A Slight Change in Plans: Part One

Friday, May 9: 7:15 am

I was scheduled for an ultrasound at 8:15 on the morning of Friday, May 9th. It's standard procedure to have an ultrasound when you're nine days past your due date, to make sure the baby is doing well, that there is enough amniotic fluid present, and that the placenta is still in good shape.

8:15 was earlier than I had been getting up, so I had to set the alarm to wake up in time, and when I did wake up I wasn't in a great mood; I was tired and apathetic and starting to feel like the prolonged pregnancy was my fault.

I got Blake to come with me to the ultrasound, even though it was early and he didn't really want to get up. But when we got to Mount Sinai, we found out they weren't letting in any extra people, only the patients, unless the fathers were needed to help make decisions. Since we didn't expect to be making any decisions, Blake stayed in the waiting room while I went on alone.

I wasn't really nervous about the ultrasound; I didn't expect them to find anything out of the ordinary. I was looking forward to seeing my baby, though; I thought it would be especially neat to see a full-term baby in utero.

It was 8:00 when I arrived, and I waited half an hour before the technician was ready to see me. She did the examination in complete silence, and never offered to let me see the screen, and I was in too dejected a mood to ask her to show me. After she finished, she told me to wait while she showed the results to a doctor.

I waited for a long time in the darkened ultrasound room; after a while the technician came back, but it was just to check something on the machine; she told me again to wait. Finally the door opened again, but it wasn't the technician, it was one of the Mount Sinai staff obstetricians. He told me that I was very low on amniotic fluid, that my placenta was old and calcified, and that I should be induced as soon as possible. He said that low amniotic fluid can cause problems during labour, since the umbilical cord isn't cushioned, and that an old placenta may not be able to support the fetus through the stress of labour. He said I shouldn't have a home birth, that I should be induced immediately with continuous fetal monitoring, and that "some women" in my position ended up having a caesarian.

I took the printed ultrasound report and went out into the waiting room, put my arms around Blake and burst into tears. He hugged me back and waited patiently until I could explain what was wrong. After I told him what had happened, he said we would go see our midwife Edan, and we would decide what to do next.

We had an appointment to see Edan at 10:00, so we went straight to the midwife clinic from the hospital. As soon as we went into the office I started crying again; at first, Edan thought I was just tired of being pregnant, but I handed her the ultrasound report and told her what the obstetrician said.

She looked over the report; it said the same thing the doctor said, that my amniotic fluid was low and my placenta was old. Edan said it was to be expected; amniotic fluid decreases as a pregnancy moves past its due date, and placentas get old. She said the obstetrician I had spoken to did not view home births favourably; he would always recommend a hospital birth. In fact, there wasn't any reason that we shouldn't attempt a home birth; any of the complications which might occur would be slow enough that we could safely move to the hospital if we needed to. There was no reason that continuous fetal monitoring should be necessary.

Having said that, she did agree that we should induce; the amniotic fluid and placenta situation wasn't going to get any better, and it was a good idea to have the baby sooner, rather than later. She said she would talk to one of the more sympathetic obstetricians on staff to get a second opinion, and she would make an appointment to induce at the hospital that afternoon. She gave us strict instructions to go home, eat, and rest to prepare for labour.

I went to the office to tell my replacement that I wouldn't be back, and to collect a few last things. I had calmed down by then, and was making plans for the next few hours. Edan called while I was at the office to say that she had scheduled the induction for 2:00; she reminded me to eat and rest, and mentioned that we should bring a bag with clothes and things, just on the unlikely chance that we ended up staying at the hospital.

Blake and I headed up to Yonge and Eglinton to get some bagels and bread, and then we went for lunch at the Bow and Arrow. We shared poutine, and I had a Greek salad with chicken. By the time we had finished eating, it was time to pack and go to the hospital.

Friday, May 10: 2:00 pm

We met Edan on the 7th floor of Mount Sinai hospital; the plan was to monitor me for twenty minutes to get a baseline idea of how I and the baby were doing, and then insert a dose of prostaglandin gel, monitor me for another hour to make sure I didn't react badly to it, then send me and Blake home to wait for labour to begin.

We were given Labour and Delivery Room 5, one of the fancy rooms; it was about 20 by 20 foot, with crown mouldings, a huge leather recliner, and furniture-style built-ins to hide all the equipment and supplies.

The en suite bathroom was entirely clad in marble tile, with a four-head shower. If I had to be in a hospital room, this is the one I would choose.

The initial twenty minutes of monitoring went well; the baby's heart rate was excellent, my blood pressure was good, and I wasn't contracting at all. Using prostaglandin can be risky if the mother is contracting, so that last part was good news, strangely enough. We brought in a obstetrician to consult and he suggested that we use Cervidil instead of prostaglandin gel. Cervidil is administered on a shoelace-like carrier, and it can be removed if there is any sign of distress on the part of either patient, whereas once prostaglandin gel is in place, you can't remove it. The problem with Cervidil is that you have to wait for twelve hours to see if it's working, as opposed to only six with the gel, and I would have to stay in the hospital for monitoring in case the baby responded badly to contractions. It was around that point that we realized we wouldn't be having a home birth after all.

The Cervidil was administered at 4:00 in the afternoon. We stayed in the nice Labour and Delivery room for two hours, monitoring me for any contractions, and monitoring the baby for any reaction to them. After two hours, nothing had happened, so Edan left us with instructions to page her if I got strong contractions five minutes apart and forty-five seconds long. Blake went home to pick up a nightgown, my minidisc player, and some food.

Labour and Delivery don't like non-labouring women hogging their rooms, so I was moved to Seven South, a kind of auxilliary prenatal ward for women not in active labour. I was put into a two-bed room with another woman; I overheard her say she was at week 26, so I guess she was in danger of premature labour. I stole a moment of guilty relief that I wasn't in her position.

Compared to the original Labour and Delivery room, this room was ugly and unpleasant, with standard hospital fixtures and an ordinary bathroom. I tried to sleep, but I was hungry and had a headache and the room was hot. The plastic mattress was making me sweaty, and I started to get mild contractions, like menstrual cramps, just bad enough to make me uncomfortable.

Monitor
A nurse named Christine came around and monitored me with the external fetal monitor; I was having mild contractions every two or three minutes, my blood pressure was still good and the baby's heart rate was excellent. The contractions were mild enough that I wasn't deemed in active labour, so I continued to wait.

Saturday, May 10: 12:20 am

After another couple of hours, I called Christine for some Tylenol, and to be monitored again because it seemed that my contractions were getting closer together and stronger. The monitor said the contractions were one and a half to two minutes apart, and a little stronger than before but still mild. Christine conferred with her colleagues and decided that I should be moved back to Labour and Delivery. I paged Edan and called Blake, and was moved into another fancy Labour and Delivery room.

Once Edan arrived she hooked me up to the monitor again to confirm the nurse's findings. Blake had brought food, so I ate, cooled down, took a wonderful shower, and finally slept.

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