Total duration: 38 hrs Pushing time: 2 hrs Birth weight: 6 lbs, 13 oz Birth length: 18.5 in Birth time: 10:05 a.m. Date: Thursday, May 16, 2019 Doctor: Sonia Arias-Franklin, M.D.
My pregnancy, from the start, was as textbook as you could imagine. Our confirmation ultrasound at 8 weeks showed a strong heartbeat and a tiny peanut-shaped fetus, subsequent appointments were smooth and no-stress, early genetic screens and blood tests all came back negative and completely normal, and everything seemed to point toward a no-risk, textbook vaginal delivery.
At our 35 week ultrasound, however, we received some surprising news. We were informed that our baby’s head was measuring in the 99th percentile--around 40 weeks 3 days. Both her biparietal diameter measurement and her head circumference measurement measured just over 40 weeks. She was also still presenting breech. These facts meant we were flagged for a potential c section. Aside from the concern about potential reasons her head was measuring so far ahead, the fact that she was breech was also a secondary potential concern to me. Was something wrong with my baby? My OB, Dr. Arias-Franklin, made the recommendation that we wait until 38 weeks, go in for one more ultrasound to check her head size and presentation at that point, and based on what we found, potentially go in the very next morning for a c section. My head was spinning.
In addition to all this--and maybe only others who have been moms-to-be at some point will understand this--I was having to mentally adjust my vision and expectations for my birth experience. Since my pregnancy had been so textbook, I had envisioned a textbook delivery--discovering my body spontaneously going into labor on its own, timing contractions, spending early labor in the comfort of my home, driving to the hospital when it was time, laboring as long as I possibly could on my own before asking for pain medication, delivering vaginally—baby right onto my chest, Andrew cutting the cord (slightly delayed), and after we’d gotten some good skin-to-skin time and she’d gotten cleaned off and assessed, we’d start trying out breastfeeding inside of the recommended one hour.
To suddenly be told my baby would likely need to be surgically removed was jarring, and it took me a couple of days chatting with other c section warrior mommas to come around to seeing all the pros of a c section and be at peace with the likely possibility. By the time we went in for the follow-up ultrasound to check presentation and head size, I was fully prepared to be told we’d be checking in and headed to the OR early the following morning. I’d even decided not to order my own hospital gown from Amazon since they’d put me in a hospital gown anyway and had stopped reading about ways to cope with labor. My mom had bumped up her already ticketed flight in order to come in Tuesday, be there for the last ultrasound on Wednesday, and present for a likely c section Thursday.
So, on Wednesday afternoon, Andrew, Mom, and I met at my OB clinic, and we were shocked when, in the ultrasound and the meeting with my doctor directly afterwards, we discovered that not only had baby flipped head down and stayed that way, but her head hadn’t really grown at all since our 35 week ultrasound, so my doctor recommended that we wait another week and induce labor the following Tuesday at exactly 39 weeks so that baby could be full term while also preventing the possibility of anymore cranial growth.
And so, we waited.
I went back to work Thursday and Friday, but decided to take Monday and Tuesday off for last minute preparations. Andrew, mom, and I went shopping, went out to eat, took lots of walks, and waited. I got an exercise ball at Target and bounced on it as much as I could to try to coax baby to start dropping before induction, since I knew the closer my baby and body were to going into labor naturally, the easier induction would be.
My mother-in-law, Dale, flew in the Tuesday morning of the induction, May 14th, and we all went to brunch. We then came home, and to keep himself occupied until we had to leave for the hospital, Andrew had planned to cook for us all and make rigatoni with a pork and red wine ragú and roasted garlic asparagus. He cooked through the afternoon, we ate dinner, walked downstairs to get some ice cream, and then it was close to time to go. We got in the cars and drove all of the 7 minutes over to the hospital.
I checked in just before 8:00pm, and we got all our bags into my labor/delivery room. My nurse, Dallas, gave me instructions, showed me where everything was, and left me to get changed and ready to go. (I did end up ordering that hospital gown for myself--worth it!)
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| My board at check-in |
We started Cytotec (a cervical ripener) a little before 8:30pm. I started out only a fingertip dilated and only a little effaced—my cervix was still very closed and firm. Almost ground zero. First time moms often don’t go into labor until 41 weeks, so at 39, my body just wasn’t ready to go into labor. But we couldn’t risk her head getting any bigger. They also started me on antibiotics, since I had tested positive for Group B Strep, and some fluids.
We settled in and I started feeling contractions. Before long, unexpectedly, the anesthesiologist on duty came in and urged me to get an epidural as soon as possible since my labor and delivery had been flagged as “high risk” and there was a high chance the induction would end in an emergency c section. She was very insistent, but we had the presence of mind to speak up and ask questions. She ended up on the phone with my doctor, who had been very hands-on and involved in the whole process. It turned out that the anesthesiologist had only seen the 35 week ultrasound results and hadn’t seen the 38 week ultrasound results showing that baby’s head had not grown at all in 3 weeks. After realizing that my baby’s head, though large, was still within the normal range for a full term baby, the anesthesiologist backed down a bit and let us tell her I was hoping to labor naturally for as long as I could, but that I would likely get the epidural shortly after the Pitocin started, since I was going to be contracting all through the night without eating anything and Pitocin-induced contractions--notoriously--can be more intense than natural labor contractions. This seemed to satisfy all parties.
After a while, mom and Dale went home to get some sleep, since we weren’t expecting much action through the night, and Andrew and I settled in. The contractions brought on by the Cytotec weren’t too bad, just very irregular and sporadic, and for awhile I could sleep through them unmedicated without much trouble. Around 3 am, though, the contractions started coming stronger and only about 90 seconds apart. I couldn’t sleep through those contractions anymore and laid awake for hours just riding them out. I got another dose of Cytotec in the night, and would have gotten a third during the night, but because of how close together the contractions were, they couldn’t give me more until the contractions regulated a bit more.
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| Settled in to the hospital room for the night |
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| Andrew's accommodations |
In the morning, I was only about 2 cm dilated and about 50% effaced—not much change in effacement from the night before. My nurse in the morning, Diane, seemed ready to start the Pitocin, but Dr. Arias-Franklin called to ask about my progress and felt we should do another dose of Cytotec before starting the Pitocin. I was so hungry when I woke up—I don’t function well without food for extended periods of time. Diane brought me a couple of popsicles, followed by some chicken broth a bit later, which helped a bit, and then I got another dose of the Cytotec. The contractions made me just want to curl up, but Diane urged me to do what I also knew I should do—get upright and walk around or bounce on a ball. I had hoped to be able to use the remote monitoring system called the Monica in order not to be hooked up with wires and be able to walk the halls near my room a bit, but both Dallas and Diane had tried to get the Monica to work for me to no avail—it just wouldn’t connect—and because this was an induction and not natural labor I wasn’t allowed to have intermittent monitoring; it had to be constant. So I was tethered, but I still managed to walk back and forth for a while and then got onto a peanut ball Diane brought and just bounced. We decided to watch Ocean’s 8, and bouncing plus the distraction of the movie meant I began weathering even stronger contractions without registering them quite as much.
Just like it had done overnight, my body started trying hard to take over to a certain extent and go into labor, still contracting long after the Cytotec wore off, but the contractions just wouldn’t regulate. They gave me another bag of fluids through my IV to try to space the contractions out a bit more and I got a fourth dose of Cytotec. By this point I had been weathering contractions unmedicated for about 19 hours. I hadn’t eaten for almost a full day. And I hadn’t slept well. I began to get nervous about having the energy to push after such a long ordeal and not having eaten anything more than popsicles, jello, and chicken broth. But finally, in the early evening, we got to a place where Dr. Arias-Franklin was comfortable with starting the Pitocin.
We called in the anesthesiology team, and they gave me the epidural just as we were starting the Pitocin drip. The epidural was amazing. In about 15 minutes I went from curled up on myself and unaware of the room trying to cope with the contractions to sitting up in bed sipping chicken broth and chatting with Andrew and our moms. I was contracting harder than ever, but I couldn’t feel a thing unless I rested my hand on my stomach, which I could feel getting incredibly tight and firm.
Mom and Dale decided not to go home overnight that night, just in case the Pitocin got things moving more quickly than expected. My nurse, Dallas (who was back with me again for the night shift), brought them pillows and blankets and they went out to the couches in the waiting room.
Once the Pitocin started, things really did start progressing. The epidural helped me relax for a while, but before too long I began having a reaction to either the hormones, the anesthesia, or a combination of the two, which made me start shaking uncontrollably. I shook all through the evening. I tried so hard to relax, but I could feel myself clenching my jaw against the shaking. It was exhausting.
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| Trying so hard to sleep |
Then, sometime after 9 or 10pm, even though I was completely numb, I felt a gush. I asked Andrew to check and hit the call button for the nurse and, sure enough, my water had broken, but hadn’t really evacuated. The certified nurse midwife on duty came in and evacuated the fluid, which soaked a towel and some bed linens and ended up spilling onto the floor. The CNM seemed to feel that it was an excessive amount of fluid, which worried Andrew and me since we’d never seen anything other than normal amounts of fluid measured in any of our ultrasounds and excessive fluid can be a sign of other problems. Dallas didn’t seem phased, however, and said she didn’t feel it was excessive. After my water broke, they decided to hook up the internal fetal monitors to keep closer track of the baby.
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| The room where it happened |
Dr. Arias-Franklin came in to see me and check my progress herself before she headed home for the evening, and based on the trajectory of my progress I began to get nervous—she told us she had a c section scheduled the following morning at 7:30, and it seemed like that was going to be right around the time I was going to be fully dilated and ready to push. But she left assuring us that all would likely time out fine for her to do the c section and also deliver my baby. My uncontrollable shaking let up for a few hours late at night, but by around 3am had picked up again, and it kept me from being able to sleep, which was frustrating since I wasn’t in pain. The team kept checking my progress through the night, and I steadily dilated more and more. 4 cm. 5 cm. 6 cm.
At one point in the night, my heart rate dropped and so did the baby’s, and a whole team poured into the room. They sat me up in the bed for a bit, put me on oxygen, and waited for our heart rates to regulate again, which they did. Dallas took full charge of turning me and changing my position multiple times through the night, putting the peanut ball between my numb legs and various other tricks to help labor progress even though I couldn’t move on my own, but we quickly discovered that baby would have late deceleration in her heart rate after each of my contractions if I was lying on my left side or on my back, which meant that she wasn’t getting enough oxygen for a few seconds at a time. In order to curb the late decels, I had to stay completely on my right side for hours, and since epidurals work largely via gravity… you can see the problem.
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| On my right side with peanut ball between my legs, trying to curb the late decels |
By early morning, I was 9cm dilated and almost totally effaced, exhausted from the uncontrollable shaking, and absolutely starving. Dr. Arias-Franklin came in to check on me around 7:00, before heading to scrub in for her c section. I got some more chicken broth and they gave me a bag of sugar water via my IV to make sure I was getting calories. But on top of all that, because I had spent so much time lying on my right side and my circulation on my left side isn’t great anyway, the epidural began wearing off on my left. I began feeling incredible pain right around my left hip. Then it spread all up my abdomen and even down into my leg, and it was a constant sharp ache, but got even worse with every contraction. I had to breathe through them to cope and I realized I was starting to feel almost the full force of the incredibly intense Pitocin-induced contractions, but only on my left side. I hit the button to self-administer an extra dose of the epidural, but it didn’t seem to help at all, other than to make my right side even more numb than it already was. We ended up calling in the anesthesiologist working that morning to consult with him. He offered to give me a higher dosage of medication to hopefully get rid of some of the pain. I was worried that if I was any more numb than I already was I wouldn’t be able to feel to push at all, or that they would have me wait the 45 minutes it would take for the extra dosage to wear off before pushing, and I was so ready to just start pushing and get the baby here. My doctor had left me in my morning nurse Martha’s capable hands to begin pushing while she performed her c section, and if things progressed extraordinarily quickly or she needed to get to me sooner for any other reason, someone would come get her and she would scrub out and come in.
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| Last selfie before baby's arrival! |
At one point before I started pushing, the charge nurse came in with another woman in tow and told me that the woman was in training to oversee medical staffing in some capacity (I don’t remember now), told me she was shadowing the nurses, and asked if I would be comfortable with her shadowing Martha during my delivery. At that point I was still waiting for the extra dosage of anesthesia to really kick in and the whole room was bustling with people coming in and out preparing various things for delivery. I figured the lady in training needed to shadow someone, Martha seemed fantastic at her job in the few hours I’d known her, and I was so distracted by the (ebbing) pain and so excited to just get to pushing and get the baby here after so many long hours that I honestly don’t think I could’ve cared less at that point if the whole thing was nationally televised, so I gave my consent.
After what felt like forever but was only a few minutes, the extra dosage of meds kicked in and, though the pain didn’t disappear entirely, it came down to a level I knew I could manage while pushing. Martha checked and I was 10cm dilated and we were ready to start. Most people had cleared out after the earlier bustling. There may have been a few other people in the room but the only people I really remember through most of the pushing are being aware of my mom and Dale off to the side, Andrew on my left, and Martha on my right. Right around 8am, Martha gave me instructions on when and how to push, and then she and Andrew helped me lift my legs and curl up and around my stomach with each push.
I could barely feel what I was doing but Martha guided me and I relied on muscle memory to bear down as hard as I possibly could. She was perfect at her job. Her confident, steady voice was a perfect focal point—I tuned out almost the entire rest of the world and just focused on what she was telling me to do. I don’t know what I would have done without her. Andrew held his breath with me on each push—I could feel him tensing his whole body in rhythm with me and releasing when I released. He whispered encouragements in my ear over and over and told me to be strong and to keep going. Before too long Martha told me her head was RIGHT there, and Andrew got to feel it and then I reached down and felt it, too. As soon as I felt her head, I got a second wind and extra motivation. She was almost here!
Unfortunately, I was still shaking uncontrollably through all this, which I knew was further sapping what little energy I had left. Also, because pushing was easiest for everyone with me on my back, baby continued to have the occasional late deceleration after each contraction and pushing. So between each set of pushes, Martha immediately put an oxygen mask to my face. At one point we tried pushing on my side and it worked for a bit, but baby’s heart rate just did not like the contractions and pushing. I also began running a fever—I had developed “chorio,” or chorioamnionitis, which is a bacterial infection of the amniotic membrane. I had already been on rounds of IV antibiotics through the night because I had tested positive for Group B Strep, but because of the chorio, baby would need to get blood cultures taken shortly after birth and start antibiotics as well.
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| On oxygen between pushes, trying to get some extra oxygen to baby |
After about an hour, they went to get Dr. Arias-Franklin to scrub out of her c section. Sincebaby was not tolerating the contractions and pushing but also seemed to not be progressing very well past my pubic bone, they needed the doctor in the room to call the shots going forward. I rested through a couple of contractions, turned back on my side with the oxygen mask, and we stopped the decels for a little bit until Dr. Arias-Franklin arrived, and then we pushed some more. Because of the fever and uncontrollable shaking, we began doing a strange, delirious dance: push, push, push, legs down, blanket up over my arms, oxygen mask off, here comes another contraction, blanket off, mask off, grab legs, curl up, push, push, push. The doctor realized baby’s head was turned completely sideways, and there just wasn’t room for it to get past the pubic bone in that direction. She needed to be face down, facing my tailbone—especially since her head was large. Through the next several pushes, the doctor did everything she could to use her hands to manually turn baby face down, but baby was incredibly stubborn and just. Wouldn’t. Turn. An older doctor who seemed brusque and no-nonsense but more experienced, Dr. Ramos, joined my doctor after a while and the two worked on the baby through the pushes, but baby kept having the late decels with every single contraction and set of pushes. We couldn’t risk continual decels like that—cutting off her oxygen supply too many times. So after several minutes, Dr. Arias-Franklin and Dr. Ramos agreed—it was time to just do what it took to get the baby out.
The entire medical team scrubbed up and Dr. Arias-Franklin and Dr. Ramos put on face shields. Dr. Arias-Franklin came around the side of the bed and explained to me that they were going to need to use forceps. They would have used a vacuum, she said, but since the baby was sideways, the vacuum would be ineffective. They needed to be able to turn her WHILE helping her out. A very small part of the back of my mind heard “forceps” and was slightly afraid, but the rest of my mind was saying “At this point, I’m up anything.” I probably would’ve been mad as hell after the fact if they’d had to wheel me into surgery for an emergency c section, just because my body would have done all that work for over a day and almost two hours of pushing to end up in surgery. In my hazy thoughts I even recall wondering if they’d even be able to do a c section since her head was already partially under the pubic bone and mentally wishing I’d read up on that scenario ahead of time. They brought out the forceps and I kept pushing through the contractions. Dr. Arias-Franklin worked through a few contractions and sets of pushes, turning and pulling. I didn’t know any of this at the time but Andrew and my mom told me later that Dr. Ramos had to join Dr. Arias-Franklin at one point—both pulling in tandem. Through it all I focused on Martha’s face, her confident voice saying “Deep breath… and... PUSH! One… two… three… four… five… six… seven… eight… nine… ten! Let it out, deep breath and right back in, momma—PUSH! Two… three…” I focused on the sound of Andrew whispering encouragement into my ear, and the sound of him breathing with me through every push. The room seemed to swirl a little, and I breathed in the plastic smell of the oxygen mask between each set of pushes.
I heard “Come on, last one. This is it,” and I steeled myself to push as hard as I possibly could. We got through the three pushes for the contraction and Andrew said that, finally, he saw her head emerge briefly, but three pushes wasn’t quite enough to get her out. Rather than wait for the next contraction, Dr. Arias-Franklin, Dr. Ramos, and Martha all told me to go again. That fourth push did it. Andrew told me that her head really came out, and then I didn’t even have to push—the two doctors pulled together and finally, finally, after so many long, hard hours, at 10:05am, she was out. I saw her waxy body briefly over my knees and then she was whisked away; my dreams of having my baby delivered directly onto my chest, delayed cord clamping, Andrew’s chance to cut the cord, and immediate skin-to-skin time overridden by the need to assess her health after all her repeated decels and my 103 degree fever. But, oh, I heard her cry. She screamed and yelled and I sobbed. The most overwhelming relief I’ve ever felt washed over me. “Sweetie, she’s beautiful,” Andrew said to me through his own tears. “Marlowe!” I cried her name out into the universe. She had her name. “Marlowe Emilia!” “She’s crying,” I kept repeating deliriously. “She’s crying, I hear her, she’s here,” over and over while the tears just streamed down my face. I heard my mom and Dale crying and exclaiming too. I was vaguely aware of Andrew grabbing his phone to take pictures. It didn’t take too long for the team to clean her up, but it felt like eons.
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| Seconds after birth |
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| Here. With a great set of lungs. |
And then they brought her to me and my baby girl was on my chest. She stopped crying and stared at me with alert, bright blue eyes, and I sobbed some more as I talked to her. “I’m your mommy,” I said. “My baby girl. I love you so much.” My mom did her best to wipe my tears and then Andrew leaned in close. Just the three of us. My little family. Nothing else existed in that moment.
They had to take her for about half an hour down to the nursery to get the blood panel and put a tiny IV into her tiny hand in order to be able to give her the antibiotics, and it was around then that I realized Dr. Arias-Franklin was still hard at work stitching me up. I had some pretty significant tearing to repair. It’s hard to say how much I would have had if she had been facedown and had come out on her own versus what was brought on by the forceps. At any rate, I couldn’t imagine having been through it without the epidural. I came back down to earth long enough to briefly feel concerned about my body and my recovery process, but I forgot about it again as soon as they brought Marlowe back into the room.
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| My baby. (Martha in the background--seriously the best labor & delivery nurse you can imagine.) |
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| So tired. So relieved. So happy. |
I had the rest of that day and two nights in the hospital. The first night was rough—Andrew was with me but he was exhausted. Marlowe and I still hadn’t really figured out breastfeeding and I’m sure she was hungry. Plus all the normal challenges, I was tethered to an IV pole for antibiotics and my poor baby had a little IV held in place on her hand and arm with a gauze-wrapped board that made nursing on the left side difficult for both of us. We finally figured out a system that sort of worked, but it definitely didn’t make things easy. The second night, Andrew went home to get some sleep and mom stayed with me. The nurse came in to give Marlowe her antibiotic, but I noticed the fluid overflowing out of the tape—her port had come out of the vein. I concernedly pointed it out and the nurse said she would take out this IV and, since Marlowe hadn’t had a fever or any signs of infection after birth, would ask if they could give the final round of antibiotics to her via injection or if they would need to drop another IV port for the last round. She then proceeded to remove the IV and board and all the tape holding it to her tiny arm, and Marlowe screamed in pain and discomfort. I’m sure all it was was just the discomfort of removing the tape, but it hurt me so much to watch her scream and know she was hurting and not be able to stop it. I sat there in the hospital bed and sobbed, my heart breaking for my baby. Oh, so this is it, I thought. I turned to my mom, who was doing her best to wipe my tears again. “I get it now,” was all I managed between sobs. And mom cried, too.
We were discharged the following day, and got inside our apartment just before a massive thunderstorm and downpour pounded down onto the city, but we were safe and snug inside. Home. Together.
