Tuesday, July 26, 2011

The Empowering C-Section Birth of Ian Gray: A Homebirth Transfer

I had been planning a homebirth that wouldn't be at my home in Sioux Falls, but just across the state line where my certified professional midwife can practice legally. My water first broke on a Wednesday morning, but contractions didn't start right away. We had a prenatal visit scheduled that evening, so we called the CPM and said if nothing much happened, we'd see her then.

I had some contractions, but nothing strong or regular. After our appointment, we stayed overnight at the birth house, returning home Thursday afternoon once contractions had died down. Late Thursday evening a stronger more consistent labor pattern sent us back. I labored through the night, but everything petered out again in the morning.

Friday afternoon it appeared as though I'd gone through transition. Looking back, I didn't really feel like it, but after the horrible Pitocin-augmented labor I’d experienced with my daughter, Rosi, I wasn't sure what to expect from natural second-stage contractions.

After several hours, I wasn't feeling an urge to push, so the midwife asked to do a cervical check. I was only dilated about 4 cm and the baby was up at -5 station. I didn't even know the scale went so high!

In the time since my water initially broke, particularly during the cervical check, I hadn't been leaking any fluid. Our CPM indicated that she suspected just the chorion (outer bag) had ruptured, not the amnion (inner bag). When my contractions died down again Friday evening, we went home to rest in our own bed—and let our midwife do the same.

On Saturday, about dinnertime, I started leaking quite a bit of fluid tinged with blood. We called the CPM and headed back over to the birth house. She checked the color of the fluid and said it looked okay, but if the blood got darker or more abundant, it could indicate a problem. Shortly thereafter, I had a big gush of dark red blood. We made arrangements to transfer to the local hospital.

Our back-up doctor came on her night off to check me. My BP was registering 170/95, so they started an IV of magnesium sulfate to help bring it down. Mag sulfate is commonly used to stall preterm labor and it completely stopped my contractions.

They did a quick ultrasound to check for previa or an abruption, but the tech said the placenta looked fine and it wasn’t near the cervix. The doctor recommended transferring to a nearby hospital with a better NICU and more specialists, should we need them.

Back in Sioux Falls, the on-call OB recommended starting a Pitocin drip to counteract the effects of the mag. I agreed it was probably the best choice at that point. They started the drip very slowly and, following a newly adopted low-dose protocol, only increased it 1-2 mu/min every half hour. Contractions picked back up, but unfortunately, they weren't moving the baby down or dilating my cervix further. The OB asked for a second ultrasound to estimate baby's weight and do an anatomy scan. They estimated the weight at 9 lbs and found no anatomical problems.

After about 14 hours on Pit, I had reached the recommended maximum 20 mu/min, but there was still no change in dilation or station. The OB suggested it was time to start thinking about a surgical birth. I’d been having similar thoughts. The pain wasn't terrible—maybe an 8 out of 10 compared with my level 12 Pitocin-enhanced contractions during Rosi's birth—but I was getting really tired. I hadn't eaten in about 24 hours or slept, beyond drowsing between contractions, in more than 30.

I asked for an epidural as a last-ditch effort to preserve a vaginal birth, just in case the pain was actually interfering with my labor’s progressing. I didn't think that was the problem, but I needed to try everything before I could consent to a c-section. Ironically, although it was nice to have the a break from the pain, I hated the epidural. I disliked feeling out of control and the sense of being stuck in bed.

Two hours and another 4 mu/min of Pitocin later, there was still no change to my cervix or baby's descent. I told the OB to get the surgical consent.

The c-section itself wasn't as scary as I'd imagined. My arms were unrestrained and I watched his birth on a monitor mounted above me. Adam was there until they took our son to the nursery for monitoring. Babies born by c-section are at higher risk for breathing problems and one of the side effects of mag sulfate is depressed respiration, so they were very cautious.

The OB mentioned afterwards that my uterus had been filled with blood clots. There had been a partial abruption, despite no evidence on either ultrasound. Weeks later I realized if we'd kept trying to up the Pit and force a vaginal birth, we very well could have lost him. Thankfully, my son was born at a healthy 8 lbs 5 oz and 19¾ inches long.

Though not at all the experience I was looking to have, it still felt like an empowering birth. I have no questions that mine was a necessary c-section. I wasn’t pressured into anything. The health care professionals offered advice and answered questions, but I always understood decisions were up to Adam and me.

I had been praying that I’d have the homebirth I so desired. I craved a respectful labor and birth. In the end, I didn't get what I prayed for, but I got what I really wanted.

By Amy James Gray


Amy @ Experience Imagination said...

Thanks for giving me the chance to share my story again!

Anonymous said...

Congrats.. and thank for sharing that although things don't go as planned in the end the one thing that matters is a healthy mom and a healthy baby!