When I was just past the 36 week mark, I saw my doctor for my final prenatal appointment.
Of course, I didn't know at the time that it was going to be the last one!
As has been par for the course in this pregnancy, I had an ultrasound first. Well, technically I had a biophysical profile, since it was followed up with a nonstress test. I wasn't expecting that, but as with so many things this pregnancy, I didn't question the necessity. I was high risk and in my final month, after all; if my doctor thought a nonstress test was needed, then I was just going to go with it. Besides, I'd already spent so many hours on the fetal monitors that twenty more minutes didn't even faze me.
Unfortunately, this particular ultrasound was not reassuring. Despite the fact that it'd been only about two weeks since my baby's last blood transfusion--a big one, and which we were hoping would indeed be the last intrauterine transfusion--baby's MCA reading (the measurement of how fast the blood was flowing in one of the arteries in the brain, which can be an marker for fetal anemia) was showing high. Not dangerously high, but much higher than my doctor wanted to see, especially so soon after a transfusion.
We did the rest of my appointment, and my doctor asked me to come back again on Friday for a follow-up ultrasound. We had already scheduled an induction for a few weeks away, aiming to get baby out around the 38/39 week mark (which is when they estimated another transfusion would be necessary), but my doctor warned me that the high MCA reading meant we'd be moving the induction forward by at least a week. Depending on how the ultrasound looked on Friday, we might need to induce that very day.
This obviously was not what any of us wanted, but I know how bad anemia can be for a baby, so I readily agreed. We'd hope for the best on Friday, and plan for induction the following week. I told my husband and he told his job, and we all planned as best we could.
I then asked my doctor if we could sweep my membranes at my next regular appointment. In case you've never heard the term before, a membrane sweep involves a doctor (or midwife) doing a cervical exam, and then if conditions look favorable (meaning, a certain amount of dilation has already occurred and the cervix is already somewhat effaced), gently lifting the amniotic sac away from the cervix. If the body is close to being ready to go into labor, this can sometimes kick things into gear. At the very least, we were hoping to encourage my body to keep making the hormones that would continue to thin my cervix out so that induction would be more likely to be successful.
My doctor agreed that it sounded like a good idea. "I can sweep them today if you want," she offered. And so she did.
Neither of us expected it to actually work, though!
The sweep itself didn't hurt at all, which I was a bit worried about. It was uncomfortable, sure; cervical exams always are. But it didn't hurt. Before I left her office, my doctor warned me that I might experience some spotting, and that some crampy feelings were normal after a sweep. So I didn't think anything of it when I did indeed find a bit of bloody discharge, or when I noticed cramps during my middle-of-the-night bathroom runs. It felt like menstrual cramps, exactly what I was expecting based on what I'd read.
The cramps did get a little worse as the night progressed, but they were nowhere close to bad. Certainly not anything I couldn't sleep through. They didn't feel like labor contractions. It was just the sweep, that's all.
Sometime the next morning, they did start feeling a bit more like contractions. Similar to my first birth, I at first assumed that I was finally feeling the Braxton Hicks contractions. After all, I had been having them for weeks. Regularly. They had caused problems leading up to the last cordocentesis and transfusion, after all; they'd been so regular that the doctors had put me on magnesium sulfate to try to slow them down (but to no avail). So surely that's all these contractions were. I was finally starting to feel them.
...Or maybe it was early labor?
A few hours later, I lost part of my mucous plug. It was at that point that I started to take things seriously.
My contractions started to get a little more uncomfortable. Still nothing I couldn't function through. I took my older child to swim class, where I found myself swaying my hips through the contractions. I was still able to drive, but sitting still was getting a bit uncomfortable.
I downloaded a contraction timer app to my phone. Bug and I went home to have lunch, and the contractions were getting worse. When I finally started timing them, I found they were coming every 4-6 minutes, and were about 30 seconds long.
The husband and I scrapped our plans for doing some baby gear shopping at Target. We went out for an early dinner of Thai food (spicy!), but my appetite was already starting to fade, and I ate barely any. I debated calling labor & delivery for advice, but my contractions were getting longer and stronger. I opted instead to just head straight to the hospital.
The drive to the hospital sucked. There was traffic, and instead of 20 minutes we were in the car for at least 45. I couldn't lean back in my seat. But sitting up straight and leaning forward (as much as one can lean forward with a big belly, anyway) were uncomfortable, too. I kept timing the contractions, and they continued at about the same pace, although they were 45-60 seconds long at this point. Every time one hit, I did my best to wiggle as I could, trying to work through them, but that's hard when you're strapped into a car! I found myself thinking fondly of my son's birth, which took place at home. Why would anyone choose to drive to the hospital while already in labor?!? I knew the nature of my pregnancy meant that a hospital was the best place for me and baby--whom we had been calling Coconut--but I couldn't help but be a little wistful for the idea of another home birth.
When we got to the hospital, I was checked in and shown to a room. I changed from my pants into a loose sarong; no hospital gown for me! They put me on the monitors and I waited for someone to come check my progress. I had put into my birth plan that I wanted to minimize cervical checks, but I was okay with a few of them (emphasizing that consent was required!). When the doctor finally came in, I was a bit disappointed to find I was only at a 5. I had already been at 3 the day before, when the membrane sweep occurred. And I'd been having contractions for hours already! The rational, birth-obsessed part of my brain tried to counsel me about the dangers of putting too much stock in exams--your cervix is not a crystal ball, after all, and just because the progress seemed slow didn't necessarily mean that I'd be in labor for days. Those contractions were working, and they were likely helping baby get into a good position and doing other things not readily apparent by the surface numbers. I was definitely in active labor; no doubt about that! Never mind the numbers!
And then further bad news: Coconut was technically coming prematurely (by four whole days), and so the doctors wanted me on the monitors continuously. My room had a nice, deep tub for laboring in, but clearly I wouldn't be using it. I was stuck with bouncing on the yoga ball, moving my hips, and being massaged by the soothing hands of my husband and doula for pain relief.
The nurse put in a heplock, and it was a sign of how far I'd already drifted into the haze of labor that I barely even cried. It took two tries, and I cried a bit for the first attempt and barely even flinched for the second. (For the record, getting an IV always makes me cry.) I just kept doing my thing.
Time passed. I bounced on the ball, tried a few different positions for labor. I couldn't move far because they didn't have wireless monitors, but I ended up ultimately finding my place on the bed, kneeling and leaning against the raised backrest. Husband and doula massaged my lower back as I moaned and swayed through contractions. Husband also fed me ice chips and offered coconut water. I had actually brought snacks to the hospital, intending to eat despite their silly, outdated nil per os rule, but I wasn't hungry at all by that point. I could barely drink and suck on the ice.
As time passed, I started to get exhausted. It was evening, past dinner. I hadn't eaten since lunchtime, and I had no interest in eating. My husband tried in vain to get our son to fall asleep. (Did I mention that he was there? Bug was super interested in being present at the birth, so we ultimately decided to bring him with us!) I continued working through contractions. Time became rather hazy.
The contractions were hard, and I was feeling discouraged. I was starting to feel flushed, but then I was also feeling cold at times, too. (Transition, anyone? The rational part of my brain recognized it, but I didn't say anything aloud because I didn't want to get anyone's hopes up, least of all my own.) I was in pain, and I was so very tired. I started to doubt myself. The contractions seemed nonstop. I couldn't get any real rest in between them, and my limited range of motion made it feel like I wasn't coping well.
I asked for pain meds.
Not an epidural, but something short-acting, just something to take the edge off so I could rest a bit. I wasn't sure I'd have enough energy for pushing if I didn't get some rest.
...And the nurses told me no.
When the nurse came in, it was apparently pretty clear to her that I was past the point of medication. She offered instead to check me, so we could see how far I was.
No one was more surprised than me to hear that I was at a 10!! I was given "permission" to push whenever I wanted. I realized I was feeling a little pushy, but not much, nothing like I remembered with my son's labor/birth. I tried bearing down a bit, but I was just so tired, and it's even harder to push when your body isn't helping you out.
So instead, I opted for an intervention: I gave the nurse the okay to break my water. I had been hoping to let that happen on its own. With my Bug, my water didn't break until literally a split second before I pushed him out. I was secretly hoping that this baby might be born in the caul, since Bug had been so close. But it was not to be. I wanted this baby out, and I wanted him/her out now! Under the circumstances, breaking my waters seemed a small price to pay.
According to my husband, the nurse soon returned with a rather scary-looking tool. I have since described a standard amnio hook to him, and apparently the tool they used at my hospital was not that. Regardless, they broke my water, and I soon felt a gush all over the backs of my legs and feet (I was still kneeling on the bed).
The difference was immediate.
With one of the next contractions, I felt an intense urge to push. And by urge, I mean my body started pushing, and there was absolutely nothing I could do to stop it at that point. My husband says that you could see the difference in the contractions, in how my belly looked once that urge to push set in. I sat up as straight as I could on my knees and pushed! I groaned as I pushed, trying to keep my noises deep and my jaw open and loose.
I pushed for another contraction or two. Apparently, I was making rapid progress, because the nurse asked me if I could try to slow it down a little. I don't remember my exact words, but my response was a resounding no! I guess no one expected baby to come quite so quickly after my waters were broken, and most of my birth "team" (on-call OB, more nurses, NICU pediatricians, etc.) was not yet in the room.
Since there's obviously no way to stop a baby once it's coming, the nurse apparently yanked the "call the nurse" remote out of the wall, which sets off alarms in various parts of the hospital. I was lost in my labor haze, so I didn't notice as the room flooded with people. Another push, and baby's head was out. I immediately felt a sense of relief, but I wasn't done yet. One more strong push, and baby was earthside!
It was 10:28 P.M. No wonder I was so tired!
I fell against the bed in relief, so glad to be done. I don't know who caught him, but my husband got to see him before me, and he quietly announced to me that we had another son! My firstborn, apparently, was standing by, completely enthralled with the process. Someone milked the cord, getting my potentially anemic baby as much of his blood as they could in a short period of time. The cord was cut, and the NICU pediatricians gave him a quick once-over before giving the okay for me to hold him. (Because of my high risk pregnancy, my Rh sensitization, they wanted to make sure he was not visibly anemic or in shock.) Someone helped me to sit down normally, to lean back, and I got to hold my precious new boy in my arms.
Everything was still very hazy at that point. I know I held him for about thirty minutes before someone told me I needed to try to birth the placenta. I think the pediatricians took my Coconut again for a few minutes while the nurses helped me into a squat. A few pushes brought the placenta out, and then I reclined again and greedily reached for my boy.
I gave the okay for someone to give me a small infusion of Pitocin at that point, to ward off any potential excess bleeding. I nursed my littlest boy while my husband and bigger (but still little) boy crowded around.
Other immediate postpartum stuff happened, but I can't remember what all that was or in what order it occurred.. Placenta was examined, and I received the okay to take it home with me (or, rather, to send it home with my husband). My bottom area was examined; I had one small tear, but it was very much a surface tear, not even bleeding. I opted not to suture it. I switched my baby to my other breast and nursed some more. I ultimately allowed the vitamin K shot, even though I had been planning to decline in favor of drops. Coconut Baby got his Apgar score: 9/9. Bug started showing random things to the baby and trying to explain what they were; he was taking his role as big brother seriously right from the start! My doula took a few pictures, and eventually, quietly, bowed out. D bagged up the placenta and put it on ice. I kept nursing, cuddling, absolutely amazed at this new little person I had brought into the world.
Coconut Baby was 6 lbs., 6 oz. He had a full head of hair and the tiniest hands and feet.
After an hour or so, the NICU pediatricians unfortunately had to take my baby away. He wasn't in immediate danger from my anti-Rh antibodies, but he did need to have some lab work done, along with frequent monitoring, and his temperature was a little low despite being skin-to-skin with mommy.
The room slowly cleared out. D took Bug home (it was after midnight by this point), Coconut was in the NICU, and the nurses cleaned me up a bit and arranged to move me to a recovery room. My arms were painfully empty, and the birth haze had lifted enough to remind me just how exhausted I was. Still, I was wired, and I sent out some text messages and called the moms to announce the good news.
It had been a hard birth, much harder than I remember Bug's birth being. But I did it, and despite the circumstances--being stuck in a hospital, tethered to the fetal monitors, high risk pregnancy turned late preterm birth--the birth was pretty much everything I could have hoped for. Very few interventions, and those that did occur were with my full consent. Natural, medication-free vaginal birth. Almost immediate skin-to-skin, and nursing in the delivery room.
Beautiful, perfect baby. My rainbow after two losses and a high-risk pregnancy. Bliss.