What You Should Know About Shoulder Dystocia

Photo courtesy of stockxchng

This is something that my doctor loved to threaten me with when I was carrying Lilly. It was ridiculous because 1. my daughter was perfectly normal sized and 2. I had no intention of birthing on my back, which is the primary cause of problems, and my doctor knew this and had agreed to it. She was just angry that I wouldn't consent to an unnecessary induction for her convenience.

What is Shoulder Dystocia? It's a very rare and serious complication in which baby's shoulders get stuck that affects babies of all sizes, though it occurs slightly more frequently in babies that are over 9lbs. It's still rare, however, and not something that you should spend time worrying about. There is no way to accurately predict it ahead of time and any provider talking about it is likely looking for the bigger paycheck that comes with a cesarean birth (the difference? vaginal birth: $10K, cesarean birth: $25K and a VBAC costs more than a regular vaginal birth, thus, it's always in an OBs best financial interest to go for a cesarean--though it's NOT in mom's OR baby's, as mom is 5.5 times more likely to die and baby is 3 times more likely to die and complications of less serious natures are far more frequent as well).

So, doctors love to say, "Your baby is too big," (usually based on faulty ultrasound data, despite the fact that ultrasounds can be wrong by 2lbs or even more and become useless in determining size after week 20). The reason is usually shoulder dystocia. Many techniques have been used over the years, including just killing the baby, though the most success has been found in the easiest technique to date--the Gaskin Maneuver. The Gaskin Maneuver consists of having mom roll onto all fours (or assisting if necessary). During the process, many babies become dislodged and pop right out. If this doesn't happen, then the doctor actually has better access to help wiggle the baby around until the shoulder releases and the rest of baby is born (Woods or Rubin maneuver).

Most obstetricians don't even know that this maneuver exists, though most midwives are trained in it. In one study, it was shown to be effective in 83% of use without any further maneuvers. No maternal or perinatal mortality occurred. Morbidity was noted in only four deliveries: a single case of postpartum hemorrhage that did not require transfusion (maternal morbidity, 1.2%), one infant with a fractured humerus and three with low APGAR scores (neonatal morbidity, 4.9%).

Many doctors use traction (pulling on baby's head) or fundal pressure (where the nurse climbs on the bed and jumps down onto your stomach) before anything else and these are not only the least effective techniques, but dangerous to mother and baby.

The McRoberts maneuver (where mom's legs are brought up as far back toward her stomach as possible, which realigns the pubic bone and can slip baby's shoulder out) should be tried first and if failing, suprapubic pressure (where the doctor or nurse makes a fist and pushes hard on the baby's shoulder just above the pubic bone) can be applied. Next, the Gaskin maneuver should be performed and if that fails, then Woods and Rubin maneuvers can be tried.

McRoberts is effective in 39.5% of cases and in 58% with the addition of the suprapubic pressure. These methods can cause serious injury to the mother (McRoberts can injure mom's legs, particularly the femur and hips), but are typically safe to the baby. Woods does not have an available statistic for effectiveness and can break the baby's humerus. The Rubin maneuver is the opposite of Woods and requires less traction and causes significantly less injury.

Australia is currently training doctors in fracture of the clavicle, which has been dismissed until now as so dangerous to the baby and difficult to perform that it should not be used. However, it is used in some cases and can be lifesaving for baby. It's a severe emergency procedure that should not be attempted until all others have failed.

The Gaskin maneuver is most criticized due to it requiring the mother to be able to roll over and support herself on her hands and knees--something that is difficult, if not impossible, to do with a normal epidural. That's the only criticism, however, that is keeping it from being more widely studied and implemented.

The evidence from the literature on shoulder dystocia shows clearly that shoulder dystocia cannot be predicted with any degree of accuracy and it cannot be prevented by any specific strategies or maneuvers. Half of the babies in the Gaskin study were not larger than average and many were in the 5lb range. The worst outcomes did occur in the 'macrosomic' (larger than 10lbs) category. However, 'macrosmia' is not a sole cause nor does it always lead to shoulder dystocia. In fact, over 90% of macrosomic babies can be delivered vaginally without incident.

Perhaps in those "birth plan creators" that are available all over the internet that include sections on emergency births, preferences on maneuvers should be included in the event of shoulder dystocia. It's unlikely that doctors would be open to this, however, despite evidence of effectiveness and safety of the procedure, simply because they have no experience with it.

The best thing you can do as a pregnant woman is to be educated and if your doctor brings up the issue, discuss it with him/her. Eve if they don't, it might be useful to know their typical management of shoulder dystocia in case of emergency and their willingness to attempt maneuvers with less risk to mother and baby, even if unconventional, before the more dangerous, riskier maneuvers. It's also important to stay calm and follow your care provider's direction if the complication does arise.

Maneuver illustrations:

Traction:



McRoberts:


suprapubic pressure:


Woods Screw Maneuver:


Rubin Maneuver:

Gaskin Maneuver:

Naomi's Birth Story

Waiting. Pregnancy includes a lot of waiting, especially if it's planned. Waiting for ovulation, waiting for a positive home test, waiting for doctor confirmation; and when you're pregnant after having lost a baby, waiting to find out if the pregnancy is viable and waiting for your loss week or weeks to pass so you can breathe easier. Then, waiting for each trimester to change, symptoms to come and go, to find out the gender if you plan to and of course, for the baby.

So it's perhaps fitting that the beginning of the end of the waiting game for me began in a waiting room. On Tuesday, I had my 39 week appointment and I was really hoping for it to be my last. The doctor was in surgery, so we were waiting quite a while, chatting with other waiting patients and sitting in the chairs, I started contracting a lot.

I didn't time them, but I knew they were frequent. They were also uncomfortable and I kept wanting to turn around in the chair and kneel on the floor so I could rest my upper body in it, but I knew that would alarm the other patients, so I just dealt with it as they got more intense. I closed my eyes and breathed.

When the doctor came into the exam room, I was taking advantage of the exam table to do just what I wanted with the chair and he wanted to check me. I declined, saying "If you check me, I won't be in labor and that would just be very frustrating." We also explained that we'd left the labor stuff at home anyway, so we'd be back if this was it and if it wasn't, then hopefully it would be soon. He reminded us to call, since he had babies coming at both hospitals he delivered at.




Those contractions would continue to build for seven and a half hours before petering out, much to my disappointment. My husband still took that day off work and we got things ready to go, because if it wasn't soon, I was at least due on Friday, so things should just be ready by then, at least. I also did laundry and some shopping, staying active and trying to keep the contractions going and get labor on the move. So I was pretty tired when they stopped and went to bed early.

I woke up on New Year's Eve the next morning at 9:30-ish and realized it was contractions that woke me up. When I decided they weren't going to go away, I went out to the living room to watch a movie and ignore them to see if they went away. They were too hard to ignore, so eventually, I started writing down times since I could see a clock. A pattern was obvious--every two minutes a new one started. Sometimes it was three and a few times it was five minutes. I got bored with writing down times after about two hours, especially when the cable stopped working so I couldn't watch my movie anymore.

I wandered around the house and told my husband that he should still go to work, to make up for some of the time he'd lost, even if this was it (which I was fairly certain it was). I got to finish my movie and then went in to take a nap since I was tired from all the contracting and waking up early. I forced down some soup first, but food and water were not something I was processing well, so I didn't push it.

Lilly let me nap until the contractions woke me up in pain. I started doing my visualizations and distraction techniques for a while and even tried to read. But the intensity was getting harder to do anything through, so I gave up on the book and got up to do stuff around the house until I realized that nothing was going to get done but a bunch of labor dancing and that was getting too painful to do, even, so I drew a bath.

The water was the relief I'd hoped for, but not as long as I'd hoped. It was all I could do not to call my husband until his lunch break. I debated on the phone on whether he should come home or not--I was having a hard time concentrating at all. Finally, I said I was tired of doing this alone and wanted him home at least for his lunch break to give me a break from Lilly and some support.

By the time he got home, I couldn't visualize anything anymore, I couldn't just breathe through the contractions and it was all I could do to remember to keep my sounds deep and low to be productive. I was sure that it was time, I could feel the baby low in my pelvis and the contractions were so strong they were intolerable. My mind was desperately seeing relief options, so we were pretty sure I was in transition--it certainly sounded like it and I felt like I did when I was ready to push out Lilly.

So my husband called in to work and we set out to go to the hospital. We took our time getting ready, making sure everything was dealt with around the house, but I was getting desperate for relief and the thought of being in the car like I was, when I couldn't take a contraction quietly anymore, was very unpleasant. Somehow, I managed to stay quiet on the ride through most of the contractions, but I felt like I was going to pass out from the pain.

Once at the hospital, it was time for my first check. I no longer planned to avoid all checks because I needed to know that all of this had amounted to something. It seemed to take them forever to get to checking me and I was in a lot of pain. The check, however, was not what I wanted to hear.

"You're at a three and about sixty percent." I started crying and felt on the edge of hysteria. My mind was so jumbled and thick that I couldn't focus on anything and each contraction felt like it was taking me by surprise, I had no relief between them and I was mentally begging them to stop. They were saying they needed to watch to see if I was really in labor and then my water broke.

"My water broke, my water broke," I said, feeling very happy about that. "You can't take it back, I'm in labor, it's not stopping now!" Of course, with my water breaking, the contractions became even more intense. My husband laughed that I'd managed not to get the house or the van with my water, again. We checked the water and I asked if it was clear--it wasn't. Sludge, again.

It wasn't as bad as Lilly's at first, but it got worse and worse with each gush. I was surprising the nurses with how much was in there. I'd tell them that the water was coming and they'd smile and look and never expected how much had come out. I told them a few times that it was the same with my last labor, too--more water than I could possibly have ever held.

I was doing okay here and there, but things were so bad I asked for an epidural because I couldn't keep going. They said I had to have a bag of fluid in me first, especially since I hadn't been eating or drinking all day and it took two nurses to start an IV because I was so dehydrated they couldn't get access to any veins. The first stick was terrible and totally fruitless. The next was painful, but successful. They also had to take blood (which they did with the second try) to make sure that I was healthy enough for the epidural that I both wanted and unknowingly at the time, needed.

The nurses kept trying to get me to get up and move around, but when I tried, I felt so sick I just wanted to lie down and so I did, knowing that it was the worst thing I could do. When I was up, I did dance around and do what I knew worked best, but I couldn't stand it for more than a few minutes at a time, then I wanted back in bed. I had been in painful labor for nine or ten hours after the five hours of easier labor in the morning, and I just wanted to be done.

The pain of the contractions were hurting both me and the baby, as she was going into distress and after a couple hours they brought me Nubain to take the edge off until I was approved for the epidural and the anesthesiologist could come. I asked if it would help and the nurse said that, at the least, I'd be calmer and back in control of the pain, so I readily agreed. Anything that would make me stop feeling insane.

The nice thing about IV meds is that you know how you're affected instantly. I was dizzy and the stuff smelled funny (I always smell IV stuff--I'd known the second they started the antibiotics that I decided to go with since I was accepting so many other interventions anyway--and they weren't giving me the same thing I'd had in my last labor--by the smell) and then this calm came over me that was priceless.

The next contractions, I was able to visualize, chant and sing at the baby. They hurt, a lot, but the pain was controllable again. I felt so much better that I even went to sleep. Unfortunately, I woke up when the Nubain wore off and was back where I'd been before.

The second check had shown me at a two to three (I'd lost progress?), the third at a four. Each check found me making progress at least, but it was slow. Finally, I was approved for the epidural I'd never thought I'd want and the anesthesiologist came in after the nurses prepped me for being still through all of the process. While the contractions continued to be hard and painful, I was still in better control than I had been earlier and I concentrated on singing through them. I found that "Oh I wish I was a fishie in the sea" was just the right length, with two verses, to get me through them. Everyone thought it was funny and the laughter was a relief with the tension all the pain had put me through.

The nurses kept telling me how great I was doing and encouraging me and were surprised to find out that I'd wanted no pain meds previously. I explained that my last labor had been nothing like this. Of course, Lilly had only been posterior--this baby's head was transverse and moving around, hurting me far more than Lilly ever could, since she never descended into my pelvis this far. Everything felt far away, though, and slightly foggy--more like I was watching than participating, much as it had been through my labor for hours now. I felt like someone else was in control of my body before and after the Nubain and I didn't recognize myself at all, which upset me even more.

Finally, there was burning in my spine and I knew that I only had to feel fifteen to twenty-five minutes more of these awful contractions and it made getting through them a lot easier.

The doctor came in a little later, after I'd had some rest and felt better and told me to labor on my side (which I did--I was even able to roll myself there as the epidural had left me still in enough control of my legs to move myself around and I could now feel baby moving instead of the pain of contractions, which was much improved) and then was gone.

My next check I was told that I was progressing and the head was transverse. The nurse said my position was good and helped me get my legs in the most productive position to move baby down. As baby moved lower, I rolled more and kept adjusting myself to keep her from backing into my ribs again (which drove me nuts with both my labors) and the nurse told me that I was looking great each time she saw me. It really helped keep my spirits up, since I felt bad about wanting the epidural in the first place and really didn't want to mess things up worse.

It was the middle of the night, so I was trying to help Lilly get to sleep and get some of my own when the nurse asked me why I wasn't just nursing her. I said I was worried about the drugs I'd had and she said it was fine, just get that baby in bed and let her nurse and snuggle to sleep. So I did and she came back later after Lilly had fallen asleep and said that the nursing had really improved my contractions and we talked about cosleeping--she apparently coslept with her kids, too, and just how great it was.



With Lilly next to me, I fell asleep easily and woke up for the nurse to come in and say that my contractions were spacing out more and more and the doctor wanted pitocin started. I asked if he was concerned about the increased risk with it and if he did it often and then just told her to go with it when she tried to explain--I'd decided before that I'd do what it took to have a vaginal birth, even with added risk like pitocin, if necessary. Besides, I had the epidural and I knew how pitocin affected my contractions from my last birth. My husband was asleep through all of this, as was Lilly.

I fell asleep thinking about the intervention domino effect and hoping I wasn't going to pay for it. My eye was only on the prize--my VBAC. I slept until they checked me and I was a seven to eight. I lied awake, bored and wanting someone to talk to until the contractions got really close together again and I started moaning a little because I was getting overwhelmed with the urge to go to the bathroom. I knew what the urge meant and I let my body do what it wanted with it and pushed a bit.

My husband woke up and said my name questioningly and I told him that the baby would be there soon and asked him to get me some ice water and take my popsicle stick from the orange popsicle that I'd been given when I complained about being hungry at my last check (first time I'd been hungry in over 24 hours). I caught him up on what he'd missed and had him move Lilly to the guest couch-bed so I could roll over even more.

I felt bad about him only getting five hours of sleep, but since I'd only had three, I didn't feel too bad. I wasn't tired at all, though and kept joking about how bad I needed to go to the bathroom. The nurse came in to check me because my contractions were happening every one to two minutes and she said my cervix was gone.

She started breaking down the bed and told me to roll over and I told her I didn't want to be in the stirrups and that I couldn't, because of the symphysis pubis dysfunction. She ignored me and pestered me into them anyway. Annoyed, I at least got the bed into a chair position so I didn't have to do sit-ups to push.

I felt the baby's head turn and it was slightly painful, but a fascinating sensation to me, since she was in my pelvis--somewhere Lilly had never made it to. She was wriggling down my bones between contractions, when I would be pushing with all my strength, to my relief. I had previously not wanted to 'purple push', but it felt so good to do it, unlike with Lilly, that I didn't mind. I didn't even mind the position as it felt easier to push than it had when I was on my side.

I asked if my pushing was doing anything and the nurse brightly encouraged me and started giving me progress reports about how close the head was getting, how baby had moved down past a zero, etc. I asked if it was close enough for me to feel the head and she said that it wasn't yet.

I kept pushing, still worried that it would end just like with Lilly, even though it was already much further than I'd ever got with her and everyone was encouraging me, telling me that I was doing great--the opposite of what I was told with Lilly. Then the nurse told me to reach down and I felt my baby's head for the first time--the first person to touch her without any barrier. It was amazing, soft and hot and alive and I made a bunch of comments that were too sappy and ecstatic.

Baby was almost here and the doctor, true to himself, was late. I don't think he realized how fast I was going to go with that last little boost and the nurse told me to just relax and stop pushing, let my body do the work. It was interesting feeling my body pushing on its own and the baby coming down even more and wiggling painfully. I told them my birth plan--what could be salvaged still, that is, and they told me hospital policy. I said that all I wanted was to do as much as I could without interfering with baby's health (the meconium sludge meant that baby's hair was green) and explained that I'd missed the first hour of Lilly's life and how important it was to me to participate in this birth and be the first one to hold my baby, etc.

They relayed all this information to the doctor when he came in (finally--the head was almost out) and he started to repeat them and I quickly just explained that I understood all that and reiterated my reasons and that I just wanted to do whatever could be done on me and asked him to help me to catch her, so that I was the one pulling her onto me.

My husband, who had been so wary of the thought of all the blood and that associated with childbirth (he doesn't do well with blood) with Lilly, watched and even reached out and touched his baby's head, with fascination and enjoyment. He was clearly amazed, especially when he realized that baby was moving herself down as well.

The doctor told me that he would ask me to stop pushing once the head was out so he could start getting the meconium out and that's how it happened. I heard him say it was a nuchal cord, so I rested while she was suctioned to get the meconium out of her mouth and the cord was removed and listened to my husband going on about how much hair she had.

Then the body was just sliding out of me, no pushing at all and the doctor told me to do my part and kept her out so that I was grabbing her torso and pulling her, bottom first, to me. So I was the first one to see that we'd had a little girl and I announced it to the room.



I touched her cord and blubbered on in joy and babbled about how I'd done it, I'd had a baby, I'd pushed her out, etc. I was so amazed. They clamped her cord and I reminded my husband that he wanted to cut and he said that it was okay if he couldn't (worried he was in the way) and the doctor handed him the scissors and told him where. He cut her loose and went with her over to the warmer where they worked to clean off all the meconium so we could see what color she actually was, weigh her, et cetera. During this, the cell phone rang, playing "Big Bang Theory" by Barenaked Ladies to the room--so Naomi came in with a big bang.

I watched them and reminded my husband to take more pictures while the placenta slipped out and the doctor showed it to me, told me which side was which and then he checked my scar, which was thin but fine and then started doing damage control. When baby was turning around so much in me, she tore my cervix and, as I expected with my body and all the pushing, I'd torn my perineum as well, third degree. The doctor debated calling it between second and third the whole time he was stitching it up (unfortunately, my epidural chose then to start wearing it off and I got to feel five or six of the stitches entirely).



While I was being stitched up, my husband brought our little girl back to me. I didn't mind handing her back after a couple minutes because I wanted to rest and relax. He looked up from holding her and asked me, "How about Naomi for a first name?" I looked at her and agreed, she looked like a Naomi. It was one of the middle names we'd been tossing around, having been debating on a girl name for months.

Lilly slept through the whole thing, eliciting comments about how she could sleep through anything (which is quite true) and was surprised and fascinated when she woke up and found that the baby I'd kept telling her was coming was actually there. She seems to like being a big sister (although not sharing her stuff--she's been quite irked with that).



So, at thirty-nine weeks and six days, my waiting was over. I had my VBAC successfully and I met my little girl, Naomi Sara, at 8:19 a.m. on New Year's Day, 2009. She weighed in at eight pounds and seven-point-seven ounces and was twenty-one inches tall. She was basically the same weight as her sister, but over an inch taller and with a visibly smaller head (but she wears preemie clothes). It was the single most amazing experience of my life. It had a rough start, it wasn't my ideal labor, but the birth--nothing can ever compare to feeling a life passing into this world from my body and knowing that I brought her here.

It was worth the wait to meet her. Welcome to the world, Naomi.



This version is graphic This version is not

Lilly's Birth Story

So, here's my (graphic and long) birth story for my first baby, Lilly. It was written about a month after I gave birth and this is the version with names removed (some of my feelings have changed since then, such as knowing that the cesarean was iatrogenic, most are the same) and Lil's pronouns corrected:



At 5:30 am on Saturday morning, October 14, 2006, I woke up after two hours of restless sleep. Contractions had pulled me into consciousness and I tried in vain to roll over and get back to sleep for a half hour before their intensity and frequency caused me to start moaning in frustration. I was sure that they were false labor contractions, yet again, or perhaps just revenge from the Mexican dinner I had the night before. I curled up onto my hands and knees for a little while, then got up to whine around the house because I was tired of looking over at the clock ever four minutes to time them. It was actually the first time I'd actively timed my contractions from the onset.

I sat on my labor ball and went online to whine some more and express my frustration and fears until I couldn't think through the pain anymore and went back to bed. My whimpering and moaning woke hubby up at about 10 am and I asked him to run me a bath. When it was ready, I happily sunk in up to my chest and marveled at how the pain vanished. Before, I was sore between every contraction that I had no relief from the pain; it was constant and intense. Now, though, the pain was not only manageable, but I was able to relax and feel good between contractions.

Things were continuing so well that hubby was getting things ready to go to the hospital and calling people to say that we were pretty certain I was actually in labor this time. I, meanwhile, moved around in the tub from a sitting position, doing butterfly exercises in the water, to lying on my tummy and floating and to an all-fours position. I got out to pee every fifteen minutes or so, but quickly hopped back in because it felt so good to be in the water.

While I labored in the tub, hubby made me food and called my doula and a few other people to let them know that I was in labor and this time, it seemed to be certainly the real thing.

At 11:15, my water broke. I felt a relieving pop and warm fluid rushing into the cooling bath water and knew what it was instantly, although I simply enjoyed the feeling for a moment, as it was wonderful. Then I looked down.

"S**t," I cursed upon seeing the yellow and green stream pouring out. I could see clearly that my water was full of meconium. "That's s**t," I said redundantly and loud enough to get hubby's attention. He quickly came and I asked him to empty the water since I needed to get out, but was in the middle of another contraction, so I couldn't safely stand, but didn't want to float in the dirty water.

I stood up and turned on the shower to clean up and the moment I turned it off, the same amount of fluid poured out of me again. So I called to hubby to get me a poise diaper and turned the shower back on. I slipped when my water poured out again as I tried to step out of the tub, but caught myself and didn't fall. I had managed to avoid getting any amniotic fluid on myself this time and quickly got into the poise before more could rush out and turned the shower on the tub to rinse it out. Hubby, upon my request, had been calling Labor and Delivery to tell them we were coming in.

Now I knew that this labor was real, I was excited and tried to go over every small detail before we left. We fed and watered all the animals and gave the kitties a can of wet food as a treat as well. I put two of the open-cage-door parrots in their cages and latched them, feeling bad about how long they would have to be in there, but satisfied that they would be safe and gave them extra toys. I had to keep going back to the bathroom to change the poise pads as what felt like gallons of water emptied from my womb.

We finally got out the door and piled everything in the van and went to the hospital, a fairly uneventful drive during which I called several people who had asked to be called when I went into labor--the ones that hubby hadn't called already, that is. It was a comforting distraction through the intense contractions.

We arrived and checked in and were set up in a room, where I changed into a hospital gown, happy to have not ruined my clothing or stained anything with the mess I could have been making everywhere. We met our nurse and then my doula arrived as I was being monitored to see how baby was doing. We went over a few things that would have to change from my birth plan due to the meconium, such as the fact that I would need to be constantly monitored. However, the pleasant surprise was that constant monitoring no longer meant being stuck in bed.

I did spend quite a bit of time in bed, as it was easiest for the monitoring and being on my back allowed me to feel the baby moving down a little. They brought in a labor ball, but I didn't get to spend much time on it as it interfered with the heartbeat monitor; which was really too bad since I felt myself making progress when I was on the ball (and it irritated me when everyone tried to adjust the monitor to hear, so I just abandoned the ball).

I was at four centimeters when I was first checked and five during the next. It made it look very promising to be a quick birth. I realized I was staying the bed too much and decided to try dancing/swaying, so I got out Deftones' White Pony CD and my discman and started to enjoy it quite a bit. During Feiticiera, the first song, I tried to use my (attempted) soft singing to move things along during contractions. I was really into the dancing and singing by Digital Bath--a song that has always felt like a birth song to me and was the first dance at our wedding--when the nurse came in so frequently (as they were changing shifts and introducing me to my new nurse--who said "Hi, my name is [] and I've had six natural births and been a Bradley Instructor for 12 years.") that I had to stop too many times and sadly, gave up trying to listen to music.

Much of the next few hours were spent with routine exams, contracting and breathing or moaning through them with my doula gently leading me through the breaths and encouraging me. I had a habit of forgetting to breathe or getting so relaxed that when the next contraction would come, I'd start to panic, but my doula was there, breathing next to me and it would pass in seconds. I had many visitors, which I enjoyed throughout the whole day. My mom snuck me in a cheeseburger and I ate some Jell-O I hid and brought with me. The food kept my strength up, since I started with so little sleep.

During this time, though, hours passed with each dilation check being the same: five centimeters. Finally, it was time to talk about pitocin. My contractions had slowed and seemed to no longer be effective (they weren't even really painful anymore, even). They hooked me up and my contractions came back. While not more intense than the earlier ones, they were more frequent, like they were in the morning, so into the jacuzzi I went.

The water once again helped with the pain, but I had to roll so my belly was out enough that the monitor wasn't under, as all it could hear was water. The nurse tried two different mediums to get the monitor to pick up under water, but no luck. I stayed in until it was time for another check and was still at five cm.

During this time, I had been having trouble with my fluid drip stopping. I'd had two doses of penicillin and was okay with them, although the second was a little achy. Well, while I was laboring in the bed after the check, I had a whopper of a contraction, thanks to the pitocin.

From my perspective, what happened is that I was doing okay in the beginning, but breathing wasn't doing it, so I moved into moaning. But the pain just seemed to keep going on and increasing and eventually, it tore a scream out of me, I couldn't handle it. Then the nurse was putting an oxygen mask on me, saying the baby needed oxygen and everyone was telling me to breathe. The nurse was also saying they had shut off the pitocin. I was a little confused, but thankful that the pain had stopped and wondered when the baby had been checked. Hubby made a joke about my Darth Vader mask and I joked back.

What I didn't know and was told a couple days later was that there was three to four minutes between the scream and the mask. Hubby said that my eyes rolled back in my head and I went limp and stopped breathing. The baby's heart rate started dropping, then they lost them on the monitor entirely. They finally turned off the pitocin and I came to. I have no memory of it at all. But I scared everyone and no one told me, since I didn't need more to worry about.

I guess what had happened was the my fluid drip stopped dripping and the pitocin had been increased a few times before it did, so I was delivered raw pitocin and my body didn't like it. So once they figured that out, the pitocin went back on at half the dosage. I tolerated it just fine, my contractions were just more frequent and while there were still a few that I couldn't just breathe through, it was all manageable.

I had visitors all day and it really helped me get through the day--it seemed to fly by and I probably spent more time in bed than I should have, but I started out depleted and didn't really get better, except for a few hours after I ate.



The nurse came and talked to me about how things might have to change if I still hadn't progressed and then she did the check. Eight centimeters. I cried with relief--all those contractions WEREN'T for nothing. A little while later, my equipment malfunctioned again and the penicillin that was supposed to take about 30 minutes to empty into me emptied in 8 minutes. The pain was so intense it totally stopped my contractions and left me with the strong desire to rip my arm off and beat the IV stand with it. They kept telling me to calm down, but I was in so much pain that I couldn't. It was hands down the worst pain of the entire labor, pushing phase included. When the bag emptied, the pain stopped. Again, no one bothered to tell me that there was a malfunction; they just let me think I was a wimp. My mom yelled at the nurse when I was yelling about the pain and she was unsympathetic. I wonder if she cared later when she found out I wasn't reacting to a normal dose.

I don't remember a lot from there, just that a short while later, things started to change. The contractions became harder and I threw up (Jell-O--it was actually very easy to handle, although I still yelled about it--I REALLY hate vomiting) and when I was checked again, I was at ten centimeters and fully effaced. I was told I could start pushing as soon as I felt the urge to bear down.

She said it was important to push now because the baby was still so high up and of course, the clock was ticking since I was 15 hours from when my water broke (only 18 hours was allowed for GBS+ mothers--stupid and defeatist). So at the first urge, I started trying to push.

It wasn't long before things felt wrong, though. I felt my body fighting me and every time I tried to push, the baby didn't get lower and the pain became immeasurable. I couldn't keep up the entire ten count that the nurse tried to get me to push for--I even tried to say that wasn't how I wanted to push, but things were very confused and I couldn't really form complex thoughts.

I moved from position to position--squatting worked the best, but I didn't have the strength to maintain it. At this point, I had been going on two hours of sleep and a couple five to fifteen minute naps for over twenty hours. I was exhausted, in tremendous pain, trying my hardest to push while my body fought me and kept telling me to stop, but the nurse kept telling me to go and everyone was saying I could do it.

After an hour, I knew they were wrong. My body was telling me, over and over, that I needed to stop. Something was wrong and I knew I couldn't get my baby out the way they went in. But all I could communicate was the physical--"I'm tired" "It hurts" and finally, "I can't do this." My support misunderstood and tried to cheer me on, but I really felt like I couldn't go on and I was getting scared because the feeling that something was Wrong was growing until it was all I could hear from my body anymore. Another nurse even came in and tried to help me, encouraging me to get back into the squatting position and moving around, but it was finally too much. I was flashing from moment to moment, having difficulty focusing on anything and all I could think of was the need to sleep and the need to get the baby OUT.

I want to note here that if it weren't for my doula, my husband and even the nurse, I couldn't have made it through feeling as good as I did. As bad as things got, they kept me going and believing in myself until my body told me "good job, but this has to stop."

Finally, to express how serious I was, I got in the bed, lied down and just gave up and cried until they understood that I didn't mean it was just the pain and exhaustion. I was reminded that the alternative was a cesarean and in my head, I was answering with "Yes, I know, I NEED HELP," but I couldn't get it out. A nurse offered an epidural quietly and I wanted to say yes, but the words wouldn't come out. The things I WAS saying were awful, but I wasn't in my right mind by any means (why no one recognized this as transition is beyond me). After I had made the decision to have the cesarean, I was depressed and terrified and didn't care about anything. I was panicked and hated myself.

The worst feeling I had was that I let everyone else down, that I'd wasted their time. I felt like a failure and that everyone was just going to either be disappointed in me or say, "I told you so." But at the same time, I was thinking of my baby and that I wanted them to come out while they were still doing so well inside me and be healthy.

Now that I had nothing to distract me but my own feelings of guilt and failure, I was screaming through the contractions, barely conscious of anything around me until one nurse grabbed my face and told me to be quiet because I was scaring the other patients. I told her I didn't f***ing care. Then it was a blur until they were taking me into a room and telling me that my husband couldn't go in with me, so I started yelling at them. They ignored me (except to tell me to be quiet again) and yelled at me to get up on the table and sit still.

All I wanted was my husband's hand to hold while they shoved a needle into my spine, but at least I was "allowed" to have him stand in the doorway. They were worried about him making the anesthesiologist 'nervous.' Why the hell should I care and why should he be nervous if he's doing his job right? No one seemed to give a damn about me anymore, which reinforced my feelings that everyone was angry that I'd wasted their time and now they just wanted me out of there. This was the worst part of the whole ordeal.

They gave me a spiel about how I needed to be very still, even if I was contracting. So of course, my body started contracting HARD, when I had finally been in a lull. I had three contractions (and the first real urge to push) while the needles went into my spine and I held onto the nurse in front of me, desperately trying not to move. My whole body was shaking and I heard the anesthesiologist cuss and I thought he was mad at me (turns out, he was cussing about a piece of equipment breaking) then I felt what seemed like warm water all over my back and I was told I needed to lie down. I was barely able to understand them and then everything started rapidly going numb and I laid back.

Everything started to clear then. The pain, the confusion, the psychosis. I could think and finally relax. I was wheeled into the operating room and moved to the table. I saw the straps on the arm board and quickly reminded them that I'd stated no restraints in my birth plan and they responded that I needed to keep my arms on the boards then. Fine, I'm so phobic of being trapped that I had no problem complying.

They put up the blue screen, the doctors came in and I was tested to see if I could feel anything--I could feel something, but not pain. A minute later, I asked if he had started and he said he'd started 30 seconds ago. I asked a lot of questions, made jokes and enjoyed listening to the doctor hum as he worked. I kept reminding hubby to keep the camera primed (it has a delay I didn't want interfering with good shots) and asked a lot of questions which the doctor answered. Then, about five minutes after asking if he'd started, he warned me that there would be a strange sensation like someone sitting on my chest.

Indeed there was, but the feeling of something being pulled out of my tummy--which is what was happening, followed it. It was the oddest sensation of my life, but then nothing mattered because I heard the baby cry. It was the softest little voice, so deep and quiet and I started crying. It was my baby. Hubby was snapping pictures over the screen. Then, without warning, their head appeared above me and I looked into their eyes briefly as a drop of blood fell on my face, then they were whisked away and I shooed hubby off to follow them. I lied there and listened to them cry as I cried my eyes out. At 3:56 am, October 15th, 2006, my child, Lilly Rose, was born by cesarean birth.

(pictures: birth emergence WTF just happened?)

That was my baby. They came from inside me. They were real and really there. Even now I can't think back on it without crying, the emotions were so strong and powerful, which is so rare for me--I have a delayed response to everything. Not this. For once in my life, I felt at the moment something happened, not later.

Everything after that was just relief. They were safe and healthy. I heard the doctor say, "That's a big baby." And they were talking about their head being too big to fit. But they were also complimenting them and then they were being held out to me. Again, I was filled with that overwhelming mix of feelings--all positive--and just marveled at how soft their skin was. I wanted to take them, but didn't feel strong enough to ask. They were rooting already and time was frozen for a few moments and I got to touch them much longer than I thought they would leave them with me before they said it was time for them to go get their tests.



I told hubby it was okay for him to go with to the nursery and after he grinned lovingly at me for a few moments, my "Go, go!" got him to scoot off after them. I wanted one of us there for all of their first moments of life outside of me and I was okay with the two doctors working on me. One of them I personally liked and the other, the one who was doing all the work I had two positive opinions on and had found that I liked him upon meeting him earlier in the day. Now that I wasn't nuts anymore, the nurses were treating me completely differently--maybe they understood that I wasn't myself earlier and that I was just panicked.

I asked if I'd be able to try for a VBAC next time while the doctor was stitching me up and he said it shouldn't be a problem. I asked a nurse for Lilly's weight and length and she said that they were 8lbs, 7oz and 19 inches long. I asked after their APGARs and she said 9 and 9. I was later told that they just had purple hands and feet (which are still their cold spots).

It was about twenty minutes of stitching and stapling and then a few minutes of other tests and they were ready to send me to my room. They told me that they were going to roll me and it would feel like I was going to fall but not to panic or move because I wouldn't. Then they tilted me and it felt like I was stiff as a board and not like I would fall as they put a blue board thing under me, then moved me into another bed and wheeled me to my post-partum room, where my doula was waiting for me.

After a little while, Lilly was brought to me and after the third try latched on and sucked like a hoover! To me, they're perfect--more than I ever dared to hope for and the best thing I've ever done in my life. I love them so much I can't find the words. Recovery was hell, but every time I saw them, it was such a tiny price to pay.

There are always maybes--maybe if I'd waited an hour to push, I'd have been ready and could have done it. Or maybe if I'd waited, I'd have been too tired to do the pushing I DID manage. Maybe if I'd done all this at home it would have taken longer, but ended in a vaginal birth. Or maybe I never would have progressed without the pitocin. Maybe if I'd got up and moved around more things would have been different. Or maybe it would have worn me out faster. Maybe they would have come out if I'd been induced two weeks earlier. Or maybe things would have ended the same, only with me traumatized by the cesarean because I had too many interventions.

I don't care about the maybes, or at least, I'm trying not to. What matters is that I did 22 1/2 hours of natural labor and pushed for an hour and a half of it. I let them come on their own time and didn't end up induced. I decided when it was time for a cesarean and thought no one pressured me into it. Sure, I'm not happy being part of that too high cesarean rate in this country, but I'd have been even unhappier if something had happened to Lilly because I didn't listen to my body/instincts. They came out and blew their tests out of the water, outperforming most babies, vaginal or otherwise. I believe very strongly that it was the time I gave them inside and the time I spent laboring and trying to get them out that gave them such a good strong start in life.

All in all, I'm satisfied that I did my best and they did their best and we are here together now and they're so amazing that I still can't believe it. I love my little Lilly.




(Having had my VBAC, I now know that my body needed to progress past a 10 with Lilly and I was 'encouraged' to push too soon, which lead to the cesarean. Yes, maybe they really were too big in their hard skull--at 3 years old, it's almost the same size as mine--but I don't really think so)

(This has been further edited to fix Lilly's pronouns, as they were assigned the wrong gender at birth)