Hannah's Birth Story - Epidural & Back Labor
Megan went into labor on Wednesday, 5 June. Her due date, as given by our doctor, was 29 May so each day we were waiting in expectation, trying to sleep late and run some errands. Megan walked two to three miles every other day for a couple of weeks preceding the birth. On Tuesday, 4 June, she felt achy and a little crampy during her walk. This feeling came and went throughout the rest of the day, but labor still did not begin.
On Wednesday morning, Megan said that she wanted pizza for dinner so Dan started some dough. Then they made a trip to the grocery store to pick up pizza toppings. After returning home in the late afternoon, Dan went out to mow the lawn. By the time he finished, Megan had begun to feel that her Braxton Hicks, frequent over the past week, had turned into tight and somewhat painful contractions occurring between 5 and 10 minutes apart. It was just after 6 p.m.
We had planned to make a cake for our little girl’s birthday, so Megan started that while Dan worked on pizza and getting a shower. Megan’s labor progressed rather quickly and we had a hard time finishing the cake and pizza before Megan needed to concentrate closely on each contraction without much of a break between them. At about 7:00, Megan noticed that the contractions were about five minutes apart. Around 7:30, she called Deborah, our doula, to let her know she was in labor but didn’t need her to come right away. Megan tried to eat some pizza but was already losing her interest in food. Dan ate almost a whole pizza, which served him well during the long night to come. Before long, Megan’s contractions intensified and Dan called Deborah to ask her to come to the house as soon as she was able. She arrived at about 10 p.m.
Throughout the first stage of labor, Dan thought that Megan was amazing. She was incredibly focused and concentrated well through each contraction. At first, she wanted to lean over the bed during contractions and as we were still working in the kitchen we would have to move quickly into the bedroom so that Megan could find a comfortable position. Eventually contractions took over and it was not possible to do anything other than labor. Megan found the contractions to vary somewhat in intensity. Almost from the very beginning, a short and less intense contraction was followed by a stronger, longer contraction and then another weaker contraction. This pattern continued for a few hours. For a while, Megan lay on the bed in the side position she learned in her Bradley class while Dan and Deborah provided verbal encouragement, water and juice to drink, and back, shoulder, and head massage. Deborah encouraged Megan to move a bit to keep labor progressing. This mostly meant walking across the living room and back with a stop at the bathroom before returning to the bed. Once, we think at about 11:30 p.m., we all walked a slow quarter-mile loop around the neighborhood. Megan found the walk to be a pleasant diversion, although it was followed by a couple of the most intense contractions that she can remember in her labor. Labor continued with consistent progress while she lay on the bed until about 2:30 a.m., when Megan asked whether it might be time to go to the hospital. Dan tried very hard to time contractions but found that Megan gave little to no indication of when they began or ended. Deborah had to ask Megan to give her a signal when each contraction started. She determined that contractions were 60 seconds long and 2.5 minutes apart and that it seemed a reasonable time to leave for the hospital. Megan would like to note that she was surprised that the time she labored at home seemed to pass rather quickly. She thinks this was due in part to Deborah’s calm encouragement. Several times, Deborah said, “Just get through this contraction and you will never have to do this one again.” Megan also found that a key to getting through contractions was to focus on one moment at a time without thinking about what was to come. Deep abdominal breathing was essential. Megan also felt that lying down for much of the labor enabled her to conserve energy. Megan’s concentrations and breathing were so focused that Dan kept thinking the Bradley people should be there filming her.
The 10-minute ride to the hospital was not as difficult as Megan had imagined it would be, although she needed to stand still and lean on Deborah during a contraction after they arrived and had walked halfway from the car to the emergency entrance at St. Joseph’s. Upon arrival to her assigned labor and delivery room, a nurse performed an exam that indicated that Megan was dilated to 8 cm. Megan then resumed laboring on her side in the bed. Our doctor arrived at about 3:45 a.m. and confirmed that things were progressing well. Megan then labored with sips of water and bathroom breaks for another couple of hours. A nurse performed another exam at about 6:00 a.m. and found that Megan was dilated to 10 cm. The nurse called the doctor, who then confirmed that Megan was fully dilated but had a lip of cervix still in place. She suggested that if Megan found it more comfortable to push, it was safe to begin doing so with her contractions. Megan pushed for about an hour before the doctor checked her progress again to find that the baby was still unmoved at -1 station. She attempted to determine the position of the baby’s head and though it was not possible to be certain, the doctor thought it was likely that the baby was in occiput posterior (face up) position, which would explain the lack of movement down the birth canal. Our doctor also found that Megan’s bag of waters was still intact and thought that breaking the water would make it easier for Megan to push the baby out at this point. Megan gave her permission to break the water and she did. The doctor also suggested that Megan take a break from pushing and relax through her contractions for a while, so Megan breathed through contractions for another couple of hours. By this time it was about 9:30 a.m. and the doctor suggested that Megan try pushing again. The lack of the bag of waters did indeed provide a bit more sensation for pushing. Megan had begun her pushing in the knees back, reclined position, but after an hour and another exam revealed a lack of movement of the baby, a nurse suggested Megan push while on her knees, leaning over the top of the bed, to see if working with gravity would help. However, this was particularly uncomfortable. Dan had also suggested squatting but Megan felt at this point that she was lacking enough energy for this. Pushing in these positions went on for 2.5 hours but did not move the baby any further along. She remained at -1 station.
At noon, the nurse became concerned that several hours of pushing had not resulted in any downward movement of the baby. At this point, Megan also was concerned, not least because she had become very tired from being up all night laboring. She was beginning to find it much more difficult to know how to deal with the pain of contractions. The nurse consulted with the doctor and then gave Megan some options. One was to have a mild dose of Pitocin, which could help increase the strength of contractions to assist in pushing out the baby. The administration of Pitocin could include or not include an epidural. The nurse also suggested that Megan could have an epidural without Pitocin, with the idea that after hours of labor, Megan’s pelvic floor was probably tense and an epidural would help it to relax as well as give Megan’s body rest for more pushing. It would hopefully also allow her natural contractions to move the baby down the birth canal of their own accord. These options were presented in an effort to help the baby progress and avoid a cesarean. This was a difficult decision for us. We wanted to have an unmedicated birth and the exhaustion of having no sleep and lots of hard work made it rather difficult to think clearly. It was an emotional time and everyone, our nurse included, had a bit of a cry as we processed the options. After some short discussion with Dan and Deborah, Megan chose to have an epidural without Pitocin.
After watching a video about epidurals and their associated risks and benefits, the anesthesiologist arrived with another doctor whom he was training to administer epidurals. The training involved the anesthesiologist explaining the how and why of the whole epidural procedure and precautions he was taking in administering it. In Megan’s wariness about epidurals, hearing this was reassuring for her. Later, the nurse told us that this anesthesiologist is known for being extremely good at giving epidurals. Megan remembered the story her mother told her about the epidural she had when she delivered Megan and how with the epidural her mother could not feel anything from the torso down and so found it very difficult to push. Her mother went on to choose unmedicated hospital births when she delivered Megan’s younger sister and brother. Megan was pleasantly surprised, therefore, to find that her epidural left her with only tingly legs. She had enough feeling to know when she was contracting and even still had some discomfort from the contractions. Megan also felt very shaky at this time, which the doctor explained was probably the adrenaline that is common after long labor and often after birth. Megan and Dan and Deborah tried to nap at this time, but Megan still had enough discomfort that she mostly just rested. She was so encouraged to be able to feel that the baby’s head now seemed to be moving down the birth canal with each contraction.
After two hours of Megan resting with the epidural, our doctor returned and an exam revealed that the baby had moved far enough down to where she could see the baby’s head! The doctor confirmed that the baby was in occiput posterior position and that this was the logical reason for the difficulty with the descent of the baby. Our doctor also noticed that the baby had passed some meconium in utero. With the doctor’s coaching, Megan then pushed in the reclined position. It was now mid-afternoon. During this pushing and most of the prior pushing, Megan wore an external fetal monitor. The baby’s heart rate remained steady until this last period of pushing, when it began to dip during a push and then recover between contractions. Our doctor watched the heart rate monitor carefully and became concerned when the baby’s heart beat eventually became much slower to come back up to speed after a contraction was over. The baby was very close to being born at this point. The doctor explained that she would need to use a vacuum to pull out the baby if her heart rate showed much slowing again. She asked for the hospital’s on-call obstetrician to assist her, as well as something like six or eight nurses to stand by in case of complications. Although Megan had planned that her birth attendants would be few, having the extra people in the room felt a little like a welcoming party and we were glad that we were well prepared if something were to go wrong. Two contractions later, the doctor did use the vacuum, which means that the baby came out with some force, and while very uncomfortable for Megan, it was of course a relief to have the baby out. Dan was still able to clamp the cord, though we were unable to wait until it stopped pulsing. The cord needed to be cut more quickly than planned so that our doctor and the nurses could assess the baby as it seemed she had been through some distress during the long labor, in particular with the dip in her heart rate and her passed meconium. Megan remembers looking over to see four nurses cleaning up the baby while the doctor sutured a second-degree tear, likely a result of the vacuum assistance. One nurse propped up a very robust-appearing 41 1/7-week baby for Megan to see across the room. We were pleased that she scored well on her Apgar test and also nursed very easily a few minutes after birth, despite the difficulties of the birth and epidural. Deborah took many pictures for us in the delivery room.
We named her Hannah Elizabeth. We like that Hannah comes from the Hebrew word for grace. Both Dan’s and Megan’s sisters’ middle names are Elizabeth.
We would like to thank Rachel Supercinski and the Bradley method for an education that enabled us to labor and birth with a great deal more confidence and coping ability than we would otherwise have had. Rachel has been so kind in being available to answer our questions, even after Hannah’s birth. We really appreciate that our obstetrician took considerable time in answering our questions at each prenatal appointment, and was there for our long labor with Hannah and cared for her and us with skill and courage. Thank you to Deborah Streahle for encouraging Megan through many hours of labor. Thank you to Hannah for putting up with our lack of experience as first-time parents. And we are so thankful to God for overseeing the details of her birth and by his grace allowing us to care for this little girl.