40 weeks

This post has been rather a while coming now! As you may have guessed, I've been busy having a baby, so I haven't had much time to write. There has been so much going on, so much I want to talk about, that it's been a mission simply writing notes for myself. To keep things from getting too out of control, I'm going to break things down a bit. So let's start as I arrived at the hospital...

40 Weeks

It's a truly strange feeling to be going into hospital knowing that you won't be leaving without having given birth to the child you've been carrying for the past nine months. It's one of those things that the movies always depict as a messy and spontaneous event. Sometimes though, there is somewhat more planning and scheduling involved. I was admitted to hospital at 40 weeks exactly to be induced. After the previous weeks attempt, we knew that I was unlikely to have a reaction to the hormone they were using, so after a quick internal examination, Dr D put some prostins gel on my cervix, to help it prepare for baby's departure. The head was nicely down and my cervix was looking better after another week waiting, though it was still long. This kid was being served an eviction notice!

After the gel was inserted, I was kept on the CTG (cardiotocograph) to monitor bubs heartbeat, to insure he/she didn't get too stressed as well as any contractions I might be having. It didn't take them long to start at all. By the time this all happened, it was about 3pm, with a progress report scheduled for 9pm, when more gel would be inserted if it was needed. Baby was doing well and I was having contractions about ten minutes apart, strong enough that I could feel some of them, but really not causing me any sort of discomfort.

The dinner the hospital gave me really wasn't looking that appealing, so Tim headed down the road and got us some burgers for tea. Turns out that wasn't such a great idea. I'd read so many times about only eating small light meals in early labour, but it didn't actually occur to me that what I was in was early labour. Not until after I went to get ready for bed and threw said burger up again.
At my nine o'clock check, I was given another internal exam and found to be 3cm dilated already! This was great progress! My cervix had shortened up to only 1/2 cm long (previously 4-5cm) as well, so things were looking good. So good that instead of inserting more gel, the doctor did a stretch and sweep instead. This is where they use a finger to separate the membrane from the cervix, reportedly somewhat uncomfortable. I'd believe that, because even though I couldn't feel it, I could feel my stomach and legs spasming as they do when they really don't like something. By this stage I was up to 2-3 contractions over a ten minute period and ready to have my waters broken in the morning, if they hadn't already done so by themselves.

By 10.30 pm my contractions were close and regular enough that I was moved to the labour ward so we were ready for things to get started. I was put back on the CTG for half an hour and had a catheter and canular put in, ready for labour.  
Not long after this I had someone from the anaesthetics team come talk to me about an epidural. My thoughts on an epidural were similar to my thoughts on a caesarean section. If I need one, fine, but give me a chance to try this myself first. The anaesthetist spoke to me about the option of putting in an epidural and setting it up so it was ready, but without actually hooking it up. I was happy with this compromise, but once she had spoken with her boss, they decided that actually, that was pointless. I was told I didn't need to make a decision just yet and since Tim had finally fallen asleep and I didn't want to wake him, (or make that decision alone) I decided to wait until they next checked my progress at 1.

40 weeks + 1 day

At 1am I was given another internal examination and was still 3cm dilated, with my cervix shortened right up. My vital statistics, otherwise known as ob's were being taken hourly, so I really wasn't getting much rest. There was another internal exam at 6am then I was left to get a bit of sleep before we started. I was offered a shower but with so little sleep and a canular in my hand that was just way too much work!

At 9am, Dr D was back to check my progress and get things started. She had been kept updated on my progress throughout the night, even though she was off duty. She broke my waters, using an instrument that closely resembles a crochet hook. Again, I couldn't really feel anything, just a pressure and that discomfort that I get when my stomach muscles protest. By this stage I was losing track of the number of times someone had stuck their hand up my vagina. Maybe 6? They do tell you to check your dignity in at the door....

When you go into labour, your body naturally produces a hormone called oxytocin, which causes the contractions of the uterus and basically pushes the baby most of the way out, until you get to the active stage of labour at the end where you push. Since I hadn't gone into labour spontaneously, I had to be given syntocin, an artificial version of oxytocin. I was started on a dose of 12ml an hour, going up 12ml at a time each hour. They do this gradually so they can get the dose right for each individual and to give you a chance to keep up with the progression, so neither mother nor baby end up too stressed.
Speaking with Dr D, she was happy for me to try without the epidural and see how I went. I was being constantly monitored anyway and we had the anaesthetics team on standby if things started to get out of hand. She was also regularly checking up on me throughout the day.

I had another visit from anaesthetics, this time from the head of the department. I'm not sure if he didn't hear me or just didn't think I was funny when I promised him I wouldn't go walking off if they gave me a walking epidural. This is a low dose epidural that allows you to still walk around during labour, but the walking part isn't an option at my hospital, due to a staff shortage. Walking epidurals require constant supervision due to the increased falls risk. Since I couldn't feel if the epidural was in the right place by the usual measure (loss of sensation and pain), we would have to use other methods to see if it was working. The two main signs would be a drop in my blood pressure and my legs should be very warm to touch as they became hyper vascular. He also assured me that it shouldn't slow down my labour or impair my ability to push. He was very keen to get this started to prevent me from getting any dysreflexia, but I wasn't ready to go ahead with it yet.

Over the next couple of hours I was gradually given a higher dose of syntocin, as well as fluids to make sure I didn't get dehydrated. I was having semi-regular contractions, strong enough that I could feel them, but not really more than occasionally uncomfortable. Certainly not painful in any way.

I sent Tim off to grab a quick lunch with his mum. Just after he left, Dr D stopped in again. By this stage my blood pressure had been slowly rising for a couple of hours. It was still well within normal range, but getting on the high side for me. I had also had the occasional twinges of sharp pain in my head, which I get when my blood pressure rises, a symptom of dysreflexia. Both these things led me to ask Dr D how she felt we were going and if she thought we needed to go ahead with the epidural. Her thoughts were that we would need to be considering it soon. That was enough for me, and I gave her the go ahead to organise it.

Once I said yes, things happened very quickly. One of the anaesthetists came up and talked me through exactly what he was going to do and got me to sit up on the side of the bed. One of the midwives stood in front of me to help brace me and make sure I stayed in the right position to allow the epidural to go straight in. I'd been in a hospital gown since the night before, but they need that out of the way as well to do the epidural, so I was sitting there basically naked in front of several people I'd never met before. Who am I kidding, I was naked! You have to kind of hunch over, so they can get the needle between the vertebrae. Tim wasn't gone very long, but he only arrived back just in time. I was really glad he made it, because I got very nervous just before they went to put it in. And scared. I was pretty sure I was doing the right thing, but I really had no way of knowing. I'd let Tim know I'd given them the go ahead to do the epidural, but in the end I'd made that decision without him and I really wanted to talk to him. I hadn't wanted to have the epidural in the first place, even though I knew it would probably be necessary, so I really didn't want to do it alone.
It turned out to be pretty quick and easy in the end and was done before I knew it. They then had to flush it and run a test through it, before they set it up for the long haul. Safe to say he got it in the right place. My blood pressure dropped right down, below my normal levels within minutes. This meant they then had to pump me with fluids to bring it back up. This was another reason I'd been reluctant to have one too early, as I knew the epidural would lower my already low blood pressure. I'm not sure if it was the epidural itself, the fluids or just the emotional toll of it all but I got cold afterwards and had the shakes up a bit. My contractions had been starting to get quite regular up to this point but had slowed down again. So much for the epidural not affecting my progress. At least we didn't have to worry about dysreflexia anymore.

By midafternoon my contractions were getting better again with the gradual increase of syntocin. I wasn't regular enough to be in what they called established labour, but I was making progress. There had been lots of clear amniotic fluid leaking out everywhere and we had had to change the bedding several times already. The fact that it was clear was a very good sign, meaning there was no sign of bleeding or infection. I'd had the risk of bub passing meconium (the first poop) while still in utero in the back of my mind for months, so I was glad to see that wasn't the case. Baby was still being very happy and active. I was trying to get a video of my belly moving, so I could send it to my sister in the Northern Territory, but I couldn't get my timing right. Tim was smashing through the levels of angry birds on the ipad.

A bit later on, the head anaesthetist came by again to check up on me. He didn't really have much to say. I sent Tim off to meet up with our neighbours and get out of the hospital for a bit while he still had a chance.

Around 5, Dr D came by to do an internal exam. They usually do one after 4 hours of established labour, but since I was close to that, she checked me anyway. I'd progressed to 4-5cm dilated. We made a plan for her to come back at 9pm, by which time I would hopefully be most of the way there. The syntocin was still being gradually increased to help strengthen my contractions. This time when Dr D examined me, I hadn't had any twitches in my feet or stomach spasms, showing the epidural was doing its job.

I spent the next couple of hours sitting up in bed, instead of lying down. It felt good to be in a different position for a bit. Tim ended up staying out for tea with the others before he came back.

Dr D came by at nine for our next check. I knew when she didn't say anything as she was going that something wasn't quite right. I was still only 4-5cm dilated and baby was presenting posterior. It wouldn't have mattered who it was on that bed, in this position, with a baby this big, a vaginal delivery wasn't an option.

Dr D told me that we could leave it for a bit if I wanted, but that with the position the baby was in, I wouldn't dilate any further, since the baby wouldn't be pushing on my cervix. As well as that, the contractions would only be putting pressure on the baby’s head, which would eventually cause the baby to get stressed. She left us alone for a couple of minutes to decide what we wanted to do, but there was never really any option. By this stage I'd been having contractions for 30 hours, I'd had next to no sleep overnight and I'd just found out that despite all our best efforts, I wasn't getting the birth I wanted. I cried. Dr D came in and we gave her the go ahead. Since neither baby nor I were in any danger, we had a bit of time to get things organised.

The next half hour or so was a flurry of people coming and going. They got a hover mat onto the bed underneath me, to make it easier when they needed to transfer me. The syntocin was turned off to slow down my contractions, since they were no longer needed. People came and went. Dr D came in and explained what was going to happen once we got moving. I was still monitored regularly. I continued to cry. Just tears rolling down my face as everything happened around me. I was so utterly disappointed. I knew it wasn't my fault, it wasn't anyone’s fault, but that didn't change how I felt. I managed to calm down enough to call my mum, only to start again as soon as she asked how I was going. Tim was coming with me to surgery, but I wanted Mum there when I came out. Tim and I passed the time trying to come up with baby names. Nothing like leaving things to the last minute.

It was about 11.30 by the time we got to the theatre. I remember lying there thinking how different this was to the last time I was going in for surgery, when the guy pushing my bed had asked if I knew what type of theatre I was going to, I was that jovial. This time I was quiet, just holding it together. I managed a smile for Tim when we stopped to take a photo of each other, me in bed, him in his scrubs. 

Tim ready to go!

They put some SCUDS on my legs, a kind of massaging pressure stocking, a far cry from the teds I got when I broke my back.

SCUDS, to keep the blood flowing through my legs properly

I cannot overstate how much of a difference it made for me, having built up such a great relationship with Dr D. She had listened to me (and Tim, which we both felt was really important) and supported me throughout everything I had asked for and left me in no doubt that she would both try her best to accommodate my wishes, without letting me put myself in danger. She had already gone above and beyond and going into theatre knowing she would be doing the surgery herself, when she could just as well have finished her shift and gone home to her own kids, made the world of difference to me. It stopped something that was really scary from being terrifying and downright traumatic. I trusted her judgement completely. Having both her and Tim there, and knowing Mum was waiting, were the things that kept me from completely falling apart; Although I’m not sure the nursing staff thought I hadn’t already, judging by the number of times they asked me if I was ok. I guess having your patient lying there in a constant flow of tears isn’t the most uplifting sight.

Now I’m sorry, but I’m going to leave you all with a cliff hanger here. I promise I’m already working on the next bit, but if I keep going now, this is going to get out of control. So give me a few days and all will be revealed!