Evelyn’s birth didn’t start how I had imagined… I’d always thought I’d go into labor, spend early labor at home, then make the drive across LA (hopefully avoiding traffic) and arrive at the hospital to complete active labor, transition and delivery. Instead, at two weeks past our estimated due date, we had a scheduled induction. It was strange knowing exactly when labor was going to start. The element of surprise was gone but at that point it was a relief to know that there was an end in sight. The induction was scheduled for 10pm. Our small group arrived at our house around 7pm to pray with us before the big event. I was feeling nervous because induced labor contractions are more intense than natural contractions… medical science hasn’t quite managed to perfectly duplicate the necessary hormones. More intense contractions are harder for Mom and can cause fetal distress, increasing the likelihood of interventions and c-sections. My hope was to give birth without pain medications, which can slow labor and affect the baby during labor and after birth.
At 9pm we got in the car and made it to the hospital in a record 30 minutes. It’s amazing what a lack of traffic can do! A plus side to having a scheduled induction is that we were able to make the drive from Pasadena to Beverly Hills minus contractions. We calmly checked in and were shown to the early labor room where we would start the induction. It took about an hour to answer all the questions from our nurse, Carmen, and do the initial exam. I was 1.5cm dilated, about 40% effaced, and the baby was at -3 station. At 11pm the pitocin was started. Induction means significantly more instrumentation than a natural labor: continuous external fetal monitoring (EFM), IV for pitocin drip and saline solution, and frequent blood pressure monitoring. To go to the restroom, I had to unplug from multiple machines, maneuver an IV pole around the bed, and hold up both my hospital gown and multiple cords… all while breathing through contractions!
My first blood pressure was a bit high so they decided to keep me on the monitor for a few hours to keep an eye on things. Not surprising considering how nervous and excited I was about the upcoming events! I started to have some light cramping in my back so my mum massaged my lower back and hip until I fell asleep. I was able to sleep for about two 45-minute stretches. Due to the late start, we had decided that Matthew would sleep during the early labor stuff so that he would be fresh for when things picked up. By about 2am, they were convinced that my blood pressure was fine and they finally took the cuff off, which made life a little more comfortable. (As a side note, I had angry red marks on my arm for about 2 weeks after Evelyn arrived from having the cuff on so long and often during labor)
We requested a telemetry monitor, which arrived around 3am, so that I could spend some time walking the halls. Basically, this a remote sensor about the size of a purse that could be hooked to my IV pole and transmit to the main EFM unit. I spent a couple hours walking the halls with mum, IV pole in tow. They start the induction with a low level of pitocin and increase the amount every 30 minutes until the body starts to experience regular contractions… for example, I started at 2 and by about level 6, I started to feel some light contractions. While I was walking Carmen came to turn down the pitocin (from 12 to 10) because I was basically have continuous contractions. I’d thought it was just increased intensity from finally getting upright and moving around. At each contraction I would stop, grab onto the hallway railings, and hula-hoop my hips while mum massaged my lower back. A doula for another patient suggested squatting during the contractions, something we had also discussed in our childbirth classes, but that made my lower back hurt.
At 6:30am I had another internal exam… I was now 2cm dilated, 60% effaced and the baby had moved down slightly to -2 station. Not much to show for the last 7.5 hours. At this point, there was a shift change and I was introduced to our new nurse, Heather, and the daytime resident, Dr. Zakhour. Shortly after this Heather introduced us to one of the physicians at Cedars and asked if I was interested in trying a technique called the foley bulb, a suggestion from my OB. The procedure involves placing a catheter with a bulb on the end inside the cervix and inflating the bulb with liquid. The catheter tube is taped to the inside of the thigh and the nurses occasionally check progress by tugging the tube slightly. When the baby has not engaged the pelvis, sometimes the cervix needs a little help. The pressure of the bulb acts to help dilate and efface the cervix similar to the way a baby’s head does normally. Eventually the cervix dilation is larger than the size of the bulb and the bulb comes out, leaving a nice large (well, relatively speaking) space for the baby’s head to drop into and finish the dilation process. It also means that the cervix has reached 4cm dilation and what the hospital considers to be active labor.
After the doctor inserted the bulb, Matthew and I walked the halls some more. By now the contractions were starting to be pretty regular and definitely made me stop to focus on each one. We were able to finally see some early morning light coming in and realized we’d probably have the baby today! After walking for about an hour, I felt something dribble down my leg and realized that I was lightly bleeding from the foley catheter tube. The nurse checked and told me everything was fine. She brought me a supersized sanitary pad (think adult diaper-sized) and mesh underwear. Incredibly unattractive. Incredibly comfortable.
I was starting to have back pain so I climbed back into bed, alternating between lying on my side and kneeling while leaning on the inclined headrest of the bed. I also spent some time in “slow-dance position” with Matthew. At 9:30, Dr. Zakhour returned to check on me and, with a small pop, the foley bulb was out! We bonded over our amusement at mesh underwear and the like while she performed an internal exam. Voilà… 4cm dilation! We were told we’d be moving to an active labor room as soon as one was available but that the ward was a bit busy. By this point I was having pretty serious back labor so we started trying the various techniques we’d learned in our childbirth class to deal with the situation. Walking felt good but I didn’t like dealing with contractions in the hall so we spent most of the time in our tiny room- swaying, side-lying, kneeling on all fours. Matthew and mum took turns applying counter pressure to my lower back during contractions and talked me through the contractions.
Just before noon, a delivery room opened up. I had originally wanted a room with a tub but I realized that I probably wouldn’t be able to get much use out of one with all the machinery attached to me. The room I ended up in had a shower and an amazing view of the hills through a full wall of windows. Once in the room we continued to work through contractions. Matthew encouraged me to continue to try new positions every hour or so. I didn’t really want to because moving hurt my back but I knew that I should. The back pain was bad enough at this point that I needed one person applying pressure to my back and the other person in my face, talking me through the contractions and helping me to remain relaxed between contractions. I rotated between sitting cross-legged on the end of the bed, kneeling on the bed with my head and arms resting on the birth ball, and sitting on the birth ball on the floor. Matthew and mum would rest between sets of contractions- I would have several contractions rapidly together and then have a break. There were a couple times I told Matthew that I didn’t think I could do this… he encouraged me and praised how well I was doing.
We had a substitute nurse, Susan, for a while as Heather was required in another delivery room. Susan informed me that Dr. Brown was going to be coming in to discuss breaking my water bags in order to help labor progress. The monitor displaying my contractions didn’t pick most of them up so the nursing staff didn’t really have a good idea of how my labor was progressing. According to the monitor, I was moving pretty slowly. We were torn on whether we wanted the intervention. Once the waters have been broken, labor has a time limit set due to the increased risk of infection. We weren’t sure we wanted to commit to that if my body wasn’t ready. It didn’t turn out to be an issue though- Matthew reminded me it was time to change positions so I rolled from being on my knees/birth ball to my side and there was a “pop” and a gush. My body did it all on it’s own at 2:55pm! A few minutes later, Dr. Brown arrived and was very pleased to hear the news. She performed an internal exam and I had progressed to 5 centimeters. Dr. Brown decided that we’d be fine for the next couple hours so she was planning in returning at 5:30 to check on me again.
Hearing that I was at 5 centimeters was a downer for me. I was already in a great deal of pain, due to the fact that the back pain did not yield between contractions. I thought about having to do this for hours and hours and started to panic. I told Matthew that I really couldn’t do this. In our childbirth class we learned about emotional signposts of labor. These signs can be an even more accurate assessment of how labor is progressing than dilation. The third and most difficult phase is self-doubt. Pre-childbirth I hadn’t realized how intense this phase was. We were taught that the woman would believe “I can’t do this” and the partner should take this as a sign that transition was happening. It would be more accurate to describe the sentiment as “I-can’t-do-this-and-I’m-going-to-die.” Matthew immediately recognized that I was much further along in the labor process than either the nurses or I realized. I didn’t ask for drugs- I remember thinking that all I needed to do was tell Matthew our safety phrase and he could tell the nurse. But I knew I’d be disappointed. Instead I stared into Matthew’s eyes and tried not to panic with each contraction. Matthew could tell I was hurting but knew in his heart that the baby wasn’t far from coming. He did his best to comfort me.
About 15 minutes after Dr. Brown left I suddenly felt a need to go to the bathroom. I told the nurse “I either need to poop or push!” She was doubtful that pushing was the case but when she performed an internal exam, my cervix had reached 7cm. She told me to breath through the urge to push, little puffs of air, since I wasn’t fully dilated yet. She spent the next bit of time fiddling with the baby’s heart rate belt and gathering items for the delivery, but with no real sense of urgency. With each contraction, my uterus would push, despite my best efforts. It was like trying to stop myself from vomiting, but in the other direction. The nurse responded to my grunts with “Don’t push. Small breaths.” Really, lady?!
“I’m not pushing,” I growled/yelled at her. That finally got her attention. She called Dr. Brown and informed us she would be there in 30 minutes.
“I don’t have 30 minutes. This is happening now!”
She sent out a call for the delivery team and sat at the foot of the bed, still trying to keep me from pushing. By this point the baby was starting to crown. Within minutes our room was filled with people, bustling through preparations for Mini Munson’s arrival- Heather, Dr. Zakhour, a nurse midwife, nursing students, the man to count gauze pads, a pediatric nurse, the pediatrician’s representative, a chief of surgery. About 15 people in all. Matthew, mum and I waited impatiently while they removed the bottom half of my bed and counted out scissors and gauze pads. Dr. Zakhour would be catching our baby in Dr. Brown’s absence. I was relieved to have a relatively familiar face in that position.
During this all, my body was still pushing the baby out, with no encouragement from me. My internal monologue at the time:
“Wait… this baby is coming out of where?!”
“Hey look- the Hollywood sign!”
“There is no way out of this now…”
Finally I was told I could push. I bore down and the head emerged. The doctor paused me to gently unwrap the umbilical cord, which was loosely around the baby’s neck. The midwife told me that when I felt the next contraction to push as I felt comfortable. A moment later the contraction started. I took a deep breath and pushed. Then another breath and another push and Mini literally shot out, with a huge splash of amniotic fluid. Our baby was airborne for it’s first seconds out here in the world, at 4:24pm. Safely caught, they lifted Mini for us to see and Matthew got to say, “It’s a girl!”
She was immediately placed on my chest, a warm, wet, wiggly little girl. We still were not 100% certain of her name so we had Baby Girl for a couple hours. I was so focused on this beautiful little person that I didn’t really notice the cord being cut and the placenta delivered. I just kept saying “baby girl” over and over. I have never felt such incredible joy.
After having her on my chest for about 15 minutes, the surgeon asked if it would be ok for Matthew to take the baby. I had a bad tear, potentially fourth degree, and they were considering taking me to the OR to stitch me up because the lighting would be better there. Matthew took Baby Girl to be weighed and measured while the team worked on cleaning me up. Between the cessation of back pain and the feel-good hormones pumping through my body, I actually laughed when they asked if I was in pain and gave a very sassy “I’m good. My back doesn’t hurt any more!”
It was decided that the lighting was fine in the delivery room and I was offered local anesthetics and an IV painkiller so they could stitch me up. The midwife told me that the drug had a very short half-life and would not affect the baby through my breast milk so I accepted. At this point, Dr. Brown arrived. The surgeon happened to be a good friend of hers so the two worked together to stitch me up. It took them about an hour to stitch the third degree tear. (Here is a link showing illustrations of vaginal tear severity by degree)
At last I got to hold my little girl again. She was very agreeable to getting some food so I nursed her for the very first time in the delivery room. What an incredible experience!
I held her as my bed was pushed to the recovery room. Everyone we passed in the hallways congratulated us. After settling into the recovery room, mum gave Matthew and I some time to our selves to discuss the all-important name. When she returned we were pleased to introduce her to her granddaughter: