I didn't wake up until seven in the morning, fifteen hours after the Cervidil was administered. Edan gave me an internal exam to see how my cervix was doing -- it was twenty-five percent effaced but no more dilated than it had been a week and a half earlier. The Cervidil had somehow gone missing, which meant we didn't know how long it had been working before it fell out. Edan called the obstetrician on call to decide what to do next; we thought we'd probably go for prostaglandin since I didn't have any bad reaction to the Cervidil, and we didn't feel like waiting around for another twelve hours.
The obstetrician gave me what seemed to be an incredibly painful internal exam. It was only afterward that he informed us he had done a stretch and sweep as well; thanks for asking permission, asshole. He agreed that prostaglandin was the way to go, so he administered it and I went back on the monitor for another hour.
After an hour, there were no change in my contractions; the cramps I was feeling before were still there, but only in my lower uterus, a hallmark of pre-labour cramps, not real contractions. I was moved back to Seven South for another five hours of waiting. Blake went home to get some sleep, and I alternated sleeping, listening to Gounod's Saint Cecilia Mass and Haydn's Creation on my minidisc player, and reading Wonder Boys.
After five hours, nothing had changed. Blake arrived back at the hospital at 1:00, because he knew that was when the prostaglandin expired, but it took another hour to get me back to Labour and Delivery, just because that's how long it took for the nurses to move me. This time, we didn't get one of the good rooms; the room we were moved to was about half the size of the first two, with no fancy furniture and an ordinary bathroom and shower. In other words, a perfectly standard Labour and Delivery room, but I was so happy with the first two rooms that this one was a crushing disappointment.
A few minutes after Blake and I got to Labour and Delivery, Edan arrived. She monitored me for twenty minutes and did an internal exam; my cervix was much softer and Edan thought I was a good candidate for more prostaglandin. I was still contracting with the low, pre-labour contractions.
We consulted with another obstetrician -- the third or fourth by then. He advised against more prostaglandin; I thought it was because I was contracting and prostaglandin can cause the uterus to seize up into a huge contraction which never ends, which obviously is an emergency situation. Blake thought he advised against prostaglandin because the first batch didn't have much effect. Whichever it was, he gave us two options: the first was to try oxytocin, a hormone which stimulates contractions, to bring on labour; the second was to have an elective ceasarian section.
He explained the relative risks of a vaginal birth, an elective caesarian section or an emergency caesarian: a vaginal birth presents the lowest risk to the mother, but a slightly higher risk to the baby. An elective section presents the lowest risk to the baby but a higher risk to the mother. An emergency section, presumably coming after some amount of normal labour, presents the highest risk to everyone because it combines the risk of vaginal birth and section, as well as being performed on a woman and baby who are exhausted from labouring for some hours. If we chose to take oxytocin, we could be setting ourselves up for an emergency section, the riskiest option, later.
Edan asked the obstetrician to leave while we discussed our options. If we went with oxytocin, it would be administered through an IV, and I would have to be continuously monitored, meaning I would not be able to move around to relieve the pain of contractions or hasten labour. That combined with the fact that oxytocin tends to bring on contractions fast and hard meant I would probably end up having an epidural, but if I didn't and I did have to have an emergency c-section, I would have to have a general anaesthetic, meaning I wouldn't be awake for the birth of my child.
We knew the baby was quite large and that she wasn't yet properly engaged in my pelvis; if she didn't engage properly or for some reason couldn't be delivered, I would end up having an emergency section. I hadn't had any real labour contractions yet, so we still didn't know how the baby would respond to them given the small amount of amniotic fluid available; if she responded poorly, I would end up having an emergency section. So far my cervix had hardly responded to either Cervidil or prostaglandin; if it didn't respond to the pressure of contractions, I would end up having an emergency section.
We talked about the longer-term ramifications of a c-section; how long it would take me to heal, how it would affect my chances of having a home birth later, whether it would affect my abdominal muscle control in terms of singing.
Edan let Blake and I decide; she asked me to listen to my gut feeling as to whether this baby would be delivered vaginally. She talked about her experience as someone who had gone through a hard labour unsuccessfully and ended up having a section anyway; a part of her wished she had just gone for the elective section, because having an emergency section after labouring for so long really sucked.
Blake thought I should try the oxytocin first, but I decided to go for the section; I had a feeling the baby wouldn't come vaginally, that I would labour long and hard and end up with an emergency section under unfavourable circumstances. I hated the idea of labouring on my back, with no opportunity to move around. I have to admit, even the crappiness of the Labour and Delivery room we had ended up in contributed a tiny bit to my decision; I wouldn't have decided differently if we were in one of the nice rooms, but I would have thought about it a little longer.
After I decided, I cried some. I had never had surgery before, never even been in hospital before. I was scared about what was coming, and sad about the home birth I wasn't going to have.
Edan said we could go ahead with the section almost immediately, so we started getting prepped right away. She put an IV into my left wrist, and then she tried to put in a catheter. She had trouble finding my urethra, so she asked a couple of the nurses to help; they clawed at my privates like harpies, and after endless minutes of the torture, they decided to try a smaller catheter, which worked almost immediately. That part sucked.
After they got me all hooked up, they wheeled me to the operating room. On the way, I cried some more; being wheeled around made me feel out of control, and it seemed like my whole birth plan had fallen apart in record time.
By the time we got into the operating room I had gotten myself together. I moved onto the operating table and sat up to get my spinal anaesthetic. Blake came into the operating room and was allowed to sit behind my arms. Then they laid me back down with my arms extended, my right arm with a blood pressure cuff and my left with the IV. I watched my blood pressure for a while, and chatted with the anaesthetist. He took on the role of an MC, talking me through what was going on, which I really appreciated because I hate not knowing what's going on.
Blake had brought the digital camera but since he wasn't allowed to move into the sterile area below my arms, he wouldn't be able to get any good shots. Edan offered to take pictures for us, and she did a better-than-fantastic job of it.
I was a little worried that the spinal somehow wouldn't kick in and I would be able to feel them cut me; I mentioned it to Edan and apparently pretty much everyone worries about that. She said they wouldn't start until they were sure I wasn't going to feel anything.
Sure enough, I heard someone below my waist say something about an incision, and Edan asked me if I felt anything; not a thing. But then I felt a lot of indescribably strange pulling sensations and pressure in my belly...
And then I heard my baby crying. The anaesthetist exclaimed "What a baby!" Edan cleaned her up and did an initial examination, and then my baby was next to me. I didn't fall in love at first sight, but I was happy to see her. Then she was gone again, and I lay there feeling dizzy, listening to Edan talk to Blake about our baby.
I used to be an utter snob about caesarian sections. I would never say so to someone who had had one, but I thought most sections happened because either the Medical Establishment had done something wrong, or the mother wasn't trying "hard enough" to have a vaginal birth. I thought having a vaginal birth was something incredibly important, something that every mother should try to do.
And then I was faced with the choice of trying a little harder to have a vaginal birth, and I made a calculated decision not to. I was happy with that decision then -- not happy that I had to make it, but happy that it was the right decision -- and I'm still happy with it now. I don't feel like I failed or messed up, I don't feel inadequate or like I have to excuse myself to anyone for the birth. In fact, I'm surprised by how okay I am with how it turned out.
I'd read it over and over again, but I didn't understand it until now: it doesn't matter how the birth goes, as long as everyone is healthy. Having a vaginal birth isn't some hippie badge of honour which proves you're more hardcore than everyone else; it can be a matter of luck, of timing, of genetics. I didn't understand that before, but I do now.What happened next: Day 13 Status Report.