Once the GBS culture came back positive, Dr. Duff wanted to check my cervix, since my prior precipitous birth would make timing of antibiotics potentially an issue if that happened again. The biggest concern with GBS positivity is duration of ruptured membranes (unless the baby is premature). At 38 weeks, I wanted to get the planning underway. I was 3/90/-1 when she checked me. “Bloody show,” she announced, showing me her bloody gloves. My heart rate went up! I had another full week of patients scheduled, my mom’s not here!
No one would blame my concern given my husband had almost delivered the last baby in the car on the way to the hospital. I put my patients on high alert, my mom started her 2 1/2 hour journey over to my house and I finally got around to packing my bag. And. Nothing. Happened. Isn’t that just peachy? I mean, I’m definitely the one preaching to wait for the baby to come when it’s time. And I certainly wouldn’t override my avoid-interventions policy because I was impatient-and-tired-of-being-pregnant. But still. I was so ready for this baby to get here.
Every day I checked with my husband about his schedule and how far he would be from Springfield if I went into labor. He works in Branson, a good 50 minutes away (maybe 40 with his driving). I stopped putting my hospital bag in the car thinking maybe if I didn’t take it, I would go into labor. You know how that reasoning (and hoping goes). Every day it was, well, guess I’ll take the kids to school, guess I’ll go to work, guess I’ll go to Shabbat services. Finally, a week after Dr. Duff’s exam, her next one I was a 4, but I had sent my mother back home since I wasn’t having any substantial contractions. We discussed coming in for AROM (artificial rupture of membranes) so that we could be sure to get the antibiotics on board given my history of a fast birth. L&D was booked so there was no time for me to officially schedule to come in for the AROM. Of course, I called Dr. Plante to discuss whether I should do this in light of the uterine rupture. Once again, she was supportive, pretty neutral, but not discouraging to the plan. I just needed her to make me feel better about not just fully allowing things to unfold. As we moved through the weekend, I tried to have low expectations but I was also aware that my husband had the following week off. I really needed to have this baby.
Sunday was my radio show and then my husband and I were to have a dinner meeting with Mary & her husband Ben, the owners of the birth center. My show ended at 6 PM and almost immediately I started having some contractions. Nothing painful, but more noticeable and frequent, enough for me to call my husband and tell him to throw my bag in the car, just in case. Mary is pregnant too so we swapped pregnancy stories while we ordered our food. How many of you have heard the old wives’ tale about spicy food sparking labor? I ordered up extra spicy food and added jalapenos, hoping to encourage these contractions. After a nice meal and conversation, I convinced my husband that since we were already in Springfield, we needed to stop by L&D to see what was happening.
We had a lovely triage nurse, Cathy, who noted a decel as soon as she put me on the monitor, and the variability wasn’t super hot. I was still 4 and having irregular contractions so she said she would call Dr. Duff with an update. I wasn’t surprised when she came back saying that she wanted me to stay overnight, as now it was about 8 PM. Eventually, my strip became reactive so I was admitted. Cathy passed me over to the night nurse and we got settled in. By then, Dennis had called my mom and she was en route. I got my first dose of antibiotics and we all tried to make ourselves comfortable and get some rest. The extremely thin plastic mattress and the hospital bed along with an IV pole did not make for very good rest, but I did get a little bit of sleep.
I expected Dr. Duff to come break my water pretty early to augment my latent phase of labor but she was tied up with a miscarrying patient, so she didn’t make it over until around 11. She tried to break my water but I was too high so she couldn’t quite get it so she suggested I walk and if she wasn’t done, she would send her partner to break my water. I prayed to myself, “L-rd, I do not want my water broken by a stranger so please do this for me.” Sure enough, as soon as I got back from walking, my water broke spontaneously. Wheeewww.
Dr. Duff and I were in agreement that we were not going to use any induction agents since I was wanting a VBAC and I had a history of uterine rupture. The baby had looked great the whole time with no further decels. We talked about our options including more ambulation (she was OK with this even though I was ruptured as long as I used the telemetry fetal monitor), nipple stimulation and the birthing ball. As I lay in the bed waiting for the ruptured membranes to do something (they didn’t), I thought, the next thing that happens if I don’t progress is an IUPC (intrauterine pressure catheter) to see how strong my contractions are. I’m ruptured and GBS positive. I see the writing on the wall if I don’t make change. So I decided right then and there, I’m going to everything I possibly can to avoid the cascade of interventions (internal monitors, epidural, “whiff of Pit,” low threshold for cesarean).
Down the hall Dennis and I went but unfortunately, it didn’t last too long because the telemetry monitor wouldn’t keep the heart rate on and the nurse was uncomfortable with not being able to monitor me. Back in the bed I decided nipple stimulation was the next step. Since I didn’t have my breast pump with me, we did it the old-fashioned way. Thankfully my mom had fallen asleep and the nurse left the room, otherwise I don’t think I (we) could have done it. The nipple stim was very effective and I started having nice regular, uncomfortable contractions. We combined that with bouncing on the birth ball which made the contractions a little more bearable. I really expected to be 7 or 8 when she came back, but I was only 5. “No,” she reassured me, “this is a really different cervical check, you’re going to go fast now. I’m going upstairs for a meeting, but I’ll come right down if they call me.”
I knew it wouldn’t be long because I was no longer in a joking mood with my husband and the contractions worsened in intensity. Finally, bouncing on the ball wasn’t comfortable anymore and I got back in bed. The only position I could handle was lying on my side, holding the bed with one hand and Dennis’ hand with the other. A new nurse came in, a friendly lady new to Springfield from Illinois. I couldn’t say much to her by this time because the pain was too much. She started getting her warmer and delivery table ready when I started groaning. She checked me and I was an anterior lip so she called for her colleagues and for Dr. Duff. By now I was getting more vocal because the contractions were slamming me every 1 1/2 minutes. By the time Dr. Duff came and told me to push, I felt like someone shoved a rod down my spine. I could not curl around the contractions like they wanted me to, I had to extend my legs straight out. I kept thinking, “this is way more painful than John Michael.” I was grunting and groaning and calling out to G-d to give me the strength I didn’t have.
I was starting to wig out a little bit because the pain was so unbearable. At one point, I asked Dr. Duff to get the vaccum, “You’ve only been pushing for 10 minutes,” she said. I tried not to cuss because I couldn’t imagine going through this pain for any longer. “What is the deal? Why is this so much more terrible than JM? I didn’t have any pain meds with him either, but this is 1000 times worse,” I was thinking. I knew my mom was over in the corner praying her heart out and Dennis kept looking down below for any progress. Finally, I think Dr. Duff saw I was out of it with the pain so she offered to give me a pudendal block (a shot of anesthetic to the nerve that feeds the pelvic are). “Yes, yes, yes” I said, praying it would give me enough of an edge to focus on pushing this baby out. It worked to that end, because I could at least listen when they told me they saw hair and that I was really close. I tried as hard as I could to bear down but I just could not curl around my belly, as much as I wanted to.
Finally, I summoned enough strength to realize I had to get through that “rock-and-a-hard-place” that so many laboring women face. I gritted my teeth and pushed with all my might. “She’s coming, she’s coming,” everyone was shouting encouragement that the end was near. Finally, one last burst of pushing and her head was out. “You did it, babe, you did it,” my husband yelled. The rest of the baby slipped out. My body collapsed as my husband dropped his head on my chest. “Is everything all right,” I whispered, wiped out. “Yes, babe, she’s perfect,” he said. “Praise the Lord!” said my mom. “You can say whatever you want because you just delivered a direct OP (occiput posterior/sunny side up) baby with no epidural,” said Dr. Duff, “that was awesome.” I was relieved that there was an explanation for my severe pain but mostly I was so grateful to finally meet my long-awaited daughter, covered in vernix and so beautiful that I couldn’t hold back the tears. Wow, she’s finally here, and yes, she’s still a she, she has 10 fingers and toes, and she is crying energetically.
They put her right on my chest. The nurses held to their statement that they gave every mom and baby at least an hour of skin-to-skin. She latched right on and I took a moment to watch her in amazement, knowing that her brothers would be there shortly to visit their new baby sister.
As the adrenaline and cortisol faded away, I lay quietly in my bed, reflecting in the culmination of my long journey to this girl, thanking the L-rd that He sent me people and words of encouragement not to let go of the promise. And to never, ever forget His faithfulness.