrangements, and managed to get everything scheduled for the following Saturday.

On Sunday night Jeff and I spent extra time talking to Leah and feeling her kick. We had a habit of doing that every night before we went to sleep, lying down and rubbing my tummy and waiting for a response. I turned to Jeff and told him I wasn’t ready to let go, that I just wanted to keep Leah in my tummy forever. He said he wasn’t ready either, but he didn’t think he would ever be ready. How could we be? Who could say, "Today I am ready for my child to pass away," even though you know death is both imminent and inevitable.

The hospital called at 6:30 Monday morning to let us know that they were ready for us. I showered and dressed, and we took one final belly picture. We packed the cooler, blankets, pillows, camping chairs, books, magazines, and movies into our Corolla and set out. They checked me in very quickly and took me to a room in the "quieter" area of the hospital. Maternity wards are designed for happy occasions, not sad ones, so we had to walk past displays of baby plates and baptismal gowns, a reminder of all the things we wanted for our baby but would never have. She would never eat, never be baptized, never take communion, never play, never grow. That was hard.

Dr. G. was in charge of my delivery, and he came in with an intern to talk about the induction. After checking my cervix (wow, was that unpleasant) they told me that it was soft and had a small opening, although it was not yet dilated. They were surprised by this, but were happy to report that it presented me with another option for induction.

They had originally planned a Cytotec induction, which uses a suppository to soften and dilate the cervix and induce contractions. The process can be very long, at least 3 or 4 doses at 4-6 hour intervals to achieve labor, but during that time you are free to move about as much as you like after the first hour, and eat if you are able. I knew all of that from previous meetings. Then they explained something I hadn’t been told: the Cytotec causes extremely hard and fast contractions, so much so that you have to sign a warning indicating you understand that your uterus could rupture or fly out, and that the severity of these contractions is very difficult on the baby. They do not usually use multiple applications of Cytotec to induce labor in a full-term pregnancy because of this. Dr. G explained that while he could only speak from his experience, his opinion was that it is unlikely that a baby would be born with a heartbeat in the case of a Cytotec induction. I felt like leaving. I only went in for the induction for a chance to meet my child, and if the medicine was going to make that next to impossible then I wasn’t interested.

They did have another option, one they have recently started using for full-term inductions, called a Cook Cervical Ripening Balloon (see here and here). It uses two balloons filled with saline to manually dilate the cervix. Then, Pitocin is used to induce contractions. However, it is difficult to get into the cervix when the cervix has not started to dilate, and because of this it would be very painful. It was described to me as an 8 or a 9 pain level on a scale of 1 to 10. In addition, with the Cook device you are allowed to move about, but the catheter hanging out of you restricts your movement. Jeff and I had to make a decision. I was concerned about the pain (and the wisdom) of inserting a catheter into a cervix that was not ready at all, but I had no intention of having an induction that would severely distress my baby, and likely prevent it from being born alive. So I asked if they could do one round of the Cytotec suppository to soften my cervix and make it easier to insert the Cook device, and then insert the catheter and use the Pitocin to induce contractions. The doctors thought it wouldn’t do any harm to try inducing that way, and agreed to the plan.

They gave me the Cytotec around ten, and we popped in The Office to pass the time that I had to spend in bed waiting for the suppository to absorb. At lunchtime I was allowed to eat, which I was very excited about since I had only eaten a light breakfast. The hospital actually had a decent cafeteria with a huge menu of items to choose from. The portions were a bit skimpy, but otherwise it was good. Mom and Jeff had packed sandwiches, fruit, chips, and lots of snacks, so they stayed and ate with me. After lunch we took a little walk. I even had permission to go outside and walk around the hospital, as long as I didn’t wander too far. It was a really beautiful sunny day with a nice breeze, so we stayed out for a while and walked around the hospital and down the block and back as well. It felt good to walk, since the Cytotec makes you feel a little bit crampy. Besides this minor cramping I felt fine during the first eight hours of the induction.

No comments: