Welcome WZW!

Little Willie has now been upgraded to WZW, his actual initials.  He was born on Saturday, September 5 and weighed in at 7 lbs. 5 oz. (3320 grams).  So much for the “borderline growth restriction.”

My husband and I are so happy to have a healthy baby, and grateful that everything went well with the delivery.  In my line of work, most of the times are happy, but I’ve also seen such horrific outcomes such as stillbirths and maternal complications (including rarely death), so I don’t take any of this for granted.  We were a little superstitious and didn’t call our little guy by his actual first name until he arrived, and told very few people what his first name was going to be.

I had the best labor and delivery I could have hoped for, but even then it was tough!  Let me back up, though, and discuss some of my preparation going into the delivery.

One of my husband’s coworkers had given me a package of raspberry leaf tea that she had leftover from her pregnancy.  She said her doctor had recommended it to her.  I was a little surprised, since I myself am hesitant to overtly recommend things to my patients that aren’t evidence-based (even if I may do them myself).  A quick Medline search came up with one double-blind, randomized, placebo-controlled trial from a midwifery journal.  In that study, they used the tablet form rather than the drinking tea.  They found a shortening of the 2nd stage of labor (full dilation to delivery), but no difference in the first stage of labor (active labor to full dilation) which is what the herb is supposedly known to do.  There were no adverse effects for mother or baby.  Another study I found showed potential benefits, and no harm as well.  I figured the risk of harm was low, so I went ahead and drank the tea daily during the last month of my pregnancy.

I have mentioned before that following everything in the Gentle Birth Method book is nearly impossible, but there are some great tips that I did get from the book.  One is the perineal stretching which my husband and I did daily at the end of the pregnancy to try to prevent perineal lacerations during the delivery.

The book also recommends visualizations for the late pregnancy- imagining your cervix getting softer, thinning out, etc.  There is also a detailed script to help visualize how things would go during the day of delivery- the initial contractions feeling similar to Braxton-Hicks contractions, the real contractions visualized as pushing on the baby’s bottom, and causing the cervix to thin out and dilate.  The script goes into way more detail about visualizing everything that is happening with the uterus, pelvis and vagina as one is in labor.  It goes all the way through the delivery, including holding baby skin-to-skin and delivery of the placenta.  I did read through it, and found it helpful as a guide going into labor.

I woke up the morning of the delivery with a small gush of bloody fluid as I got up out of bed at 7:40.  I thankfully had a full night’s rest, which had been unusual during my late pregnancy.  It was more liquid than I’d expect for just bloody show, which is usually mucous.  But it wasn’t a ton of fluid, so I wasn’t quite sure if I’d ruptured my membranes.  I didn’t want to go in too early, for one if I hadn’t really ruptured.  Also, if I didn’t start to have contractions on my own, there’d be the tendency to start Pitocin (oxytocin) to induce contractions.  We do that because if the membranes are ruptured for many hours before delivery, there is a higher risk of infection (chorioamnionitis) since the barrier between the outside world and the contents of the uterus has been broken.

I figured it’d be easier to wait and see if I’d get more contractions on my own, or if I got more leakage of fluid to suggest I’d broken my water.  After a few hours, I’d had a couple more gushes that again were small, but more liquid than I’d expect for just bloody show.  I was having mild contractions every 10-15 minutes, but that was it.  I decided it would probably be best to get checked for rupture of membranes, so I called Labor & Delivery and they confirmed I should come in.

No joke- I’d told my husband that the Peet’s Mayan Mocha was back in season, so since I was still comfortable he wanted to stop by and pick one up.  While in downtown, we also picked up some food, since I knew they’d limit my food once I was on L&D.  So I had a samosa on the drive in.  I was still having mild contractions at 11 am when we were getting food.

By the time I arrived on L&D, it was probably 11:30 am.  At my hospital, midwives manage uncomplicated patients, and the doctors manage patients who have medical complications, are preterm, need an instrumented delivery (vacuum or forceps), need a C-section, etc.  Since I was uncomplicated, I’d always envisioned having a midwife manage my labor and deliver me if all went well.

The midwife checked for rupture of membranes by confirming the appearance of what we call ferning on a microscope slide of the fluid.  Since I wasn’t having consistent contractions yet, she deferred checking my cervix since we don’t want to increase risks of infection.  Around 12:30 pm as I was getting ready to be admitted was when I felt my first really painful contraction.  After that, the contractions started to really pick up.  They starting coming more regularly, every few minutes.  Interestingly to me, I didn’t feel them throughout my uterus like I’d imagined.  The pain was low, like menstrual cramps except WAY worse.

The Gentle Birth Method book recommends training in self-hypnosis during the pregnancy in preparation for labor.  I certainly wasn’t able to manage that.  Apparently some women are able to get themselves into a more pain-tolerant state, where they can imagine their contractions like crashing ocean waves.

As for me, my contractions were still painful as %*#$!  I had to just dig deep and breathe as best through my contractions as I could.  I did try to think about my cervix thinning and opening with my contractions.  In between contractions, I continued to breathe, and tried to relax as best as I could.  Even between contractions, I could feel pain of my pubic symphysis (pubic bone) area, so I wasn’t getting 100% relief from pain.  I basically had my eyes closed the majority of the time.

In the beginning, I tried walking, and tried different positions to see if they’d help.  In the end, I just sat up on my bed somewhat cross-legged.  I guess in hindsight it was sort of a meditative position for me.  I’ve seen some women hold their partner’s hand and squeeze hard with contractions, but for me I didn’t want to be touched.  So I pretty much was sitting there, eyes closed and my poor husband had to look on and watch me in pain.  He was great at being supportive as best as he could given the situation.

As it approached 3 pm, after 2 hours of these true labor pains, I asked to have the midwife check my cervix.  I didn’t think I could last much longer, and was open to getting an epidural.  Although I didn’t necessarily want an epidural ASAP, I’d always been open to getting one.  Well, when the midwife checked me, she said, “You’re not going to believe this- you’re rim.”  What she meant was that my cervix was almost fully dilated except for a little rim of cervix that was still left.  It was the equivalent of being 9.5 cm dilated (which is how she’d document numerically in my chart).  She said it was soft and easily reducible (meaning could be pushed back), so it would probably be gone shortly.

At that point, I decided to soldier on without an epidural.  My midwife suggested that I sit on the toilet, as that position can help relax my pelvis further and be a better position at this stage than sitting in bed.  She said as I developed the urge to push, then I’d return to the bed for pushing.  I wasn’t sure what to expect in terms of how that urge to push would feel.  Many times, women report an urge as if they want to have a bowel movement as the baby’s head fills the pelvis and they are ready to push.  But I’d felt some rectal pressure for quite some time.

Well, what I found was that as I transitioned into the second stage of labor (full cervical dilation to delivery), I would inadvertently start pushing a little with the contractions.  My midwife suggested that I could feel the baby’s head myself as I was on the toilet.  It’s weird after checking so many patients’ exams to now do my own.  I felt my baby’s wrinkly head (from the molding in the birth canal), which descended in the time I was on the toilet early on to when I started feeling the urges to push.

At that point, I went back to my bed.  Starting about 4:30 pm, I began to officially push.  I had read previously that side-lying can help prevent perineal lacerations, so I went with that position.  More importantly in that moment, it helped to be able to relax as best as I could between contractions in that position.

I’d always instructed patients to push like they’re constipated, since it’s the same muscles, and they feel rectal pressure from the baby’s head occupying that space.  So I figured that pushing would be a controlled, voluntary effort.  That is probably the case when one has an epidural.  What I found interesting is that when I started pushing voluntarily with a contraction, then it was like my body would take over and intensify it automatically.  My midwife described it like when you’re vomiting- the stomach contracts to expel its contents.  In a similar way, my uterine contractions were intensifying my pushing without my full control.  I could feel it, and also was getting feedback from my husband and nurses as they could see the head moving more.

At 5:15 pm, after 45 minutes of pushing, WZW delivered!  Luckily, his tracing had remained reassuring and there were no concerns, so we were able to put him immediately on me for skin-to-skin contact.  Given my emotions during my pregnancy (I cried watching The Little Mermaid), I thought I’d get emotional after the delivery.  Instead, I was just so relieved to have the contractions finally be over.

My midwife told me I had a small 2nd degree laceration.  Did the perineal stretching exercises help?  Who knows?  But I’m glad it wasn’t worse.  Based on my mother’s recollection, they might have cut an episiotomy when I delivered, and it sounds like it might have been a 3rd or 4th degree laceration because they wanted her to have a bowel movement before she went home.  And I weighed one ounce less than WZW did.  I always thought it must be really painful to have the laceration repair without an epidural based on how my patients flinch as I’m performing it.  But for me, the whole area just felt raw so it didn’t feel bad as my midwife injected the local anesthetic for the repair.

WZW was able to stay skin-to-skin on me and breastfeed early.  It was weird for me and my husband to finally meet him, and see what he looked like.  This little creature who had inhabited my uterus for so long was finally his own little person.

We feel very fortunate that everything went smoothly.  I still can’t quite believe how everything went so amazingly well with my labor and delivery.  I mean, I’d certainly hoped for it, but I knew from experience that on L&D, things rarely go as hoped.  I was able to manage no pain meds for a short labor, but I don’t know how women do it for many more hours.  Ultimately, no matter how things go, the goal is a healthy baby and mom, so hopefully women aren’t disappointed if their labors and deliveries don’t always go as anticipated.